SagaPro: Pure Bollocks

The company behind SagaPro claims the herbal supplement is clinically proven to aid those with bladder problems reduce the frequency of bathroom visits. However, cold, hard science shows that the product is no better than placebo.

When you last awaited the bus in Reykjavík, you may have noticed the black and white bus shelter advertisements exclaiming “Ég nota SagaPro“ (“I use SagaPro”). SagaPro is the flagship product of an Icelandic company called SagaMedica, a herbal supplement made from angelica extract, marketed as being useful for people with an overactive bladder, prostate enlargement and nocturia (frequent nighttime bathroom trips).

Sadly, none of these claims are true, indeed many of them are pure hogwash. This article is not the place for an extensive overview of SagaMedica’s false claims, but what follows are their top three falsehoods.

“SagaPro is proven to reduce urinary frequency”

No, it isn’t. You can just see for yourself

The above table is from a clinical trial published by SagaMedica. It demonstrates that the number of times people go the bathroom decreases in both groups after using SagaPro. Before treatment, men would visit the bathroom almost three times a night while afterwards they went twice. The difference is exactly the same in both groups.

However, this is not the story SagaMedica uses to market its product. Instead, it uses a subgroup analysis for men with a so-called NBC-index above 1.3, where statistically significant changes were found. However, this is most likely due to chance. For this subgroup, the number of patients in each group is remarkably small (10 and 19), with totally different baseline values, giving rise to a statistical problem called regression to the mean. It is a well-known fact that if you do enough subgroup analyses, one will turn out to be significant by sheer chance.

Given all this, I can agree with SagaMedica‘s marketing department that the slogan “Might work for men between 45 and 85 not taking sleep medication and with an NBC-index above 1.3” doesn’t quite have that necessary punch you’d want to plaster all over Reykjavík’s bus stops.

“SagaPro is a safe product”

It is a well-established fact that biochemicals found in the leaves of angelica have negative effects on people. The European Medicines Agency (EMA) published a report stating that chemicals present in angelica pose a potential risk to human health. SagaMedica claims that SagaPro is even safer than the herb itself, “as not all biochemical constituents are contained in the finished product.”

The safety profile of the drug is highly overrated. In the clinical study, the tablets were used only for a brief period of time—not long enough to assess safety—and in a small sample. Likewise, of the four complications that were recorded, which could likely be attributed to the treatment (SagaPro or placebo), three were in the SagaPro group and one in the placebo group. You don’t have to take my word for it. The Icelandic Medicines Agency (which has no jurisdiction over supplements) has gone out of its way to announce that claims cannot be made concerning SagaPro’s safety.

“SagaPro is also for women”

One of many troubling things about the SagaPro ads are the small pictograms at the bottom. They depict a man and a woman crossing their legs, obviously in dire need of a bathroom visit. Yet, the clinical study did not include any women whatsoever.

If the company wants to use the clinical study as a basis for safety and efficacy, it cannot indicate that the product helps women as well.

Pure bollocks

It might very well be that SagaPro works better than placebo. It may even be perfectly safe. Nonetheless, the manufacturer’s claims about the product are not founded in the research conducted, and that they so often cite. In their own words: “This study did not show that SagaPro improved nocturia overall compared to placebo.” That is the unavoidable admission when you’ve got peer reviewers breathing down your neck.

When the marketing department comes in, however, all gloves seem to be off.

The department is also responsible for the below video. It does not feature your regular greyscale infomercial scene of an old man going to the bathroom at night. Nor does it show anatomical images of enlarged prostates. Instead, it features video footage reminiscent of travel brochures and chocolate boxes at the duty free store.

Sadly, the positive image that Iceland’s waterfalls bring to mind is being used as a vehicle for selling a product that is somewhat toxic to begin with, has to be purified, and then, when tested against a placebo, doesn’t seem to do any good.

To quote Brian Molko: “There‘s something rotten down here…“

—

Gylfi Ólafsson is a health economist.