The prostate is a single, doughnut-shaped gland about the size of a walnut that lies below the bladder and surrounds the urethra. The prostate secretes a thin, milky, alkaline fluid that increases sperm motility and lubricates the urethra to prevent infection. Prostate secretions are extremely important to successful fertilization of the egg.

Benign (nonmalignant) enlargement of the prostate gland is known medically as benign prostatic hyperplasia, or BPH for short. Because an enlarged prostate can pinch off the flow of urine, BPH is characterized by symptoms of bladder obstruction, such as increased urinary frequency, nighttime awakening to empty the bladder, and reduced force and caliber (speed of flow) of urination.

BPH is an extremely common condition. Current estimates are that it affects more than 50 percent of men during their lifetime. The actual frequency increases with advancing age from approximately five to ten percent at age 30 to more than 90 percent in men older than 85 years of age.

The key symptoms relate to blockage of the bladder outlet and include progressive urinary frequency, urgency, increased nighttime urination, hesitancy and intermittency with reduced force and caliber (speed of flow) of urine.

Please note: Prostate disorders can be diagnosed only by a physician. Do not self-diagnose. If you are experiencing any symptoms associated with BPH, see your physician immediately for proper diagnosis.

Causes of prostate enlargement

BPH is largely the result of hormonal changes associated with aging. It is clearly dependent on the actions of male hormones (androgens) within the prostate gland. These changes within the prostate reflect the many significant changes in both male (androgen), female (estrogen), and pituitary hormone levels in aging men. The ultimate effect of these changes is that there is an increased concentration of testosterone within the prostate gland and an increased conversion of this testosterone to an even more potent form known as dihydrotestosterone (DHT). The increase in levels of testosterone and DHT is largely due to a decreased rate of removal combined with an increase in the activity of the enzyme 5-alpha-reductase, which converts testosterone to DHT.

Begin with diet

Diet appears to play a critical role in the health of the prostate. In trying to treat or prevent BPH, the diet should be as free as possible from pesticides and other contaminants (e.g., dioxin, polyhalogenated biphenyls, hexachlorobenzene, and dibenzofurans). It is quite possible that the tremendous increase in the occurrence of BPH in the last few decades reflects the ever-increasing effect that toxic chemicals have on our health. BPH is perhaps just one of many health problems that may be due to these toxic substances. A diet rich in natural, whole foods may offer some protection against these toxins.

In particular, focus on whole, unprocessed foods, including whole grains, legumes, vegetables, fruits, nuts, and seeds in your diet. Eat on fourth cup of raw sunflower seeds or pumpkin seeds each day for the zinc—an important mineral for prostate health. Consuming soy foods helps balance testosterone metabolism and has been shown to help prevent prostate cancer. Also, lycopene-rich fruits and vegetables, such as tomatoes, spinach, kale, mangos, broccoli, and berries, when consumed daily promote prostate health and play a role in preventing prostate cancer. It is also important to reduce the intake of alcohol (especially beer), caffeine, and sugar, all of which have an adverse effect on the way testosterone is metabolized by the prostate.

Herbal relief

Several herbs have been shown to be effective in relieving symptoms of enlarged prostate. These herbs can be used individually or taken in combinations as they have different yet synergistic effects. The following are listed in order of greatest benefit as noted in clinical trials:

Saw palmetto (Serenoa repens) extract has the most scientifically documented benefits of any natural treatment for BPH. Numerous clinical studies have shown that saw palmetto extract significantly diminishes the signs and symptoms of BPH. Roughly 90 percent of men who have mild to moderate BPH experience some improvement in symptoms during the first four to six weeks of therapy. All major symptoms of BPH have been relieved, especially nighttime urinary frequency. The recommended dosage of the extract, standardized to contain 85 to 95 percent fatty acids and sterols, is 320 to 640 mg daily.

Cernilton, an extract of flower pollen, has been used in Europe to treat BPH for more than 35 years, and its effects have been confirmed in double-blind clinical studies. The overall success rate of Cernilton in patients with BPH is about 70 percent. The typical dosage of is 63 to 126 mg two to three times per day.

Pygeum africanum is an evergreen tree native to Africa. Numerous clinical trials in more than 600 patients have demonstrated pygeum extract to be effective in reducing the symptoms and clinical signs of BPH, especially in early cases. However, in a double-blind study that compared the pygeum extract with the extract of saw palmetto, the saw palmetto extract produced a greater reduction of symptoms and was better tolerated. There may be circumstances in which pygeum is more effective than saw palmetto, and as the two extracts have somewhat overlapping mechanisms of action, they can be used in combination. The typical dosage of pygeum extract is 50 to 100 mg twice per day.

Stinging nettle (Urtica dioica) root extract also have been shown to be effective in the treatment of BPH. Two double-blind studies have shown it to be more effective than a placebo. However, it may work best when combined with saw palmetto extract. A large double-blind study in 431 patients using both the extracts of saw palmetto and stinging nettle found clinical benefit equal to that of finasteride (Proscar). The typical dosage is 120 to 150 mg twice daily.

Final thoughts

Even if symptoms of BPH are quite mild, it is important to treat. Early treatment, especially with natural approaches, will produce better results. If left untreated, BPH can eventually obstruct the bladder outlet, resulting in the retention of urine and eventually kidney damage. As this situation is potentially life-threatening, proper treatment is crucial.

The chance of clinical success with any of the botanical treatments of BPH appears to be determined by the degree of obstruction as indicated by how much urine is left after attempting to void the bladder (the residual urine content) as determined by an ultrasound exam. For mild cases of BPH (residual urine levels less than 50 ml), the results are usually excellent and quite noticeable within the first month of therapy. For moderate cases (residual urine levels between 50 and 100 ml), the results are usually quite good within the first four to six weeks. For example, roughly 90 percent of men with mild-to-moderate BPH experience some improvement in symptoms during the first four to six weeks after beginning to take saw palmetto extract.

If the residual urine level is between 100 ml and 150 ml it may take two to three months before significant improvements are noted. If the residual urine content is greater than 150 ml, saw palmetto extract and other herbal medicines are not likely to produce any significant improvement on their own. In these cases, it may be necessary to use the herb in combination with drug therapy, and in very severe cases, a surgical procedure to open up the passage way known as transurethral resection of the prostate (TURP) may be necessary.

Decreased nighttime awakenings to empty the bladder are usually the first signs of improvement, followed by a reduced sense of urinary urgency and increased caliber and flow of urine.

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