Benign prostatic hyperplasia (BPH) is commonly referred to as prostate enlargement. The prostate is a walnut sized gland that lies below the urinary bladder and surrounds the urethra (the tube that carries urine from the bladder). The main role of the prostate is to make nutrient-rich fluid for the sperm that becomes part of the semen.
BPH is very common with more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH. Symptoms are rare in men in their forties or younger.
As this gland enlarges it encroaches upon the urethra and interferes with urine flow. This causes the bladder to become irritated and as a result thickens. This irritation of the bladder causes it to contract even when it contains small amounts of urine.
Hormonal stimulation of the prostate gland appears to be the root issue with BPH. As men get older their testosterone levels decline while their relative estrogen level increases. Estrogen stimulates the growth of prostate cells. Another probable hormonal factor is dihydrotestosterone (DHT), a hormone metabolite of testosterone produced in the prostate. Older men tend to accumulate higher levels of DHT in the prostate that also may encourage the growth of cells. BPH is not the same as prostate cancer and is not considered a precursor to prostate cancer. A diet high in fat and low in fiber, as well as nutritional deficiencies contribute to this problem.
Following are tests that help assess possible reasons for prostate enlargement:
- Hormone testing (thyroid, DHEA, cortisol, testosterone, DHT, estrogen, progesterone) – saliva, blood, or urine tests
- Vitamin and Mineral Analysis – blood test
- Food sensitivities – blood test
- Toxic metals – urine tests
- Essential fatty acid balance – blood test
Diet and Lifestyle
A diet that incorporates more plant foods and less red meat and dairy products can be helpful. A high fiber diet will help bind and expel hormones that inflame the prostate. Foods rich in zinc such as pumpkin seeds are recommended. Also, sources of anti-inflammatory omega 3 fatty acids as found in fish, flaxseeds, and flax oil are recommended. Make sure to restrict caffeine and alcohol which can be irritating to the prostate gland.
A number of supplements can help with symptoms of prostate enlargement. The more well studied ones include saw palmetto, beta-sitosterol, rye pollen extract, and pygeum africanum.
Consume foods rich in omega-3 fatty acids and monounsaturated fat that help to decrease inflammation of the prostate gland. Good choices include avocados, cold water fish (wild salmon, sardines), ground flaxseeds (1-2 tablespoons daily), and pumpkin seeds. Tomatoes and tomato paste, watermelon, and cantaloupe contain the prostate friendly nutrient lycopene. Consume 3 servings weekly.
Men with BPH should avoid caffeinated beverages as well as alcohol—they irritate and inflame the prostate. Also reduce your intake of foods that contain harmful fats such as fried foods that contain hydrogenated or partially hydrogenated oils which promote inflammation. Minimize your intake of dairy and red meat as they contain saturated fat which also may worsen inflammation of the prostate. Stay away from packaged foods that are high in sugar, which can worsen inflammation.
Regular exercise is important in the prevention and treatment of BPH. For example, a study in the Archives of Internal Medicine reported that men who walked two to three hours a week had a 25% lower risk of developing BPH. (Platz EA, Kawachi I, Rimm EB, Colditz GA, Stampfer MJ, Willett WC, Giovannucci E. Physical activity and benign prostatic hyperplasia. Arch Intern Med. 1998 Nov 23;158(21):2349-56.)
The berries of this plant were first used medicinally by Native Americans for prostate and urinary problems. A multitude of published clinical studies have demonstrated that saw palmetto provides improvement for mild to moderate symptoms of BPH. This includes benefit for frequent urination, hesitancy, painful urination, night time urination, and generally improved urinary flow.
Researchers have found that saw palmetto helps the prostate by reducing the activity of 5-alpha reductase enzyme, which is involved in the production of DHT. It also reduces the growth effects of estrogen on prostate cells. Saw palmetto has also been shown to reduce smooth muscle contraction allowing the bladder and sphincter muscles to relax, thus reducing urinary urgency. It also exerts an anti-inflammatory effect on the prostate gland by inhibiting the cyclooxygenase-2(COX-2) enzyme. This enzyme is active in the inflammatory pathway.
In one study involving 1098 men over the age of 50, researchers compared 320 mg of Saw Palmetto extract with the prescription drug Finasteride (Proscar). At the end of the six month trial both treatments were shown to be equally effective in reducing the symptoms of BPH in two thirds of participants. However, Saw Palmetto was found to have far fewer problems with sexual dysfunction such as decreased libido and impotence. (Carraro JCRaynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC, Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D,Kalinteris A, Marencak J, Perier A, Perrin P.
Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996 Oct;29(4):231-40.) A 2002 review of Saw Palmetto studies involved 3139 men from 21 randomized trials lasting 4 to 48 weeks. 18 of these trials were double-blinded. The researchers concluded the evidence suggests that Saw Palmetto provides mild to moderate improvement in urinary symptoms and flow measurement. It also produced similar improvement in urinary symptoms and flow compared to finasteride and was associated with fewer adverse treatment events.Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):
It should be noted that a 2006 study published in the New England Journal of Medicine reported that Saw Palmetto was not effective for symptoms of BPH. The double-blind trial randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo. The problem with the media headlines of this study is that it ignored more than 20 other well designed studies showing the efficacy of Saw Palmetto. However, the biggest problem with the media coverage of this story is that it failed to report the men with BPH in the study had moderate to severe symptoms. Saw Palmetto has shown unquestionably it is effective for mild to moderate symptoms of BPH. ( Bent S, Kane CShinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL. Saw palmetto for benign prostatic hyperplasia.N Engl J Med. 2006 Feb 9;354(6):557-66.)Dosage: Take 320 mg daily of a product standardized between 80-85% fatty acids.
Safety: Saw Palmetto is well tolerated with occasional reports of dizziness, headache, and digestive complaints.
This compound is naturally occurring in plant foods such as rice bran, wheat germ, corn oil, soybeans and peanuts. The supplemental extract form significantly relieves BPH urinary symptoms. Animal research shows that beta sitosterol may inhibit 5-alpha-reductase activity. It has been shown in animals to shrink the prostate but this has not yet been demonstrated in humans.Dosage: Take 60 to 130 mg of beta-sitosterol divided into 2-3 doses daily on an empty stomach.
Safety: Digestive upset such as gas, nausea, or diarrhea occurs rarely with users. Beta-sitosterol may reduce absorption and blood levels of alpha- and beta-carotene and vitamin E so it should be taken by itself on an empty stomach. Beta sitosterol should not be taken by those individuals with a rare genetic disease known as sitosterolemia. With this disease people have an abnormally high absorption of beta-sitosterol and cholesterol from the diet. Consult with your doctor before using this supplement in conjunction with cholesterol lowering medications.