Prostatic Hyperplasia: An all too common problem.
Prostatic hyperplasia is characterised by an enlarged, non-tender prostate giving rise to symptoms of bladder outlet obstruction. These symptoms include; progressive urinary frequency, urgency and nocturia, hesitancy and intermittency with reduced force and calibre of urine (1). The underlying cause of prostatic hyperplasia is androgen-dependent and related to the excessive conversion of testosterone to dihydrotestosterone (DHT) in the prostate gland.
50-60% of middle-aged men suffer from this problem. It is caused by changes in steroid hormone levels in ageing men. Testosterone levels tend to fall after the fifth decade, as prolactin, estradiol, sex hormone binding globulin, LH and FSH levels all increase. Prolactin increases the intake of testosterone by the prostate (2). The end result is an increased intra-prostatic concentration of DHT due to its increased production and decreased removal.
Melatonin is a potent inhibitor of the androgen receptor. It has been found to decrease the proliferation of prostatic tumours. Melatonin levels fall significantly with age. (3)
Risk factors:
* A family history of prostatic hyperplasia or prostate cancer.
* Elevated levels of PSA or a family history
These can suggest increased 5-alpha-reductase activity and/or reduced DHT detoxification (via the liver).
Cadmium from cigarette smoke and air pollution can also increase risk. Cadmium increases the activity of 5-alpha-reductase. Interestingly, zinc helps the body remove cadmium as well as inhibiting 5-alpha-reductase. (4)
Zinc has been shown to reduce the size of the prostate, this is probably due to its critical involvement in many aspects of androgen metabolism. (5)
Some nutrients that have been found to help prostate health include; zinc, selenium, essential fatty acids, melatonin, and vitamin D3 (although there is a sweet spot with this). GLA has a significant inhibitory effect on reductase activity.
Infection and Prostatic inflammation:
It has been postulated that the bacterial endotoxins released from low-grade, chronic or recurrent infections of E-coli may play a significant role in prostatic hyperplasia. This is something to keep in mind, especially in the case of recurring urinary tract infections. (6)
An antibacterial strategy will need to be implemented in such cases as well as general immune support.
In summary, some nutritional recommendations/considerations I often make to my clients with benign prostatic hyperplasia include:
* Avoid exposure to cigarette smoke, pesticide-treated food or pesticides
* Increase consumption of sulfur-containing foods; garlic, onions and cabbage as it helps detoxify cadmium from the body.
* Increase consumption of foods high in zinc; pumpkin seeds, red meat, shellfish, hemp seeds.
* Increase intake of fibre as it helps with the detoxification and elimination of hormonal metabolites.
* Stick to a healthy sleep schedule, and reduce exposure to blue lights before bed to help increase melatonin levels.
* The herb Saw Palmetto has an inhibitory effect of 5-alpha-reductase activity
* Increase consumption of isoflavones and lignans by eating a diet high in soy and plant foods.
* Reduce saturated fat intake and supplement with essential fatty acids.
References:
(1) https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph
(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734997/
(3) https://pubmed.ncbi.nlm.nih.gov/34746997/
(4) https://pubmed.ncbi.nlm.nih.gov/24872436/
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424038/
(6) https://pubmed.ncbi.nlm.nih.gov/32835423/