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Dr. Bernard Presser D.C.
5696 Magnolia Woods Drive
Memphis, TN 38134
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Only men have a prostate. Because prostate enlargement hinders a man's ability to urinate, many people mistakenly think this gland is part of the urinary tract. It is actually part of the male reproductive system.
The prostate is a small gland, about the size and shape of a chestnut and weighing less than an ounce, located near the base of the penis in front of the rectum and just under the bladder, where it surrounds - like a donut -- the tube (urethra) that carries urine from the bladder through the penis to the outside. The prostate organ contains about 70% glandular tissue and 30% fibro-muscular tissue. It is surrounded by a thick fibrous capsule.
The prostate produces internal and external secretions. It secretes a fluid which carries and stimulates the activity of sperm. The sperm cells are manufactured in the testes and are transported into the epididymis and vas deferens for storage where the sperm gradually mature. During ejaculation, the prostate gland contracts and mixes its thin, milky iridescent secretion with the semen (giving semen its characteristic odor). The fluid secretion bathes, protects, supports, nourishes, and keeps the sperm alive. It increases the bulk of the semen and provides the proper pH to the surrounding fluids. This alkaline prostatic secretion may reduce the acidity of the vaginal fluids and thus improve the sperms' motility and capacity to fertilize the ovum. The mixture of the sperm with the secretion of the prostate animates the sperm, making it procreative.
The prostate's secretion also lubricates its central canal to protect it from any possible irritation when urine passes through it. And it helps to regulate the flow of urine from the bladder. The prostate keeps the outlet of the bladder tightly closed while the bladder is filling. When the need to urinate arrives, the prostate relaxes the outlet from the bladder and when the bladder is emptied the muscles of the prostate contract and expand to expel the urine remaining in the urinary canal. Obviously, any affliction of the prostate gland is first noticed in the control of urine in the bladder.
From birth to puberty, very little growth of the prostate takes place. At puberty there is a growth spurt; weight is increased and size is doubled. In some men the prostate never again increases in size. Unfortunately, for most men these days, the prostate will begin to enlarge when they are in their 40s, 50s, or 60s, and, for some, it will continue to enlarge.
There are two conditions of enlargement that produce similar symptoms: (1) Benign prostatic hyperplasia or BPH (formerly benign prostatic hypertrophy), and (2) prostatitis, inflammation of the prostate.i
BENIGN PROSTATIC HYPERPLASIA
BPH is a nonmalignant enlargement of the prostate. Both the glandular and the muscular or connective tissue elements of the prostate may be involved in the size increase. "Benign" affirms this is not a cancerous condition. "Hypertrophy" refers to increase in size; "hyperplasia" means an increase in the number of cells. BPH is very common in men over 40 years of age in all races and cultures, though symptoms are usually not noticed until age 50 or beyond. More than 50% of men aged 50 and above have enlarged prostates. The number steadily increases with age so that by age 80, about 90% of men have prostatic enlargement. Half of these men have symptoms of BPH.
Generally, BPH is described as an increase in the number of cells of the transitional zone of the prostate, the area that surrounds the urethra. This enlargement may cause symptoms of urinary tract blockage. As the tissue enlarges, it can compress the prostatic urethra, impeding the flow of urine through its normal route. This results in symptoms or urinary-flow impairment. Symptoms can be placed into two categories: urinary obstruction symptoms and bladder irritability symptoms. Obstructive symptoms may include more frequent urination (especially during the night), difficulty in starting urination, a weak or interrupted urine stream, hesitancy (trouble initiating urination), dribbling (difficulty stopping the urine stream), and a feeling of bladder fullness even after voiding. Irritative symptoms may develop from the enlargement itself or from inflammation (prostatitis). These include dysuria (painful urination), frequent urges to urinate, and a feeling of urgency that may precede voiding. If the condition worsens, the amount of urine retained in the bladder increases, and additional symptoms may occur. These include nocturia (waking up several times during the night to urinate) and incontinence (the inability to prevent urination). Rarely, the prostate will enlarge posteriorly and cause obstruction of the rectum and constipation. BPH is considered serious or critical if total urinary blockage occurs.
By itself, BPH is not a problem. Difficulties arise only when continued growth squeezes the urethra (like pinching a straw) and interferes with the normal flow of urine, causing uncomfortable and embarrassing symptoms. The enlarged prostate itself causes little or no actual pain. Although BPH is a common finding in older men, "not every man develops the condition, and in those who do, it is not always progressive."
What causes BPH? "No one knows what causes it," so it is assumed that there is no way to prevent it. Though prevalent, it "is probably not normal." So there should be clues to its cause, prevention, and alleviation. There are some medical theories for its cause. One theory is BPH is caused by "normal" changes in hormone levels, especially a drop in the male hormone, testosterone (testosterone therapy, however, is not a safe or recognized treatment). Another theory is that a substance called dihydrotestosterone (DHT), produced by aging men, promotes cell growth. DHT is a derivative of testosterone. As men age, testosterone levels generally diminish after age 50, and other hormones including FSH (follicle stimulating hormone), LH (luteinizing hormone), prolactin, and estradiol (an estrogenic hormone) increase. This change in hormone balance leads to an increase in DHT which causes overproduction of prostate cells. Also, prolactin - which increases with stress and age (and possibly excess beer consumption) - can cause an increase in testosterone uptake by the prostate, increasing DHT production. FSH, LH and prolactin are produced by the pituitary gland. The prostate is influenced by the middle lobe of the pituitary. In other words, hormonal balance - or perhaps more accurately, hormonal imbalance - seems to be a contributor to BPH.
Another factor that has been connected with prostate difficulties is excessive fat in the diet, though upon closer examination, it is consumption of too many altered fats - which disrupt proper fat metabolism, create deficiencies and imbalances - that causes problems. Men with BPH had 80% more cholesterol in their blood than those without BPH. Cholesterol levels may increase in the blood when there is a biochemical disturbance requiring more cholesterol to aid equilibrium restoration or repair. Caffeine, which has a diuretic effect, may add to the burden on the prostate. Too much alcohol indulgence is also diuretic and with today's production methods, can stress the urinary tract with toxic insults. Tranquilizers and cold or sinus medications (drugs containing decongestants or antihistamines) are known to worsen urinary symptoms. Obesity - 20% to 30% over average weight - can certainly create prostate problems.
Recent studies have revealed a link between pesticide and other chemical exposure with prostate conditions. Pesticide exposure can result in an increase in the formation of DHT in the prostate. Evidence points to hormone disrupting effects from many pesticides including antiandrogenic (demasculinizing) effects. Certain chemicals can affect sperm counts and the structure of the prostate as well as cause other hormonal and reproductive harms. Exposure to hormonally active chemicals prenatally or in adulthood increases vulnerability to prostate cancer and exacerbates enlarged prostate glands. Exposure to estrogenic chemicals - such as those in plastics, canned goods, and detergent breakdown products - before birth "appears to make males more vulnerable to prostate enlargement later in life". With just a slight increase in estrogen exposure in adulthood, the number of androgen receptors in the prostate may increase an additional 50%. This makes the prostate "permanently hypersensitive to male hormones and vulnerable to prostate enlargement". Evidently, the "significant increase in the number of BPH problems in the last several decades may be linked to toxic chemicals in our environment." ii
MEDICAL TREATMENTS FOR BPH
There are three choices in traditional medical practices for BPH: surgery, microwave, or drugs.
About 400,000 men have surgery for enlarged prostates each year. Transurethral incision of the prostate (TUIP) is done by making one or two cuts through the muscular fibers of the bladder neck and prostatic urethra to spring open the prostate and enlarge the urethra. Transurethral resection of the prostate (TURP) involves cutting away "abnormal" prostate tissue with an instrument inserted through the urethra," commonly called "roto-rooter" surgery. Partial prostatectomy selectively removes all of the hyperplastic prostatic tissue down to the so called surgical capsule, leaving the outer prostate intact. And yet, even after surgery, the prostate usually keeps growing.
TURP fails to alleviate symptoms in one out of every five men submitting to the surgery. In approximately 15%, symptoms return within a year, and 20% require repeat surgery within 10 years. There is a 20% chance of incurring an infection from the surgery, a 4% chance of losing bladder control, and a 5% chance of impotency. A conservative estimate is that sexual function is adversely affected in at least 30% of cases. A federal study following 100,000 mean for two years following TURP found that, while "only" 2.7 % of the patients died within the first six weeks, complications occurred in 8.2%, so the long-term death rate actually varied from 3% to 9%, depending on the hospital where the surgery was performed. Surgery, according to William Campbell Douglass, M.D., "is the last resort."
Some doctors widen the urethra with balloon dilation which offers fewer complications than surgery, but is "less effective" and usually temporary in symptom improvement. Other physicians use ultrasound to turn the excess prostatic tissue to pulp. In recent years, microwave hyperthermia has been used. A catheter with a microwave "antenna" on the tip is inserted through the penis and the urethra to the area of the prostate. The microwave "cooks" the tissues to be removed, heating the prostate to at least 111 degrees Fahrenheit. The walls of the urethra are protected from the heat by a special cooling device to prevent damage to other tissues. The microwave-treated tissue dies and is absorbed into the body. Urinary flow is usually improved 40%. Impotence is not as prevalent as it is with surgery. Long-term data are still lacking. "While not a cure, it effectively treats the symptoms," of enlarged prostates said former FDA Commissioner David Kessler.
Drug therapy is usually either alpha-blockers (Hytrin, Cardura) or finasteride (Proscar). Alpha-blockers relax the smooth muscles of the bladder, bladder neck, and prostate, causing a "modest" increase in urinary flow rate and symptom reduction. Finasteride blocks conversion of testosterone to DHT. This drug (Proscar) can reduce the size of the prostate, reduce symptoms, and "modestly" increase the urinary flow rate. Hytrin, the alpha-blocker most frequently prescribed, is an antihypertensive (originally used to lower blood pressure) that relaxes the muscle tissues of the prostate, relieving compression on the adjacent urethra.
Like any hypertensive drug, Hytrin has a host of side (unwanted) effects. A study in 1996 found Proscar to be ineffective and Hytrin to be much more helpful in alleviating the urinary symptoms of BPH. The trial showed Proscar could shrink the prostate somewhat (in only about half of the men taking it), but symptom improvement occurred in only 31% of treated men compared to 17% of those taking a placebo. And, relief - if it occurs - takes place only after taking the drug for six months to a year. Proscar has a host of possible side (unwanted) effects including loss of energy, decreased libido, erectile dysfunction (impotence), breast tenderness, gynecomastia (excessive development of the male breasts) - it has even been associated with breast cancer in men - as well as artificially lowering the PSA (prostate specific antigen) levels (potentially making the diagnosis of prostate cancer more difficult). Women are advised to avoid exposure to the semen of men taking Proscar.
A "new" study in 1998 showed that Proscar can reduce the rate of symptoms, prostate volume, and probability of surgery. Risk of requiring surgery or catherization was reduced by 51%. This study, though, was sponsored by Merck, producers of the drug. In an editorial accompanying the study, a translation of the new study's findings was translated by John H. Wasson, M.D., of Dartmouth Medical School: "After four years, 13 of 100 men had complete urine blockage or needed surgery for their prostate. [Proscar] reduced the chances of these problems; instead of occurring in 13 of 100 men, they occurred in 7 of 100. In other words, about 6 of the 100 men benefited after four years of taking the drug". Dr. Wasson wrote that Proscar may be unwarranted for most men with this condition. Hytrin, by the way, had no role in this new study.
A study in early 1995 showed that urinary symptoms often do not get worse for men with BPH. Many doctors observe that urinary-tract symptoms "do not necessarily correlate with the degree of prostatic enlargement..." A review of the research "challenged the conventional wisdom that mild symptoms of BPH always get worse." For men with mild or moderate symptoms, the U.S. Agency for Health Care Policy Research describes various treatments including "watchful waiting." The research suggested that up to 75% of the surgical procedures are unnecessary. The placebo effect of BPH is also quite high; trials involving drugs and procedures show that 30% to 40% of the men given the inactive treatment thought they had been given the active therapy because symptoms had improved significantly. "Patients can get better just by seeing a physician." In a 1997 proscar trial, over 80% of those taking the placebo reported adverse side effects, including impotence, decreased libido, palpitations, and cardiac arrhythmias; 13% of all patients who dropped out of the study due to perceived danger of adverse proscar effects were taking placebo. Thus, for moderate symptoms, "it is reasonable to offer nothing because there is a very real probability the disease will not progress," says Herbert Lepor, M.D., Medical College of Wisconsin.
There was a "clear message" at the World Health Organization meeting "that future research needs to be directed at understanding the disease better." It was agreed that surgery is justified only with serious symptoms and is clearly unnecessary with mild symptoms. Otherwise, there is "not sufficient evidence to dictate the best appropriate treatment." The new federal guidelines for treating BPH say that men with mild to moderate symptoms may wish to consider periods of doctor-monitored observations - "watchful waiting" - instead of choosing drug or surgical therapy right away. When symptoms are not too bothersome, making some minor lifestyle changes can relieve symptoms, such as drinking less after the evening meal to bedtime, cutting down on alcohol and caffeine, and avoiding over-the-counter cough and cold medications. Harvard researcher, Dr. Edward Giovannucci, stated that current medical practices for prostate disorders in the U.S. are of "doubtful value." Studies indicate that the best treatment for BPH is "no treatment at all." Most symptoms may "go away by themselves." iii
Prostatitis is inflammation or irritation of the prostate, indicating tissue insult or injury. It may afflict one out of four men, usually between the ages of 30 and 50. Nearly half of all men will have symptoms of prostatitis some time in their lives. Symptoms can range from being only bothersome to being extremely uncomfortable. The flow of urine may be partially or totally blocked, depending on the degree of swelling.
Usually the tissue injury occurs in the urinary tract - most often in the area of the urethra or bladder.
Symptoms of acute prostatitis are pain or tenderness between the scrotum and rectum (in the area of the prostate, possibly extending into the genitals), fever, frequent and/or urgent urination accompanied by a burning sensation, and flulike aches in the back, rectum, and between the legs; a discharge from the penis after bowel movements; and pain following ejaculation. Symptoms of chronic prostatitis are frequent and burning urination, lower back pain, premature ejaculation, blood or pus in the urine, impotency, and depression (which occurs in over two-thirds of men with chronic prostatitis). Either way, symptoms can be intermittent and range from mild to severe.
"While it is not known precisely how the condition originates, researchers theorize that bacteria may travel up the urethra (the canal that carries urine from the bladder through the penis) to the prostate either on its own or via a catheter. Other theories hold that the bacteria may originate in infected urine, blood or even the rectum (traveling through the lymphatic system to reach the prostate." For many years, open-minded researchers have found that bacteria do not cause "infection;" rather bacteria are simply present as scavengers, "garbage collectors," for dead or damaged tissues. Killing the bacteria may alleviate symptoms for a while, but does not approach the cause of the damage.
The conventional medical treatment for both acute and chronic prostatitis consists almost exclusively of antibiotics. However, in up to 95% of the cases, bacteria are not even involved. Since antibiotics kill bacteria - the accused culprit - the treatment is useless. Even "chronic bacterial prostatitis" treated with antibiotics has a "lower rate of success due to the elusiveness of the bacteria responsible". Smart bacteria! The cause or causes of "nonbacterial prostatitis" are "open to debate." And yet antibiotics and anti-inflammatory drugs are administered. "Lack of knowledge of the etiology and pathophysiology often results in non-bacterial prostatitis being treated as if it were bacterial. This leads to a substantial overuse of antibiotics...to an increasing risk of resistance, and to lack of patients' confidence in their doctors". Patients have found that cutting back on alcohol, caffeine and spicy foods "often alleviates symptoms".
Prostatitis is one of the more common conditions that bring men to the offices of urologists. "But few cases can be clearly explained or effectively treated". Says Dr. Richard Berger, professor of urology, University of Washington School of Medicine: "It's difficult to help patients understand prostatitis when physicians don't understand it either. There is a lot of misunderstanding about this condition". Approximately 5% of prostatitis cases are caused by "an infection" (acute "bacterial" cases) that can be diagnosed and treated. The remaining 95% of cases are "idiopathic" - cause unknown. In chronic "bacterial" cases, symptoms may ease with antibiotic "treatment," only to return later. There is even a diagnosis for "noninflammatory" prostatitis, having with no evidence of inflammation. Men with the inflammatory type have leukocytes (white blood cells that act as scavengers - phagocytes - to engulf and digest dead or damaged cells) in their prostatic secretions.
Research finds that men with "nonbacterial prostatitis" (now called chronic pelvic pain syndrome - CPPS) have "low prostatic epithelial activity," that the degree of discomfort and degree of inflammatory response "are related to the amount of reflux of urine into the prostatic ducts," and that changing the composition of urine results in relief of symptoms. In other words, the lining of the urinary tract in such patients is not as healthy as it should be and that the contents of the urine affect the condition of those linings. Further, chronic symptoms may be due to "incomplete relaxation of the bladder neck or inappropriate contraction of the external urethral sphincter during voiding". The smooth muscles are too constricted, needing to properly relax and dilate.
"Nonbacterial" prostatitis is medically treated with antibiotics, muscle relaxants, analgesics, relaxation exercises, lifestyle changes, and massage. "Different treatment may work better for different people". Despite what is NOT known, it IS known that prostatitis is not sexually transmitted, and does not lead to cancer or other more serious "medical" conditions. Older men with prostatitis may be mistakenly diagnosed with BPH "because the symptoms overlap so much". Is it possible that both conditions may have similar causes and/or effects? No doubt. iv
What is the evidence for the use of natural, nutritional, and lifestyle-change therapies for BPH and prostatitis?
Symptoms of BPH and prostatitis may be reduced by avoiding cold and sinus medications - as mentioned - that contain antihistamines and decongestants. These drugs "can cause an increase in impaired urination associated with prostate enlargement". Plenty of water intake eases the stress of dehydration on the prostate, though intake should be limited in the hours before bedtime. Caffeinated products should be avoided due to their potent diuretic effects. In some cases, foregoing coffee has improved symptoms by 50% within a week or two. Avoiding alcohol, especially beer and wine, decreases the risk for BPH. Cigarettes are high in toxic cadmium and should be avoided directly and from secondary smoke. Prostatic cadmium concentrations in BPH have been found to be higher than in normal tissues and cadmium has caused hyperplasia and cancer in the prostates of experimental animals. Warm baths may soften the gland and relax pelvic muscles. Prostate massage - administered by a physician, the patient, or the patient's partner - can enhance excretion of fluid and aid penetration of needed nutrients. Acupuncture and massage may benefit the prostate by improving blood flow to the area.
Nonjarring exercise such as yoga, walking, or swimming will bring blood, nutrients, and oxygen to the prostate area. Exercising five or six times a week for 30 to 40 minutes a day is often recommended. Men who walked for two to three hours a week had a 25% lower risk of BPH. In fact, the more active men are, the lower the risk of symptomatic BPH. Heavy lifting or exercises that place excessive strain on the lower abdominal area - particularly if the bladder is not emptied beforehand - may exacerbate symptoms. And, sitting for long periods of time can increase the risk.
BPH and prostatitis are less common in the Far East than in Western countries. And yet, immigrants from China and Japan, after a few generations, begin having a similar incidence of prostate trouble as those born and raised in the U.S. Thus there is reason to suspect that some environmental factors - including diet - play roles in prostate enlargement.
It is known that food can change organs, glands, and tissues for either better or worse. Food can actually change the size and weight of glands. For example, the pituitary gland - a body regulator which has been shown to influence, control and coordinate the prostate and most all endocrine glands -- exhibits microscopic changes during "aging." However, "heat treated, enzyme-free, refined items of food caused the most drastic deviations in pituitary gland size and appearance". Animal trials show that those fed diets greatly restricted in enzymes have identical or similar damage in the pituitary as humans subsisting on "conventional" food with greatly lowered food enzyme intake. So, are all endocrine changes - including BPH - due to "aging" or to years of nutrient- and enzyme deficient diets? "Hormones influence the activity of enzymes, and enzymes are necessary in the formation of hormones".
Further, enzymes from raw foods work with their nutrient components therapeutically to promote mechanisms which aid in limiting tissue damage, rectifying any present damage, and forming new healthy tissues. They "accelerate the progress of the inflammation necessary for the healing" of the insult or injury. This means that "the work of damage control, damage repair and new tissue construction is carried out more forcefully, efficiently and precisely, and is thus completed all the sooner". Symptoms of inflammation (as in prostatitis) include reddening, swelling, warmth, and perhaps discomfort. They are signs that the body is functioning as it should, that the "rescue and repair teams" are hard at work. "After all, an inflammation is nothing more or less than the magnificent response of the body to local tissue damage. It is a beneficial reaction aimed at maintaining life. To suppress it, to interfere with it, will sooner or later result in some degree of bodily harm." Supporting this process with good foods and supplements to provide the vast range of nutrients and enzymes that contribute to the proper activation and regulation of immune mechanisms assists the body's efforts for repair.
Diet should stress fresh, whole, and natural foods including plenty of fruits and vegetables, whole grains, legumes, raw nuts and seeds, and other healthful items. This supplies the wide range of nutrients needed by the prostate and the rest of the body to function properly; fruits and vegetables are packed with minerals, trace minerals, and vitamins. Freshly made juices - particularly a combination of carrot, beet, and cucumber - have been quite helpful. Raw foods supply essential enzymes - the catalysts required for best nutritional availability and use. Many of these foods contain carotenoids, flavonoids, phytoestrogens, and other plant compounds. Some of these compounds - such as the plant "estrogens" - are capable of blocking some effects of chemical hormone disruptors. Flavonoids influence the liver's metabolism of steroid hormones such as testosterone. More is and will be discovered about the benefits of foods and herbs as Nature created them. The interaction of thousands of natural food chemicals is extremely complex and much is still not specifically known or identified. Still, it is known that these chemicals "not only influence the metabolism of sex hormones, but also influence protein synthesis, cell growth, the health of blood vessels, and practically every organ, tissue, and cell". No one food or herb is a "miracle food". All whole, natural foods contain important compounds. No doubt a number of compounds within these foods influence the prostate gland. For a while, focus was placed on lycopene, a carotenoid found in tomatoes, as a protective against prostate cancer. Some newspaper and magazine articles even promoted increased consumption of pizza as a way to get additional lycopene. What about the pizza's "white" (refined flour) crust, processed and altered oil, pasteurized (altered protein and fat) cheese, and other non-food or foul food ingredients? Thousands of carotenoids have been identified. How many others - and how many other nutritional compounds - are needed for prostate health? No one knows. Whether lycopene, beta-carotene, or any other popularized carotenoid or other nutrient, it is far wiser to obtain needed nutrients from complex, interacting, whole food "packages" than from isolated (often synthetic) supplements. Excessive or long-term intake of isolated factors creates biochemical imbalances, does not have a true nutritional effect, and creates relative or reactive deficiencies.
Foods should be organically raised whenever possible because they are basically free of synthetic pesticides. Many compounds from pesticides and other contaminants - such as dioxin, polyhalogenated biphenyls, hexachlorobenzene and dibenzofurans - can increase hormone imbalance in the prostate. Refined sugars, refined flours, and any altered fats should be carefully avoided. Avoiding refined sugars and refined flours improves the body's ability to repair and function. "Knowing which fats to eat and which to minimize is also important in controlling BPH".
Most diets in developed countries are low in essential fatty acids (EFA), the building blocks of necessary prostaglandins, a class of hormone-like compounds which, among many other functions, are vital for proper prostate function. EFAs are found in most nuts and seeds and unrefined vegetable oils as well as raw or lightly cooked milk, eggs, and other foods. Flaxseeds, pumpkin seeds, sunflower seeds and walnuts are particularly rich sources that have a positive effect on symptoms for both BPH and prostatitis; they also contain zinc, other minerals, and other needed nutrients. Avoiding harmful fats - altered fats - such as hydrogenated fats in fried foods, vegetable shortenings, margarine, and processed vegetable oils; trans fatty acids; overcooked fatty foods; most processed and refined foods is extremely important.
Dr. Royal Lee explained over 40 years ago that "the value and effectiveness of the oils depend upon their content of the active principal". EFAs have their vegetable forms and their animal forms, and some deficient victims have lost the power of conversion from one form to the other. "One test is the effect on the patient with prostate enlargement". The widespread deficiency of unsaturated fatty acids - which must be biologically active to be healthful - is a probable cause of prostate disease. EFA levels and ratios are often abnormal in the prostate and seminal fluid of men with problems in this area. Most cases of BPH are relieved by the use of a potent form of this nutrient complex. It has also been shown that the most important blood change following this deficiency is a lowering of the blood iodine level, quickly relieved by administration of biologically-active unsaturated fatty acids. Iodine is, of course, linked to the thyroid, a part of the endocrine system that affects the energy and metabolism of every cell in the body. As the body ages, the metabolic rate progressively lowers. The endocrine gland clock runs down. "This trend is enhanced by the refining of our food, by which our glands are starved into atrophy or compensatory enlargement". The prostate enlarges to compensate for deficits of nutrients it needs. Food sources of unsaturated fatty acids relieve prostate hypertrophy (enlargement), indicating a deficit of these and related nutrients, "placing prostate hypertrophy in the deficiency disease category as clearly as an enlarged thyroid indicates iodine deficiency". Neither of these glandular enlargements is due to one deficiency. Many nutrients, known and unknown, available in working complexes only from food sources, are required. For example, the vitamin C complex is a valuable synergist in both goiter and prostate hypertrophy. Hormone precursors of the vitamin E and A complexes, other fat-soluble vitamins and unsaturated fatty acids are also essential. The fatty acid and vitamin E deficiencies are probably most common since these nutrients are lost by oxidation in all stale or refined cereal foods. Wheat loses them soonest - one week in warm weather after milling the flour. Vitamin E complex, zinc and vitamin C complex are major components of prostatic tissue, and are necessary for the formation of sperm. Both vitamin E and A complexes are pivotal in maintaining healthy mucous membrane tissues, including those lining the urinary tract. The vitamins E, A, and C complexes all enhance the immune system mechanisms.
It is the FORM and freshness of the dietary fats that are important. A low-fat diet is not necessary and, in fact, is unhealthful. A study on subjects with BPH revealed no association between total dietary fat intake and BPH. In fact, many foods and herbs that benefit BPH contribute a complex mixture of free fatty acids and their esters.
The omega-3 fatty acids have immune bolstering capacities that make them useful in aiding enlarged prostate. GLA (gamma-linolenic acid), a fatty acid synthesized in the healthy body from linoleic acid, converts into a prostaglandin with many values. For instance, it is required for proper functioning of the immune system and the inflammation/repair processes; it inhibits excessive cell proliferation, and is known to help prostate problems. Alcohol use temporarily raises the levels of this prostaglandin (PGE1) dramatically, but then depresses it afterward. Chronic use of alcohol leads to failure of the body to produce it.
The administration of an EFA complex containing linoleic, linolenic, and arachidonic acids has resulted in significant improvement for many men with BPH. All 19 subjects in a study showed diminution of residual urine, with 12 of the 19 having no residual urine by the end of only several weeks of treatment. There was also a decrease in leg pains, fatigue, kidney disorders, and excessive urination at night. Such effects "appear to be due to the correction of an underlying essential fatty acid deficiency, since these patients' prostatic and seminal lipid levels and ratios are often abnormal".
Cholesterol tends to accumulate in enlarged human prostate glands, a signal of deficiency or imbalance. A low-fat diet would not necessarily be the solution. The elevated cholesterol level is a "cry for help" rather than a problem in itself. For example, EFAs, vitamins E complex, A complex, C complex, and other nutrients help to control cholesterol levels. Supplying the nutrient deficits can thus alleviate the need for the cholesterol accumulation.
Raw animal proteins supply the enzymes and other nutrients needed for prevention and recovery of many illnesses for many people. Raw milk (certified grade A) has been used in the treatment of "disease of the prostate gland" with incredible success. "Rapid and marked improvement" in inflammation (prostatitis) and in reduction of the size of the gland (both BPH and prostatitis) was seen "routinely". Thus unchanged, intact foods of animal source may certainly be beneficial. Raw bovine prostate substance is an excellent source of the protein configuration, nucleic acids, fatty acids, and associated nutrients important to the body's prostate. Raw prostate actually has a higher content of zinc than pumpkin seeds.
Pumpkin seeds improve the tone of the bladder muscles, relax the sphincter, act as a mild diuretic, and thus help to achieve "decongestion of the prostate...and general relief of the condition." The seeds are a good source of needed EFAs (including the omega-3s), highly unsaturated fat, as well as a concentrated source of zinc. Other components such as the vitamin E complex and certain phytochemicals also contribute to their therapeutic value. According to Dr. James Duke, formerly of the USDA Research Center, the fatty acids in pumpkin seeds contain a diuretic. Other nuts and seeds (rich in fatty acids, vitamins, minerals, trace minerals, etc.), as well as borage or evening primrose (sources of GLA) may also help reduce residual urine, restore hormonal balance, and reduce the buildup of extra prostate tissue.
Zinc is vital to prostate health and is more concentrated in the prostate than in any other tissue. This trace mineral is required for hormonal balance, for utilization of carotenes and vitamin A complex, and much more. "Zinc supplementation has been shown to reduce the size of the prostate...and to reduce symptoms in the majority of patients." Its clinical efficacy may be due to its critical involvement in many aspects of hormonal metabolism and immune function. The mineral has also been shown to normalize prostate function. In BPH sometimes the prostatic zinc is elevated, but the elevation is in the prostatic fluid rather than within the cells due to decreased tissue binding. In other cases, particularly prostatitis, there are abnormally low levels of zinc in the prostate and semen. In one study, zinc supplementation relieved the symptoms of prostatitis in 70% of the men. Low zinc levels are correlated to low testosterone levels and low sperm counts. Zinc can normalize sperm counts and testosterone levels. Prolactin increases testosterone uptake by the prostate; zinc inhibits prolactin secretion by the pituitary gland. While zinc increases prolactin uptake into the prostate, it reduces the specific binding of prolactin to the receptor. Each month men lose approximately 12 milligrams (mgs) of zinc through seminal flow. The actual amount depends on the frequency of ejaculation - almost one mg per ejaculate. As is the case with all natural complexes, food sources of zinc aid in balancing the biochemistry, depending on individual needs. Nature's wisdom can be trusted far more than the latest refined or synthesized laboratory concoction. Fish, shellfish, lean meats, whole grains such as wheat, legumes, nuts and seeds are zinc-rich.
Vitamin B complex, including its pyridoxine (B6) component, is intricately involved with zinc, EFAs, fat-soluble vitamins, needed amino acids, other minerals and trace minerals, and many enzymes, to enhance the beneficial effects on the prostate. A deficit of B complex may be a contributing factor in prostate disorders. If vitamin B6 is lacking, for instance, zinc absorption can be limited. A deficit of either zinc or pyridoxine can cause prostate enlargement. B vitamins affect hormone metabolism too.
Vitamin C complex with its organic copper component (tyrosinase) would be helpful, particularly with the inflammation of prostatitis due to its support of the immune mechanisms. Kelp or other seaweeds, rich in minerals and trace minerals would aid endocrine gland and hormone balance, inflammation and repair processes, and urinary tract function. Patients with BPH are frequently found to be deficient in magnesium; green leafy vegetables and other sources of chlorophyll are excellent sources. Selenium may protect against cadmium-induced growth stimulation of prostatic tissue.
The amino acids glycine, alanine, and glutamic acid seem to be particularly beneficial to the prostate gland, no doubt because they are highly concentrated in that gland. Experimental studies have yielded mixed results with some outcomes showing significant improvement (e.g., reduction in subjective symptoms, decrease in prostate size) and others showing no change in enlargement. The use of isolated amino acids in the studies may certainly be a factor; these supplements would produce more of a drug-like effect including "prompt and rather spectacular relief" initially. But, for a lasting, nutritional effect, a rich food source of these amino acids would be far better for absorption, utilization, and nutritional effects. A prostate glandular supplement would be ideal.
Cernilton, an extract of various pollens from different plants, popular in Europe, is the most comprehensively studied phytotherapy (plant therapy) for BPH and prostatitis. It has been used to treat BPH for nearly 40 years with "favorable results." Studies showed improvement in night-time urination, reduced residual urine, reduced prostate size. Three to six months are typically required for its therapeutic effects. Hormone levels usually remain unchanged. At the very least, Cernilton "appears to provide modest symptomatic relief" - and sometimes "significant subjective improvement" - without the side effects of drugs. As part of a comprehensive supplement schedule and dietary guidelines, it appears to be a valuable adjunct. Its effect may be related to its high content of flavonoids.
Other herbs that have been successfully used for BPH and/or prostatitis include: Horsetail has been reported to help reduce inflammation or benign enlargement of the prostate. Panax Ginseng increases testosterone levels while decreasing prostate weight; testosterone improves zinc absorption, decreased prostatic size, and alleviation of symptoms. Stinging nettles' root extract has been shown to cut down on night-time trips to the bathroom, increase urinary flow, and decrease residual urine that can contribute to inflammation. Hydrangea has been successfully used to treat inflamed or enlarged prostate glands. Juniper berry helps to relieve the symptoms of BPH since it is a diuretic; there is also some evidence that it can specifically help the prostate. Cereal grasses such as wheat grass or barley grass have been used in the treatment of prostate difficulties including BPH and prostatitis.
The most popular herb for the prostate is saw palmetto (Serenoa repens), a rejuvenative tonic used traditionally for impotence and infertility and as a mild aphrodisiac. This berry herb evidently provides precursors that help increase testosterone levels and may inhibit production of dihydrotestosterone. The herb is supportive to any genito-urinary tract disturbances. It enhances blood flow and nutrition to the prostate. Saw palmetto has been demonstrated to act directly on the enlarged prostate to reduce inflammation, pain, and throbbing. And, it is used, not only for maintenance, but also for preventing prostate enlargement. It has halved the number of nightly trips to the bathroom and produced a 50 % increase in urine flow. Double-blind trials and meta-analyses showed it increases mean urinary flow and reduces residual urine volume; the drug Proscar fails to reduce residual urine volume. Thus saw palmetto is more effective in reducing prostate symptoms than the much-prescribed BPH drug. The herb has been shown to be effective in almost 90 % of patients usually within four to six weeks. Proscar is effective in reducing symptoms in less than 37 % of patients after the drug is taken for six months to one year. A standardized extract of the liposterolic (fat-soluble) fraction of the saw palmetto berries shows "pharmacological effects" by inhibiting dihydrotestosterone. But, for true nutritional benefits - for the therapeutic effects observed in folk medicine for many decades - the intact, whole herb would be preferable. "The mechanism of action and active ingredients are unknown at this time." As is true of any other food or herb, there is a complex mixture of many constituents present that function together for the healthful effects. The effectiveness of saw palmetto and pygeum (Pygeum africanum) may be partially attributable to the presence of plant sterols (solid lipids) which work with other components of the herbs.
Even establishment medical doctors are admitting that there is an abundance of "circumstantial evidence" that suggests plant-based therapies might work for prostate and urinary problems. "More important are the experiences of some of our patients, who say they feel better after taking herbal remedies for their prostate-related problems." So, it is admitted that "plants may contain compounds that relieve urinary symptoms."
Saw palmetto does not mask or alter PSA test results. "Saw palmetto continues to be very effective in dealing with prostate enlargement problems and may even be helpful in preventing prostate cancer."
Pygeum contains a number of natural sterol compounds that apparently help to reduce inflammation and edema (fluid retention) as well as possibly inhibit 5-alpha-reductase and thus reduces dihydrotestosterone. Experimental studies reveal significant improvement in nighttime need to urinate, frequency of urination, urgency, pain on urination, urinary flow, and residual urine. This herb reduces prostatic inflammation, congestion, and edema. It also naturally balances prolactin levels. Pygeum consistently improves symptoms of BPH - in about 66 % of all cases. This herbal bark has been used for many years to treat bladder pains and urinary difficulty. There is some evidence that it may assist men with chronic prostatitis and sexual disorders due to BPH or prostatitis. Pygeum has an "ability" to "combat" inflammation within the prostate cells, aiding this biochemical repair process. Again, rather than one "active ingredient," pygeum contains "several compounds thought" - so far - "to be helpful in reducing prostate enlargement." Actually, "the exact mechanism of how pygeum influences the prostate gland is currently not known." Much better to use the whole package. A variety of compounds apparently work together for a synergistic effect.
Which is more effective, saw palmetto or pygeum? Should they be taken together? One study lasting only one month showed significantly greater improvement with saw palmetto extract than with pygeum extract, though a longer period of time and use of the whole herbs may have produced different results. As is true with all herbs, one specific herb may have much better effects on some people than others. It is a matter of individual biochemistry. Saw palmetto might be tried first in the therapy for BPH or prostatitis. If, after four to six weeks, there is not enough improvement, it would be reasonable to add pygeum. v
Enlargement of the prostate does not appear to be a "normal" consequence of aging in men. Rather, disturbances in fat metabolism and/or endocrine balance, chronic deficiencies or imbalances, and chronic poisoning can - any or all - contribute to the problem. Attitude and mental/emotional status apparently have profound effects on symptoms, so neurological/hormonal balance probably is involved as well. One study found that nearly one-third of men who awake frequently during the night to empty their bladder may not have a prostate problem. Men who snore excrete more urine during the night and visit the bathroom three times as often as quiet sleepers who may have enlarged prostate glands. And yet, such men - and their doctors - will suspect BPH or prostatitis.
Natural therapies have shown impressive results, particularly if symptoms are not critical (requiring immediate surgery or other medical treatment). Supplying natural, unaltered unsaturated fatty acids, foods and food supplements rich in needed amino acids, zinc, and other nutrients supportive to prostatic tissues, inflammation and repair - as well as whole herbs shown to aid genito-urinary health - can only help and do not have the adverse (unwanted) effects of drugs. Sensible lifestyle habits and a wholesome, balanced diet stressing raw foods - unaltered and unrefined - should always be considered. Then BPH and prostatitis may not have to be an "exclusive men's club" that must be visited or frequented. vi
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vi ANMA & AANC Journal, Apr/May 1996, p.26, citing The Lancetl, 27 Jan 1996.
Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.