Causes and risk factors
While the exact cause of BPH remains unclear, a number of contributing factors have been identified. As previously stated, BPH occurs primarily in older men and is believed to be related to hormonal changes and inflammation. BPH has also been linked to age-related metabolic conditions, such as obesity, dyslipidemia, diabetes, and metabolic syndrome. (10)(19) While some of the risk factors for BPH are unmodifiable, others may be addressed through diet, lifestyle, and other interventions. (5) Risk factors for BPH include:- Age 40+
- Certain cardiovascular and metabolic conditions, such as heart and circulatory disease, obesity, and type 2 diabetes
- Erectile dysfunction
- Genetic predisposition
- Sedentary lifestyle (13)
Signs, symptoms, and complications
BPH is generally characterized by lower urinary tract symptoms (LUTS), including:- Nocturia (frequent urination during periods of sleep)
- Pain during urination or after ejaculation
- Post-void dribbling
- Reduced void volumes
- Unusual color or smell to urine
- Urinary frequency
- Urinary hesitancy, straining, and/or trouble starting a stream
- Urinary retention, incomplete emptying
- Urinary urgency
- Urinary incontinence
- Weak and/or interrupted stream (5)(13)
- Acute or chronic urinary retention
- Blood in urine
- Bladder and/or kidney damage
- Bladder stones
- Urinary tract infections (UTIs) (13)
Supplements for prostate care
Addressing certain risk factors through lifestyle modifications and supplementation may help improve prostate health and mitigate the negative effects of BPH. The ingredients listed in this protocol have demonstrated effectiveness in supporting prostate health.Saw Palmetto (Serenoa repens)
Serenoa repens, commonly known as saw palmetto, is an extract derived from the ripe berries of the American dwarf palm, a plant native to some areas of the southeastern United States. (7)(17) Saw palmetto has been used as a treatment for BPH-associated urinary dysfunction since the 1800s and remains the most commonly used phytotherapy for the condition. The effects of saw palmetto extract on BPH are believed to be attributed to its antiandrogenic, antiestrogenic, antiedema, and anti-inflammatory effects. (7) Proposed mechanisms of actions include inhibiting 5α-reductase (7)(17) , prolactin, and growth factor-induced cell proliferation (7), as well as binding to lower urinary tract receptors, such as α1-adrenoceptors, 1,4-dihyropyridine receptors, muscarinic cholinoceptors, and vanilloid receptors. (17) Saw palmetto has been shown to decrease inflammatory markers that can contribute to chronic prostatic inflammation and subsequent hyperplasia. (22) Additionally, saw palmetto supplementation may contribute to increased average flow rate values, decreased prostate volume, and improved International Prostate Symptom Scores (IPSS). (16)
Lycopene
Lycopene is a non-provitamin A (18) found primarily in tomatoes and tomato products. (3) Lycopene possesses anti-oxidant properties and its ability to scavenge free radicals has been found to be greater than vitamin E, α-tocopherol, and glutathione. (18) In addition to reducing oxidative damage in the body, lycopene is involved in the regulation of genes and metabolism, intercellular communication and growth, and modulation of hormones and immune function. High lycopene intake has been shown to reduce the risk of chronic diseases, such as cardiovascular diseases, cancer, and neurological conditions. (3)(18) Increased dietary and circulating lycopene has been associated with a reduction in prostate specific antigen (PSA) levels and overall improvement of IPSS. Furthermore, supplementing with lycopene may inhibit the overall progression of BPH. (15)Beta-sitosterol
The most abundant phytosterol in the diet, beta-sitosterol can be found in the leaves, fruit, rhizomes, and tissue cultures of many plants, such as beans, nuts, and seeds. (2)(12) It is also a primary constituent of certain medicinal herbs, including stinging nettle, devil’s claw, and saw palmetto. (12) Beta-sitosterol has anti-inflammatory, antioxidant, antimicrobial, antinociceptive, angiogenic, and immunomodulatory properties. (2) Beta-sitosterol also demonstrates inhibitory effects on 5α-reductase, which may account in part for its therapeutic effects as 5α-reductase inhibitors have been shown to improve benign prostatic hyperplasia symptoms. (6) Research has shown that beta-sitosterol can improve IPSS, urinary and flow scores, and overall quality of life. (1)(11)(21)
Pygeum (Pygeum africanum)
Pygeum africanum, commonly referred to as pygeum, is an extract from the African prune tree, an evergreen tree native to Afromontane forests. Several active constituents of the plant have been identified, including β-sitosterol, β-sitostenone, n-docosanol, lauric acid, myristic acid, and ursolic acid. (9) Used traditionally in herbal medicine to address benign prostatic hyperplasia, (9) modern research now demonstrates the effectiveness of pygeum in improving BPH-associated urinary symptoms (4)(8)(20) and suggests that pygeum possesses antiproliferative and apoptotic effects on prostate cells. (14)The bottom line
While certain factors associated with the development of BPH are unmodifiable, such as age and genetic predisposition, other risk factors may be addressed through dietary, lifestyle, and dietary supplement interventions. (5) A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to find out whether these supplements are right for your wellness plan. If you are a practitioner, view our prostate care protocol.References
- Berges, R.R., Kassen, A., & Senge, T. (2000). Treatment of symptomatic benign prostatic hyperplasia with beta-sitosterol: an 18-month follow-up. BJU International, 85(7), 842-6.
- Bin Sayeed, M. S., Karim, S., Sharmin, T., & Morshed, M. M. (2016). Critical analysis on characterization, systemic effect, and therapeutic potential of beta-sitosterol: A plant-derived orphan phytosterol. Medicines (Basel, Switzerland), 3(4), 29.
- Cámara, M., de Cortes Sánchez-Mata, M., Fernández-Ruiz, V., Cámara, R.M., Manzoor, S., & Caceres, J.O. (2013). Lycopene: A review of the chemical and biological activity related to beneficial health effects. Studies in Natural Products Chemistry, 40, 383-426.
- Chatelain, C., Autet, W., & Brackman, F. (1999). Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology, 54(3), 473-8.
- Chughtai, B., Forde, J.C., Thomas, D.D.M., Laor, L., Hossack, T., Woo, H.H., … Kaplan, S.A. (2016). Benign prostatic hyperplasia. Nature Reviews Disease Primers, 2(16031).
- Dhingra, N., & Bhagwat, D. (2011). Benign prostatic hyperplasia: An overview of existing treatment. Indian Journal of Pharmacology, 43(1), 6–12.
- Fagelman, E., & Lowe, F.C. Saw palmetto berry as a treatment for BPH. Nature Reviews Urology, 3(3), 134–138.
- Ishani, A., MacDonald, R., Nelson, D., Rutks, I., & Wilt, T.J. (2000). Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. The American Journal of Medicine, 109(8), 654-64.
- Kadu, C.A., Parich, A., Schueler, S., Konrad, H., Muluvi, G.M., Eyog-Matig, O., … Geburek, T. (2012). Bioactive constituents in Prunus africana: geographical variation throughout Africa and associations with environmental and genetic parameters. Phytochemistry, 83, 70-8.
- Kim, E.H., Larson, J.A., & Andriole, G.L. (2016). Management of benign prostatic hyperplasia. Annual Review of Medicine, 67, 137-151.
- Klippel, K.F., Hiltl, D.M., & Schipp, B. (1997). A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. BJU International, 80(3), 427-32.
- Lomenick, B., Shi, H., Huang, J., & Chen, C. (2015). Identification and characterization of β-sitosterol target proteins. Bioorganic & Medicinal Chemistry Letters, 25(21), 4976–4979.
- National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Prostate enlargement (benign prostatic hyperplasia). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
- Quiles, M.T., Arbós, M.A., Fraga, A., de Torres, I.M., Reventós, J., & Morote, J. (2010). Antiproliferative and apoptotic effects of the herbal agent Pygeum africanum on cultured prostate stromal cells from patients with benign prostatic hyperplasia (BPH). Prostate, 70(10), 1044-53.
- Rowles, J.L., Ranard, K.M., Smith, J.W., An, R., & Erdman, J.W.Jr. (2017). Increased dietary and circulating lycopene are associated with reduced prostate cancer risk: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 20(4), 361-377.
- Saidi, S., Stavridis, S., Stankov, O., Dohcev, S., & Panov, S. (2017). Effects of Serenoa repens alcohol extract on benign prostate hyperplasia. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 38(2), 123-129.
- Suzuki, M., Ito, Y., Fujino, T., Abe, M., Umegaki, K., Onoue, S., … Yamada, S. (2009). Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacologica Sinica, 30(3), 271–281.
- Venkata Naveen Kumar, P., Elango, P., Asmathulla, S., & Kavimani, S. (2017). A systematic review on lycopene and its beneficial effects. Biomedical and Pharmacology Journal, 10(4).
- Vignozzi, L., Gacci, M., & Maggi, M. (2016). Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nature Reviews Urology, 13, 108–119.
- Wilt, T., Ishani, A., MacDonald, R., Rutks, I., & Stark, G. (2002). Pygeum africanum for benign prostatic hyperplasia. Cochrane Library Systemic Reviews, (1), CD001044.
- Wilt, T.J., MacDonald, R., & Ishani, A. (1999). Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU International, 83(9), 976-83.
- Wyatt, G.K., Sikorskii, A., Safikhani, A., McVary, K.T., & Herman, J. (2016). Saw palmetto for symptom management during radiation therapy for prostate cancer. Journal of Pain and Symptom Management, 51(6), 1046-54.
