Nutritional Considerations In Benign Prostate Enlargement
by Carl Germano, M.A., R.D., CNS
Frequent need to urinate, inability to empty the bladder, pain associated with urination and sitting. Frustration best describes the emotional feeling towards these symptoms and current medical treatment for enlargement of the prostate. While this condition is not uncommon to men between 20 and 40 years of age, it may typically be a problem for all men over 40. Therefore, it would be wise to pay particular attention to the nutrient and dietary measures that can support the gland. What must also be distinguished is the difference between a bacterial infected and inflamed prostate (prostatitis) and benign prostatic hypertrophy which is characterized by an enlargement of the gland that is hormonally influenced. For those with the latter condition, frustration is further compounded with the fact that prior to Proscar, medical treatment was limited to frequent use of antibiotic therapy which often was ineffective or surgery. An emphasis on natural nutritional treatments has been very helpful in relieving the symptoms and reducing enlargement of the prostate and is the focus of this article.
The prostate is a small hormone dependent organ positioned under the urinary bladder that is influenced by the androgen hormones, testosterone and dihydrotestosterone. Under the influence of these hormones, by puberty the prostate matures and reaches full size and weight by the age of 25. While testosterone has received much attention for contribution towards one's masculinity, it's conversion to dihydrotestosterone, by the enzyme steroid 5 a-reductase, is associated with benign growth of the prostate. Testosterone is thought to be responsible for androgenic effects in tissues with low levels of steroid 5 a-reductase activity, such as muscle, or with extremely high levels of testosterone, such as the testes. Whereas, tissues where steroid 5 a-reductase enzyme activity is high, such as the prostate, seminal vessels and other sexual organs, dihydrotestosterone is believed to be the major active androgen. It is, therefore, critical to address the suppression of steroid 5 a-reductase enzyme in efforts to resolve an enlarged prostate. Adjunct therapy must also focus on nutritional support for the gland which includes nutrients that enhance blood flow, reduce swelling, balance hormonal disturbances and provide for the health of prostate tissue.
Nutritional Considerations Diet
A low fat diet with emphasis on controlling serum cholesterol is of utmost importance. Since the blood supply to the prostate is provided by an abundant fine capillary network, it is imperative that atherosclerotic blockage is avoided and that an ample blood supply to the prostate is not impaired. Saturated fats (primarily from animal foods except for fish) must be reduced and hydrogenated fats (margarine, most commercial packaged breads and sweets) must be eliminated since they affect prostaglandins that cause inflammation. Dietary essential fatty acids may be of benefit since they affect different prostaglandins which prevent unrestrained growth of the prostate (1). Choices from the omega 3 fatty acids series include the fish oils and flaxseed oil while choices from the omega 6 series include borage and evening primrose oils. It would be advisable to consume some of the essential fatty acids from both series since they both influence the beneficial prostaglandins. Avoidance of alcohol (especially beer), caffeine, spicy foods and sugar are all recommended since any one of these can irritate the prostate or urinary tract. Judicious use of pumpkin seeds due to their high zinc and important fatty acids have been beneficial to the health of the prostate gland. Lastly, the diet needs to include adequate soluble and insoluble fibers either through the diet (whole grains, vegetables) or via supplement (oat bran, rice bran, apple pectin, wheat bran).
Zinc - the prostate contains a higher concentration of zinc than any other organ in the body. It has been found that men with benign prostatic hypertrophy have low levels of zinc in the prostatic fluids and that supplementation with zinc may reduce enlargement and inhibit the activity of steroid 5-a reductase enzyme (2,3). Adequate dosages from 15 - 60mg preferably from a well chelated form such as zinc picolinate, zinc histidinate or zinc citrate. Long term administration of elevated amounts of zinc require monitoring of copper status.
Saw Palmetto Extract (Serenoa repens) - the berry of this herb contains an oil composed of lipid sterols and various fatty acids. The liposterols found in saw palmetto have demonstrated strong antiandrogenic activity in many pharmacological and in vitro studies. Clinical investigations have revealed that saw palmetto extract can significantly improve symptoms of benign prostatic enlargement. It is believed that one of the mechanisms is the ability of the actives in the extract to block the conversion of testosterone to dihydrotestosterone by inhibiting the steroid 5-a reductase enzyme (4,5,6,7). It is important to use only extracts or standardized extracts of saw palmetto in powder or liquid forms when treating prostate problems. Lastly, saw palmetto seems to principally address a natural approach to quick symptom relief and is best used in conjunction with another herb called Pygeum africanum.
Pygeum (Pygeum africanum) - the chemistry and medical application of this herb is principally directed at the bark portion of this species of evergreen tree. Pygeum extract contains at least 3 different classes of compounds which can interfere with the development of prostate disease. These include phytosterols which reduce inflammation, triterpenoids which can reduce swelling in the prostate due to water accumulation and esters of fatty alcohols which can lower cholesterol levels in the prostate (8). Numerous studies have supported the beneficial effects of treating prostatic enlargement as well as it's symptoms including reduction in inflammation and swelling, reduction of cholesterol and urinary urgency and frequency (9,10,11,12). As with saw palmetto, an extract or standardized extract in powder, oil based softgel or liquid is preferred.
Selenium - experimental studies have demonstrated that the heavy metal cadmium was found to stimulate the growth of prostate tissue. The administration of adequate amounts of selenium was found to inhibit the growth stimulation of cadmium (13 ) and thereby place it as an important nutrient to consider in the nutritional treatment of benign prostatic enlargement. While L-selenomethionine is an excellent non yeast selenium supplement, it is important to assess total selenium intake especially from antioxidant formulas and multiple vitamin preparations which commonly contain selenium. Lastly, it would be advisable to have heavy metal tissue analysis performed by a competent nutritionally oriented physician to assess possible cadmium involvement.
Amino Acids - there is limited controlled studies utilizing the 3 amino acids: glutamic acid, alanine and glycine. Significant reduction in symptoms were shown in those taking the amino acid preparations with reduction in frequency and urgency to urinate most noted (14).
While natural nutritional treatments offer a safe alternative to treating benign prostate enlargement, one must work closely with a nutritionally oriented physician or have a nutritionist work closely with your urologist. A total therapeutic approach need also address stress reduction, since the prostate may be a target organ, and aerobic activity to provide for adequate circulation. The use of an multiple antioxidant which also includes the proanthocyanidin family would be beneficial to round out you nutritional protocol. Lastly, hot mineral soaks, ultrasound and microwave technology have offered additional symptom relief and may be explored with your physician. Remember, if your medical practitioner does not offer you the opportunity to embrace the various safe nutritional components described in this article as an adjunct to your medical care, it is time to seek out a more competent educated one
1) Klein, LA, et al, "Prostaglandins and the Prostate", Prostate 4(3):247-251, 1983
2) Schrodt, GR, et al, "The Concentration of Zinc in Diseased Human Prostate Glands", Cancer 17:1555-66, 1964
3) Leake, A, et al, "The Effect of Zinc on the 5-Alpha Reduction of Testosterone by the Hyperplastic Human Prostate", J Steroid Biochem 20:651-5, 1984
4) Sultan, C, et al, "Inhibition of Androgen Metabolism and Binding by a Liposterolic Extract Of Serenoa Repens (Saw Palmetto", J Steroid Metabolism 20: 515-519, 1984
5) Carilla, E., et al, "Binding of Permixon (Saw Palmetto Extract), A New Treatment For Prostatic Benign Hyperplsia", J Steroid Biochem 20 (1): 521-523, 1984
6) Champault, G., et al, "A Double Blind Trail of an Extract of the Plant Serenoa repens in
Benign Prostatic Hyperplasia", Br J Clin Pharmacology 18:461-62, 1984
7) Tasca, A, et al, "Treatment of Obstructive Symptomatology Caused By Proatatic Adenoma with an Extract of Serenoa Repens", CR Ther Pharmacology, 4(25):15-21, 1985
8) Mowrey, D., "Herbal Tonic Therapies", Keats Publishing, CT, 1993
9) Bassi, P., et al, "Standardized Extract of Pygeum africanum in the Treatment of Benign Prostatic Hypertrophy", Minerva Urologica 39:45, 1987
10) Feng Yi-Ping, "Clinical Trial of Pigenil (Pygeum) in Benign Prostatic Hyperplasia", Department of Urology Medical College, PR China, Abstracts 2nd Congress of Urology, November 1993
11) Legramandi, C, et al, "Importance of Pygeum in the Treatment of Prostatic Hypertrophy", Gazz. It. Medical 143:73, 1984
12) Schaffner, CP, et al, "Effect of Cholesterol Lowering Agents In Benign Prostatic Hypertrophy", Springer-Verlag, New York, 1983
13) Webber, MM, "Selenium Prevents the Growth Stimulatory Effects of Cadmium on Human Prostatic Epithelium", Biochem Biophy res Commun 127(3):871-77, 1985
14) Dumrau, F., "Benign Prostatic Hyperplasia: Amino Acid Therapy for Symptomatic Relief", Am J Geriatrics 10:426-30, 1962