If you're a man approaching age 45, you have a nearly 50% chance of having an enlarged prostate. By age 70, the chances are almost nine in 10 that you'll have it. Called benign prostatic hyperplasia (BPH), the condition involves an enlarged prostate that compresses the urethra and partially blocks urine flow. BPH is the most common prostate problem among men. While it's not life-threatening—it is not, for example, related to the development of prostate cancer—symptoms can be troublesome. Fortunately, there are natural ways to prevent and treat it.
THE PROSTATE PRESSURE POINT
The job of the prostate is to produce fluid that nourishes and transports sperm. This walnut-sized gland weighs approximately 20 grams, about as much as two Fig Newtons. Located in front of the rectum and below the bladder the prostate surrounds the urethra, the passageway that carries urine away from the bladder and into the penis.
A swollen prostate can compress the urethra like a clamp on a garden hose, restricting urine flow. It also may press upr /ard, irritating the outer wall of the bladder. This irritation makes the bladder wall thicker and even more easily irritated. A man with BPH might start having bladder contractions, making him feel the need to urinate frequently even when there's not much urine. Over time, the bladder may lose the ability to completely empty, increasing discomfort.
There remains a lot to be answered when it comes to the causes of BPH. One thing researchers can agree on is that hormonal factors play the largest role.
Research has focused on the hormone testosterone and a related substance called dihydrotestosterone (DHT). Some researchers believe that testosterone, an anabolic (growth-promoting) hormone, is the main culprit. Others disagree because prostate growth tends to be a problem later in a man's life, while the amount of testosterone is at its highest when males are in their late teens or early 20s.
The conversion of testosterone to DHT increases as men get older—and DHT is very potent. It stimulates the proliferation of new prostate cells and slows the death of older ones. But if DHT is a cause, why do some men with prostate enlargement have normal DHT levels? Could another hormone be involved?
Now researchers are looking at the effect of the hormone estrogen (especially the kind called estradiol) on prostate growth. Estrogen isn't just a "female" hormone. Men have it as well, and as they age, estrogen levels increase. High estrogen- to-testosterone ratios could increase the effects of DHT on prostate cells.
LOOKING FOR TROUBLE
The most common test to diagnose BPH and other prostate-related problems is a digital rectal exam. Your physician inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum for any enlargement or hardness. All men over age 40 should have this test once a year.
A variety of pharmaceuticals can help relieve BPH symptoms, but each has potential side effects. Many doctors prescribe alpha-blockers, such as terazosin (Hytrin) or doxazosin (Cardura), which relax the neck of the bladder, making urination easier—but these can cause fatigue, weakness, headaches and dizziness. Another prescription drug, finasteride (Proscar), relieves symptoms by shrinking the prostate gland, but it can cause impotence and reduced sexual desire.
For men who have serious BPH problems that are interfering with their lifestyle, some doctors recommend surgical procedures—but surgery can lead to impotence or incontinence.
I find that drugs and surgery usually are unnecessary. As long as a man is getting his prostate checked at least once a year and there are no signs of tumor growth or urinary blockage, BPH can be treated with natural therapies. These include improved diet and supplements. Also, 30 minutes of daily exercise has been shown to reduce BPH symptoms quite significantly.
- Avocados contain beta sitosterol, a phytonutrient that protects against prostate enlargement by inhibiting grov/th factors that cause prostate swelling. Avocados also are a good source of oleic acid, a monounsaturated fatty acid that is thought to reduce inflammation, which can contribute to BPH. Have at least two weekly servings (one-fifth of a medium avocado per serving). If you don't like avocados, you can have three half-cup servings a week of peanuts, rice bran or wheat germ.
- Fish is a good source of eicosapentaenoic acid (EPA), a powerful omega-3 fatty acid that helps reduce swelling and inflammation. Eat at least two three-ounce servings of trout, salmon or sardines each week.
- Ground flaxseed has been shown to reduce estrogen levels, and it contains anti-inflammatory omega-3 fatty acids. I advise men to take one or two tablespoons daily along with 10 ounces of water (to prevent constipation). Ground flaxseed has a mild, nutty flavor and can be added to salads, cereals, yogurt, smoothies and protein shakes or just eaten plain.
- Pumpkin seeds are natural sources of zinc. This mineral helps keep your prostate healthy by reducing the activity of the enzyme 5-alpha reductase, which produces DHT. Sprinkle a tablespoon or two of pumpkin seeds—raw or roasted, with or without the hulls—on salad, yogurt, cereal, etc. four times weekly.
- Soy contains a number of phytoestrogens (plant chemicals that balance estrogen), including genistein, which can help control prostate enlargement. I prefer fermented soy foods, such as miso, tempeh and fermented soy protein powder, which provide a form of genistein that can be readily absorbed by the body. Have at least one-half cup serving daily.
- Tomatoes are rich in the disease-fighting antioxidants known as carotenoids. Preliminary scientific research has suggested that tomatoes and tomato products help prevent prostate cancer. They also may have a beneficial effect on prostate enlargement. Consume two servings of fresh tomatoes and two servings of cooked tomatoes (e.g., tomato paste/sauce) weekly (one serving equals one-half to one cup of tomatoes and/or tomato sauce). If you don't like tomatoes, eat watermelon or cantaloupe.
Foods to avoid: Men with BPH should avoid caffeinated beverages and alcohol—they irritate and inflame the prostate. Also reduce your intake of foods that contain harmful fats, such as hydrogenated or partially hydrogenated oils, that promote inflammation. Stay away from packaged foods that are high in sugar which also can worsen inflammation.
The following supplements are listed in order of importance—start with the first and move down the list until you find what works best for you. Many formulas contain a blend of two or three of the ones listed.
- Saw palmetto berry extract is a mainstay in the natural treatment of BPH and alleviates most symptoms. It was first used medicinally by Native Americans for prostate and urinary tract problems. Recently, researchers have found that saw palmetto helps the prostate by reducing activity of the DHT-producing enzyme 5-alpha-reductase. A review of 18 randomized, controlled trials involving 2,939 men found saw palmetto to be as effective as the BPH drug finasteride.
It can take six to eight weeks before this natural prostate protector begins to fully take effect. I recommend a product that is standardized to contain 80% to 95% fatty acids (check the label) and a total daily dosage of 320 mg, which can be taken all at once. Two brands I recommend are Nature's Way Standardized Saw Palmetto Extract and Enzymatic Therapy Super Saw Palmetto, which are widely available at health-food stores. It is best to take it on an empty stomach. A small percentage of men get stomach upset from saw palmetto. If this occurs, try taking it with meals.
- Pygeum africanum, an extract that comes from the bark of the African plum tree, decreases the need to urinate at night and improves urine flow during the day. I prefer a formula that combines pygeum with saw palmetto, such as Ultra Saw Palmetto and Pygeum by Jarrow Formulas (800-726-0886, www.jarrow.com). The daily pygeum dosage is 100 mg.
- Nettle root can provide modest benefits. The nettle-containing product from Nutrilite, Saw Palmetto with Nettle Root, produced good results in a UCLA study. Over six months, the 44 men in the study showed modest improvements in BPH symptoms. The Nutrilite formula includes saw palmetto, nettle root, beta-carotene, pumpkin seed oil and lemon bioflavonoid concentrate (Quixtar, 800-253-6500, www.quixtar.com). Take one softgel three times daily.
- Rye grass pollen extracts seem to relax the muscles of the urethra and improve the ability of the bladder to contract. The extract most widely tested is from Graminex (877-472-6469, www.graminex.com). Take three 63-mg tablets twice daily for a total of 378 mg.
- Fish oil can help reduce prostate swelling and inflammation. Take 3,000 mg to 5,000 mg daily in addition to two weekly servings of fish. If you prefer a vegetarian source of omega-3 fatty acids, use one to two tablespoons of flaxseed oil.
Caution: Fish oil should not be used by anyone who takes blood-thinning medications such as warfarin (Coumadin).
COMMON SYMPTOMS OF BPH
- A need to urinate frequently.
- Urination that is hard to start or stop.
- Weak urination or "dribbling."
- Sensation of an incompletely emptied bladder.
- Increased need to urinate at night.
- Burning pain accompanying urination.
- Recurring bladder infections.