Benign prostatic hyperplasia (BPH) is a common enlargement of the prostate gland as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause symptoms before age 40, but more than half of men in their sixties, and as many as 90 percent in their seventies and eighties have some symptoms of BPH. These are typically referred to as lower urinary tract symptoms (LUTS), and include incomplete bladder emptying, frequent urges to urinate during the day and at night. However, it should be understood that LUTS and BPH are not equivalent. While all BPH includes LUTS, not all LUTS are reflective of BPH.

Lifestyle and LUTS

This is comprehensively explained in a peer-review article from Current Opinion in Urology.1 The authors of the article explain that LUTS has also been associated with many factors, including diet—which is unrelated to the prostate directly but which is reflective of various lifestyle factors. The article indicates that:

  • Increased total calorie intake has been associated with LUTS;
  • Red meat, fat, cereals, bread, poultry and starch have been associated with increased risks of symptomatic LUTS;
  • Total protein, dairy, vegetables, fruits, polyunsaturated fatty acids, linoleic acid, carotenoids, vitamins A, C and D have been associated with decreased LUTS;
  • Lower vitamin D status and caffeine intake were associated with a greater prevalence of LUTS;
  • Higher serum levels of vitamin E, lycopene, selenium and carotene have been associated with reduced LUTS.

Vitamin D and LUTS
This relationship between vitamin D and LUTS was demonstrated in the National Health and Nutrition Examination Survey, where a majority of men with LUTS (89 percent) had insufficient vitamin D levels. In fact, 55 percent had deficient vitamin D levels. Among the 1388 men (58 percent) with LUTS data and vitamin D levels, 48 percent had at least one LUTS. The researchers concluded, “Vitamin D insufficiency and deficiency are highly prevalent among adult men in the U.S., and vitamin D deficiency is associated with moderate-severe UI and the presence of at least one LUTS.”2

Additional non-BPH disease states and LUTS Additional research has similarly demonstrated that other non- BPH, non-disease states are associated with LUTS:

Non-disease state Study description

Stool / Bowel Movement3

Less LUTS in the adult male were independently associated with low stool frequency, hard stool type and loose stool type. These data suggest causality of lower urinary tract functions and abnormalities of bowel



Prospective study of 1740 elderly men > 65 years in the U.S. untreated for LUTS, to determine non-urological lifestyle and health factors independently associated with LUTS.

  • 345 men with progressing LUTS were more likely to have mobility limitations.
  • Men with mobility limitations or back pain may perceive their symptoms as becoming more severe over time, if difficulty with ambulation alone, or because of pain, interferes with their ability get to or use a toilet.

Poor Diet5

Cohort consisted of 1385 men aged .40 years, of which 279 (21.1%) reported LUTS. Poor diet quality was independently associated with patient-reported LUTS.
Higher prevalence of LUTS:

  • among men with poor dietary intake of dairy (22.4% vs 16.4%, P =.013)
  • among men with poor intake of protein (24.6% vs 17.9%, P = .012)
  • among men with overall poor diet (25.8 vs 17.8%, P = .018)
  • among men with little dietary variety (26.1 vs 17.6%, P = .001).

Physical Activity
Inverse Association
LUTS not assoc. with
changes in prostate size

Cross-sectional analysis study included 405 men without prostate cancer or prostatic intraepithelial neoplasia.
Higher leisure-time physical activity energy expenditure and light housework activities were significantly associated with lower LUTS.
Although, higher LUTS was not mediated through changes in prostate size.


This study analyzed the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited the institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months.

  • Light-moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of pronounced LUTS.
  • Heavy alcohol consumption (.30 g/d) was associated with increased likelihood of pronounced LUTS.
Risk Factors–

708 African-American men aged 40–79 years in Flint, Michigan, studied between 1996 and 1998.

  • Men aged 70–79 years experienced more than a twofold increase in the odds of pronounced LUTS.
  • Both current and former smokers were at increased odds of having pronounced LUTS in comparison with never smokers.
  • Former alcohol drinkers, when compared with never drinkers, had an approximately twofold increase in the odds of pronounced LUTS.
  • Current heavy drinkers (>72 g/day) had a nearly threefold increase in the odds of pronounced LUTS increase.
  • There was no consistent pattern of association between increasing body mass index and LUTS, but engaging in vigorous physical activity was inversely associated with the odds of pronounced LUTS.

While many men who experience LUTS symptoms do have BPH, those same symptoms may occur as the result of lifestyle factors, independently of BPH. Consequently, it makes sense to get a proper diagnosis of your symptoms. Also, assuring adequate vitamin D intake (2,000 IU daily recommended), while eating a good diet and exercising, while avoiding constipation, smoking and the overconsumption of alcohol, may also help you to avoid LUTS or even help reduce those symptoms in some instances. Of course if you do have BPH, there are nutraceuticals, which can help. Refer to “Naturally Improving Prostate Health” in the May 2016 issue of Total Health.


  1. Lin PH, Freedland SJ. Lifestyle and lower urinary tract symptoms: what is the correlation in men? Curr Opin Urol. 2015 Jan;25(1):1-5.
  2. Vaughan CP, Johnson TM 2nd, Goode PS, et al. Vitamin D and lower urinary tract symptoms among US men: results from the 2005–2006 National Health and Nutrition Examination Survey. Urology. 2011; 78(6):1292–7.
  3. Thurmon KL, Breyer BN, Erickson BA. Association of bowel habits with lower urinary tract symptoms in men: findings from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey. J Urol. 2013 Apr;189(4):1409-14.
  4. Marshall LM, Holton KF, Parsons JK, Lapidus JA, Ramsey K, Barrett-Connor E; Osteoporotic Fractures in Men (MrOS) Study Group. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis. 2014 Sep;17(3):265-72.
  5. Erickson BA, Vaughan-Sarrazin M, Liu X, Breyer BN, Kreder KJ, Cram P. Lower urinary tract symptoms and diet quality: findings from the 2000-2001 National Health and Nutrition Examination Survey. Urology. 2012 Jun;79(6):1262-7.
  6. Fowke JH, Phillips S, Koyama T, Byerly S, Concepcion R, Motley SS, Clark PE. Association between physical activity, lower urinary tract symptoms (LUTS) and prostate volume. BJU Int. 2013 Jan;111(1):122-8. BJU Int. 2013 Jan;111(1):122-8.
  7. Suh B, Shin DW, Hwang SS, Choi HC, Kwon H, Cho B, Park JH. Alcohol is longitudinally associated with lower urinary tract symptoms partially via high-density lipoprotein. Alcohol Clin Exp Res. 2014 Nov;38(11):2878-83.
  8. Joseph MA, Harlow SD, Wei JT, Sarma AV, Dunn RL, Taylor JM, James SA, Cooney KA, Doerr KM, Montie JE, Schottenfeld D. Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol. 2003 May 15;157(10):906-14.

When we think of chronic illnesses, conditions such as heart disease, diabetes and cancer are usually at the top of the list. Chronic pain is rarely, if ever mentioned in this discussion. Statistically though, chronic pain sufferers far outnumber all three of these conditions combined. According to the Institute of Medicine of The National Academies, there are more than 100 million Americans suffering from chronic pain versus diabetes (25.8 million), heart disease (16.3 million) and cancer (11.9 million). This is quite staggering when you think people with chronic pain encompasses almost one-third of all Americans. If these numbers don’t grab your attention then perhaps the amount of money spent on health care and lost productivity for chronic pain will at $635 billion (which equals about $2,000 per person, per year).

What is Chronic Pain?
Chronic pain is defined as pain that lasts longer than several months. The pain can be continuous or random, mild or severe, debilitating or just plain annoying. The most common conditions associated with chronic pain include backaches, headaches (including migraines), fibromyalgia, sinusitis, joint pain and carpal tunnel syndrome. The cause can be from physical trauma/injury, infections, ongoing conditions (cancer, arthritis, infections, neuralgia) and even emotional trauma.

If living with chronic pain isn’t bad enough, chronic pain sufferers usually have other health challenges such as depression, fatigue, sleeplessness, changes in appetite, anxiety and other emotions that contribute to the worsening of their pain. We also know that chronic pain will decrease immune function, allowing for other health challenges to manifest such as cancer, colds/flu and more. Bundling these all together, we can see that people who suffer from chronic pain have a less than desirable quality of life.

With regards to treating chronic pain, I don’t always agree with the modern medicine approach. Modern medicine often treats the symptoms without addressing the root cause of the pain. An example would be someone who suffers from migraines. In most cases, medications such as narcotics, vascular flow regulators, antidepressants, antianxiety, anti-nausea and OTC analgesics are used to either “prevent” or “treat” a person’s symptoms. The harsh reality is that these drugs do not necessarily address the root cause such as stress, food sensitivities, other medication use, hormone imbalances, sleep disturbances, being overweight, caffeine consumption, smoking, chemical exposures, etc., which could be the underlying cause of the migraine. Failing to address the root cause of a migraine will allow it to continue to manifest (or even worsen over time), or become chronic.

My approach to helping those with chronic pain (and all health challenges) begins by looking for the underlying root cause of pain. Following is a list of some of the more common areas for chronic pain and their possible “root” cause:

Fibromyalgia: Acute or chronic trauma to the nervous system. Do you suffer from chronic anxiety or worry, depression; or were you involved in, or did you witness, a horrific event? Arthritis: Was your joint inflammation caused by an injury or was it something that occurred over the years (progressive decline such as; drying out of connective tissue, osteoarthritis or mineral deposits in the joints) or development of an autoimmune condition?

Migraines: Are you stressed, have food sensitivities, hormone imbalances, sleep disturbances, smoke or consume too much caffeine?

Backache: Was the cause from an injury (sports, car accident, etc.)? Is there an emotional link (stress, anxiety or depression)? Or other physiologic condition that impacts your spine or back muscles (bladder or bowel health, pregnancy)?

Sinusitis: Do you have food sensitivities? Do you have an underlying physical issue such as polyps or deviated septum? Do you have issues with stress or anxiety?

The examples above are not the definitive list of “why” you might have chronic pain, but are there to give you an “outside the box” look into why you are suffering. Take lower back problems for example, I often find that there is a link to bowel or bladder issues. No one would think there is a link between either one of those areas because they directly have little to do with your back. Yet more times than not, people with sciatic/ lower back issues often have problems with bowel health (constipation, IBS, diarrhea) or bladder health (chronic UTIs, bladder spasms, pregnancy that impacted the bladder muscle negatively). When we focus on fixing the bowel or bladder health condition, the pain eventually goes away. Modern medicine on the other hand would not take this approach and your condition would continue to worsen because the underlying cause was never “treated.”

Integrating Natural Medicine
The natural medicine approach should be multifaceted. This means that taking supplements should be a part of your regimen, but not the only thing you do. Before I give my recommended supplements for chronic pain, consider adding these strategies to your health program too:

  • Get out and socialize
  • Join a support group
  • Avoid extended use of addictive medications
  • Treat underlying anxiety and/or depression
  • Pray or meditate
  • Explore other modalities such as acupuncture

I have personally suffered with chronic pain for the past two years. The supplements I use and recommend are backed by more than testimonies and anecdotal information, they are also backed by science. Here is a quick list of what I suggest for chronic pain and why:

Perluxan: Perluxan is supercritical extract from hops cones (Humulus lupulus). For years now I have been calling this my “herbalibuprofen” and now there is a pilot study showing it is actually similar in action. Perluxan was found effective in reducing pain-causing biochemical (COX-2) and 1,000 mg of Perluxan was evaluated to have a similar effect as two, 200 mg ibuprofen tablets. Perluxan is also well tolerated, has a good safety profile for those with gastrointestinal side effect concerns. Ibuprofen rips my stomach up and Perluxan does not. Another huge advantage is that while most supplements take weeks or even months to show benefit, Perluxan can start relieving pain within 30 minutes.

Celadrin: I recommend Celadrin to be taken orally and/or applied topically to help with your pain and inflammation concerns. Orally, Celadrin works by decreasing inflammation and by lubricating cell membranes throughout the body. By restoring fluids that cushion bones and joints, it helps promote flexibility and mobility. If you are like me and over the age of 50, you may notice your “joints creak,” which could be due to your connective tissue drying out. Celadrin helps re-hydrate that tissue while also helping the body to decrease any swelling or inflammation. If you suffer from chronic pain, you know there are days or moments when your pain is worse than usual. Celadrin works great topically for these instances. I am also suggesting it to be used 20–30 minutes prior to bedtime. Since Celadrin takes only 20 minutes to begin working, you can help get added pain relief before you go to bed, which may allow you to fall asleep faster and stay asleep longer. There are no clinical trials on my last comment about sleep, but the application makes sense and works for me.

Finally, science has shown that people, who suffer from chronic pain and take an active role in their health, versus just sitting back and accepting their fate, have much better outcomes. Continue to seek out solutions to your pain and you are likely to find significant relief and perhaps even eliminate it completely.

David Foreman RPh, is a retired pharmacist, author and radio host of the syndicated show, “The Herbal Pharmacist.” He is well versed on the healing powers of herbs, vitamins and other natural supplements. Foreman is a graduate of the University of South Carolina College of Pharmacy and is author of, “4 Pillars of Health: Heart Disease.” He is a frequent speaker at some of America’s leading universities, medical groups and hospitals on the subject of natural health and healing. His shift from traditional pharmacist to herbal pharmacist was based on his belief that education is the key to understanding that natural health plays a vital role in mainstream medicine; and he has dedicated his entire career to educating consumers about the benefits and power behind natural herbs and supplements ( Follow him on Twitter: @Herbalrph or

1. To begin with, Healthy Aging starts NOW! Everything we do, how we live our lives and the choices we make every day influence how healthy or ill we will be as we age. Of course, we have some genetic predispositions, yet our lifestyle trumps our genetics. The field of Epigenetics is one of the hottest areas of study these days wherein it has been proven that our food habits/choices and stresses influence whether certain genes are expressed or not. Check out this topic online to learn more and how it may relate to you.

2. LOVE is essential for healthy living and feeling youthful as well as sensual and sexy. It's even more important for men than women as research shows that men live longer when coupled with a life partner, whereas it's not the same for women, who seem to embrace their independence in later years, especially when they have financial comfort. Medicare and insurance companies realize that loneliness and isolation are factors that create more likelihood for medical problems as we age and so, they ask physicians to inquire about these factors during their health reviews with patients.

3. FOOD is vitally important as a building block for our body as well as nourishment for our brain and other body tissues. At the core of us, our cells need a selection of the many nutrients we need for optimal functioning?vitamins, minerals, amino acids from proteins, fatty acids from oil-containing foods, and the many bio-active phytonutrients from plants. It's also important to avoid as many toxins, primarily chemicals and metals that come into our bodies from air, food, and water, and also from what we put on our skin or how we treat our hair. Vital cell function is the basis of body/life vitality, and good, nutrient-rich foods provide the electricity for life.

Detoxification can be valuable for most men with breaks from any SNACC Habits (my acronym Sugar, Nicotine, Alcohol, Caffeine, and Chemicals) as well as occasional cleansing juice fasts (I do them yearly), which I feel and believe keep us feeling youthful with lower inflammation, and from them, help reduce degenerative disease so common in aging men.

In general, we mostly need lots of veggies and I suggest 50 percent and up, with quality proteins within your belief construct, and I like some fish, fresh local eggs, legume sprouts, tofu and tempeh, and some nuts, seeds, and avocado to add some oils and protein, along with a few fruits and some grains as you tolerate for your carb and weight levels. That's the food we need and be aware of your 'treats' such as most all the processed foods and sugar-laded items so readily available everywhere. These treats are occasional and less than 20 percent, even 10 percent, of our total diet.

4. A Place called Home forms a foundation for many good health habits and a sanctuary for relaxation and recharging. The place you sleep and dream is home, and good sleep is essential to good health, from youth and throughout life. Here's where you care for your body with love and ideally embrace the attitude that, "This is the only body I have and I am going to care for it as best I can. As I acknowledge this, I am going to eat well, lower my stress, sleep great, and keep an active fitness program." That's an "attitude" and a positive one. It helps to keep a clean body and home, well organized and that allows us to be creative and comfortable.

5. Creative Spark?be happy with who you are inside yourself, and that takes the right attitude as well. It helps to have something to do in and for the world to keep you engaged in life with some level of passion. This is important as we age unless you are someone who wishes to retire and enjoy your favorite hobbies and pastimes, travel, and embrace the world, or just relax at home and enjoy family, grandkids, and friends.

6. Fitness is fantastic! Staying fit or working hard to improve any poor fitness is a good plan for us all. I find for me that an hour a day or more helps me feel good and maintain my fitness and I encourage a regular, yet varied, program that fits in with your lifestyle and work schedule. Remember, the best exercise is the one that you will actually do. What do you like? Hikes in nature, gym workouts for aerobic activity, weight training, and always stretch and that includes yoga. We are as young as our spine is flexible. Meditation and tuning in helps us stay aligned with our true selves and helps us listen to our mission message and inner guidance and truth. This helps us stay aligned with a spiritual calling, so important for what I call our "destiny years" post age 60.

7. Supplements and Hormones are an important area to look at for healthy aging. It's wise to have an assessment and look at risk factors (see below) as well as hormone levels, and that includes testosterone values and DHEA, a hormone precursor. Many men can benefit from adding a little bio-identical testosterone to their regimen, especially if they measure low or they have some of the symptoms of low testosterone, such as fatigue, depression, low libido, or lack of enthusiasm for life.

Important supplements for aging men include vitamin D, vitamin C and other antioxidant nutrients (E, B vitamins, and selenium) along with zinc (also antioxidant) are all needed by many men, as is magnesium. Omega-3 oils are helpful to keep inflammation down and CoQ10 can be beneficial and is especially important for men who are taking statin drugs for their cholesterol levels. Protecting the heart is vitally important and that's a whole new discussion.

Prostate Health is an area to keep aware of and make sure the urine flow and sexual function is working. Checking for prostate cancer is wise to do with your physician, either the family doctor or urologist.

8. Financial health often affects physical health (and emotional and mental health as well); at least it can. While money doesn't protect us from worry or stress (it may add) it gives us the options to do what we need for ourselves and not make it seem like an expensive luxury. Hopefully the career years, mainly 30? 60, have brought in support for your later life, and yet, many men enjoy what they do and choose to keep working into their 70s and longer. This whole area is an individual journey and it helps to plan ahead and include your family in this area, especially a spouse if that's relevant.

9. Risk Factors are something to be aware of and there are many that can be assessed and reviewed. These include vitamin D, C-Reactive Protein (CRP is an inflammatory marker), Homocysteine (related to cardiovascular health), and Hemoglobin A1C (evaluating blood sugar over time). Body acid/alkaline state measured by morning urine pH (6.5?7.5 is ideal) is of value, as is bowel transit time to make sure our intestinal function is appropriate. Russ Jaffe, MD reviewed all of these areas and more at a recent talk in San Francisco.

10. Spirit Connection, Heart Affection, Stress Deflection, and Disease Protection?live each day in the moment, be present and mindful. Our loved ones, friends and co-workers often appreciate this. Learn to be a nurturer to those around you if you haven't developed that too much. Learn to listen and communicate better; it saves on the stress. A favorite part of my new and upcoming book, Staying Healthy with NEW Medicine, is in the stress section and relates to knowing how to "fair fight" or as the topic title suggests "The Art and Technique of Peacefully 'Not' Getting Along!" This is important.

It matters what you think, what you say, what you eat, and what you do. Be True to YOU!

Do you remember what life was like when you were 20 years old? Vaguely, huh? Well, those were the days when you had the energy to shoot hoops for three hours for nothing more than something to do. Those were the days of a 34-inch waistline and maybe some blonde highlights in the hair that grew on top of your head (not out your ears). And “ready for action” meant “ready anytime” not just for the next 36 hours like the Cialis® commercial promises.

When one thinks about sexual problems like erectile dysfunction (ED), the first thing that usually pops into the mind is, “the little blue pill.” But despite the fact that ED drugs like Viagra® (sildenafil citrate) and Cialis (tadalafil) don’t work for everyone and are associated with numerous possible side-effects, this doesn’t stop millions of men from using them. Figures show that one out of every five men over the age of 40 has tried Viagra with 48 percent experiencing at least one side effect.1

The problem with most ED drugs is they do nothing to increase sexual arousal. Just because the blood is pumping, doesn’t mean you’re in the mood to make things happen. This is where the “so-called” male hormone testosterone comes in. Testosterone is the key hormone of desire—in both men and women. As testosterone levels decline through age, so does libido. Studies show that low testosterone can lead to ED—especially in those with blood sugar disorders. Research presented in the International Journal of Impotence Research shows that testosterone supplements should be considered in the treatment of ED. The study indicated that testosterone therapy was able to alleviate ED in 34 percent of men who were unable to experience benefits from Viagra alone, whereas 38 percent of men showed improvements by using testosterone along with Viagra.2

One of the easiest ways to ensure healthy testosterone levels for maximum sexual health is to lose the excess belly fat. Studies show that the sexual function is usually diminished by the degree of obesity. In other words, the fatter one becomes, the harder it is to keep up in the bedroom (no pun intended).3

Enhancing libido and overcoming ED naturally

Following are natural way’s that have been proven to help overcome ED:
  • Follow a healthy diet. Italian researchers discovered that those who followed the Mediterranean diet (consuming lots of fish, vegetables, fruits, nuts and monounsaturated fats) the closest, tended to have the lowest incidence of ED.4
  • Exercise regularly. Regular exercise effectively reduces blood sugar and helps to clear occluded arteries (yes even that one).
  • Maintain prostate health through nutrient intervention. Nutrients like beta-sitosterol, flower pollen extract, natural lycopene, stinging nettle root, pygeum, selenium and zinc have been shown to help maintain healthy prostate function.
  • Supplement with Tongkat Ali Root (in order to elevate testosterone naturally). Studies show that a water extracted 100:1 extract of Tongkat Ali Root are able to naturally elevate testosterone levels and increase libido.


  1. Zhang XH, et al. Testosterone restores diabetes-induced erectile dysfunction and sildenafil responsiveness in two distinct animal models of chemical diabetes. J Sex Med. 2006 Mar;3(2):253– 64
  2. Hwang Ti-S , et al. Combined use of androgen and sildenafil for hypogonadal patients unresponsive to sildenafil alone. International Journal of Impotence Research (2006) 18, 400 –4.
  3. HammoudA, et al. Surgery on the Sex Steroids and Quality of Life in Obese Men. Journal of Clinical Endocrinology & Metabolism, April 2009, Vol. 94, No. 4 1329 –32
  4. Esposito K, et al. Dietary factors in erectile dysfunction. International Journal of Impotence Research (2006) 18, 370 –4.

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