More men than not have prostate symptoms.
If you are a man reading this article you either have symptoms of an enlarged prostate or there is a 50% chance you will develop symptoms.
Symptoms of an enlarged prostate have a significant impact on quality of life so it is worth taking the time to read this article to find out what you can do now – or in the future – to improve your symptoms. (I'll post another article soon to tell you what you can do to avoid getting an enlarged prostate as this was the topic of my final year research project!)
What is enlarged prostate?
The three most common prostate issues are prostate cancer, enlarged prostate and prostatitis (or inflamed prostate). This article focuses on enlarged prostate.
Enlarged prostate starts to affect men as young as 30, but mostly it starts to raise its head around age 50. From then on it affects a significant number of men. Some studies estimate it affects 50% of men in their 50s, 60% of men in their 60s and 70% of men in their 70s and so forth. Based on other studies these numbers strike me as a little high, but the numbers are certainly not insignificant.
The prostate encases the urethra, which is the pipe allowing urine to travel from your bladder to the toilet bowl. The prostate ‘enlarges’ in most men starting from around age 40. The increased size of the prostate can impact mens’ ability to urinate.
Common symptoms include:
· nighttime urination (multiple times)
· finding it difficult to start urinating
· straining to urinate
· having a weak flow of urine
· "stop-start" urinating
· needing to urinate urgently and/or frequently
· accidentally leaking urine (incontinence)
How to improve symptoms of enlarged prostate?
When men see their doctor and discover they may have an enlarged prostate the treatment will often depend on symptom severity (and findings from a raft of available tests that are usually used to rule out other more sinister conditions). Mild symptoms will get the ‘watch and wait’ treatment in the hope that things don’t get worse. Moderate to severe symptoms will be treated with either medication or surgery, if medications do not work.
What most men are not told by their doctor is that there are a range of ‘natural’ approaches to addressing prostate symptoms that may be worth a shot, especially if they are only have mild symptoms and they would like to prevent symptoms from worsening.
Natural approaches have been used for a long time in other cultures. One natural approach is a herb called saw palmetto (aka serenoa repens or sabal serrulatum) which can be taken as a supplemement. Saw palmetto comes from the fruit of the American dwarf palm tree and has been used for centuries to address enlarged prostates in other cultures. In other countries such as Italy and Germany it is used by more than 50% of enlarged prostate cases!
Does saw palmetto work? How does it work?
Research suggests saw palmetto may be as effective as prescription medications for improving symptoms of enlarged prostate, but without the unwanted side-effects such as decreased sex function (libido, erectile function and performance).
Saw palmetto may work in a similar way to common medications (e.g. finasteride) by blocking the conversion of testosterone to its more potent and less desirable cousin dihydrotestosterone (DHT) by inhibiting the enzyme (5-alpha reductase) which ‘controls’ the conversion. This over-conversion is thought to explain the excessive growth of the prostate. For saw palmetto the exact mechanism is incompletely understood – it may inhibit the 5-alpha reductase enzyme, decrease other growth factors (e.g. insulin-like growth factors), or have anti-inflammatory properties that help to reduce symptoms. In any event, the research suggests it works and that the risks of trying it are low.
Is saw palmetto effective?
One study collected and summarised the findings from all previous studies and concluded that saw palmetto may provide mild to moderate improvement in urinary symptoms and flow measures that is similar to the improvement seen with the common medication finasteride, but with fewer side-effects. This study collated data from a total of 3,139 men taking saw palmetto for up to 48 weeks from across 21 studies so it was no small study! And the study was a Cochrane review which means it is good quality research (which isn’t always the case!).
Should I try saw palmetto?
Saw palmetto is probably worth a shot and the risks of trying it are low. However, the studies only looked at men using it for less than a year so there is not evidence for long term use as yet.
A dosage of 160 mg twice daily or 320 mg once daily seems to be the ‘going dose’. But the supplements must be of good quality. You can’t just buy saw palmetto (or any supplement for that matter) off the shelf in the pharmacy because they may have different levels of the active ingredient in them. This is particularly so for saw palmetto because the important part of the plant (called the active ingredient) seems to be the volatile sterols and free fatty acids found in the berry of the plant. Different solvents used to extract the oils may leave different levels of the ‘fats’ you are after. Most research uses supplements with 80% to 90% free fatty acids, but an analysis of products in Europe showed the free fatty acid content to vary from about 41% to 81% (Habib, 2004). Price is often a good guide as to supplement quality, but not always. Get in touch if you would like help identifying a quality brand that might be suitable for you.
What if saw palmetto doesn’t work for me?
Saw palmetto may not work for everyone. (This is usually the case if finasteride hasn’t worked for you either). This is because your prostate symptoms may not be caused by the testosterone to DHT over-conversion. They may instead by due to irritative hormones of the sympathetic nervous system.
Despite the name, “enlarged prostate” symptoms are not always due to an enlarged prostate. Research has found that symptoms may be caused by a different hormone system (in the sympathetic nervous system) irritating muscles of the prostate. This explanation is useful because it explains why prostate symptoms exist in some men, but when their prostate is examined using ultrasound there is no enlargement to explain the symptoms. This type of ‘enlarged prostate’ may even explain most symptoms in most men.
Medications targeting this pathway tend to be alpha-blockers such as Flomax with tamsulosin which relax the prostate muscles.
If this is the cause of your symptoms then diet may be more helpful to reducing your symptoms. This is not the topic of this article but focusing on omega-3 may be helpful as one study showed men taking omega 3 supplements, alongside prostate medications, for 6 months showed a significant improvement in symptoms compared to men taking a placebo (Ghadian, 2017).
Conclusion
There are lots of other diet and lifestyle tricks that can make a significant improvement to urinary symptoms caused by an ‘enlarged’ prostate. In most cases, with very simple changes, men see a significant improvement in their symptoms. Please get in touch to discuss if you would like to know more. If talking about your prostate with other people is not high on your list of things to do then I do offer phone consultations where you can remain as anonymous as possible.
An afterword…
Please don’t let this article detract from seeing your GP and making sure there is nothing more sinister going on. And please don’t try to buy supplements from the local chemist to see if they’ll work… this is never a great option.
References:
Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol. 1992;21:309-14.
Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 2004;7:195-200.
Wilt T, Ishani A, MacDonald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;3:CD001423.
Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001;58:960-4.
Ghadian, A., & Rezaei, M. (2017). Combination therapy with omega-3 fatty acids plus tamsulocin and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Inflammopharmacology, 25(4), 451–458. https://doi.org/10.1007/s10787-017-0343-2
References:
Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol. 1992;21:309-14.
Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 2004;7:195-200.
Wilt T, Ishani A, MacDonald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;3:CD001423.
Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001;58:960-4.
Ghadian, A., & Rezaei, M. (2017). Combination therapy with omega-3 fatty acids plus tamsulocin and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Inflammopharmacology, 25(4), 451–458. https://doi.org/10.1007/s10787-017-0343-2
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