Animals and Native Americans in North America both consumed saw palmetto berries. Legend claims that after observing the animals become "sleek and plump," European settlers tasted the berries and believed they had therapeutic effects. The fruit pulp has been used as a tonic since the 19th century, and it is being used today to treat urinary tract issues, debility, and enlargement of the prostate gland. The effectiveness of lipid or fat extract or saw palmetto in reducing prostate gland enlargement has been demonstrated by extensive clinical studies, mostly in Europe. The extract also facilitates easier urine flow while reducing urinary retention Saw palmetto extract is a common prostate enlargement therapy in several European nations. How the plant extracts function is unclear. Two clinical trials conducted in the late 1990s saw palmetto and nettle root combined and given to men with early-stage BPH. In one experiment, a placebo was used as a control, while in the other, finasteride, a widely used conventional medication for BPH, was used. The herb mixture had excellent results in both studies, with symptoms clearly improving compared to placebo and equivalent results for those using the herbs or finasteride, although the herbs had fewer adverse effects.