Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland.
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. Half of all 50-year-old men have BPH, and the prevalence of the condition increases with advancing age. 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.
Lifestyle changes that may be helpful for benign prostatic hyperplasia
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.1 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 for benign prostatic hyperplasia
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.2 Another double-blind study reported similarly positive results using 130 mg per day of beta-sitosterol.3
Rye pollen extract has improved the symptoms of BPH in preliminary trials.4 5 6 Double-blind trials have also reported that rye pollen extract is effective for reducing symptoms of BPH7 8 This rye pollen extract was shown to be comparable in effect to an amino acid mixture used for BPH in a double-blind study.9 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.10 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.11 Another similar controlled trial of this combination also reported positive results12 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.13 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.14 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.15 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 with benign prostatic hyperplasia?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for benign prostatic hyperplasia
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.16 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.17 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.18 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.19 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.20 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.21
In a preliminary study, supplementation with a special aged garlic extract (Kastamonu Garlic) in the amount of 1 ml per 2.2 pounds of body weight per day for one month resulted in a 32% reduction in the size of the prostate gland and a significant improvement in urinary symptoms.22 It is not known whether other forms of garlic would have the same effect.
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.23 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.24 It has been successfully combined with both saw palmetto and pygeum to treat BPH in double-blind trials.25 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).26 27 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.28 29 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.30 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.
Are there any side effects or interactions with benign prostatic hyperplasia?
Refer to the individual herb for information about any side effects or interactions.