Enlarged Prostate – Symptoms, Causes, Natural Treatment

Enlarged Prostate or Benign prostatic hyperplasia is a non-cancerous growth of the prostate gland that gradually narrows the urethra. The clamping effect can obstruct the flow of urine, leaving the patient vulnerable to infections, bladder stones and kidney damage. BPH affects 50-60% of men over 50, and 75% of men over 75.

Causes of Benign Prostatic Hyperplasia

• Testosterone is converted to either estrogen or dihydrotestosterone (DHT) in the ageing male. In both cases, the result is an increase in pro-inflammatory mediators in the prostate gland which leads to increased prostate activity and enlargement
• Dihydrotestosterone (DHT) is a critical mediator of prostate growth. Increased DHT accumulates in the prostate and stimulates cell growth. DHT may be increased by high estrogen and prolactin levels.
• Additionally, as men age, testosterone decreases, resulting in a higher estrogen to testosterone ratio. This higher level of estrogen can increase cell growth in the prostate.
• Excess estrogen and prolactin also increase DHT levels and stimulate growth of prostate cells.
• Increased exposure to insulin may also initiate the onset of BPH

Risk factors of BPH

• Age over 50
• Relative testosterone deficiency or increased conversion of testosterone to DHT
• Relative estrogen excess
• Alcohol (especially beer) – increases prolactin levels
• Stress: increases prolactin
• High-GI diet and high insulin levels
• Central obesity
• Metabolic syndrome and diabetes
• Zinc and/or vitamin B6 deficiency: needed to maintain healthy testosterone levels

Signs & symptoms of Benign Prostatic Hyperplasia (enlarged prostate)

• Progressive urinary frequency and urgency
• Hesitancy and intermittency of flow
• Excessive night time urination
• Perianal discomfort and fullness
• Reduced ejaculation pressure

Differential Diagnosis

• Acute prostatitis
• Prostate cancer
• Urethral blockage/stricture
• Neurogenic bladder

TREATMENT STRATEGY FOR BPH – ENLARGED PROSTATE

• Support healthy testosterone production and metabolism
• Reduce excess estrogen
  • Reduce exposure to exogenous estrogens (added hormones in some chicken and other animals, exposure to xeno-estogens that mimic estrogen etc)
  • Support liver conjugation
  • Support bowel clearance
• Reduce excess prolactin
• Reduce inflammatory prostaglandins
• Reduce weight and insulin resistance
• Support urinary tract health

Diet plan guidelines that support Benign Prostatic Hyperplasia

• Weight loss diet (if indicated): obesity increases aromatisation of testosterone into estrogen in the fat cells
• Low-GL diet: to control blood insulin levels; eliminate sugars and refined carbohydrates and limit high GI foods.
• High-protein diet: may inhibit 5-alpha-reductase; plant proteins and fish, rather than animal sources of protein, should be emphasised as high animal-protein intake has also been linked to BPH
• Lycopene-rich foods: powerful anti-oxidant that is protective to the prostate; found in tomatoes/tomato products, watermelon, guava, papaya, grapefruit, red capsicum, red cabbage, mango, carrots, asparagus
• Zinc-rich foods: needed to inhibit 5-alpha-reductase enzyme; found in seafood, pumpkin seeds
• Selenium-rich foods: Brazil nuts
• Include cruciferous vegetables: to support clearance of excess estrogen
• High-fibre and probiotic foods: to support bowel clearance of estrogen
• Increase essential fatty acids: oily fish, nuts and seeds, linseeds, free-range eggs and meat
• Include other anti-inflammatory foods (turmeric, ginger, berries) and avoid pro-inflammatory foods (processed foods, sugars, refined grains, etc)
• At least 2 L filtered water per day: to prevent UTI‘s
• Avoid exogenous estrogens: non-organic animals fats, plastics, tinned foods, etc
• Avoid excess alcohol (especially beer): alcohol impairs liver function and beer increases prolactin which may increase DHT

Supplement considerations for Benign Prostatic Hyperplasia

• Zinc – inhibits 5-alpha-reductase thus inhibiting the conversion of testosterone to DHT; also inhibits prolactin, inhibits binding of testosterone to receptors and can reduce size of prostate
• Indole-3-carbinole – promotes liver clearance of estrogen
• Omega-3 fatty acids – anti-inflammatory
• Cernilton – a rye-grass pollen extract that has been used in Europe for more than 35 years and can reduce BPH in about 70% of cases. It is TGA approved and available in pharmacies and health food shops in Australia
• Probiotics – healthy immune response and to support clearance of estrogens
• Glycine – supports renal clearance

Herbal considerations

• Anti-prostatic – saw palmetto, nettle root, epilobium, pygeum, crataeva
• Male reproductive tonic – Korean ginseng, tribulus
• Support estrogen clearance – St Mary‘s thistle, turmeric, rosemary
• Urinary antiseptics – horsetail, uva ursi, couch grass
• Diuretics – buchu, uva ursi, corns silk, juniper berries

Lifestyle / Physical measures

• Exercise – there is an inverse association between physical activity and BPH
• Stress management – sympathetic nervous system activation may cause contraction of the smooth muscle of the prostate, resulting in a worsening of symptoms
• Pelvic floor exercises

FUNCTIONAL MEDICINE TREATMENT OF BPH (Enlarged Prostate)

Benign Prostatic Hyperplasia is a condition that affects older males that are having testosterone decline.  Addressing the fundamentals of testosterone production and ensuring there aren’t mechanisms in the body blocking testosterone production is vital.

Seemingly unrelated issues such as SIBO or bacterial overgrowth of the gut can cause hormone production to be downregulated, in addition, it contributes to nutrient deficiencies, some of which are need for testosterone production such as zinc and B6.

Other potential contributing factors include poor methylation and detoxification, causing levels of estrogens to raise in the body as they cannot be cleared efficiently.

We have experience with men’s health problems at our Perth clinic of Functional Medicine.  If you are suffering from an enlarged prostate or having complications with low testosterone we would love to hear from you.  Please leave a comment below.

Book Appointment