Functional Support for Benign Prostate Hyperplasia

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Benign prostate hyperplasia (BPH) is a common and progressive condition that generally occurs in men over the age of 50 and typically includes lower urinary tract symptoms (LUTS).  It has been suggested that the increased aromatase activity (an adrenal enzyme that converts androstenedione and estrone to estrogen) found in the aging male alters estrogen levels, enlarging the prostate and leading to obstruction of the bladder, urination retention, and if left untreated, kidney disease (1).  Diet and exercise, dietary supplements, and some botanical medicines have shown promise to manage symptoms, improve flow rate, reduce disease progression, and thus improve quality of life. 

Exercise

            Abdominal obesity is highly attributable to BPH.  Studies show a significant positive association between obesity and BPH, whereas a clear inverse association exists between physical activity and BPH (1).  Exercise appears to reduce signs and symptoms of BPH due to increased blood flow to the prostate that allows for efficient removal of wastes (1).  It also decreases sympathetic stress responses, thus relaxing the prostate muscle and reducing contractility (1).  Most importantly, sufficient exercise reduces excess abdominal weight, decreasing overall lower body pressure, and improving blood flow (1).  Therefore, incorporating a regular exercise program of 150 minutes a week at moderate intensity may significantly reduce the risk and symptoms of BPH.

Diet

            Most studies indicate an association between diet and BPH, though some variability exists for recommendations.  Kristal et al. (2008) found that a diet low in fat, high in vegetables and lean protein (minimal red meat), and regular alcohol consumption reduced risks of BPH.  Though recent studies indicate a protective effect, alcohol consumption aggravates LUTS and higher alcohol consumption is associated with BPH in several studies (1).  Therefore, reduced or no consumption is recommended until LUTS and clinical signs of BPH are much improved.

            Lagiou, Wuu, and Trichopoulou (1999) found that fruits were inversely related with BPH, while butter and margarine were positively associated.  Fats overall appear to increase risk, and it is recommended to keep cholesterol below 200 mg/dL (1).  Reports on high protein diets have been conflicting, but animal proteins propose a higher risk of BPH.  One study found a 91% increase in BPH in men eating animal meat versus a 12% risk in those eating plant protein (4).

Dietary Supplements

            Numerous studies report zinc supplementation as a protective factor, reducing both size and symptoms.  Thirty to 45 mg/day of zinc picolinate is recommended for a maximum of six months, reducing dosage to 15 to 30 mg/day after six months, and monitoring copper levels if taken long-term (1).  The amino acids glycine, alanine, and glutamic acid appear to significantly relieve symptoms of nocturia, urgency, and frequency, though their effects are strictly pallative (1). Two hundred mg/day is recommended for each amino acid.  High doses of vitamin D have been shown to inhibit prostate growth, lower excess contractility, and reduce inflammation though recommended doses, 2000 to 5000 IU/day, breach upper levels (1).

Botanical Medicines

            Herbs such as Saw palmetto (Serenoa repens), nettle (Urtica dioica), and Pygeum (Pygeum africanum) are well studied and have produced consistent positive results, especially for mild to moderate cases of BPH.  Urtica dioica, an extract from the root of stinging nettle, has anti-inflammatory, anti-tumor, anti-viral, and immunomodulatory properties that are shown to relieve associated LUTS without adverse side effects (5).  Saw palmetto is shown to drastically improve symptoms in mild to moderate cases, but shows even better results when combined with Urtica dioca (Shrivastava & Gupta, 2012).  Combined therapy substantially reduces total IPSS scores and improves obstructive as well as irritative symptoms (Pizzorno & Murray, 2013).  In clinical trials, Pygeum has been effective in improving signs and symptoms and produces even greater results in conjunction with Saw palmetto (Pizzorno & Murray, 2013).  However, Saw palmetto has not been shown to improve prostate secretion as seen with Pygeum, but they are typically recommended together (Pizzorno & Murray, 2013).

References

1. Pizzorno, J. E., & Murray, M. T. (2013). Textbook of natural medicine (4th ed.). Philadelphia, PA, United States: Elsevier/Churchill Livingstone.

2. Kristal, A. R., Arnold, K. B., Schenk, J. M., Neuhouser, M. L., Goodman, P., Penson, D. F., & Thompson, I. M. (2008). Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: Results from the prostate cancer prevention trial. American Journal of Epidemiology, 167(8), 925-934. doi:10.1093/aje/kwm389

3. Lagiou, P., Wuu, J., Trichopoulou, A., Hsieh, C., Adami, H., & Trichopoulos, D. (1999). Diet and benign prostatic hyperplasia: A study in greece. Urology, 54(2), 284-290. https://www.ncbi.nlm.nih.gov/pubmed/10443726

4. Zhang, S., Yu, B., Guo, S., Wang, Y., & Yin, C. (2003). Comparison of incidence of BPH and related factors between urban and rural inhabitants in district of Wannan. Zhonghua Nan Ke Xue = National Journal of Andrology, 9(1), 45-47. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12680332

5. Men, C., Wang, M., Aiyireti, M., & Cui, Y. (2016). The efficacy and safety of Urtica dioica in treating benign prostatic hyperplasia: A systematic review and meta-analysis. African Journal of Traditional Complementary, and Alternative Medicines, 13(2), 143-150. http://dx.doi.org/10.4314/ajtcam.v13i2.17

6. Shrivastava, A., & Gupta, V. B. (2012). Various treatment options for benign prostatic hyperplasia: A current update. Journal of Mid-Life Health, 3(1), 10–19. http://doi.org/10.4103/0976-7800.98811