SENIORS | Top 4 Herbs to Shrink an Enlarged Prostate

Dr. Stengler: Do you know the real reasons why you have prostate enlargement? So many men have urinary symptoms that keep them up at night and going to the bathroom throughout the day, and they're not addressing the root causes. In this video, I'm going to walk you through the hormonal connection — the connection that a lot of doctors don't treat — as to why men have prostate enlargement symptoms, and why addressing the hormonal issues can really help. I'm Dr. Mark Stengler. I've been practicing integrative medicine for 30 years and I've seen a lot of men with prostate problems. I even wrote a book on the subject, but in this video I'm going to give you the key information you need to know.

Benign prostatic hyperplasia, known as BPH, is an age-associated condition that involves enlargement of the prostate gland. This common condition affects approximately 50% of men between the ages of 51 and 60, but it becomes increasingly common as men age, with 90% of men at age 85 having this condition. The older you get, the more likely you'll have prostate enlargement. The condition is generally more severe and aggressive in African-American men.

The following urinary symptoms indicate you may have an enlarged prostate, or BPH: incomplete emptying of your bladder, where it feels full even after voiding; increased frequency, the need to urinate often, every hour or two; intermittency, the need to stop and start several times while urinating; a sense of urgency, needing to urinate right away; a weak or feeble urinary stream; straining or the need to push to start urine flow; and nocturia — nighttime urination, the need to wake up more than two times. Men with severe cases end up with urinary retention that can lead to hospitalization or surgery. Pharmaceuticals are conventional medicine's treatment, but they can carry risks such as sexual dysfunction, breast enlargement, fatigue, decreased libido, and headaches.

One of the fundamental causes of why men are prone to prostate enlargement is hormonal changes — your prostate gland is very hormonally sensitive. Most of the research focuses on testosterone, dihydrotestosterone, progesterone, and estrogen. Let's start with testosterone. The first thought for many people is that high testosterone is the likely culprit. However, testosterone levels decrease as men age, and we do not find prostate enlargement to be common in males in their teens or early 20s, when testosterone is at its highest. So no, testosterone really is not a driving factor.

Dihydrotestosterone is different. This is a metabolite of testosterone associated with prostate enlargement. The prostate gland contains tissues with the enzyme 5-alpha-reductase, which converts testosterone into dihydrotestosterone (DHT). DHT binds to androgen receptors in the prostate and stimulates growth. Men with prostate enlargement have much higher blood DHT concentrations compared to healthy men their age, and higher DHT levels increase the activity of 5-alpha-reductase. There can be other reasons too — genetic factors affecting the androgen receptors, known as polymorphisms, which research has shown to be related to prostate enlargement.

The other hormone that may surprise you is estrogen, which influences prostate growth. Although it's a normal part of the male hormonal system, most of it is produced in fat, brain, bone, and other tissues. The production of estrogen is primarily controlled by an enzyme known as aromatase, which converts androstenedione, made by the testicles and adrenal glands, into the estrogen estradiol, and also converts testosterone from fat and muscle cells into estradiol. Increased aromatase activity seems to be a causative factor. Men tend to accumulate fat as they age, leading to increased aromatase activity, decreased testosterone, and elevated estrogen. Unlike testosterone, age does not cause estrogen levels to decline — it's the opposite; as men get older, their estrogen levels tend to go up.

There are other factors. One is insulin — as insulin levels rise and men are predisposed to pre-diabetes and diabetes, that's a risk factor. Insulin-like growth factors may be a risk factor, as may hormones like norepinephrine and angiotensin. Men who are obese or have a greater waist-to-hip ratio are more susceptible too. And there are dietary concerns: research shows that men who consume high amounts of animal protein, saturated fat, and cholesterol, have a high calorie intake, don't consume enough omega-3 fatty acids, or are deficient in vitamin D and zinc, are predisposed to prostate enlargement.

Let's look at some of the natural supplements that prevent this excess hormonal stimulation. The first is beta-sitosterol, one of several plant sterols, found in foods such as rice bran, wheat germ, soybeans, corn oil, peanuts, avocados, pumpkin seeds, cashews, and some fruits. You also find it in prostate herbal supplements like saw palmetto and Pygeum africanum. Beta-sitosterol is the most abundant plant sterol consumed by humans, and it's unique because it inhibits the 5-alpha-reductase enzyme and has anti-inflammatory properties. Research has demonstrated that beta-sitosterol supplementation improves BPH symptoms such as urinary symptom scores and flow measures better than placebo. In one study of 200 men, those taking 20 mg of beta-sitosterol three times daily had significant improvements in urinary flow, while the placebo group did not. Another study of 177 men who supplemented with 130 mg daily had significant improvements in urinary parameters and quality-of-life scores compared to placebo. However, beta-sitosterol was not shown to reduce the size of the prostate gland. A typical dose is 60 to 130 mg daily, and it has an excellent safety rating.

The next supplement is saw palmetto berry extract, very popular for treating prostate enlargement in North America and Europe. This plant has a long history of use by Native Americans for prostate and urinary symptoms, later adopted by American settlers and Europeans; around 50% of German urologists prefer to prescribe plant extracts such as saw palmetto rather than pharmaceuticals. Several studies have shown its effectiveness, mainly focusing on a standardized extract that's about 85% to 95% fatty acids and sterols. Saw palmetto has multiple mechanisms: it has anti-estrogenic effects, inhibits the conversion of testosterone into DHT in the prostate tissue, and affects intracellular binding to receptors. As with other herbal therapies, it works best for mild to moderate symptoms in earlier stages. About 90% of men will notice improvement in mild to moderate urinary symptoms within the first 4 to 6 weeks of starting supplementation with a dose of about 320 mg per day of a liposterolic extract. A 2018 systematic review and meta-analysis of 27 studies found that saw palmetto reduced nocturia and improved maximum urinary flow compared to placebo, with a similar benefit to the drug tamsulosin in relieving lower urinary tract symptoms, no negative effect on sexual function or PSA levels, and a slight decrease in prostate volume. Another review of 21 randomized trials lasting between 4 and 48 weeks found saw palmetto improved urinary symptom scores and flow measures, with similar improvements to the drug finasteride and fewer adverse events.

The next supplement is Pygeum africanum, also known as Prunus africana, which has a history of use in Africa for urinary disorders. Its active components appear to be ferulic acid esters, which lower cholesterol within the prostate and reduce metabolites that contribute to prostate growth. It also contains sterols that reduce inflammatory compounds, and — here's the hormonal effect — they reduce testosterone accumulation within the prostate. One study found Pygeum had anti-proliferative and apoptotic effects, meaning it improves natural cell death on certain tissue without affecting the smooth muscles of the prostate gland. A review of 18 randomized controlled trials involving over 1,500 men, ranging between 30 and 122 days, was positive: compared to placebo, Pygeum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures, with those supplementing more than twice as likely to report improvement, nighttime urination reduced by about 19%, and other urinary flow markers significantly improved. Side effects were mild and comparable to placebo. The recommended dose is 100 to 200 mg daily of a standardized extract, usually one containing about 14% triterpenes.

Now let's talk about nettle root, which has research showing it is very effective in treating prostate enlargement and has traditional use in Europe for urinary tract infections. The mechanisms appear multifactorial: it inhibits sex hormone-binding globulin from binding to the prostate receptors, reduces conversion of testosterone into estrogens by reducing aromatase activity, and has anti-inflammatory effects on the prostate tissue. One double-blind, placebo-controlled, randomized study compared nettles with placebo in 620 patients; at the end of the six-month trial, about 81% of those receiving nettles reported improvement in urinary symptoms, versus only 16% on placebo. Those taking nettles also had a reduction in post-void residual urine volume, from an initial value of 73 to a final value of 36, while placebo saw no appreciable change, plus a modest decrease in prostate size by ultrasound. There were no side effects in either group. In another double-blind trial, 100 men ages 40 to 80 were given nettles 300 mg twice daily or placebo for two months; those taking nettles had significant improvements in urinary symptoms, while placebo had no change.

The combination of nettle root and saw palmetto is popular in dietary supplement formulas. In one double-blind trial, the combination of 160 mg of saw palmetto and 120 mg of nettle root was evaluated in 257 elderly men with moderate to severe urinary symptoms; assessments at week 96 revealed that the International Prostate Symptom Score was reduced by 53%, and the combination was very well tolerated. If you're a man with prostate enlargement suffering from urinary symptoms, a large part of the problem is the hormone sensitization of the prostate gland. By using the dietary supplements I just talked about, you can reduce the effects of these hormones on the prostate, which can improve your urinary symptoms and in some cases actually reduce the size of your prostate. I hope you liked this video. Look for my other videos on prostate health, men's health, and many videos on women's and children's health. If you liked this video, hit the like button.

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