One of the most common diseases in older men is an enlarged prostate.
It is rare in men under 40; however, by 60 almost 50 percent of men will have an enlarged prostate. That figure jumps to 80 percent in men over 80 years.
Although the exact reason for the prostate to enlarge with age is unknown, it seems to be closely related to testosterone and estrogen levels. There are a number of effective prescription medications that address symptoms of benign prostatic hypertrophy such as frequency of urination, urgency for urination, difficulty in starting to urinate and a reduced urine stream.
These medications have side effects and for men with early-stage BPH, supplements and herbs may be a reasonable alternative.
The reason why the prostate gland enlarges as men age may be related to an increase in one specific form of testosterone, dihydrotestosterone.
DHT has a direct effect on stimulating the prostate gland to grow. DHT is derived from testosterone and accumulates in the prostate gland because of estrogen. With age, men's estrogen levels increase. Increased estrogen levels stimulate the prostate gland to bind more DHT resulting in enlargement of the gland.
Estrogen also reduces the body's ability to eliminate DHT. It is reasonable therefore to postulate that blocking the production of DHT will reduce the symptoms of BPH.
One of the more common supplements used to treat the symptoms of BPH is saw palmetto.
Saw palmetto is a plant common to many areas of Florida. Extracts from saw palmetto, primarily beta-sitosterol, inhibits the enzyme, 5a-reductase, that converts testosterone into DHT. In addition, it seems to reduce the number of estrogen and DHT receptors in the prostate gland itself.
Reasonable medical research has demonstrated that saw palmetto improves urinary flow as well as the commonly used BPH medication, Proscar. Interestingly, the mechanism of action of Proscar in treating BPH is also to inhibit 5a-reductase.
Zinc, a common mineral found in most multivitamins, also inhibits the conversion of testosterone to DHT by reducing the activity of 5a-reductase. It also directly inhibits the binding of DHT to prostate cells.
Zinc levels in older men may be reduced because increasing estrogen levels limit zinc absorption from food. Pumpkin seeds are a very rich source of zinc. Pumpkin seeds also seem to be of benefit in reducing the symptoms of BPH.
Some prescription medications may reduce zinc levels. These include diuretics, steroids, methotrexate as well as some antibiotics.
One of the best supplements for reducing the symptoms of BPH is beta-sitosterol. This molecule is found in most plants. It may be the reason why consumption of fruits and vegetables reduces the risk of BPH. Beta-sitosterol is also found in robust quantities in peanuts, wheat germ and corn-based oils.
For those who have mild to moderate symptoms of BPH, the use of dietary supplements may be a good first step. The side effects are rare and the benefits may be significant.
• Patrick B. Massey, MD, PH.D., is medical director for complementary and alternative medicine at Alexian Brothers Hospital Network and president of ALT-MED Medical and Physical Therapy, 1544 Nerge Road, Elk Grove Village. His website is www.alt-med.org.