Prostate Health and BPH / Enlarged Prostate

By Drew Sinatra, ND, LAc, MSA

It is well known that men are less likely than women to seek professional medical care when their health is compromised. It is also known that men visit doctors less for preventative medicine. There are many reasons why men do not see doctors as often as women. Some men were raised to “be tough” and “not to cry,” or led to believe “if it’s not broken then there is no need to fix it.” Additionally, some men choose to ignore physical exams, screening labs, or a symptom because they would rather not know if something is wrong.1 Fortunately, many men are beginning to listen to their bodies, and when a symptom arises (i.e. chronic cough) they get checked out. I believe it’s important to take health to the next level by explaining to men that the absence of symptoms does not equal absence of disease. For example 90 percent of coronary disease is asymptomatic, with sudden death emerging as the first sign in half of these cases.2

Benign Prostatic Hyperplasia (BPH)

In this article I will explore lifestyle measures to improve prostate health, and ways to treat common prostate conditions like benign prostatic hyperplasia (BPH). I am choosing not to discuss prostate cancer or prostatitis, as the diagnoses and subsequent treatments are highly controversial. For example, data from two recent studies have led researchers to believe that the PSA test used to screen for prostate cancer is not as accurate or beneficial as once thought; it can lead to risky and unnecessary tests and procedures (i.e. prostate removal) while saving very few lives in the process. Instead of removing the prostate, which can cause irreparable sexual dysfunction, urinary incontinence, and intense pain, many physicians are opting to “watch and wait” depending on the severity of the cancer.3

Although I will not directly discuss prostate cancer and prostatitis, the recommendations in this article support overall prostate health, which may reduce the incidence of prostate cancer and prostatitis. The emphasis on supporting prostate health will be directed at treating benign prostatic hyperplasia (BPH), as this condition is extremely common in the aging population. Also, in Everyday Body Detoxification, I suggest simple detoxification ideas to support organ system function. Try to incorporate as many of the detox recommendations as you can into your daily routine, as they will facilitate optimal body physiology to improve prostate function.

What Is the Prostate?

The prostate is a gland that produces and stores an alkaline substance called seminal fluid, which is designed to protect sperm as they travel through the female reproductive tract. It also contains smooth muscle to help project sperm during ejaculation. The prostate rests directly below the urinary bladder and encircles the urethra. The best description for the size and texture of a prostate is a small plum, which has soft skin and a fluid-filled interior.4 Since the prostate is located near the rectum, a doctor can palpate it during a digital rectal exam (DRE) to learn of its size, texture and boundaries. Commonly performed during routine physical exams, the DRE test is a very useful, and (relatively) non-invasive means of identifying enlarged or abnormal prostate tissue.

What Causes an Enlarged Prostate?

As men age, hormone levels change and the prostate tends to grow. Prostate enlargement caused by an increase in cells is known as benign prostatic hyperplasia, or BPH (“benign” because the growth of the prostate is not cancerous in origin; “hyperplasia” meaning overgrowth of cells). Typically with BPH, the transition and periurethral zones of the prostate grow, which puts pressure on the urethra. Increased urethral pressure leads to many of the common symptoms of an enlarged prostate:

  • difficulty starting and stopping urination
  • increased frequency and urgency of urination
  • straining
  • terminal dripping
  • nocturia (urinating at night)

The current theory is that prostate enlargement may be due to decreasing testosterone levels and increasing estrogen levels. As men age, testosterone decreases and dihydrotestosterone (DHT), a highly active form of testosterone, increases, likely encouraging prostate cell growth. Studies show that castrated men, men lacking the enzyme which converts testosterone to DHT (5-alpha-reductase), and men who do not produce DHT do not develop BPH, which suggests that hormones play an important role in the pathogenesis of BPH.5

It is not uncommon for men to experience problems with the prostate gland. Medical professionals are divided as to whether BPH is a normal part of aging or is a disease. According to an epidemiological study conducted in Italy, BPH was identified on autopsy in 88 percent of men over the age of 80 years old, and 50 percent of men over 50 years of age experience urinary symptoms.6 Some men don’t mind frequent trips to the bathroom, but for others BPH symptoms are bothersome and treatment is necessary. If you suspect you may have BPH talk to your doctor, and fill out the International Prostate Symptom Score (IPSS) questionnaire to assess the severity of your symptoms. This questionnaire will also provide a useful tool for tracking progress of therapy for BPH.7

If you or anyone you know suffers from BPH, rest assured that research shows no association between BPH and prostate cancer. Having BPH does not increase your chance of developing prostate cancer.

Conventional Treatments for Enlarged Prostate

Standard medical treatment for an enlarged prostate usually involves medication and/or surgery to relieve signs and symptoms. Alpha-blockers such as tamsulosin (Flomax) or alfuzosin (Uroxatral) work by relaxing smooth muscle tension in the prostate, urethra, and bladder neck, allowing urine to flow more easily. Another common BPH medication, finasteride (Proscar), can gradually shrink the prostate by inhibiting production of the enzyme, 5-alpha reductase, which blocks conversion of testosterone into dihydrotestosterone (DHT). The most common surgery to treat more advanced cases of BPH is transurethral resection of the prostate (TURP). This procedure involves surgically removing excess urinary tissue including the prostate, and using an electrical current to cauterize the wound. Opting for medication and surgery is not without risk, however, as some men develop unwanted adverse side effects such as impotence, decreased libido, hypotension, and ejaculatory dysfunction.8

Natural BPH Treatments

For mild to moderate cases of BPH (prostate size less than 50 cc), natural medicines like herbs can reduce symptoms. Natural medicines typically cause fewer side effects than medications or surgery, and work with the body’s physiology instead of against it to support the health of the prostate. If a patient is suffering from a severe case of BPH, however, surgery and/or prescription medications may be required.

Foods for Prostate Health

If diagnosed with BPH, no matter how severe, a man should first address his diet, as a healthy, whole foods diet has proven beneficial for prevention and treatment of prostate diseases (particularly cancer). A diet rich in fruits and vegetables provides high levels of fiber, antioxidants, vitamins, and minerals that protect the prostate from free radical stress and toxins. I recommend filling 2/3 of one’s dinner plate with a rainbow assortment of vegetables to maximize antioxidant content, and dividing the remaining 1/3 of the plate between a grain (i.e. brown rice, quinoa), protein source (i.e. wild salmon, lentils or beans), and healthy fat for cooking or dressing (i.e. coconut oil, olive oil, flax oil).

For prostate health, eating 1/4 cup of pumpkin and/or sunflower seeds a day provides adequate zinc and healthy polyunsaturated fats. Lycopene (a carotenoid) is especially protective for the prostate and is found in tomatoes (ketchup), kale, broccoli, watermelons, and mangoes.9 Research also shows that soy products are beneficial for prostate conditions. I like to suggest fermented whole food soy products like tempeh and miso, which help support the digestive system as well as the prostate.

Ground flax seed is an excellent food to consume regularly to support healthy prostate function. A moderate strength phytoestrogen that supplies the body with soluble and insoluble fiber from lignans, flax contains high levels of alpha-linolenic acid, which is an essential omega-3 fatty acid. The body is able to convert a small amount alpha linolenic acid into DHA and EPA, which are essential fatty acids (EFAs) found mainly in fish. EFAs help reduce inflammation, and the phytoestrogens from flax lignans prevent binding of estrogen to estrogen receptors, which may help decrease circulating levels of estrogen in the body. The general recommendation for ground flax seeds is 1-2 Tbsp. a day with oatmeal, cereal, in salads, or in a smoothie.

Other dietary recommendations for prostate health include limiting intake of fast and processed foods, as well as eliminating conventional meats and dairy products from the diet. Conventionally produced meats and dairy products contain elevated levels of hormones and antibiotics which may adversely affect prostate and gut health. Eating 100 percent grass fed meats and organic pasture-raised animals will provide higher levels of EFAs, as these animals are eating mineral rich grasses instead of corn and soy products from conventional feedlots. Generally, buying foods, including meats, from a local farmers market is your best option for high quality food. Lastly, minimizing consumption of caffeinated and alcoholic beverages and other diuretics, and avoiding drinking fluids after 7pm, can help reduce nocturia.10

Additional Lifestyle Choices to Support a Healthy Prostate

Since estrogens may play a role in the etiology of BPH, I always recommend using glass or steel products over plastic products when storing food and beverages. Plastics, which have infiltrated our bodies and wreaked havoc on the environment, contain toxic phthalates, which are xenoestrogens. Xenoestrogens are compounds that mimic estrogen in the body, so they may have a deleterious effect on the endocrine system including the prostate. I also advise people to choose phthalate-free personal products (like shampoos) and to opt for glass containers whenever possible. Typically, most, but not all, organic beauty products contain safer ingredients than their conventional counterparts.

Incorporating exercise into your daily routine is very important for increasing blood flow to the pelvic region, including the prostate. Movement as simple as walking 30 minutes a day is sufficient, or try yoga or qi gong to move stagnant energy out of the pelvis. In addition, drink plenty of water to help flush toxins out of your body and help hydrate your cells, ideally 1/3 to1/2 of your body weight in ounces per day (i.e 180 lb male should drink between 60-90 oz of water a day).

Alternating hot and cold sitz baths (a.k.a. contrast sitz baths) is another technique for relieving pelvic congestion and discomfort associated with an enlarged prostate. Basically, a sitz bath is a partial immersion of the pelvis and abdomen in warm water that brings blood flow into the prostate region. If interested in sitz baths, ask your doctor or alternative health care provider for more information.

Herbs that Support Prostate Health

Saw Palmetto

Saw palmetto (Serenoa repens) has been shown to significantly improve symptoms associated with BPH.11 Saw palmetto is an herb that grows mainly along the coasts of Georgia and Florida, and has reportedly been used for over 300 years by the Seminole Indians for medicinal purposes. It contains fatty acids like lauric acid, phytosterols such as beta-sitosterol, and essential oils. Saw palmetto is thought to inhibit the enzyme, 5-alpha reductase, which is involved in converting testosterone to dihydrotestosterone (DHT). Through a 1998 JAMA meta-analysis, researchers showed that saw palmetto standardized extracts are as effective as finasteride (Proscar) in men with prostate volume less than 60 cc with mild to moderate symptoms, and produce fewer side effects.12 On a more energetic level, saw palmetto strengthens the male reproductive tract by acting as a male tonic.13 Recommended dosage is 320 mg a day, or 160 mg taken twice daily.

Stinging Nettle

Stinging nettle (Urtica dioica) is another prostate-friendly herb that grows all over North America and Europe, and, if touched it may produce a mild sting (hence the common name). The whole plant contains beta-sitosterols, flavonoids, carotenoids, and is rich in minerals. Used more specifically for prostate support, the nettle root acts as a mild aromatase and 5 alpha-reductase inhibitor, and may inhibit testosterone binding to sex hormone binding globulin (SHBG). Aromatase is an enzyme that converts androgens (testosterone) into estrogens, so inhibiting this enzyme results in the production of fewer estrogen hormones. The recommended dose of nettle root is 300 mg a day.

Pygeum

With a similar action as nettle root (as a mild aromatase and 5-alpha reductase inhibitor) the herb, Pygeum africanum (African Prune Tree), can also help improve symptoms associated with an enlarged prostate. According to the Cochrane Review, men taking Pygeum experienced a 19 percent reduction in both nocturia and residual urine volume, and a 23 percent increase in peak urine flow, as compared to men who took a placebo. The authors also concluded that “Pygeum africanum is well tolerated, cheaper than many prescription medicines used for BPH, and provides moderate relief from the urinary problems caused by an enlarged prostate;”14 they recommended 100 mg of Pygeumeach day. Look for cultivated sources of Pygeum as wild crafted sources are now endangered.

I always suggest taking all three abovementioned herbs together in an herbal supplement, and/or talking to a qualified naturopathic doctor or herbalist about combination therapy. While there are many prostate-supporting products on the market, many companies produce less than optimal products; always do your research and ask the company if it independently tests its herbal ingredients. Just like with many of the 5-alpha reductase medications (finasteride, Proscar), it may take months to notice significant changes in your symptoms because altering hormone levels takes time.

Remember that if you are currently experiencing symptoms of BPH you are not alone. As mentioned previously, BPH is a common condition that afflicts many men, and some argue that it’s a normal part of the aging process. Try some of the suggestions above including adding in some detoxification treatments, and see what changes occur over the next 6 months.

References:

1. Yarnell, E. Espinoza, G. McClure, M.  Roundtable Discussion: Focus on Men’s Health. Alternative and Complementary Therapies. April 2010, 16 (2): 77-82. doi:10.1089/act.2010.16210.

2. Sinatra Stephen. Reverse Heart Disease Now. John Wiley & Sons (2007).

3.Kolata, Gina. “Prostate Test Found to Save Few Lives.” New York Times, March 18, 2009.

4, 5. Scardino, Peter. Dr. Peter Scardino’s Prostate Book. Penguin Group (2005).

6. Napalkov P, Maisonneuve P, Boyle P. Worldwide patterns of prevalence and mortality from benign prostatic hyperplasia. Urology (Sept. 1995) 46;3:Suppl.1:41-46. See abstract.

7, 8, 10, 12. Yarnell, E. Naturopathic Urology and Men’s Health. Healing Mountain Publishing (2001).

9, 11. Murrey, M. Pizzorno, J. The Encyclopedia of Healing Foods. Atria Books (2005).

13. Mitchell, William. Plant Medicine in Practice. Churchhill Livingstone (2003).

14. Wilt T, Asahni A. Pygeum Africanum for Benign Prostatic Hyperplasia. The Cochrane Collaboration. Cochrane Review.

© 2010, 2016 HeartMD Institute and Drew Sinatra, N.D. All rights reserved.

Leave a Reply

3 Comments

  1. sugar

    on July 18, 2014 at 12:58 am

    Reply

    Dr.John Lee in his book on menopause states that men lacking testosterone will experience osteoporosis. He states that he would hope that a clinical trial of natural progestrone might be offered to protect their bones. My husband takes your prostate supplement but should he add natural progestrone for bone health. Thanks for your time.

  2. Paul Fantaskey

    on June 18, 2015 at 6:06 pm

    Reply

    Great article very informative. Thank you

  3. Vern

    on June 18, 2015 at 7:30 pm

    Reply

    Can you write an authoritative article about sex and the prostate. The internet is filled with chatter, but is it reliable? No.

    Something written frankly, without embarrassment would be helpful.

    Thanks.

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