Introduction to BPH Natural Treatment
BPH occurs when the prostate compresses the urethra and causes symptoms of urinary retention, prolonged/incomplete bladder emptying, thin urine stream, a frequent need to urinate, painful urination, urge to urinate at night, and urgency to void. BPH stands for Benign Prostatic Hyperplasia which occurs when cells of the prostate develop hyperplasia and nodular enlargement.. The BPH disease process is known to begin early since about half of all men over 50 and most men over 70 will have evidence of BPH that can be detected in the cells of the prostate. There are several natural therapies which may be effective for symptoms of BPH which will be discussed below.
Role of DHT (dihydrotestosterone):
DHT (dihydrotestosterone) is believed to play a role in the hyperplasia of prostate tissue by conversion of testosterone by 5-alpha reductase to DHT in the prostate.
Medication and treatment for BPH:
You may decide not to use BPH natural treatment and try medication. Medications used to inhibit 5-alpha reductase such as Proscar (finasteride) are known to reduce the size of the prostate. The 5-alpha reductase inhibitors reduce the conversion of testosterone to dihydrotestosterone (DHT). This medication takes about 6 months to reduce prostate size and typically works better in patients with a larger sized prostate. However, since this medication does not work immediately to help relieve the symptoms of poor urine flow, alpha blockers are often used.
BPN natural supplements may have fewer side effects than BPH medication. Alpha blockers such as Flomax (tamulosin) dilate smooth muscle in the urethra and improve urine flow, but have several adverse reactions to be concerned about. Research has been published showing that older men may be at increased risk of stroke after starting alpha blockers for BPH. This risk is due to an initial blood pressure drop which lowers the perfusion of blood flow in the brain experienced after starting this medication. Another major concern of alpha blockers is a significant reduction in a man’s ability to ejaculate. Physicians often recommend tadalafil (Cialis) to improve this sexual side effect. This is essentially using one pill to take care of side effects from another pill. If symptoms of BPH remain uncontrolled despite BPH natural treatment and medication efforts, the prostate gland may eventually require surgery to reduce the compression upon the urethra.
Surgery Concerns with BPH
If you are recommended to undergo surgery for your enlarged prostate and elect to proceed, discontinue all herbal therapies and supplements 2 weeks prior to the surgery date. If you happen to be on an alpha blocker such as Flomax (tamulosin) for BPH and need surgery for cataracts, discontinue the Flomax (tamulosin) 2 weeks prior to and 2 weeks after surgery. Bell et al found that Flomax (tamulosin) resulted in 5% more surgical complications after cataract surgery including retinal detachment, lost lens or lens fragment, or endophthalmitis (20). Endophthalmitis is inflammation of the inner eye which can result in loss of vision.
Diagnosis of BPH:
Diagnosis is often accomplished by the primary physician after a patient experiences symptoms as noted above. The symptoms may require the physician to do a rectal exam to palpate the prostate gland and a PSA level to evaluate for malignancy. An ultrasound may be used to look for additional cause of urinary symptoms.
BPH and Genetics:
Men who have had a relative under 64 years old requiring prostatectomy related to BPH were 66% more likely to develop BPH verses 19% for controls without BPH in a relative. Therefore, a genetic predisposition to developing BPH likely exists (1).
Diet for BPH Natural Treatment:
Populations that consume a Western style diet have a higher incidence of BPH than some populations in China (2). Whether there is a cultural connection or dietary factors to BPH is not well understood. Prevention may be possible by dietary modification. According to Sebastiano C et al, a review of studies found that a diet low in of amount calories and fat as well as high in fruits and vegetables may have a protective role in preventing disease of the prostate but in summary the data was not conclusive (3).
Saw Palmetto for BPH Natural Treatment:
Permixon (320 mg) (also known as Saw Palmetto, Sabal serrulata and Serenoa repens) for BPH natural treatment appears to be as effective as finesteride, an alpha-5 reductase inhibitor. In a double-blind study, Carraro JC et al randomized 1098 men with benign prostatic hyperplasia (BPH) to either plant extract Permixon (320 mg) (also known as Saw Palmetto, Sabal serrulata and Serenoa repens), or finasteride (5 mg) and monitored them for 6 months. According to the results, the two treatments were about equally successful at reducing noticeable symptoms (37% with Permixon and 39% with finasteride). Peak urinary flow rate increased by 3.2 mL/sec (25%) and 2.7 mL/sec (30%) for the 2 groups, respectively. Permixon had little effect on prostate size (6% reduction in size), whereas finasteride caused the prostate to shrink by 18%. Finasteride also reduced prostate-specific antigen (PSA) levels by 41%. (4)
A study followed 26 men with enlarged prostates who received a daily dose of 320 mg Permixon twice a day taken before a meal with water (also known as Saw Palmetto, Sabal serrulata and Serenoa repens). Results show Permixon reduced symptoms (measured using the international prostate symptom score) by 76% and improved quality of life by 53.3% from baseline. The average internation prostate symptom score (IPSS) was reduced by 8.8 or 76% from baseline. Permixon caused men’s prostates to shrink by 29.8%. On average, peak urinary flow rate increased by 4.13 mL/sec (35%). Improvements in symptoms and quality of life were maintained during the entire five year study. (5)
Sabal extract IDS 89, (also known as Saw Palmetto, Sabal serrulata and Serenoa repens) improves symptoms of men suffering from enlarged prostate. A total of 435 men were included in this 3-year prospective study that reported a 50% reduction in residual urine and a 6.1 ml/sec increase in peak urinary flow rate due to IDS 89. The effectiveness of IDS 89 was reported to be ’good’ or ’very good’ in over 80% of cases. Additionally, disease progression at the end of 3-years was significantly lower among patients taking IDS 89 compared to those not treated. No major side-effects were reported. (6)
Saw palmetto for BPH natural treatment, an extract of the fruit of the dwarf palm tree Serenoa repens or Sabal serrulata, was reported to have no effect on the symptoms of benign prostatic hyperplasia (BPH) or enlarged prostrate in this double-blind study that included 225 men aged 49 years and older with moderate-to-severe symptoms of BPH. Participants were randomly assigned to receive saw palmetto extract (160 mg twice a day) or placebo for an entire year. At the end of the study, no significant differences in the change in scores on the American Urological Association Symptom Index (AUASI), maximal urinary flow rate, prostate size, residual volume, quality of life, or serum prostate-specific antigen levels were reported between the treatment group and placebo group. (7)
Debruyne and colleagues demonstrated that Permixon (Serenoa repens) for BPH natural treatment and tamsulosin (alpha-blocker) were equivalent in terms of improvements in Internation Prostrate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in the medical treatment of lower urinary tract symptom in men with benign prostatic hyperplasia (BPH) or enlarged prostrate, during and up to 12 months of the therapy. At 12 months, I-PSS decreased by 4.4 in each group and the increase in Qmax was similar at 1.8 ml/s Permixon and 1.9 ml/s tamsulosin. Both compounds were well tolerated; however, ejaculation disorders occurred more frequently in the tamsulosin group. (8)
An overview by Neelima Dhingra and Deepak Bhagwat of BPH natural treatment with saw palmetto found that 160 mg of this agent for 2 times per day for 1 to 3 months was shown to be beneficial over placebo for improving symptoms of enlarged prostate (benign prostatic hyperplasia or BPH). S. repens does not cause impotence, and has no effect on prostate size or the prostate-specific antigen test. (9).
Researchers reviewed 13 studies (n= 2859), eleven of which were randomised, and seven placebo controlled to examine the effect of Permixon (also known as Saw Palmetto, Sabal serrulata and Serenoa repens) in the treatment of symptomatic benign prostatic hyperplasia (BPH), enlarged prostate. Results show a mean increase in urinary maximum flow rate with placebo was 0.6 ml/second, and there was an additional 2 mL/second with Permixon. The mean number of decreased episodes of night urination (nocturia) was 0.6 episodes with placebo and an additional 0.5 episodes with Permixon. In conclusion, Permixon was superior to placebo in increasing peak urine flow rate and reducing nocturia. (10)
A review of BPH natural treatment including 18 trials (n=2939) found that Serenoa repens (S. repens), extracted from saw palmetto, was superior to placebo in increasing peak urine flow rate and reducing night-time urination (nocturia) in men with benign prostatic hyperplasia (BPH), enlarged prostrate. S. repens decreased nocturia by 0.76 times per night and increased peak urine flow by 1.93 ml/s. Men on S. repens treated reported a 72% greater improvement of their urinary tract symptoms versus men taking placebo. (11)
Champault, et al. performed a double-blind placebo controlled trial on 94 outpatients with benign prostatic hypertrophy (BPH) using PA109 (Permixon®), a type of BPH natural treatment which is a liposterolic extract of Saw Palmetto, scientific name Serenoa repens. Subjects who took 160 mg oral twice per day of the extract experienced 45% less nocturia, 50% higher urine flow rate, and 41% less post void residual bladder volume. The placebo group experienced 15% less nocturia, 5% higher urine flow rate, and 9% higher post void residual. Subjective dysuria also improved in the majority of patients. (17)
Saw Palmetto Adverse Reactions, Interactions:
In the study mentioned above by Champault, et al, less adverse effects were reported by the treatment group than the placebo group (5 vs 11 instances) and were minor such as headache(17).
A case report showed that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto. (18)
Saw Palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect. Consumption should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding. (19)
Flaxseed Supplementation and BPH Natural Treatment
Flaxseed effects on the prostate: A pilot study in prostate cancer patients suggests that a low-fat, flaxseed-supplemented diet decreases prostate-specific antigen (PSA) and cholesterol levels as well as benign prostatic epithelial cell proliferation. Fifteen men who were scheduled to undergo repeat prostate biopsy were instructed to follow a low-fat (less than 20% kcal), flaxseed-supplemented (30 g/day) diet for 6-months. At the end of the study period, significant decreases in PSA (8.47 to 5.72 ng/mL; P = 0.0002) and cholesterol (241.1 to 213.3 mg/dL; P = 0.012) were seen. Significant change was not observed in total testosterone. A significant decrease in proliferation rates in the benign epithelium from 0.022 to 0.007 (P = 0.0168) was observed. (12)
Flaxseed and urinary symptoms in BPH: A randomized, double-blind, placebo-controlled clinical trial by Zhang W et al investigated the ability of flaxseed lignan extract containing 33% secoisolariciresinol diglucoside (SDG) to lessen symptoms of Benign Prostatic Hyperplasia (BPH) (enlarged prostate). Eighty-seven participants were randomize to either Placebo (0 mg flaxseed extract), Group 1 (300 mg flaxseed extract) or Group 2 (600 mg flaxseed extract) daily for four months. There were statistically significant improvements in the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOL score) in both the 300 mg and 600 mg groups. There were statistically significant improvements in lower urinary tract symptoms (LUTS) in both the 300 mg and 600 mg groups. There were also improvements in measurements of urinary flow and post voiding urine volume. The study proposed several possible mechanisms of action which include inhibition of 5-alpha reductase, phytoestrogen action of SDG competing with hormones or hormone binding receptor sites, coumaric acid glucoside or ferulic acid glucoside. The researchers concluded that dietary flaxseed lignan extract appear to exert beneficial effects on the male prostate and improves LUTS in BPH subjects.(13)
Pygeum africanum Bark Extract for BPH Natural Treatment :
Pygeum africanum bark extract dosing, safety, and symptoms: A dose of 100 mg Pygeum africanum (bark) extract once daily appears to be as effective as the more common dosage of 50 mg twice daily. For 2 months, 209 study subjects took either 50 mg of Pygeum twice daily (group A) or 100 mg once daily (group B). Then, 174 of the subjects continued taking the second preparation for 10 months. Both treatments had similar efficacy. The International Prostate Symptom Score improved by 38% in group A and 35% in group B. Quality of life improved by 28% in both groups. Maximum urinary flow rate increased by 16% in group A and 19% in group B. After 12 months, the IPSS had improved by 46% in the 174 patients who continued the study. According to the authors of the study, the supplement was taken for 12 months without major safety concerns. (14)
Additional Pygeum africanum dosing and safety for BPH natural treatment has been researched. Pygeum africanum extract can safely and effectively help to reduce the symptoms of benign prostatic hyperplasia (BPH), enlarged prostrate. Eighty-five men aged 50-75 years old with mild to moderate BPH were given 50 mg of pygeum twice daily for 2 months. The study participants demonstrated a 40% decrease in the International Prostate Symptom Score, an assessment of the severity of symptoms of BPH. Pygeum-supplemented men also reported a 32% decrease in frequency of night-time urination (nocturia) and a 31% improvement in quality of life. After the supplementation with pygeum ended, the patients were followed for one additional month. The benefits from pygeum therapy for a month after supplementation had ended. This study also found the safety profile to be highly satisfactory. (15)
Review of 18 randomized controlled trials with Pygeum africanum bark extract for BPH natural treatment showed the following findings. Pygeum africanum may reduced the symptoms of lower urinary symptoms in men with benign prostatic hyperplasia (BPH), enlarged prostrate. A review of 18 RCTs looked at 1562 men with BPH. Study duration ranged from 30 to 122 days (average was 64 days) and used a standardized dose of Pygeum africanum extract between 75 and 200 mg daily. Compared to men receiving placebo, men taking Pygeum africanum were more than twice as likely to report an improvement in overall symptoms: night-time urination was reduced by 19%, residual urine volume by 24% and peak urine flow increased by 23%. Side-effects were mild and similar to placebo. (16)
Summary for Benign Prostatic Hyperplasia (BPH) Natural Treatment
- Saw Palmetto in various standardized formulas, (a.k.a. Sabal serrulata and Serenoa repens) or Permixon brand name has been well studied and improved urine flow rate, reduced nocturnal urination, was comparable to finasteride, and in some studies reduced enlarged prostate size associated with BPH. Prostate specific antigen (PSA) levels were not reduced by this herbal treatment. The most common dosage studied in research was 160 mg oral twice per day. Permixon, Saw Palmetto, (a.k.a. Sabal serrulata and Serenoa repens) was associated with few adverse effects and no sexual side effects in the majority of studies. One study of 94 patients noted less adverse effects by the treatment group than the placebo group and were minor such as headache (17). A case report showed that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto (18). Saw Palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect and should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding (19). It is important to discontinue saw palmetto 2 weeks prior to any invasive dental procedures or surgery.
- Pharmaceutical agents compared to saw palmetto in studies include Proscar (finasteride) which reduced PSA levels but caused erectile dysfunction, reduced ejaculation volume, and in some cases irreversible erectile dysfunction. Flomax (tamulosin) caused low blood pressure, dizziness, and retrograde ejaculation.
- Saw Palmetto may be associated with an increased anticoagulation (reduce blood clotting) effect. Consumption should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding (19). A case report outlined that a patient experienced excessive bleeding after surgery for meningioma and was found to have increased bleeding time on laboratory testing which normalized after discontinuation of saw palmetto (18). Less adverse effects were reported by Champault, et al the treatment group than the placebo group (5 vs 11 instances) and were minor such as headache (17).
- Flaxseed appears to be a promising and safe whole food supplement for BPH which may reduce PSA levels , reduce benign prostate epithelial cell proliferation, and decrease cholesterol level but is not yet well studied. The best form appears to be 30 grams of whole ground brown or golden flax seed per day which can be taken after it has been ground up in the blender or chewed to release the beneficial fiber and lignans, otherwise the seeds will pass through the gastrointestinal tract undigested. Flaxseed lignin extract may improve lower urinary tract symptoms.
- Pygeum africanum taken at an oral dose of 50 mg twice per day or 100 mg oral once per day up to one year has been studied. It may reduce the symptoms of lower urinary symptoms in men with BPH and treatment effects may last for one month after stopping the supplement. Side-effects were mild and similar to placebo. This agent was described as safe in research with mild adverse effects, but to ensure safety more research is needed.
- Allergy to any of the above mentioned treatments is a contraindication to taking these agents.
