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The article and protocols on this website are for informational purposes only, and not intended as medical advice. Please consult your personal licensed health care provider prior to taking supplements or acting upon information contained herein. Please read full medical disclaimer below.
Nutritional supplements, if taken in the right spectrum, dosages, and purity can and do help reduce the incidence and severity of several symptoms of benign prostatic hyperplasia (BPH), in many cases just as well as some medications. There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies, and surgery. In this article, I will review what we know about BPH and which supplements can be used for those who wish to avoid the side effects of medications, and hopefully surgical treatments.
A normal prostate gland is about the size of a walnut, which is situated directly below the male bladder. The urethra is the tube through which urine flows from the bladder to the end of the penis. The urethra passes right through the center of the prostate gland, which is why urine flow can be altered when the prostate gland enlarges.
The function of the prostate gland is to secrete seminal fluids (semen) that provide nourishment for sperm motility. Sperm is produced in the testes, and semen is produced by the glandular cells of the prostate. Much like glandular cells of the breasts, which are sensitive to hormones, the prostate glandular cells are sensitive to both estrogen and testosterone. The glandular cells and epithelial cells of the prostate are at risk of over-growth, known as hyperplasia or hypertrophy, as well as cancer development.
After age 40, the prostate gland begins to enlarge due to an increase in the number of cells (hyperplasia). A variety of factors, including androgens (male hormones), estrogens, growth factors and other cell signaling pathways usually leads to benign overgrowth (hypertrophy).
Although men’s free testosterone levels decline after 30, and more so after 40, a stronger form of testosterone, di-hydro-testosterone (DHT) increases slightly, which causes a significant change in the free testosterone-to-DHT ratio. DHT is a factor in acne, excessive skin oil, male-pattern baldness, development of BPH, and prostate cancer.
As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men over 60 years of age.
In the early stage of prostate enlargement, the bladder muscle has to contract ever more strongly to overcome the resistance from a constricted urethra; and it becomes thicker as it works harder to empty the bladder. As a result, the bladder muscle is sensitized to contract powerfully and early in bladder filling, causing a man to urinate more often and more suddenly.
As the prostate grows larger and the urethra is constricted more tightly, the bladder might not be able to completely empty. In some cases, blockage and backflow of urine due to a narrow urethra may cause frequent lower and upper urinary tract infections and gradually result in bladder or kidney damage.
The severity of symptoms tend to worsen over time. Common signs and symptoms of BPH include:
Risk factors for prostate gland enlargement include
Prostate-specific antigen (PSA) is a protein produced by prostate cells. PSA blood levels increase simply because there are more prostate gland cells when the prostate is enlarged. However elevated PSA levels can also be due to recent prostate procedures (e.g., prostate exam or biopsy), a prostate infection (prostatitis), and especially prostate cancer. PSA levels are followed during treatment of prostate cancer as a means to determine the trend of whether prostate cancer cells are increasing or decreasing in number.
Medication is the most common treatment for mild-to-moderate symptoms of prostate enlargement. The options include:
Surgical therapies might be recommended if medications do not work and/or the symptoms worsen. Of course, any type of prostate procedure can cause side effects and complications. Such complications include:
There are several types of minimally invasive or surgical therapies, which you can discuss with your doctor if needed.
There are several things you can try to help control the symptoms of BPH, which do not require drugs or surgery; or, may be used to enhance the efficacy of a medication.
Traditionally, most doctors will say that supplements do not work. This is due to two factors:
Over the past two decades, despite beginning my career in obstetrics and gynecology, I have been suggesting that men make lifestyle changes, including adhering to a high-quality, potent and pure nutritional supplement program to help decrease the risk of many chronic diseases, including BPH. My transition into nutraceutical medicine in 1995 allowed me to witness remarkable results among my hundreds of patients and several thousands of others worldwide.
My intention in this article is not to name each micronutrient and how it can help prevent and manage BPH. I only intend to cite some micronutrients, and how research has demonstrated a positive effect on the prostate. There are thousands of studies showing how micronutrients help reduce the incidence and progression of prostate cancer, but since BPH is not associated with an increased risk of prostate cancer, I will only focus on the studies involving BPH.
There is a vitamin D deficiency epidemic, and studies have shown that low vitamin D status is associated with an increased risk of prostate cancer and BPH. (1 – 3) Scientific evidence suggests that boosting vitamin D blood levels to more optimal levels are associated with a reduced risk of prostate cancer and BPH. (4, 5)
Those who have read my article on Vitamin D will know that I advocate that people maintain their vitamin D blood levels well above 50 ng/ml. Many doctors are now recommending their patients maintain a vitamin D blood level of 50 ng/ml; however, after looking at the research on what is effective and safe, the target blood level for vitamin D that I suggest is closer to 75 ng/ml. There are no reports of any health problems or negative effects from taking vitamin D3 up to 10,000 IU/day, and maintaining a vitamin D blood level of up to 100 ng/ml.
Blood calcium and parathyroid hormones may play a role in the development of BPH; indicating that there is not just one simple factor that leads to BPH, but a complex interplay between calcium metabolism, aldosterone actions, vitamin D, estrogen, androgenic hormones, and inflammation/oxidation.
Aldosterone is a hormone produced in the adrenal glands, which are located above the kidneys. Aldosterone plays a role in regulation of blood pressure. It influences the kidneys (i.e., the renin-angiotensin system) and colon to retain sodium in the blood, increasing the osmotic pressure to reabsorb water, as well as the amount of potassium released in the urine, all for the purpose of regulating blood volume and blood pressure. Indirectly, the hormone also helps maintain the blood’s pH and electrolyte levels.
A study in 2014 demonstrated that a combination of vitamin D deficiency and elevated aldosterone levels that affect the renin-angiotensin system play a role in BPH development. (6) This provides a basis for why supplementation with micronutrients would help prevent and help treat BPH.
BPH development is a dysfunction of a fine network of hormones and micronutrients, rather than a failure of a particular substance. This is why no single nutrient or medication prevents or cures benign prostatic hyperplasia.
All treatments for BPH to date are based on symptomatic relief, not a fundamental understanding of the cause of the disease. Recent studies have shown that small varicoceles (enlarged blood vessels in the scrotum, similar to varicose veins), which are more common than generally realized, increase blood flow from the testes to the prostate gland, exposing the prostate gland to a 130-fold increase in free testosterone. Some of the free testosterone is converted to a stronger form of testosterone, DHT, by the enzyme 5-alpha reductase in the prostate, which causes prostate cell proliferation.
So what causes small varicose veins in the scrotum? Recent research has demonstrated the role of vitamin K2 in the calcification of varicose veins, as well as in the proliferation of smooth muscle cells in the vein wall. Vitamin K2 deficiency is involved in the formation of varicose veins, and is a factor in the development of BPH. (7)
The hypothesis of the researchers in that study concluded that poor prostate health is essentially a vitamin K2 insufficiency disorder. By providing vitamin K2 in the right form (MK7) and quantity along with other supporting nutrients, such as vitamin D, lycopene, lutein, zeaxanthin, grape seed extract, resveratrol, curcumin, N-acetyl-L-cysteine, alpha lipoic acid, broccoli extract, olive extract, green tea extract, saw palmetto, and soy isoflavones, it is likely that BPH can be prevented, or at least inhibited from getting worse.
Saw palmetto has been shown to reduce the incidence and severity of BPH. (60 – 62) Saw palmetto is an herbal supplement derived from the fruit of the small palm plant, Serenoa repens. It is rich in fatty acids and phytosterols.
The saw palmetto fatty acids have the ability to block the enzyme 5-alpha reductase, which converts testosterone into di-hydro-testosterone (DHT), a strong androgenic hormone that can cause hair loss in genetically susceptible men, and less often, women. It can also cause acne and oily skin in either men or women, particularly those with higher concentrations of 5-alpha reductase in their skin.
Since the prostate also has a high concentration of 5-alpha reductase enzymes, an increase in DHT stimulates the development of BPH. Saw palmetto inhibits 5-alpha reductase, which reduces DHT production, which in turn removes the stimulus to cause BPH. It is especially helpful when taken with other micronutrients. Saw palmetto also helps reduce the incidence of lower urinary tract symptoms, i.e., bladder and prostate infections in men. (8)
As mentioned already, BPH is associated with inflammation. This is due to increased COX-2 enzymatic activity within the prostate gland. (9 – 11) In addition to inhibiting 5-alpha reductase enzyme, saw palmetto inhibits the COX-2 enzyme, which is involved in inflammation. (12) This provides yet another mechanism by which saw palmetto may slow both the development and progression of BPH and prostate cancer. (BPH by itself has not shown to be directly associated with an increased risk of prostate cancer; but the same factors that lead to one disorder can lead to the other.)
The combination of saw palmetto and other micronutrients, e.g., lycopene, soy isoflavones, and vitamin D, effectively reduces BPH symptoms of urinary frequency, urgency, and nocturia. It also improves urine flow-rate. (13, 14)
Lycopene is a carotenoid red-orange pigment, responsible for giving color to many fruits and vegetables. It is abundant in tomatoes, but also red carrots, watermelons, papayas and pink grapefruit. Lycopene is a powerful antioxidant, and research has shown that it helps prevent heart disease, atherosclerosis, skin aging, and lung, colon, liver, breast and prostate cancers. (15 – 17) Lycopene may boost sperm count in men with infertility. And, in relationship to this article, studies have shown that lycopene plays a role in BPH prevention and regression.
Lycopene alone or in combination with selenium and saw palmetto, inhibits abnormal prostate cell growth, angiogenesis, and induces apoptosis of abnormal cells. Therefore, it is useful in the treatment of prostate cancer and BPH. (18 – 22)
However, the combination of micronutrients is significantly more effective in the induction of apoptosis, and preventing urinary symptoms and bladder infections than any of the micronutrients individually. The combination of micronutrients makes certain medications to help with urinary flow more effective than the medication alone. (23)
An animal study has shown that vitamin C inhibits DHT-induced BPH. (24) In a 3-month placebo-controlled study, a combination of saw palmetto, beta-sitosterol, vitamin E, and pollen extract, was shown to decrease many of the symptoms of BPH over the course. (25)
Vitamin E is known as tocopherol. Not all vitamin E is the same. Some formulations of vitamin E might actually work against you, while the proper formulation of the various tocopherols (vitamin E) works in your benefit by reducing the risk of many chronic diseases, including reducing the growth and inhibiting the spread of cancer.
Vitamin E is known as tocopherol, with the various forms of tocopherol, alpha, gamma, beta, and delta. There are also tocotrienols, which are all found in the natural state of vitamin E. Cheaper productions of vitamin E are derived from petroleum-tar distillates, and provide only alpha tocopherol in both the D and L isomeric forms. That is, there is a “right-handed” (D) and “left-handed” (L) molecular form (isomer) of alpha tocopherol. However, your cells only recognize the “right-handed” isomer, that is, the “D” structure. Therefore, you should select a supplement that not only provides the “D” isomeric formulation of alpha tocopherol; but also, a brand that provides a wide array of tocopherol subtypes; beta, gamma, delta, etc.
Armed with this information about the differences between the various forms of vitamin E, don’t let anyone tell you that vitamin E is harmful; unless they qualify it as only the synthetic form, D,L-alpha tocopherol, which may be harmful. Avoid that form.
The cancer-preventive activities of catechins, as found in green tea, have been extensively studied. Of these, (-)-epigallocatechin-3-gallate (EGCG), the principal catechin in green tea, has received the most attention. Green tea extract provides EGCG and other catechins. Many studies in the laboratory have demonstrated inhibition of both cancer development and cancer progression by green tea catechins.
Green tea extract has shown to reduce the risk of cancer (including prostate cancer) and of BPH by inhibiting the COX-2 enzyme, reducing inflammation, protecting against free radical oxidative damage, and inhibiting abnormal cellular growth. (26)
There are numerous studies extolling the benefits of grape seed extract in the preventing and adjunctive treatment of many cancers, including prostate cancer. (27 – 33) I have not found a study evaluating the effectiveness of grape seed extract for the prevention and reduction of symptoms of BPH. However, given the mechanism of action for the prevention and destruction of prostate cancer cells, there is no reason that the same mechanism would not apply for BPH. And, given the results I have seen for over 20 years of recommending grape seed extract, I feel it is a critical nutrient in my protocols.
Not all grape seed extracts have the same purity or potency. Most people purchase grape seed extract over the counter, and do not see any significant results. Most grape seed extract brands have such a low potency and purity, it is a wonder how they are able to get away with calling it grape seed extract.
For grape seed extract to have any significant effect, it needs to have at least a potency of 80% of the active ingredients. That means, for every 100 mg of grape seed extract, at least 80 mg needs to be pure, bio-active proanthocyanidins and monomers. Most brands provide grape seed extract with a potency of 10 – 15% proanthocyanidins, and no monomers at all.
The brand of grape seed extract I use and recommend has 93 – 95% potency of both proanthocyanidins and monomers. A higher potency and purity brand does not exist. This is the reason I have seen such dramatic results when I use higher doses of this grape seed extract, and why it is part of almost all of my protocols to maintain and support optimal health.
Resveratrol is a natural polyphenolic antioxidant from the red grape, just like grape seed extract. It is well known for its cardio-protective, anti-cancer, and anti-inflammatory properties. It has also been shown to prevent overgrowth, or hyperplasia of the prostate (helps prevent and reverse BPH). (34)
In the United States, African American men have a 60% higher risk of developing BPH and prostate cancer. Hispanic men have a lower risk than Caucasians. Asian and Indian men living in their respective original countries, have a significantly lower risk of BPH and prostate cancer, but that lowered risk evaporates when these men adopt a typical “American” or Western diet. (35)
Asians consume more soy than a typical Western diet, which apparently accounts for the lower incidence of both BPH and prostate cancer in men, and a low incidence of breast cancer in women. (36)
Isoflavones are phytoestrogens that have recently gained interest as dietary factors related to prostatic diseases. Studies have shown that those with the most advanced cases of BPH, requiring removal of the prostate, were found to have the least tissue concentration of soy isoflavones, and that those with milder cases had higher tissue concentrations. (37) This is evidence that isoflavones help reduce the severity of BPH. One soy isoflavone, genistein, has been shown in the laboratory to inhibit growth of human-patient BPH and prostate cancer cells. (38)
Soy isoflavones are selective estrogen receptor modulators. (39) That is, soy isoflavones act as both estrogen receptor agonists (stimulators) to directly benefit the heart, arteries, and bones, and as estrogen receptor antagonists (blockers), protecting against breast and endometrial cancers in women, and BPH and prostate cancer in men. (40 – 45)
Prostate cells have estrogen receptors. A rise in estrogen as a man ages is associated with BPH and prostate cancer. Using an effective estrogen blocker, such as soy isoflavones would therefore help reduce the risk of both BPH and prostate cancer. As mentioned earlier, soy isoflavones are more effective if working synergistically with saw palmetto and lycopene.
Curcumin, or turmeric extract, is derived from the Indian spice turmeric and possesses several active components, all of which contribute to its anti-inflammatory and chemo-preventive power. (46) Impressively, it causes cancer cells to be more sensitive to chemo or radiation therapy, allowing more effective cancer killing and at the same time, blocks damage of cancer therapy to normal cells. (47 – 51)
Curcumin has been shown to have powerful anti-proliferative effects on prostate cells, inhibiting prostate cancer and benign prostatic hyperplasia. (52) Curcumin even inhibits DHT production by down-regulating the 5-alpha reductase enzyme. (53) Curcumin demonstrated the same inhibition of DHT production as the medication finasteride (Proscar), preventing cellular abnormalities and reducing prostate size, without the side effects of the medication. (54)
Meriaâ brand is a special-formulated, highly absorbable preparation of curcumin, 30 – 60 times more absorbable than standard curcumin preparations. It demonstrated a reduction of BPH symptoms of urine flow restriction and lower urinary tract infections (bladder and prostate) without any side effects. (55)
Since there is no known toxic dose to turmeric extract, I believe every person should be taking curcumin, which is in the “liver support” supplement, as well as in the “joint support” supplement in some of my protocols.
As mentioned above, inflammation is a key component of cancer and BPH development and progression. Turmeric extract (curcumin), grape seed extract, and olive extract are particularly good at suppressing inflammation via inhibition of the COX-2 enzyme, inhibiting angiogenesis, and inducing apoptosis. All micronutrients work better together than any of them separately.
Beta glucans have shown a diversity of bioactivities involving anticancer, immunomodulatory and anti-inflammatory effects. Beta-glucans are polysaccharides (glucose modules) derived from the cell membranes of the Reishi and Shiitake mushrooms, as well as from baker’s yeast extract (Saccharomyces cerevisiae), which have been found to have powerful immunomodulating properties, meaning they help kick the immune system into high gear to fight off foreign invaders that would cause infection. They also help kill abnormal cell development and growth, including hyperplasia and cancer cells. (56, 57)
The beta glucan polysaccharides are a type of fiber that do not break down in the stomach, and therefore do not have any impact on blood glucose levels and do not add calories. Of note, beta glucans increase damage to abnormal prostate cells, inducing apoptosis. (58)
Beta-glucans distinct molecular structure allows them to bind to receptors on cell membranes of white blood cells, including cytotoxic T cells, macrophages, and natural killer cells, and to cause cell death of many types of cancer, including prostate, lung, and breast cancer cells. (59, 60)
Macrophages are white blood cells that “eat up” and “digest” bacteria or cancer cells; and natural killer cells are white blood cells that kill abnormal cells by triggering the release of cytokines to dissolve the cell membranes of abnormal cells, inducing apoptosis.
Beta-glucans work synergistically with other supplements, to work better together to destroy abnormal cells. Some of the micronutrients shown to work synergistically with beta-glucans are resveratrol, vitamin C, selenium, and melatonin; but there is no reason that adding all other micronutrients would not produce a similar or greater effect. (61 – 63)
I have created what I consider to be the minimal – high-dose protocols for benign prostatic hyperplasia. Which one to follow is up to you, based upon how severe the symptoms are, and what levels work for you. One suggestion would be to start with a higher dose than you think may be necessary, and then taper down after 3 months. However, if after tapering down your symptoms worsen, increase the dosages again. Through this titration method you will find what works best for you. There is no toxicity with any of these doses.
The article and protocols on this website are for informational purposes only, and not intended as medical advice. Please consult your personal licensed health care provider prior to taking supplements or acting upon information contained herein. Please read full medical disclaimer below.
Minimal Protocol for BPH
Basic Protocol for BPH
Average Protocol for BPH
Advanced Protocol for BPH
Ingredients that I like to see provided collectively by vitamin-antioxidant & chelated mineral tablets
Vitamin A, mostly as Beta Carotene
Vitamin C
Vitamin D3
Vitamin E
Vitamin K (K1 & K2)
B-Complex Vitamins
Curcumin (turmeric extract)
Quercetin
Green Tea Extract
Olive Extract
Rutin
Resveratrol
Choline
Lutein
Lycopene
N-Acetyl-L-Cysteine (NAC)
Calcium
Magnesium
Iodine (as potassium iodide)
Zinc
Selenium
Copper
Manganese
Chromium
Molybdenum
Including Ultra Trace Minerals
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