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Benign prostatic hyperplasia

[From New Vegetarian and Natural Health, Winter 2010 issue]


By Robyn Chuter


Benign prostatic hyperplasia, also known as benign prostatic hypertrophy or BPH, is a non-cancerous enlargement of the prostate that afflicts older men. Over half of men in their 60s and up to 90% in their 70s and 80s have some symptoms of BPH, such as urinary hesitancy, urgency and leaking or dribbling; an interrupted, weak stream of urine; and more frequent urination, especially at night.

Over time, urinary retention and strain on the bladder caused by severe BPH can lead to urinary tract infections, bladder or kidney damage, bladder stones, and urinary incontinence (loss of control over urination).(1)

While the causes of BPH are not fully understood, there are two major hormonal changes that are believed to play a role:

Firstly, as men get older the amount of testosterone they produce declines, and an enzyme called aromatase, which converts the ‘male hormone’ testosterone to the ‘female hormone’ oestrogen, increases. This tips the ratio of testosterone to oestrogen more toward oestrogen.(2) Relatively higher amounts of oestrogen in the bloodstream and in the prostate may cause proliferation of prostate cells.(3)

Secondly, in ageing men more testosterone is converted within the prostate gland into dihydrotestosterone (DHT), which causes prostate cells to multiply and the entire gland to hypertrophy (grow too big).(4)

The first piece of good news is that having BPH does not increase a man’s risk of developing prostate cancer.(5)

The second is that up to a third of mild cases of BPH resolve spontaneously, without any treatment at all.(6)

The third is that there are safe, effective non-drug treatments for BPH:

1. Losing weight – especially the ‘spare tyre’ or ‘beer gut’ – decreases the production of the aromatase enzyme, which, as described above, converts testosterone to oestrogen. Subcutaneous abdominal fat (the fat right under your skin) produces large amounts of aromatase.(7)

2. Lignans (of which linseed is an especially rich source) are converted by friendly gut bacteria into enterolactone, which inhibits the growth-promoting activity of oestrogen and DHT. Flaxseed lignans have been found to improve lower urinary tract symptoms in men with BPH, as effectively as the two types of drugs used to treat BPH – alpha1A-adrenoceptor blockers and 5alpha-reductase inhibitors.(8)

3.The herb saw palmetto inhibits the conversion of testosterone to DHT within the prostate, and also decreases the production of inflammatory chemicals called prostaglandins. In fact, saw palmetto has been found to be as effective at relieving urinary symptoms as the drug finasteride (Proscar) – but without the side effects such as erectile dysfunction, ejaculatory disorders and decreased libido, commonly reported by men who take finasteride.(9)

4. Pygeum africanum and other sources of beta-sitosterol, also decrease inflammatory prostaglandin production in the prostate, reducing urinary tract symptoms.(10)

5. Nettle root protects prostate cells against the growth-promoting effects of sex hormones.(11)




(2) Aging Male 2002 Jun;5(2):98-102.

(3) J Endocrinol 2008 Jun;197(3):483-91.

(4) Urology 2003 Apr;61(4 Suppl 1):2-7.



(7) Aging Male 2002 Jun;5(2):98-102.

(8) J Med Food 2008 Jun;11(2):207-14.

(9) Aging Male 2004 Jun;7(2):155-69.

(10) Curr Med Res Opin 1998;14(3):127-39.

(11) Planta Med 1997 Dec;63(6):529-32.