Among the dietary supplements recognised as beneficial for benign prostatic hyperplasia, there are certain plant extracts and nutrients which extensive research shows to be the ‘undisputed masters’. Here we focus on these key supplements and on other promising substances.
Extracts of Serenoa repens - or Saw Palmetto - have for many years been successfully used in Europe and across the Atlantic to provide long-lasting relief from the symptoms of benign prostatic hyperplasia (BPH), also known as enlarged prostate, and to clear the urinary tract. Saw Palmetto is rich in phytosterols and specific fatty acids that can block hormones which stimulate growth of the prostate. Extracts of saw palmetto, standardised in free fatty acids, work in a number of ways:
- They inhibit 5-alpha-reductase and prevent dihydrotestosterone (DHT) – the active form of testosterone which stimulates prostate cell growth – from binding to androgen receptors,
- They stem the proliferation of prostate cells and may even induce apoptosis of cancer cells,
- They reduce inflammation and the urgent need to urinate,
- They increase urinary flow and promote complete voiding.
The efficacy of saw palmetto extracts may therefore be as good as that of finasteride or tamsulosin, two drugs commonly prescribed to treat BPH.
In clinical studies, these extracts have often been combined with nettle root extract
), for their synergistic and side effect-free action 1
. Nettle root also inhibits the binding of DHT to prostate cells and studies show it significantly eases symptoms. It is actually recommended by the German Commission E for providing natural relief from BPH-associated urinary problems.
Another beneficial plant is Pygeum africanum
, or African cherry tree, used in Europe since the mid-Sixties. Its phytosterols improve contractility in the bladder, decrease inflammation by inhibiting prostaglandin production, prevent the growth of prostate cells, reduce nocturia (getting up in the night to urinate) and increase urinary flow, so promoting complete emptying of the bladder.
Like saw palmetto and soya, pygeum africanum contains beta-sitosterol
which as various studies have shown, increases urinary flow and reduces post-void residual urine. Its benefits also continue for several months after supplementation ceases.
These plant extracts are generally used either on their own or in conjunction with:
- A hydrophilic and lipophilic pollen extract which inhibits DHT formation, and produces modest decreases in BPH-related urinary symptoms and particularly in nocturia.
- Zinc – the no. 1 mineral for the prostate. In fact, the epithelial cells of the prostate gland accumulate high levels of zinc which research shows inhibits cell growth and DHT activity and also prevents 5-alpha-reductase activity. In BPH, zinc levels in prostate cells are significantly reduced, thus limiting zinc’s growth-regulating function
- Boron which also promotes healthy development of prostate cells.
DIM or diindolylmethane, extracted from cruciferous vegetables such as broccoli and cabbage, is a promising new molecule. It plays a balancing and supportive role in optimal endocrine system function. It reduces levels of PSA (prostate-specific antigen) elevated by DHT, and prevents testosterone from being converted into oestrogens. In addition, DIM has been identified as a natural indole. It therefore supports the body’s natural defences and protects it from environmental carcinogens.
A better understanding of BHP …
There are two key enzymes which can cause the prostate to triple in size:
- 5-alpha-reductase which converts testosterone into the most active form, dihydrotestosterone (DHT)
- Aromatase which converts testosterone into oestrogens. Excess oestrogen not only exacerbates BPH but also increases the risk of it developing into prostate cancer.
DHT and oestrogens are responsible for the proliferation of prostate cells via activation of certain growth factors (IGF-1 – insulin growth factor). Any substance that can diminish these two enzymes or impede the binding of DHT or oestrogens to prostate receptors therefore reduces BHP.
Increasing age is obviously one risk factor for BHP due to changes in hormone production but others include sedentarity and certain drugs.
And quercetin for prostatitis
Quercetin – at a dose of 1g spread across the day - has powerful anti-inflammatory properties. These are mainly exerted by inhibiting the NF-kappaB pathway, a protein which plays a central role in controlling the expression of genes encoding pro-inflammatory cytokines.
Its effects are most evident in chronic inflammation of the prostate sup>2as demonstrated in a double-blind study of 15 males with non-bacterial chronic prostatitis. Of those men who took 500mg of quercetin twice a day for six months, two thirds noted a reduction in pain of at least 25%, compared with just a fifth of those in the control group.
A number of other extracts also constitute valuable weapons in preventing or combatting the development of cancer cells.
One such substance is lycopene
, a powerful antioxidant carotenoid found in high concentrations in tomatoes. Studies show it can inhibit growth of prostate cancer cells thus offering protection against this form of cancer.
is another, though it is much less abundant in the diet than lycopene, oily fish being one of the few sources. Essentially produced by the body through exposure to the sun’s UVB rays from a cholesterol derivative, the majority of Europeans are lacking in vitamin D, and are thus at risk of cancer, including (for men) prostate cancer. Daily supplementation with vitamin D is therefore essential from October to March when sun exposure is low.
Two polyphenol compounds have emerged - pterostilbene and resveratrol
- that are able to counteract the growth of prostate cancer cells. In research conducted in Chicago, pterostilbene acted as an inhibitor of the P450 enzyme which activates ‘pro-carcinogenic’ substances. Other studies have found it impedes the growth of certain types of cancer, including that of the prostate, by blocking cell cycle progression and inducing apoptosis, thus stemming the spread of other cancer cells or metastases. As for resveratrol, animal and human studies suggest it could constitute a more effective and less toxic alternative to chemotherapy.
, or more specifically punicalagin and ellagic acid, are also recognised for their protective effects. They prevent the triggering of mutations and have been shown to exert anti-proliferative activity in vitro. Ellagic acid also has an inhibitory effect on two essential proteins (VEGF and PDGF) necessary for tumour blood vessel formation; these are mainly involved in angiogenesis processes, a key hallmark of cancer development.
Researchers have shown that pomegranate extract inhibits cell growth, induces apoptosis in a highly aggressive prostate cancer cell line and reduces secretion of PSA.
Other scientifically-investigated ingredients have been identified as potentially beneficial:
- Chrysin, a flavonoid compound extracted from passion flower (passiflora caerulea), which inhibits the conversion of testosterone into oestrogens.
- Naringin, extracted from grapefruit, which is now fully-recognised as an oestrogen-inhibitor (cytochrome P 450).
- Genistein extracted from Sophora japonica (more active than soya-extracted genistein), which is a potent inhibitor of aromatisation.
- Epilobium parviflorum (epilobe small-flower), which with its high content of terpenes, phytosterols, flavonoids, tannins and particularly oenothein B, simultaneously inhibits the two key enzymes, aromatase and 5-alpha-reductase.
- Selenium which, as studies have shown, may reduce the risk of prostate cancer and slow its progression.
Progesterone cream is not just for women!
Healthy males naturally produce 1.5mg of progesterone a day via the adrenal glands, although this production declines with age. Progesterone plays an important role in inhibiting aromatase activity and restricting DHT levels in the blood and prostate by competing with 5-alpha-reductase.
1- Sokeland J. et al., Combination of Sabal and urtica extract versus finasteride in benign prostatic hyperplasia (stages I and II). Comparison of therapeutic effectivness in one year double-blind study, Urology A, 1997, 36(4): 327-33.
2- Shoskes, D. A., Zeitlin, S. I., Shahed, A. and Rajfer, J. (1999) Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial, Urology, 54, 960-3.