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Benign Prostatic Hypertrophy (BPH) | | Description |
The prostate is a small gland that surrounds the neck of the bladder and
urethra in men. Its major function is to contribute to seminal fluid. If
the prostate enlarges, pressure may be put on the urethra, acting like a
partial clamp and causing a variety of urinary symptoms. This condition is
known as benign prostatic hyperplasia (BPH). Half of all 50-year-old men
have BPH. The name "benign prostatic hyperplasia" has replaced
the older term "benign prostatic hypertrophy"; both terms refer
to the same condition.
What are the symptoms of BPH? A man
with BPH has to urinate more often, especially at night, and experiences
less force and caliber while urinating, often dribbling. If the prostate
enlarges too much, urination is difficult or impossible, and the risk of
urinary tract infection and kidney damage increases. A doctor can usually
detect an enlarged prostate during a rectal exam.
Conventional
Treatment Options: Drugs are available that can decrease urinary
symptoms in about half the men with BPH, although it is not clear whether
these drugs slow the progression of the condition. However, one of these
drugs (finasteride [Proscar]) causes erectile dysfunction (impotence) in
about 5% of men who take it. Doctors often recommend surgery when symptoms
are severe or when there is a high risk of urinary obstruction. Although
prostate surgery has a high success rate, it also has a higher rate of
complications than drug therapy.
Lifestyle changes that may be
helpful: More physically active men have a lower frequency of symptoms
related to BPH. In a preliminary study, physical activity was associated
with a decrease in occurrence of BPH, surgery for BPH, and symptoms of
BPH. Walking, the most prevalent activity among men in this study, was
related to a decreased risk of BPH. Men who exercised by walking two to
three hours per week had a 25% lower risk of BPH compared with men who
didn't use walking for exercise.
Nutritional supplements that
may be helpful: Beta-sitosterol, a compound found in many edible
plants, has also been found to be helpful for men with BPH. In one
double-blind trial, 200 men with BPH received 20 mg of beta-sitosterol
three times a day or a placebo for six months. Men receiving
beta-sitosterol had a significant improvement in urinary flow and an
improvement in symptoms, whereas no change was reported in men receiving
the placebo. Another double-blind study reported similarly positive
results using 130 mg per day of beta-sitosterol.
Rye pollen extract
has improved the symptoms of BPH in preliminary trials. Double-blind
trials have also reported that rye pollen extract is effective for
reducing symptoms of BPH. This rye pollen extract was shown to be
comparable in effect to an amino acid mixture used for BPH in a
double-blind study. A double-blind comparison with pygeum resulted in
significant subjective improvement in 78% of those given the rye pollen
extract compared with 55% using pygeum. Research on this commercial rye
pollen extract has used three to six tablets, or four capsules, per day;
the effect of other pollens in men with prostate conditions has not yet
been studied.
In a controlled trial, men with BPH received a
supplement containing three amino acids (glycine, alanine, and glutamic
acid) totaling about 760 mg three times per day for two weeks, then 380 mg
three times per day for a total of three months. After three months, about
half of these men reported reduced urgency, frequency, and/or less delay
starting urine flow, compared to 15% or less of the men who received a
placebo. Another similar controlled trial of this combination also
reported positive results. Although it is not known how the amino acid
combination works, it is believed to reduce the amount of swelling in
prostate tissue.
In a 1941 preliminary report, 19 men with BPH were
given an essential fatty acid (EFA) supplement. In every case, the amount
of retained urine was reduced, and nighttime urination problems stopped in
69% of cases. Dribbling was eliminated in 18 of the 19 men. All men also
reported improved libido and a reduction in the size of the enlarged
prostate, as determined by physical examination. Because this study did
not include a control group and the amount given was surprisingly small,
the possibility of a placebo effect cannot be ruled out.
Despite
the lack of good published research, many doctors have been impressed with
the effectiveness of essential fatty acids (EFAs) in cases of BPH. A
typical recommendation is one tablespoon of flaxseed oil per day, perhaps
reduced to one or two teaspoons per day after several months. Because
taking EFAs increases the requirement for vitamin E, most doctors
recommend taking a vitamin E supplement along with EFAs. However,
controlled research is needed to establish whether EFAs are helpful for
BPH.
Prostatic secretions are known to contain a high concentration
of zinc; that observation suggests that zinc plays a role in normal
prostate function. In one preliminary study, 19 men with benign prostatic
hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100
mg daily. In 74% of the men, the prostate became smaller. Because this
study did not include a control group, improvements may have been due to a
placebo effect. Zinc also reduced prostatic size in an animal study but
only when given by local injection. Although the research supporting the
use of zinc is weak, many doctors recommend its use. Because supplementing
with large amounts of zinc (such as 30 mg per day or more) may potentially
lead to copper deficiency, most doctors recommend taking 2 to 3 mg of
copper per day along with zinc.
Are there any side effects or
interactions? Refer to the individual supplement for information about
any side effects or interactions.
Herbs that may be helpful:
In many parts of Europe, herbal supplements are considered standard
medical treatment for BPH. Although herbs for BPH are available without
prescription, men wishing to take them should be monitored by a
physician.
The fat-soluble (liposterolic) extract of the saw
palmetto berry has become the leading natural treatment for BPH. This
extract, when used regularly, has been shown to help keep symptoms in
check. Saw palmetto appears to inhibit 5-alpha-reductase, the enzyme that
converts testosterone to its more active form, dihydrotestosterone (DHT).
Saw Palmetto also blocks DHT from binding in the prostate. Studies have
used 320 mg per day of saw palmetto extract that is standardized to
contain approximately 80 to 95% fatty acids.
A three-year
preliminary study in Germany found that 160 mg of saw palmetto extract
taken twice daily reduced nighttime urination in 73% of patients and
improved urinary flow rates significantly. In a double-blind trial at
various sites in Europe, 160 mg of saw palmetto extract taken twice per
day treated BPH as effectively as finasteride without side effects, such
as loss of libido. A one-year dose-comparison study found that 320 mg once
per day was as effective as 160 mg twice per day in the treatment of BPH.
A review of all available double-blind trials has concluded that saw
palmetto is effective for treatment of men with BPH and is just as
effective as, with fewer side effects than, the drug
finasteride.
Pygeum, an extract from the bark of the African tree,
has been approved in Germany, France, and Italy as a remedy for BPH.
Controlled studies published over the past 25 years have shown that pygeum
is safe and effective for men with BPH of mild or moderate severity. These
studies have used 50 to 100 mg of pygeum extract (standardized to contain
13% total sterols) twice per day. This herb contains three compounds that
may help the prostate: pentacyclic triterpenoids, which have a diuretic
action; phytosterols, which have anti-inflammatory activity; and ferulic
esters, which help rid the prostate of any cholesterol deposits that
accompany BPH.
Another herb for BPH is a concentrated extract made
from the roots of the nettle plant. This extract may increase urinary
volume and the maximum flow rate of urine in men with early-stage BPH. It
has been successfully combined with both saw palmetto and pygeum to treat
BPH in double-blind trials. An appropriate amount appears to be 120 mg of
nettle root extract (in capsules or tablets) twice per day or 2 to 4 ml of
tincture three times per day.
Pumpkin seed oil has been used in
combination with saw palmetto in two double-blind human studies to
effectively reduce symptoms of benign prostatic hyperplasia (BPH). Only
one group of researchers has evaluated the effectiveness of pumpkin seed
oil alone for BPH, but the results of their large preliminary trials have
been favorable. Researchers have suggested the zinc, free fatty acid, or
plant sterol content of pumpkin seeds may account for their benefit in men
with BPH, but this has not been confirmed. Animal studies have shown that
pumpkin seed extracts may improve the function of the bladder and urethra;
this might partially account for BPH symptom relief. Pumpkin seed oil
extracts standardized for fatty acid content have been used in BPH studies
in the amount of 160 mg three times per day with meals.
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May We Recommend...
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