The prostate

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

One of the prostate's main roles is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, improves sperm mobility and makes the vaginal canal more alkaline. It can be readily understood that the overgrowth of the prostate, caused either by an infection (prostatitis - prostate inflammation) or by the normal hormonal changes associated with mid-age in men (Benign Prostatic Hyperplasia), will affect urine flow because the prostate will gradually choke the urethra and the base of the urinary bladder.

Since benign prostatic hyperplasia is a normal and generally non-life threatening disease, I'd like to address this condition more particularly in the pages that follow.

What is benign prostatic hyperplasia (BPH)?

Benign Prostatic Hyperplasia (BPH) is a hormonally dependent disorder causing the enlargement of the prostate and leading to a constriction of the neck of the urinary bladder with a proportionate reduction in the flow of urine. The symptoms may include difficulty and pain on urination, increased urinary frequency, a reduction in the force of the urine as well as the presence of a milky or cloudy urine. The physical signs may include an enlarged, non-tender, prostate.

What causes BPH?

BPH reflects significant changes in the ratio of male  (particularly free testosterone) to female sex hormones in men. In men fifty and over, there is generally a decrease in testosterone and free testosterone. There is also at this time an increase in female sex hormones, including prolactin and estradiol. Normally, the testosterone and dihydroxytestosterone (DHT), are metabolized and thereby excreted more effectively. However, the increase in female hormones (estrogens) which takes place in the early to mid fifties inhibits this metabolism. These changes lead to an increase of DHT within the prostate. However, the prostatic male hormone receptors have a fivefold greater affinity for DHT than for testosterone. The end result is a progressive increase in the production of prostate tissue, which can lead to the symptoms mentioned above.

How many men are affected by BPH?

In 1983 it was estimated that the incidence of BPH was at 50-60% of men between the ages of 40 and 59 years of age¹. The incidence may be as high as 95% in men over 80².

Natural solutions for BPH

Though BPH is caused by normal hormonal changes it is possible to reduce the symptoms by a variety of modalities, including prescription drugs, nutritional factors and phytotherapy. Since nutritional factors and phytotherapy have given best results with virtually no side-effects, when compared to prescription drugs, we will focus on this approach.

Several nutritional factors are thought to be involved in the rate of development of benign prostatic hyperplasia. There are indications that the trace-element zinc, may inhibit the activity of an enzyme, 5-alpha-reductase (5-A-R)³. This enzyme is required for the conversion of testosterone into the most active form, dihydroxytestosterone. this effect of zinc on 5-A-R does not seem to be consistent, and zinc supplementation should not be considered as the only dietary measure in the prevention or alleviation of the symptoms of BPH.

Fatty acids may also play an important role in reducing the severity of BPH. Research undertaken in the 30s and 40s suggested that inadequate essential fatty acid levels might be a factor in benign prostatic hyperplasia⁴. This may explain the use by nutritionally oriented physicians of nutritional sources of essential fatty acids such as evening primrose and fish oils in the prevention or support of individuals with BPH. Unfortunately, as in the case of zinc, research in this area has lagged in the last few decades and irrefutable evidence is still wanting.

Herbal support

In the last few decades an increasing amount of research has focused on herbs and their effects on the symptoms of benign prostatic hyperplasia. Flower pollen⁵ and pumpkin seeds⁶ have been documented for their effects on the symptoms of BPH.

European studies however have focused on the effectiveness of three herbs in the prevention and treatment of BPH. The combined use of Pygeum africanum (African plum tree) bark extract and Urtica dioica (stinging nettles) extract have shown significantly positive effects on the symptoms of BPH⁷. The combination was more shown to be more effective than Pygeum, Epilobiumparviflorum or Urtica alone⁸. Serenoa repens (Saw Palmetto) is a small shrub that has been shown to significantly imporve the symptoms of of BPH⁹.

It is helpful to understand the mode of action of each of these three plants in order to understand the modus operandi of this combination.

Pygeum Africanum

Several studies have been undertaken on the use of Pygeum in helping to alleviate the symptoms of Benign Prostatic Hyperplasia. One such study demonstrated that "the extract provided an overall improvement in the functional symptoms" of BPH¹⁰. Another study showed improved symptomatology as well as an improvement in sexual parameters¹¹. Pygeum has been shown to inhibit the enzyme, 5-?-reductase, thereby reducing the production of dihydroxytestosterone¹². It is also effective in inhibiting the aromatase enzyme, which coverts testosterone into estradiol¹³.

Urtica Dioica

Stinging nettle is regarded by German health authorities as an effective treatment for the urinary problems that arise from BPH¹⁴. Tyler also notes that "the herb may have an effect on the amount of free testosterone circulating in the blood." And, like Pygeum, Nettles may also effective in inhibiting the aromatase enzyme, which coverts testosterone into estradiol¹⁶. Finally, according to Hoffman, "Nettles are one of the most widely applicable plants we have. They strengthen and support the whole body. Throughout Europe they are used as a spring tonic and general detoxifying remedy."¹⁷

Serenoa Repens

Clinical trials have demonstrated the efficacy of Saw palmetto berries in alleviating the symptoms of BPH. This effect is considered to be due to its inhibition of dihydrotestosterone, though the fatty acids found in Saw palmetto also inhibit the binding of dihydrotestosterone to prostate cells¹⁸. It has also been demonstrated to have some anti-inflammatory effects on the prostate. The effectiveness of Saw plametto was demonstrated when patients taking this plant alone had a 45% improvement in urine flow¹⁹. The German Commission E recognizes the effectiveness of this herb in alleviating the urinary problems associated with BPH²⁰.

Other traditionally used herbs

Corn silk (maïs) has traditionally been used for the improvement of the urinary flow²¹ helping thereby to reduce the symptoms commonly associated with BPH²². The Physician's Desk Reference for Herbs also notes the use of Corn silk as a diuretic²³. 

Finally, Chinese licorice can be used in the treatment of BPH symptoms because of its adaptogenic effects. Licorice is known to help the body adapt to stress as well as to exert anti-inflammatory action.

Conclusion

Benign prostatic hyperplasia will affect a majority of men at one time or another in their lives. The issue is not whether this will occur, but whether these will suffer from the symptoms of BPH. Research has shown that the symptoms of BPH can be reduced significantly, if not eliminated entirely, thanks to the use of a safe and natural approach.  Pygeum africanum, Urtica dioica, Serenoa repens, extracts have shown themselves to be an important part of this approach.

¹ Benign Prostatic Hyperplasia, F Hinman, Springer-Verlag (NewYork: 1983)

² E Montanari, A Mandressi, V Magri, G Dormia and E Pisani, Benign prostatic hyperplasia, Gazette Médicale, 6a:593-598 (1991)

³ The effect of zinc on the 5-alpha-reduction of testosterone by the hyperplastic human prostate gland, A Leake, GD Chisholm and FK Habib, Journal of Steroid Biochemistry, 20:651-5 (1984)

⁴ Prostatic hypertrophy as part of a generalized metabolic disease. Evidence of the presence of a lipopenia., EM Boyd and NE Berry, Journal of Urology, 41: 406-11 (1939)

⁵ Botanical Influences on Illness, M Murray and M Werbach, Third Line Press (1995)

⁶ Herbal Medicine, Rudolph-Fritz Weiss, Beaconsfield Arcanum (1988)

⁷ Combined Extracts of Urtica dioica and Pygeum africanum in the treatment of Benign Prostatic Hyperplasia: Double-Blind Comparison of Two Doses, T Krzeski, M Kazon, A Borkowski, A Witeska and Jkuczera, Clinical Therapeutics, Vol. 15, No. 6 (1993)

Benign Prostatic Hyperplasia: Differential therapy with phytopharmacological agents - a randomized study of 63 patients, E Montanari, A Mandressi, V Magri, G Dormia and E Pisani, Gazette Médicale, 6a:593-598 (1991)

⁸ Benign Prostatic Hyperplasia: Differential therapy with phytopharmacological agents - a randomized study of 63 patients, E Montanari, A Mandressi, V Magri, G Dormia and E Pisani, Gazette Médicale, 6a:593-598 (1991)

⁹ A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia, Champault G et al. British Journal of Clinical Pharmacology, (1984)

¹⁰ Etude controlee des effets de l'extrait de Pygeum africanum sur les symptomes fonctionnels de l'adenome prostatique., Dufour B  Choquenet C  Revol M  Faure G  Jorest R , Ann Urol 18(3):193-5  (1984)

¹¹ Valutazione urologica e sessuologica del trattamento della patologia prostatica benigna mediante Pygeum africanum ad alte dosi., Carani C  Salvioli V  Scuteri A  Borelli A  Baldini A  Granata AR  Marrama P, Arch Ital Urol Nefrol Androl 63(3):341-5 (1991)

¹² Combined Extracts of Urtica dioica and Pygeum africanum in the treatment of Benign Prostatic Hyperplasia: Double-Blind Comparison of Two Doses, T Krzeski, M Kazon, A Borkowski, A Witeska and Jkuczera, Clinical Therapeutics, Vol. 15, No. 6 (1993)

¹³ ibid

¹⁴ Herbs of Choice, Varro Tyler, Pharmaceutical Products Press (1994)

¹⁵ Herbs of Choice, Varro Tyler, Pharmaceutical Products Press (1994)

¹⁶ Combined Extracts of Urtica dioica and Pygeum africanum in the treatment of Benign Prostatic Hyperplasia: Double-Blind Comparison of Two Doses, T Krzeski, M Kazon, A Borkowski, A Witeska and Jkuczera, Clinical Therapeutics, Vol. 15, No. 6 (1993)

¹⁷ The Herbalist, David Hoffman, Hopkins Technology (1994)

¹⁸ Serenoa repens : A review of its pharmacological and therapeutic efficacy in benign prostatic hyperplasia, Plosker GL, Brogden RN, Drugs & Aging  9(5):379-395 (1996) 

¹⁹ A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia, Champault G et al. British Journal of Clinical Pharmacology,  (1984)

²⁰ The Complete German Commission E Monographs, M. Blumenthal Ed. Intergrative Medicine Press (1998)

²¹ Chinese Herbal Remedies, AY Leung, Universe Books (1984)

²² Potter's New Cyclopoedia of Botanical Drugs and Preparations, R.C. Wren, Ed., CW Daniel Co. (1989)

²³ PDR of Herbal Medicines, J. Gruenwald Ed. Medical Economics Press (1999)