Supplements for prostate enlargement

Executive Summary
Here are the supplements that are advisable for prostate enlargement.

Necessary:
Saw Palmetto (320 mg a day).

Optional:
Pumpkin Seed Oil (500 mg a day); and
Beta-Sitosterol (60 mg a day).

There are other supplements that are helpful, too. Read the article for more details.

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Prostate enlargement is a condition in men where the prostate gland is enlarged. This can happen due to multiple reasons such as swollen prostate (prostatitis) or prostate cancer. However, the most common cause is a non-cancerous condition called Benign Prostatic Hyperplasia (BPH). Benign means non-cancerous; hyperplasia means an increase in the number of cells in an organ or tissue.

Another word used in place of hyperplasia is hypertrophy. Both of them mean the same thing: enlargement. I will restrict the current article to this specific type of prostate enlargement—BPH.

It is a very common condition that affects only men. Eight percent of men above the age of thirty years, Fifty percent of men above fifty years, and ninety percent of men above eighty years suffer from BPH.

Women don’t have a prostate gland, and so cannot suffer from this condition.

We will look at the basic science behind the condition and how we can intervene with supplementation.

Introduction

The prostate is a walnut-shaped gland located below our bladder. It makes the fluid that goes into semen and is essential for male fertility. The left panel of exhibit 1 shows a normal prostate gland.

The bladder is the organ where urine accumulates. Once enough urine gathers inside the bladder, the increased pressure makes its outlet valve or sphincter (shown by a blue arrow coming out of the bladder) open and eliminates the urine through a tube called the urethra.

The urethra joins the bladder at the neck of the bladder. The prostate gland sits below the bladder and surrounds the urethra near the neck of the bladder.

Prostate Enlargement

After puberty, the prostate continues to grow throughout a man’s life. As the prostate enlarges, as seen in the right panel of exhibit 1, it constricts the urethra more and more. As a result, three things happen:

1. When the urine is eliminated from the bladder, the pressures inside the bladder and the urethra drop progressively. This leads to a dribbling or weak urine stream.
2. At some point during urination, the enlarged prostate pinches the urethral opening enough to stop the further flow of urine. This leads to incomplete voiding of the bladder with some urine still retained in it.
3. Since the voiding is incomplete each time, the bladder fills up faster, leading to a frequent urge to urinate.

A combination of these issues leads to various symptoms of BPH, such as:

1. Problem to start urination;
2. Slow urine flow;
3. Pain during urination;
4. Feeling of a full bladder all the time;
5. Frequent urination;
6. Repeated starting and stopping of urine; and the worst of all,
7. A need to wake multiple times at night for urination. Disturbed sleep is a major problem for men, especially for those who work. This comes under an umbrella problem of Excessive Daytime Sleepiness. Constant fatigue, a loss of productivity, and incomplete attention in high-risk situations such as driving are fallouts of this problem.

The first six symptoms above are called Lower Urinary Tract Symptoms (LUTS). The seventh one is an outcome of LUTS.

How Prostate Enlargement Develops

Scientists don’t understand fully why the prostate keeps enlarging. But based on the current knowledge, a male hormone called Dihydrotestosterone or DHT is implicated. DHT is produced in the body by conversion of another male hormone, testosterone, by an enzyme called 5-alpha reductase.

DHT causes the enlargement of non-cancerous prostate cells. Over the years, the prostate can become large enough to cause lower urinary tract symptoms. This is when the person’s quality of life starts deteriorating. This stage is designated as Clinical BPH, hinting that the problem now needs medical treatment.

It is not understood why as the prostate enlarges, some men develop BPH symptoms, while others don’t. However, we know that controlling DHT is one way of managing BPH problems.

Principles of Supplementation for BPH

Supplementation in BPH focuses on two aspects:

1. Stopping or Slowing Down Prostate Enlargement:
   Since DHT causes the prostate to enlarge, reducing either DHT or 5-alpha reductase—the hormone that converts testosterone to DHT— can stop the enlargement, and in some cases, even reduce the prostate size by a small fraction.
2. Supporting Health of Prostate, Bladder, and the Urinary Tract:
   The urine retention in the bladder can lead to infections of the urinary tract, irritation of the inner linings of the organs involved, and stone formation. Supplements that support the urinary tract will be useful for these. Swollen or inflamed prostate may benefit from anti-inflammatory supplements.

Supplements for Stopping Prostate Enlargement

1. Saw palmetto: Blocks the action of 5-alpha reductase, with a mechanism similar to medicines such as finasteride. But those synthetic medicines act differently and have far more side effects. Give at least three months to see the effect. 320 mg a day.
2. Pumpkin seed oil: May inhibit 5-alpha reductase. Reduces prostate inflammation and symptoms of lower urinary tract symptoms in BPH. Take 500 mg a day. It is found to be more effective if taken with saw palmetto.
3. Beta-sitosterol: A 5-alpha reductase inhibitor. It is a natural plant compound that is anti-inflammatory and antioxidant. Reduces inflammation associated with BPH. Improves urine flow. Take 60 to 130 mg a day.
4. Soy: Soy isoflavones reduce the effect of excess DHT. Don’t take soy protein supplements for BPH exclusively. But if you are already taking that, it will help with your BPH, too.

Supplements for Health of Prostate, Bladder, and Urinary Tract

1. Nettle root extract: Helps reduce lower urinary tract symptoms (LUTS) commonly seen in BPH. Contains anti-inflammatory and antioxidant compounds.
2. Omega-3 fish oils: These are high in anti-inflammatory omega-3 oils that reduce prostate inflammation. Take 3,000 mg of fish oil daily or 1,000 mg of omega-3 oils (typical fish oils contain 30% omega-3 oils by weight). For detailed coverage of this nutrient, read on this website: Omega–3 oils: A complete guide.
3. Cranberry: Contains phytonutrients that help urinary tract symptoms. Cranberry helps in preventing bacteria from sticking to the walls of the urinary tract. Take 500 mg a day of dried powder.

Long Term Complications

If untreated, BPH can lead to the following problems:

• Urinary tract infections (UTIs): Not emptying the bladder fully can cause infections in the urinary tract.
• Urinary retention: Sudden blockage of the urinary tract may need surgery and insertion of a catheter tube into the bladder for drainage of urine.
• Bladder damage: If some urine is retained in the bladder all the time, the bladder muscles may stay stretched. They may lose their contracting ability over a period of time, making it more difficult to empty the bladder.
• Kidney damage: This is the biggest risk. UTIs can lead to kidney infections. The bladder pressure can damage kidneys, too.
• Bladder stones: If some urine is retained in bladder all the time, there is a risk of calcification and stone formation in the bladder.

My Views

1. There are many medical and surgical options for BPH. One may wish to consider all the options available. Some of the links given below list a panoply of such choices. Do discuss with your doctor.
2. Many simple lifestyle changes can help you with controlling the symptoms of BPH. In my view, they are the best low-hanging fruits for managing BPH without any side effects. Some of them are:
   • Don’t drink fluids 1-2 hours before bedtime;
   • Avoid diuretics such as alcohol and caffeine, especially near bedtime;
   • Practise double-voiding, in which you empty the bladder, then pause for a couple of seconds and then try emptying again;
   • Anti-allergic medicines and decongestants may prevent bladder and prostate from relaxing. That makes urination difficult. Avoid them if possible; and
   • Management of stress is found to be helpful in relaxing the prostate and bladder muscles.
3. On a personal level, I faced this problem around 2010-12. I started myself on a supplement containing saw palmetto, nettle roots, and pumpkin seed oil. The problem reduced in intensity over the next two to five years.
   Of course, I had not done any diagnostic tests for prostate size measurement. However, I had all the typical LUTS issues that come with BPH.
   Interestingly, over the last five years, I could not regularly take saw palmetto supplements for technical reasons (non-availability locally). Yet, I don’t have the BPH problem anymore.
   In fact, over the last couple of years, I have become more adventurous and sometimes consume 200 to 500 mL of water before bedtime, which is a strong lifestyle advice for BPH. Yet, I don’t get a disturbed sleep with a need for urination.
   I have never taken any medical or surgical treatment for BPH. So is it possible that once your BPH is controlled with some supplementation, it does not come back?
4. The causes of male-pattern baldness and BPH are very similar. Therefore, many of the supplements useful for the two conditions are also the same, albeit the dosage may vary a little bit. Read on this website: Supplements for hair loss.
5. Finally, the question that is on minds of many men: Can prostate enlargement lead to prostate cancer? Even I wondered about the same since my father suffered from an advanced prostate cancer. The answer is No. Having an enlarged prostate does not increase your risk for prostate cancer. Read here on National Cancer Institute Website: Understanding Prostate Changes: A Health Guide for Men.
6. If you need help with any of the points discussed, write to me on madhur.kotharay@gmail.com (Disclaimer: No medical advice from my side, please. But I will be happy to help with supplement selection part). Kindly mention “Supplements for Prostate Enlargement” in the subject of the email.

To Read More

• NIDDK: Prostate Enlargement (Benign Prostatic Hyperplasia);
• Mayo Clinic: Benign prostatic hyperplasia (BPH);
• Consultant360: Managing the Enlarged Prostate Gland in Elderly Men;
• Harvard Medical School: Testosterone, prostate cancer, and balding: Is there a link?;
• Medscape: Benign Prostatic Hyperplasia (BPH);
• EMedicineHealth: Enlarged Prostate (BPH) Symptoms, Diagnosis, Treatment;
• US Pharmacist: Supplements for Prostate Health;
• MedicineNewsToday: How to shrink the prostate naturally.

First published on: 15th April 2022
Image credit: Male model photo created by benzoix – www.freepik.com
Last updated on: 2nd June 2022