Prostate Enlargement (BPH)

a man lying in bed

Benign prostatic hypertrophy (BPH), or the benign enlargement of the prostate gland, affects 50% of men over fifty years old and most men over sixty years old. The enlarged prostate interferes with the flow of urine from the bladder which can produce mild to severe urinary obstruction, inducing frequent urination at night with little flow. The degree of prostate enlargement dictates the most practical therapeutic approach. If prostate cancer is ruled out, most men will find relief from natural plant extracts.

According to conventional medicine, BPH develops when the active form of testosterone, DHT, stimulates cell growth. Testosterone is converted to DHT throughout the body as well as within the prostate by an enzyme known as 5-alpha-reductase. DHT is far more active than testosterone in binding to sites in prostate cells that regulate prostate growth. Herbs like saw palmetto, pygeum, and drugs like Proscar inhibit 5-alpha-reductase in order to reduce DHT-stimulated growth in the prostate.

The other mechanism contributing to prostate hypertrophy may be the predominance of estrogen over testosterone in males. Hormone-fed beef cattle, cows and chickens provide significant sources of estrogen when ingested. Cow’s milk, eggs, meat and chicken are gross offenders. In addition, environmental chemicals and toxins (called xenoestrogens) abound everywhere. Lawn chemicals, garden chemicals, golf course chemicals, insect sprays, dioxin, and many other chemicals “mimic” estrogen receptors in the body. In time, this may lead to estrogen-dominance and lower testosterone levels in males, leading to BPH.

Conventional treatments include surgery as well as non-surgical procedures such as prostatic stents and balloon urethroplasty.  For prostate cancer, treatment options–which may include surgery, hormone medication or radiation–depend on the age of the patient and the extent of the medical condition.

DIET & LIFESTYLE APPROACH

Make high quality food a priority. Try buying and eating natural, organic and whole foods. Vegetables, whole grains, fruits, legumes, nuts, high-fiber and low-fat products are excellent choices. Avoid excessive meat, dairy, sugar, and poultry intake. Meat and dairy should be organic. Eliminate aspartame-diet soft drinks, alcohol and caffeine drinks since they are believed to increase risk of prostate problems.

a healthy assortment of fruits and vegetables and legumes

Various toxins can harm the prostate. These include chemicals we’re exposed to at home and work, pesticides, smog, coffee, tap water, alcohol, tobacco, illegal drugs, acidic foods (soft drinks) and food preservatives. Parasites, bacteria and viruses add to our toxin load. Golf courses are chemical cocktails that may cause prostate stress.

Cleanse the body by fasting or detoxification. As toxins pile up (usually in the liver, kidneys, lungs, skin, colon and lymph glands), there is a great need to expel them from the body. Drink lots of clean filtered water, and supplement with alkaline minerals and antioxidants.

Reduce stress regularly. Stress is an “acidic” condition, and all acidic foods and acidic states have a negative effect on the integrity of the prostate. Regular sex helps keep the prostate healthy.

Exercise regularly. Staying active promotes stronger circulation throughout the body, including the prostate gland. Exercise also helps to reduce stress.  Other therapies may include meditation, silence in the natural environment, massage oils, detoxification, nourishing music, religious literature, and laughing.

Emotions are important; develop an open, positive attitude. All of our emotions and judgments regarding sexual inadequacy, guilt, anger, and stress are stored in the tiny muscles and other tissues of the prostate. The restriction of blood flow causes a tightening in the groin area, and the muscles clamp down on the tissue surrounding the prostate, preventing normal expansion.

CHRONIC PROSTATITIS and PROSTATISM

Chronic prostatitis is an inflammation of the prostate that may be marked by pelvic pain, painful ejaculation, and irritation or obstruction during urination, all unrelated to a bacterial infection. Antibiotics are frequently prescribe by a physician for this infection. Natural remedies include supplementing with quercetin, abundant in red grape juices and wines, apples, tea, and onions.  Prostatism is defined as any prostate condition that causes interference with the flow of urine from the bladder.

THE TESTOSTERONE/DHT/ESTROGEN CONNECTION

Local conversion of testosterone to its metabolite dihydrotestosterone (DHT) is implicated as a casual factor in BPH. DHT exerts its effects by binding to androgen receptors inside the prostate cells, stimulating cellular growth and division. In some cases, a genetic disease may be at fault. Estrogen receptors are abundant in the nuclei, and some researchers believe that estrogen itself (synthetic or hormonal), or a decrease in the DHT:estrogen ratio may be involved in this abnormal growth in the prostate. There is an increase in estrone and estradiol in men as they age as well as an increase in DHT. This stromal estrogen increase is accentuated in BPH prostates.

Another popular hormones used as a supplement called dehydroepiandrosterone (DHEA), sometimes used by athletes to raise their testosterone levels and improve performance, may actually be raising levels of a hormone that could lead to prostate growth.  See a qualified practitioner before taking DHEA in hopes of increasing testosterone, it may not work.

PSA SCREENING

Prostate-specific antigen (PSA) screening determines the likelihood that prostate cancer will be diagnosed. There is a certain amount of anxiety associated with the test, and there are possibilities that false negatives and false positives may result. A desirable reading is less than 4, with under 1 being ideal.

a man getting a psa screening

SUPPLEMENT PROTOCOL

  1. SAW PALMETTO, PYGEUM, NETTLE ROOT, UVA URSI COMBINATION
    This herbal combination decreases inflammation and improves the integrity of the prostate, circulation, and BPH. When frequent urination at bedtime occurs, this combination increases urinary flow and decreases frequency. Within one month there should be a 50% improvement in nightly urination trips to the bathroom. Saw palmetto is reported to be as effective as common drugs for BPH. It increases testosterone and inhibits dihydrotestosterone (DHT), which is thought to play a role in prostate enlargement. PYGEUM AFRICANUM is an extract derived from the bark of an African tree.  Pygeum extract contains phytosterols which can inhibit prostaglandin synthesis (inflammatory mediators), thereby reducing high levels found in BPH. Clinical effects of pygeum include reduction of the prostate size, decreased night-time urinary frequency, reduction in residual urine and urinary urgency. Overall, it works to improve the quality of life in men with BPH. Dosage: 160 mg 3 times a day, but cancer patients require higher doses.
  2. LYCOPENE
    Mainly derived from tomatoes, lycopene is a phytochemical that gives tomatoes their bright red color.  A powerful antioxidant, lycopene has properties that may inhibit prostate carcinogenesis, but surely helps prevent prostate cancer.  Men who consumed the highest levels of lycopene appear to have a lower risk of certain types of cancer, especially cancers of the prostate, lung and stomach. Dosage: 2-3 capsules daily or as directed on package.
  3. HIGH ANTIOXIDANT SUPPLEMENTATION
    Antioxidants are one of the most important supplements in boosting the immune system, decreasing free radical destruction, increasing natural killer cell activity, and improving blood and lymph in cells and fluid.

    1. VITAMIN C & BIOFLAVONOIDS (QUERCETIN and OPCs)
      Quercetin, a plant-derived polyphenolic flavonoid found in high concentrations in green tea, onions, red wines and other fruits, was found effective in relieving prostate pain (chronic prostitutes and pelvic pain) and decreasing inflammation. The National Institutes of Health have evaluated the effectiveness of quercetin and discovered 25% improvement of symptoms. It may be more effective when given with bromelain and/or papain. Dosage: 500-1,000 mg once or twice daily.
    2. VITAMIN E
      Vitamin E is an antioxidant that helps with the control of cellular damage that may promote prostate cancer. Adding vitamin E to lycopene resulted in a 90% decrease in cell proliferation. Dosage: 400-1,000 IU daily.
    3. BETA CAROTENE
      Studies have shown that men supplementing with beta carotone die from prostate and lung cancer less than men who do not. Dosage: 10-25,000 IU daily.
    4. SELENIUM
      Higher selenium levels have been associated with a reduced risk of prostate cancer and may cut prostate cancer death toll by 64%. Foods rich in selenium may ward off advanced prostate cancer. Dosage: 200 mcg daily.
    5. VITAMIN D
      In countries where men have more exposure to sun light, there is less prostate cancer. Dosage: 400-2,000 IU daily, see a qualified practitioner.
    6. GLUTATHIONE and ALPHA LIPOIC ACID
      Glutathione is the single most important protective and regulatory antioxidant in cells. Alpha lipoic acid is a potent antioxidant that helps to prevent free-radical destruction. Dosage: As directed.
    7. GREEN TEA, GRAPE SEED EXTRACT
      Both herbal products have additional antioxidant activity.  Dosage: As directed.
  4. ZINC
    Zinc deficiency is a worldwide public problem, especially in men. Zinc is the most important nutrient for the prostate gland and is a key ingredient for prostate health. Prostate health depends on plentiful zinc stores (the prostate contains the highest concentration of zinc in the body), and zinc is critical for healthy sperm production. When zinc stores are low, growth retardation, lower testosterone levels, and susceptibility to infections are some of the consequences. Vitamin B6 is thought to increase the absorption of zinc. Dosage: 30-60 mg a day.
  5. L-ARGININE
    Supplementing arginine has been associated with a wide range of health benefits. Although this amino acid is involved in multiple areas of human physiology and metabolism, its greatest role may be as a precursor of nitric acid. This results in relaxation of vascular muscles and reduced platelet aggregation. L- Arginine may protect a man against oxidative damage. Arginine promotes healthy estrogen metabolism and excretion, and supports men’s immune system functions.  Arginine also supports healthy sexual performance, presumably through enhancing genital blood flow. Dosage: 350 mg 3-6 times a day.
  6. COENZYME Q-10
    CoQ10 is an essential coenzyme that is an important component of the mitochondria (the energy-producing units of the cell). CoQ10 serves as an antioxidant, neutralizing harmful free radicals that promote tumor growth and metastases. A recent study at the National Institutes of Health confirmed the importance of CoQ supplementation in men with prostate disease. Dosage: 60-300 mg a day.
  7. ESSENTIAL FATTY ACIDS (EPA and DHA) and FLAX LIGNANS
    A deficiency in essential amino acids is postulated as a possible contributing factor in BPH. EFA’s are necessary for normal prostaglandin synthesis and may limit progression of the disease. Dosage: 1000mg 3 times a day of high quality wild salmon oil. FLAX SEED (lignans) interferes with DHT (the cancer-causing form of testosterone) by 15%, slowing the growth rate of cancer cells and helping to reduce BPH. Flaxseed and a low-fat diet may influence the progression of prostate cancer by influencing both estrogen and androgen metabolism. Flaxseed is a source of dietary fiber that is especially rich in dietary lignans. Dosage: up to 30 grams a day (approx. 3 round tablespoonfuls of ground flaxseed).
  8. BETA SITOSTEROL
    Beta-sit sterol is the active ingredient in saw palmetto berries, an herb that has been used for centuries to treat BPH. Used widely in Germany and France, this extract may be one of the most effective remedies known for prostate problems. Dosage: 100-300 mg a day.
  9. STINGING NETTLE
    Stinging nettle root extract contains high amounts of lignan, which is responsible for the root’s ability to bind to sex hormone-binding globulin (SHBG), key for its use in prostate problems. As men age, their SHBG level increases, making them more susceptible to abnormal cell proliferation. Stinging nettle has a strong affinity for SHBG, thereby limiting the amount of testosterone and oestrogen that can bind to it and influence cell proliferation.  It has been shown to reduce the risk of abnormal prostate cell proliferation, decreasing night-time urinary frequency while increasing urinary flow-rate and reducing residual urine. Stinging nettle also encourages hormonal balance and improves the quality of life of people with BPH.  Dosage: As directed.
  10. AMINO ACIDS
    A combination of amino acid glutamic acid, alanine, and glycine was found to be effective in BPH treatment with significant improvement in nocturia, urgency, frequency, and delayed micturition. Dosage: 2 caps 3 times a day for 2 weeks, then 1 cap 3 times a day thereafter.
  11. SOY and other PHYTOESTROGENS (RED CLOVER)
    Phytoestrogens, found in many vegetable foods, particularly soy, linseed, and red clover, seem to mitigate the negative effects of sex hormones in the body. Scientists have long speculated that dietary isoflavones may help in the treatment and/or prevention of prostate cancer. Research shows that genistein, one of the naturally-occurring isoflavones in soy, may work well with erd clover in inducing apoptosis of prostate cancer cells. Another alternative treatment for BPH is red clover.  Red clover’s isoflavones help lower the rate of prostate problems. In higher doses of 100-200 mg a day, soy helps to block estrogen receptor sites in prostate cells.
  12. COX-2 INHIBITING BOTANICALS (Zyflamend)
    A noted urologist has studied how herbs that can decrease COX-2 activity (I.e. oregano, tumeric, ginger, holy basil, green tea, rosemary, skullcap, boswellia), may have a beneficial effect in treating both BPH and prostate cancer. COX inhibition is being looked at throughout oncology as a potential mechanism for chemo protection. Dosage: As directed on label.
  13. INDOLE-3-CARBONOL
    This compound from broccoli is an antioxidant and a potent stimulator of natural detoxifying enzymes in the body. In men who have high levels of estrogen (which will lower their testosterone levels), supplementation of indole-3-carbonol may be advised. Dosage: See a qualified health care practitioner before use.
  14. MILK THISTLE
    Milk thistle is another agent that bolsters the immune system. Its active ingredient, silymarin, slows the entry of liver-damaging toxins, free-radicals that would otherwise damage the liver. Dosage: 300 mg 1-3 times a day.
  15. PROGESTERONE CREAM
    Progesterone cream has been used topically for men to decrease BPH and the risk of cancer. Use 25 days per month and rotate sites of application (palms, inside thighs, wrists, above breasts). Dosage: See a qualified health care practitioner before instituting this cream.
  16. WILLOW HERB (EPILOBIUM PARYIFLORUM))
    Even though the scientific evidence for using willow herb for BPH is lacking, Australian physicians are convinced of its positive pharmacological activity. Best when combined with saw palmetto and nettle root. Dosage: As directed.

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Brown, DJ. Low-fat Diet Supplemented with Flaxseed, May Influence Prostate Cancer Progression. Herbalgram, Number 54, 2002. Pp. 24-26.

Burny, P. Prostate Care Through Diet and Lifestyle. Vitamin Retailer, Feb. 2006. 13(2): 48-50.

Clapp, L. Prostate Care-Necessary Steps for the 21st Century. Alive #228. October 2001. Pp. 36-37.

Cunningham, M. Support BPH with Supplementation. America’s Pharmacist, June 2002. P. 33.

Curtis, James. Foods for Your Prostate. Alive #240, October 2002. Pp. 36-39.

DHEA Intake Could Lead to Prostate Harm. Vitamin Retailer, November 2004. 11(5): 41.

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Kidd, P. Th1/Th2 Balance: The Hypothesis, its Limitations, and Implications for Health and Disease. Alternative Medicine Review, August 2003. 8(3): 223-244.

James, L. An Old Plant with New Tricks. Energy Times, July/August 2005. 15(7): 51.

Lahti, H. Prostate- A Review of the Facts. BioMed Report, Spring 2004. 3(2): 4-5.

Larson, H. PSA Screening for Prostate Revisted. Alive #228. October, 2001. P. 18.

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Maitake Shows Promise Against Prostate Cancer. Natural Pharmacy. Sept 2000. 4(8): 5.

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The Saw Palmetto Controversy

A widely used herb for mild to moderate benign prostatic hyperplasia is in the limelight after a trial published recently suggested that it was no better than a placebo. Is this really the case?

,The latest results of a new clinical trial on the popular herb saw palmetto, may confuse the public, especially men with prostate problems, according to the American Botanical Council (ABC), a non-profit herb research and education group.

The trial, published in the Feb 2006 issue of the New England Journal of Medicine (NEJM), found no significant differences between saw palmetto pill and a placebo in men with moderate to advanced prostate problems.

Mild to Moderate

Saw palmetto is an herbal supplement that is widely known for its safety and efficacy in treating mild to moderate symptoms of benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate gland, which is common in men over 50 years of age, affecting almost 75% of men in this category.

Symptoms of BPH include weak urine flow, difficulty in starting urination, straining to urinate, dribbling after urination and incomplete emptying of the bladder. Other symptoms include the urgent need to urinate, frequent need to urinate, increased frequency of urination at night and urge incontinence.

“Our primary concern with this trial is the relatively advanced conditions of the prostate problems in many of the men who were tested,” said Mark Blumenthal, Founder and Executive Director of ABC.

Blumenthal emphasized that the men in this trial experienced moderate to severe symptoms of BPH, although most of the previous controlled trials showing positive results and efficacy for saw palmetto were conducted on men with mild to moderate symptoms of BPH. The men in the trial had scores between 8-35, i.e., moderate to severe BPH, according to the American Urological Association Symptom Inventory (AUASI).

“Most of the official international monographs that recognize the benefits of saw palmetto do so for stage 1 and 2 of BPH, i.e., the mild to moderate range of BPH symptoms,” said Blumenthal. “These include monographs from the German government and the World Health Organization.

“The results of this trial need to be seen in the perspective of the preponderance of the existing evidence, including at least 21 controlled trials showing positive outcomes with saw palmetto preparations,” he added.

Saw palmetto extracts are widely used in Europe, and in the past decade, in the United States as a natural therapy to help maintain normal prostate and urinary function, particularly by treating the symptoms of BPH in men with mild to moderate cases of BPH.

Over 22 clinical trails carried out in over 3,000 men as reviewed by the Cochrane Collaboration2 have confirmed the safety and efficacy of saw palmetto standardized extract preparations in treating mild to moderate symptoms of BPH.

The latest meta-analysis2 concludes that the clinical literature supports the use of 160mg (twice daily) saw palmetto standardized to contain 85-95% fatty acid extract preparations in mild to moderate symptoms of BPH, and that the saw palmetto standardized extract preparations have shown efficacy and greater safety when compared to conventional pharmaceutical drugs.

Saw palmetto is frequently combined with other herbs that have shown benefit for prostate function to produce safe and effective preparations that have been clinically documented, which include stinging nettle, pygeum, pumpkin seed and tomato extract.

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