Men’s Health: Proper Treatment of Benign Prostatic Hypertrophy

Only about 30% of my patients are men. I don’t know why this is the case, but I would guess that men tend to avoid going to the doctor until they have a condition that stops them in their tracks. Such stoicism can be a dangerous thing. Cardiovascular disease is the number one killer of men, followed rapidly by diseases of the colon and prostate.

Although these conditions are amongst the most important health issues for men to address (and these conditions start in our twenties), it is beyond the scope of this short article to address all of these complex conditions. Here I’ll focus on benign prostatic hypertrophy, or BPH, a disorder that normally affects all men if they live long enough. Still, I hesitate to use the word “normal”, which implies that it is expected, because with proper lifestyle modifications most prostate conditions can be avoided.

BPH is a condition of excessive proliferation of prostatic stromal cells that probably occurs as part of the aging process. These cells are not malignant; they maintain their usual function and do not metastasize. However, approximately 10-15% of prostate cancers do arise in the same part of the prostate in which BPH develops, so men with symptoms should still consult their physician. Typical BPH symptoms include an increased need to urinate at night, urinary incontinence, difficulty starting urination, a sense of urgency to urinate, and a sense that the bladder did not empty fully. Later symptoms may include a tendency to form stones and presence of blood in the urine.

Initiation of treatment should include a visit to your physician, a proper physical exam, and a complete laboratory panel. Prostate tissue responds to testosterone (without it, BPH will not develop), but also to other steroidal hormones, non-steroidal hormones and growth factors. At a minimum, I recommend performing a panel of labs that includes a comprehensive metabolic panel, a complete blood count, a lipid panel, sex hormone binding globulin (SHBG), testosterone free and total, dihydrotestosterone (DHT), estrogen, PSA free and total, IGF-1 and homocysteine. Recognition of imbalances in these tests allows for the development of a thorough, holistic, more effective treatment protocol. If your physician declines your request to perform this panel, please consider speaking with your friendly neighborhood naturopathic physician!

As a naturopath, I am obviously a supporter of naturopathic therapies to treat BPH. (I must add, however, that allopathic therapeutics may be necessary in certain circumstances). Generally speaking, the standard American lifestyle is sedentary, low in unsaturated fat, high in saturated fat, low in fruits and vegetables and high in processed carbohydrates. Making changes to your menu is always the best place to start. Cleanses can be helpful, although they are often very “cooling”, so I do not recommend them at this time of year. The Masters Cleanse, which involves consuming only a “lemonade” mixture of water, lemons, cayenne and grade B maple syrup, is a versatile cleanse as it allows you to work, exercise and go about your day with an abundance of energy. Those who are experiencing BPH symptoms may wish to start with such lifestyle changes; if your symptoms are mild, these changes will almost certainly reverse or eliminate any discomfort.

Alternating sitz baths take some effort, but can be extremely helpful at increasing blood flow to the prostate, which can lead to decreased inflammation. These can be done in fifteen minutes and require two basins that you can put in your bathtub (65 quart basins sold at Home Depot will suffice). Instructions can easily be found on the web.

Men with BPH should avoid drinking after 7 pm to help reduce nocturia (urinating at night). Caffeine, table salt and other diuretics (including drugs) should be avoided. Interestingly, parsley is one of nature’s most potent diuretics. If your meals contains this herb, you may want to substitute another spice. Marijuana, flax seed and ethanol (especially hops) should be avoided as they are estrogenic in nature and may contribute to a worsening of BPH. Animal foods, such as eggs and meat, should be minimized.

Generally speaking, the metabolic goals of a physician treating BPH involve lowering SHBG, PSA, and estrogen and minimizing conversion of testosterone to DHT, which is a potent stimulator of cell growth. Vitamin A, zinc, epicatechins and pygeum (Prunus africanum) are examples of supplements that help to minimize this conversion. Perhaps the most often studied nutrients/herbs are beta-sitosterol and saw palmetto (Serenoa repens). Both have the well documented ability to diminish BPH symptoms and rarely cause adverse effects. Nettles (Urtica dioica) and whey protein are capable of reducing the activity of SHBG. Consumption of zinc is a common recommendation; however, recent studies have cast some doubt on the efficacy of this mineral for BPH.

I recommend that all you stoic men visit with a naturopath – in your 30s- because of our ability to avert many common men’s health issues before they ever arise.

Dr. Daniel Smith practices at Bear Creek Naturopathic Clinic. His new office is at 2612 Barnett Ave. He specializes in naturopathic oncology, but still maintains a strong family practice, treating all manner of conditions. He can be reached at 541-770-5563 or at drdanielnd@gmail.com If you would like to schedule an appointment, please ask specifically for Dr. Dan.