Benign prostatic hyperplasia (BPH), commonly known as “enlarged prostate,” is a non-cancerous growth of the prostate gland that affects a large proportion of men over the age of 50.
By the age of 80, the vast majority of men are affected by this condition, which includes symptoms of urinary urgency, frequency, and reduced urine flow (1,2). This article reviews some of the data on natural agents as well as dietary factors in managing BPH.
The development of BPH is thought to be driven by a lifetime of exposure to the testosterone metabolite, dihydrotestosterone (DHT), and possibly estrogen (1). In men, estrogen is produced by the enzyme aromatase, which is present in fat cells (1). As a result, obesity is associated with higher risk of BPH. On the other hand, prostatic cells convert testosterone to the more potent metabolite, DHT. The most common medication used to treat BPH is finasteride, which inhibits the conversion of testosterone to DHT; however unpleasant side effects such as erectile dysfunction affect up to 9% of men who take this drug (3). Newer research suggests that more serious side effects may also be associated with finasteride, including higher risk of more aggressive types of prostate cancer as well as depression (4). Researchers emphasize the importance of patients being adequately informed as to these risks when prescribed their medication (4).
Get your Prostate-specific antigen (PSA) tested from a young age
The mainstream medical community suggests initiating screening for PSA levels at the age of 50. Yet there is a problem with this… The cut-off for further evaluation of possible prostate cancer is a PSA of greater than 4.0. However, if your PSA was 0.2 when you were 30 years old, a PSA of 3.0 at age 50 might be a cause for concern, yet will not be evaluated because it is below the cut off of 4.0. Likewise, if your PSA was 3.5 when you were 30 years old, a PSA of 4.5 at age 50 is likely not a cause for concern. Keeping an eye on prostate health from a young age can avoid needless invasive tests later in life, or prove life saving by finding cause for further evaluation years before it may otherwise be picked up.
Several natural agents have been shown to be highly effective in reducing symptoms of BPH.
Saw palmetto (Serenoa repens) has been very well studied for its effects on BPH (5). A systematic review including 18 randomized trials concluded that “Saw palmetto improves urologic symptoms and flow measures. Compared with finasteride, Saw palmetto produces similar improvement in urinary tract symptoms and urinary flow and was associated with fewer adverse treatment events” (5), a strong statement indeed from the Journal of the American Medical Association. Beta-sitosterols are another plant derived agent that has been shown to improve BPH, likely through effects on modulating hormones and inflammation (6). In another study, stinging nettle (Urtica dioica) was shown to improve lower urinary tract symptoms in 81% of patients, compared to only 16% in the placebo group (7). This was accompanied by a modest decrease in prostate size.
Dietary factors have also been associated with BPH. Consumption of flaxseed extract has been shown to reduce symptoms associated with BPH (8). Flaxseeds contain a type of ingredient called lignans, which are known to modulate the effect of hormones such as estrogen, and possibly testosterone. An easy way to incorporate this into your diet is simply consuming 2 heaping tablespoons of ground flax daily. Lycopene, an antioxidant found in rich concentrations in tomato skins, has also been shown to decrease the progression of BPH, meaning that it halted the increase in prostate size over time as measured on ultrasound (9). Lycopene also decreased PSA levels, a blood marker associated with BPH as well as prostate cancer (9). Dietary lycopene is best absorbed from cooked tomatoes; one study found that consumption of 50mL tomato paste (not sauce) daily resulted in lower PSA levels after ten weeks (10). In addition, vegetable consumption, moderate alcohol intake, regular exercise, and maintaining a healthy weight have been shown to reduce risk of BPH, while obesity and high meat consumption have been associated with increased risk (11).
Philip and his wife, Dr Heidi Fritz, MA, ND, practice at the Bolton Naturopathic Clinic in Bolton, Ontario. Philip’s areas of clinical focus include mental health, autoimmune disease, and metabolic syndrome. He also serves as an Associate Professor at the Canadian College of Naturopathic Medicine (CCNM), responsible for delivery of the second year curriculum in Clinical Nutrition. Philip graduated from CCNM in 2004, preceded by an honours undergraduate degree and Masters of Science degree, both in Nutritional Sciences from the University of Guelph.
References
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4. Traish AM, Mulgaonkar A, Giordano N. The dark side of 5α-reductase inhibitors’ therapy: sexual dysfunction, high Gleason grade prostate cancer and depression.Korean J Urol. 2014 Jun;55(6):367-79.
5. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998 Nov 11;280(18):1604-9.
6. Wilt T, Ishani A, MacDonald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000;(2):CD001043.
7. Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.
8. Zhang W, Wang X, Liu Y, Tian H, Flickinger B, Empie MW, Sun SZ. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food. 2008 Jun;11(2):207-14.
9. Schwarz S, Obermüller-Jevic UC, Hellmis E, Koch W, Jacobi G, Biesalski HK. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J Nutr. 2008 Jan;138(1):49-53.
10. Edinger MS, Koff WJ. Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia. Braz J Med Biol Res. 2006 Aug;39(8):1115-9.
11. Raheem OA, Parsons JK. Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Curr Opin Urol. 2014 Jan;24(1):10-4.
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