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Benign prostatic hyperplasia

  • 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.

  • The prostate is an important male gland that secretes a fluid found in semen.1 In addition, the urethra (the tube through which urine flows) runs through the prostate, so changes in prostate structure, such as prostate enlargement, can profoundly and negatively affect urinary function. The most common issue that impacts prostate health for most men is benign prostatic hyperplasia. A more serious, common issue is prostate cancer. This article will review these problems, and consider some key nutraceuticals that may help.

  • You don’t need to believe that “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As is often observed, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. Women are not only the fairer sex, but when it comes to health, they are in general, also savvier. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. For example, whereas calcium and iron are good for women, these minerals may not be good supplement choices for men.

    For men, the primary health issues today probably are cardiovascular disease and conditions affecting the prostate. Heart disease is the leading cause of death in men and prostate cancer is the seventh. Are matters improving? It is hard to tell. For instance, the incidence rate of prostate cancer went up in the period from 1995 to 2000, although the death rate appeared to have stabilized. Fortunately, the rate of lung cancer continues to decline. As for heart disease, our current emergency medical interventions are so effective that the death rate is declining. However, actual cardiovascular health is not improving—the rate of occurrence of first heart attacks is going up. How could it be otherwise? Obesity, diabetes and hypertension are all increasing. Diabetes in adults males over the age of 20 is estimated to now occur at a rate of 9.3 percent (data for 1999–2000) compared to 7.9 percent in the period from 1988 to 1994. For men aged 60 or over, the rate in 1999–2000 was roughly 19 percent. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

    Cardiovascular Disease
    Cardiovascular health is a common topic of conversation. The reason, of course, is that heart disease in its various forms is the leading cause of death in adults and is especially prevalent in males. By age 60, one in five men will have already suffered a heart attack. The conditions to watch usually have been taken to be dysregulated blood lipids, homocysteine levels, hypertension, and obesity. More recently, it has been suggested that chronic low-level inflammation is a major causal factor in cardiovascular disease and that the Metabolic Syndrome (insulin resistance) is the actual underlying condition responsible for many or even most of the risk factors traditionally treated as indicators of heart and circulatory health.

    Antioxidants, Essential Fatty Acids and Minerals
    So-called “bad” cholesterol, low-density lipoprotein (or LDL), according to much current thinking, is only harmful if it has been damaged by oxygen and/or free radicals. Therefore, a protective program might include vitamin C (500 mg—2 grams daily) taken along with vitamin E as gamma-tocopherol (200 IU daily) and plant antioxidants. Tocotrienols, compounds from the same family as vitamin E, may be even more protective. A spate of studies have shown that the beneficial effects of vitamin E are much more pronounced in the gammatocopherol form and that vitamin E should not be supplemented alone, but rather in conjunction with vitamin C and the other antioxidants mentioned here. Indeed, many researchers now believe that the vitamin antioxidants are much more effective if used together and along with a variety of plant-derived antioxidants.

    Grape seed extract (100–300 mg daily) is commonly used in Europe by individuals who experience vascular and general circulatory problems. According to epidemiological data, safe and effective means of reducing heart disease risks include the ingestion of many such flavonoids, catechins and other polyphenols found in fruit extracts and tea. With regard to tea, these benefits come not just from green tea, but also from the theaflavins found in black and oolong teas. Another set of plant compounds that support heart health are lignans. Flax is especially rich in lignans. Tea, of course, is a beverage and flax is a food. Other food sources being mined for special antioxidants include olives and various highly colored berries.

    Similarly useful nutrients include the combination of L-carnitine (500–1,500 mg daily) and coenzyme Q-10 (30– 300 mg daily). Specialty forms of L-carnitine include L-carnitine fumarate, GPLC (glycine propionyl L-carnitine hydrochloride) and acetyl L-carnitine. Alpha-Lipoic acid (100–300 mg daily) is another good choice, and one with a particularly broad range of benefits. Minerals to supplement are chromium (200–600 mcg daily), magnesium (400 mg daily, preferably as magnesium aspartate) and selenium (200 mcg daily). A good broad-spectrum mineral supplement containing the Reference Daily Intake of copper should be considered if using the higher recommendation of vitamin C or if elevated triglycerides are a problem. Emerging evidence also supports supplementation with the lesser-known mineral silicon in the form of orthosilicic acid.

    Of great importance, for instance, in controlling inflammation, is the right balance of fats in the diet. It is accepted by most researchers that the modern Western diet is very poor in the essential fats known as omega-3 fatty acids. Sources of omega-3 fatty acids are flaxseed oil (1–2 tablespoons daily) and fish oil capsules (follow manufacturers’ recommendations). Just how important are these oils? Well, when the fish-supplemented trials are removed from statistical analyses of the standard low-fat dietary interventions routinely touted in medical circles, the benefits with regard to heart disease are marginal and overall mortality rates actually increase! Gamma-linolenic acid (GLA, 100–300 mg daily) can be taken in conjunction with omega-3 fatty acids for further protection against inflammation and to maintain immune balance when large amounts of fish oils are ingested. Finally, to protect against elevated blood homocysteine levels, supplement with vitamin B-6 (15–50 mg daily), vitamin B-12 (250 mcg daily) and folic acid (400 mcg daily).

    Prostate Health
    What can go wrong with the prostate? Plenty. Prostate problems typically can be catalogued under four headings: prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer. Prostatitis is really a catch-all term for several types of prostate problems. It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain (as opposed to discomfort). Prostatitis is fairly common in adult males. It sometimes has a bacterial infectious component, but it often has no clear cause. Abstaining from alcohol and spicy foods helps in some cases. Prostatodynia, which is most common in young and middle-aged men, often appears as pain and/or discomfort in the groin, perineum, testicles, lower back, and penis. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

    Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, nearly 60 percent of men age 40 to 59 are likely already to suffer from BPH. This usually does not present a noticeable problem until after age 50, but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer,although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers. Antioxidants, Essential Fatty Acids and Minerals

    Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruit and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a strongly negative effect upon prostate health. Studies suggest that supplementing with vitamin E (200 IU daily), lycopene (5–10 mg daily), and the minerals selenium (400 mcg daily) and zinc (15 mg daily) are good protective measures. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism. The work of E. Giovannucci of Harvard Medical School has been instrumental in uncovering the calcium/prostate cancer connection and the protective effects of fruit consumption nd an adequate intake of vitamin D (but not more than 400 IU daily).

    Isoflavone Herbal Preparations
    Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represent a promising approach to prostate health management. Also useful are extracts of saw palmetto berries and flower pollen. Indeed, specialty flower pollen extracts (from mostly rye pollen) have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis and prostatodynia.

    Prolonged stress poses a very real health risk, one with which men are less physiologically equipped to cope than are women. Higher rates of heart disease and high blood pressure are but two results. In the pre-modern world, many or even most threatening or challenging situations (“fight or flight” situations) led to a physical response which consumed and directed the energy made available by the release of hormones such as epinephrine into the blood stream. Physical responses, however, are not usually possible or even desirable in the face of stalled traffic or office frustrations. In such cases, the released energy is “bottled up,” as it were. This results in disturbances in sleep, immune function, blood pressure regulation and other bodily systems. As the “fight or flight” reference suggests, the best responses to stress are often physical. Try to get some vigorous physical exercise every day, but also consider practicing yoga or some similar form of relaxing physical therapy.

    Nutrients and Herbs for Relaxation
    Generalized emotional and physical stress leads to oxidative stress. Therefore, a broad-spectrum antioxidant mixture is an excellent countermeasure. Be sure to include in the diet, as well, the recommended daily intake of all of the B vitamins. The amino acids taurine (500 mg to 1 gram daily) and glutamine (750 mg to several grams daily) play important roles in the body’s response to stress. These are best utilized if taken between meals with a small carbohydrate snack. The bioflavonoid known as chrysin (1–3 grams daily) is an important stress-reducing compound, as are theaflavin, valerian and skullcap (see manufacturers’ directions). Also useful are calming herbal teas. The best known of these is chamomile.

    Sports Aches and Pains of the Weekend Warrior
    Exercise is important. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is that those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find that we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

    Conditioned athletes are actually able to produce more of certain antioxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. However, it is still true that exercise puts oxidative stress on the body. In various studies, athletes who ingested an antioxidant “cocktail” before working out experienced faster recovery and fewer aches and pains than those who did not take the antioxidants. The daily antioxidant intake might include vitamin C (500 mg–2 grams), vitamin E (100–200 IU as gammatocopherol), coenzyme Q-10 (30–300 mg), alpha-lipoic acid (100–300 mg), plus a number of plant antioxidants, such as mixed citrus bioflavonoids (1,000–3,000 mg). Individuals who are involved in contact sports might consider either grape seed or pine bark extracts (200–300 mg) to help prevent bruising. Glutamine (750 mg to several grams daily) recently has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion.

    Nutrients for Repair
    Ligament and cartilage injuries are common in sports. Glucosamine and chondroitin sulfate are often recommended in osteoarthritis to improve the repair of cartilage, and these compounds can also be used to speed up repair—or to improve general resilience—of the joints, ligaments and tendons in sports. (Follow manufacturers’ directions.) Sadenosylmethionine (SAMe) is another nutrient that improves tissue repair and indirectly reduces pain and inflammation; the dosage is typically 400–800 mg of SAMe per day. Expect to wait from one to four weeks to experience the benefits of these supplements if you are just starting to use them. These items improve the body’s ability to heal itself and are not directed at symptoms as such.

    Hair Loss
    Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean that other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. For example, extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence, this problem is not always cosmetic and concern may not be limited to vanity.

    Hair Nutrients
    Deficiencies in the B vitamins biotin, inositol, pantothenic acid, and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that high-potency supplementation with the entire range of B vitamins, with special attention paid to biotin, inositol and pantothenic acid, may prove to be helpful. Vitamin C (1–2 grams daily) is important for the circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–300 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1–3 grams daily), also supplemented as Nacetyl-cysteine (NAC, 500–750 mg daily), can help to increase the speed at which the hair grows. A new and really interesting item that improves the quality of the hair is choline-stabilized orthosilicic acid (BioSil)—it is worth a shot. No major improvements in scalp health or hair loss should be expected in less than three months’ time (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function, in which case, adding omega-3 fatty acids to the diet is also a good idea.

    Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, it is recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

  • More than fifty years ago, a special extract made from rye and other pollens was first discovered to provide dramatic relief not only from the symptoms of benign prostatic hyperplasia (BPH), but also from the symptoms of prostatitis and prostatodynia, two other common prostate conditions. The story of the discovery of these health benefits of pollen extract is wonderfully recounted in the book, The Prostate Cure, written by Harry G. Preuss, MD, and Brenda Adderly, MHA. However, the story of pollen extract does not end with its benefits in these conditions or even with its benefits in the area of prostate health. Recent research has shown that pollen extract inhibits the growth of some forms of cancer, that it activates important protective liver enzymes, and that it protects against damage to the heart and may improve athletic performance.

    Focus on the Prostate

    Pollen extract is a special mixture of both water-soluble and fat-soluble compounds derived from various pollens, chiefly rye, and often marketed under the name Cernilton. Most people know of pollen extracts in conjunction with prostate health. This generally is associated with benign prostatic hyperplasia (formerly called hypertrophy), which involves a renewed growth in the number of prostate cells late in life.1 Unfortunately, of men between the age of 40 and 59, nearly 60 percent can be shown to already be suffering from benign prostatic hyperplasia. This usually does not present a noticeable problem until after the age of 50; by the age of 80, however, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. The American Urological Association Symptom Index is now a standard assessment for BPH severity.

    Prostatitis is really a catch-all term for several types of prostate problems.2 It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain at all (as opposed to discomfort). Prostatitis is fairly common in adult males and has been classified into four types. Only at most five percent of all cases consist of either acute or chronic bacterial prostatitis, i.e., cases in which infection and the aftermath of infection are the main issues. Nonbacterial prostatitiscomprises 64 percent of cases and Prostatodynia makes up another 31 percent.

    Nonbacterial prostatitis is the most common of the prostatic conditions, but its cause has not been isolated. It is characterized by an unusually high number and activity of inflammatory cells in the prostate. The resulting inflammation resembles that found in chronic prostatitis, but there is no history of infection nor do cultures (for bacteria) prove positive. Conventional medical treatments do not yield good results. Abstaining from alcohol and spicy foods helps in some cases.

    Prostatodynia, which is most common in young and middleaged men, presents many symptoms similar to the above, but lacks the excessive number of inflammatory cells. Just as nonbacterial prostatitis has some symptoms that are peculiar to it, so, too, does prostatodynia. In particular, pain and/or discomfort in the groin, perineum, testicles, lower back and penis seem to characterize this condition. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. The subsequent reflux of urine into prostatic and ejaculatory ducts causes a chemically-induced inflammation. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

    Of these three conditions, BPH is what concerns most men. Prostate enlargement is strongly related to normal aging. Some of the factors involved are quite well understood. Nevertheless, there also is substantial disagreement about other issues. BPH can be called an aspect of male menopause because an increased ratio of estrogen to testosterone is active in BPH just as, conversely, in women passing through menopause the ratio of testosterone to estrogen increases. Testosterone, the “male” hormone, is at its peak during adolescence. It decreases thereafter, and the rate of decrease sharpens by about age 50. The decline in testosterone production typically calls into play the compensatory release of other hormones, which are stimulants to testosterone production. These cannot prevent the decline in testosterone levels, but they can lead to an elevated rate of transformation of testosterone into 5-alpha-dihydrotestosterone (DHT) and to the increased binding to and/or decreased clearance of DHT from prostate cells. Testosterone is converted to DHT by the enzyme 5-alphareductase. Ultimately, it is DHT’s actions that cause the enlargement of the prostate. DHT binds to specific receptors on the prostate cells, the alpha 1-receptors. It then is transported into the nucleus of these cells where it attaches to the DNA and ultimately turns on prostate growth.

    How do pollen extracts work? Clinical trials with these extracts covering 12 weeks of treatment generally have produced improvements in cases of BPH and prostatodynia of between 60 and 88 percent when adequate dosages were administered and depending upon the severity of the starting condition. The first mechanism of action is smooth muscle relaxation, something that promotes the ability to urinate as spasms in the smooth muscle tissues are reduced. In animal studies, pollen extracts have been shown to inhibit urethral contraction, which facilitates the discharge of urine. Data in these studies is consistent with the observations that pollen extracts facilitate voiding of the bladder and reduce residual urine.

    A number of clinical studies have shown that the pollen extracts reduce the size of the prostate in those individuals suffering from BPH. These data indicate that pollen extracts should either inhibit the formation of DHT by blocking the alpha-reductase enzyme, or act to block the binding of DHT to the alpha 1-receptor and thus improve the clearance of DHT from the prostate. Either mechanism could be effective in blocking the DHT-induced biological cascade that leads to prostate enlargement.

    Inflammation, Immune Functions and the Liver

    Inflammation underlies a large number of conditions, including several of those improved by pollen extracts. Evidence to support the anti-inflammatory action of the pollen extracts comes from both animal and clinical experience. Three animal studies indicated that pollen extracts exhibit anti-inflammatory activities. The first showed that pollen extracts inhibit the arachidonic acid cascade, a primary generator of free radicals in the tissues. The second indicated that orally administered pollen extracts counteract the inflammatory process found with artificially-induced liver damage in rats. The third showed that an induced inflammatory condition in rodents was significantly reduced by pollen extracts. It has been proven that pollen extracts are active in human subjects against inflammation. As noted already, several clinical studies also have shown that pollen extracts are an effective treatment for the inflammatory prostate conditions prostatitis and prostatodynia.

    Mechanisms of action involving inflammation link pollen extracts to conditions that involve more than just the prostate. It has long been known that pollen extracts modulate the actions of the immune system. Many years ago, researchers showed that the water-soluble fraction selectively inhibits the growth of some prostate cancer cell lines. Later research was published, which showed that a compound found in the water-soluble fraction does not merely inhibit prostate cancer cell growth, but actually causes the death of these cells.3 These results were found in vitro studies (that is, in cultured cells), yet they provide promise for research to come.

    The liver protective effects of pollen extract, which have been researched over the years, have received another boost from scientists in the Ukraine. In this case, the tests were in vivo, that is, with animals using a special extract of beecollected pollen. First, it was established that small doses of x-ray radiation cause oxidative damage to fats in the liver (lipid peroxidation) and that this damage activates antioxidant enzyme protective systems. Next, it was discovered that the introduction of pollen extract into the animals’ systems normalized the activity of the glutathione enzyme system, one of the most important of the body’s in-built antioxidant systems.4

    Immune Functions for the Heart and Recovery

    Surprisingly, pollen extracts may possess the ability to protect the heart against certain types of assault. The ability of pollen extract to protect the cardiovascular system against free radical damage was demonstrated over a decade ago. Now, taking research in a quite different direction, it has been shown that the damage to the heart that can be caused by excess adrenaline also can be reduced by the use of the water-soluble fraction of the pollen extract.5 Researchers admit that they do not have a good explanation for how this cardioprotection is achieved; yet their findings open up the possibility for totally new uses for pollen extract in the future!

    Similar to the cardiac protection afforded is general immune protection. Although primarily known as treatments for BPH, flower pollen extracts have been thoroughly studied for their anti-inflammatory properties and their abilities both to boost flagging immune functions.6 One of the findings of this research is that pollen extracts act as immunoregulators and can reduce immune hyperactivity. The serious reader can work through the earliest literature on the development of pollen extracts in Europe and discover that the early uses of pollen extracts were a) for recovery during convalescence and b) recovery from sports exertions.

    Pollen extracts have turned out to be surprisingly versatile in their range of health benefits. Along with the prostate benefits, there further are general immune benefits, effects on cancer, the liver, sports recovery and much more.7 Every man aged 50 and above probably should consider a pollen extract supplement as insurance against BPH and other prostate issues. However, given the range and variety of benefits associated with pollen extracts, there is a good argument to be made for men to supplement with pollen extracts for general protection against over-training and or supporting immune imbalance.

    1. 1 F. Hinman, Benign Prostatic Hypertrophy. New York: Springer Verlag, 1983.
    2. 2 E.M. Meares, Jr., “Prostatitis and Related Disorders,” in Campbell’s Urology, 6th edition, ed. by P.C. Walsh, et al. Philadelphia, PA: W.B. Saunders Company, 1992, pp. 807–22.
    3. 3 Roberts KP, Iyer RA, Prasad G, Liu LT, Lind RE, Hanna PE. “Cyclic hydroxamic acid inhibitors of prostate cancer cell growth: selectivity and structure activity relationships.” Prostate 1998 Feb 1; 34(2):92–9.
    4. 4 Bevzo VV, Grygor’eva NP. [Effect of bee pollen extract on glutath one system activity in mice liver under X-ray irradiation]. [Article in Ukrainian] Ukr Biokhim Zh 1997 Jul-Aug; 69(4):115–7.
    5. 5 Polanski M, Okon K, Przybylo R, Frasik W. Cardioprotective properties of hydrophilic pollen extract (HPE). Polish Journal of Pathology 1998; 49(2):109–12.
    6. 6 Samochowiec L, et al., “General immunological properties of fat soluble (Cernitin GBX) and water-soluble (Cernitin T60) pollen extracts,” European Journal of Pharmacology 183, 3 (1990) 906.
    7. 7 Graminex_Clinical_Studies_Index found at
  • As pointed out last year in a review of pollen extract for prostate support, benign prostatic hyperplasia (BPH, formerly called hypertrophy), involves a renewed growth in the number of prostate cells late in life.1 Unfortunately, of men between the age of 40 and 59, nearly 60 percent can be shown to already be suffering from benign prostatic hyperplasia. This usually does not present a noticeable problem until after the age of 50; by the age of 80, however, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra.

    BPH is hardly the lone prostate and sex hormone related issue that can be troubling to men. Aside from prostate cancer, which for most men is so slow growing as to not be life threatening, many men are concerned about low testosterone, which has its own repercussions. Two of the repercussions of low testosterone are a low level of muscle-maintaining free testosterone and elevated levels of estrogen produced from testosterone by a pathway referred to as the aromatase pathway. Fortunately, there are a number of safe natural compounds that can help to regulate both sides of this equation.

    Protective herbs and nutrients have counterparts that increase the risks of various conditions. Some of these potentially damaging compounds are prescriptions given for unrelated conditions and this provides a rationale for being cautious about prescription drugs. What you do not know definitely can hurt!


    In 2013, experts slammed a claimed fish oil/omega-3 fatty acid intake link to prostate cancer as “scaremongering.” The trial in question purported to find increased risks for total prostate cancer as well as increased risks of both low-grade and high-grade prostate cancer, an increase of 71 percent in this latter category.2 The responses were quick and brutal. One nutritionist (Duffy MacKay, vice president of scientific and regulatory affairs at the for Responsible Nutrition (CRN)) pointed out, quite correctly, that the findings of this study were based on blood level differences so small that “[t]his change [of 0.2%] literally could have occurred if somebody ate a fish sandwich on their way to get their blood drawn.”3 Both the consumers of the low and the high levels of long chain omega-3 fatty acids were within the normal blood range.

    Others pointed out that the findings of the study clearly imply that men in countries with high levels of consumption of seafood, such as Scandinavia and Japan, should exhibit high levels of prostate cancer, yet the opposite is the case. Alan Ruth, PhD, CEO of the Irish Health Trade Association observed, “[i]n a 2010 meta-analysis of 31 studies published in the American Journal of Clinical Nutrition, the risks of prostate cancer diagnosis calculated for high fish consumption ranged from a 61% decrease in risk to a 77% increase in risk, and several showed no significant differences in risk at all…In the same meta-analysis, pooled data from four studies on fish consumption and death from prostate cancer (rather than diagnosis of prostate cancer) found a 63% decrease in risk for high fish consumption.”4

    Especially interesting in this dust-up is the recent attempt to rehabilitate omega-6 fatty acids. In pre-modern times, the intake of omega-3 to omega-6 fatty acids in the diet typically was in the range of one-to-two, whereas today in the United States it regularly may be as low as one-to-twentyfive, with prostate cancer rates climbing steadily over the last 60 years. In this instance, a headline is revealing: “Corn oil, omega-6 could speed up prostate cancer.”5 Journal article titles are more prosaic, yet just as damning: “A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer.”6

    Barry Sears, who has written for years on the health effects of fatty acids, both good and bad, tartly comments in his blog, “Omega-3 fatty acids and prostate cancer? Oh, really?”7 Among other things, Sears demonstrates how easily a statistically significant blood reading of fatty acid profiles can be attached to otherwise clinically irrelevant findings. The take away message in this case is that the experience around the world repeatedly has been that prostate risks, especially death from prostate cancer, are lower in matched populations that consume more fish. There is nothing in recently published research that should make us doubt that improving the omega-3 to omega-6 ratio in our diets is a good goal at which to aim.

    Grape Skin Extract & Resveratrol
    In many areas in the US and the United Kingdom (Scotland has not yet opted out of the Union), one cannot visit a doctor without being queried about alcohol intake and then the required lecture on the evils of alcohol. The distinction as to the source of alcohol in the diet routinely drops out despite the fact that red wine has been recognized in Europe for centuries as exhibiting various health benefits and little downside as long as consumed in moderation. It turns out that red wine, often thought of in terms of the heart, may benefit the prostate, as well.

    The trick to the studies is that the researchers must work vigorously to screen for the different sources of alcohol over the course of a man’s life. If this is done, then the research is likely to confirm that a glass of red wine per day may be protective against the risk of prostate cancer.8 Less clear is which compounds in red wine are protective. Perhaps many are. A recent study on grape skin extract and resveratrol identified several protective mechanisms of action.9 Some of the factors linked to resveratrol have been known for years, whereas other mechanisms and, similarly, the benefits of other red wine compounds, are being vigorously researched. Grape seed components (proanthocyanidins) are another example of a source of anti-cancer benefits.10 Given the huge volume of papers being published today on the healthprotective benefits of red wine and its ingredients, it is a reasonable conclusion that most men may benefit from one or two glasses of red wine per day consumed with meals.

    Quercetin & EGCG
    The dietary bioflavonoid quercetin is well known to readers of this magazine, as is epigallocathechin gallate (EGCG). Both compounds are considered to be health protective and quercetin, in particular, is known to improve the uptake (bioavailability) and the benefits of many other compounds found in the diet and in herbs. Papers routinely show greater efficacy or even benefits where none initially were found, when quercetin is combined with resveratrol, with sulphorafane, with EGCG, etc. One of the more interesting recent findings is that these combinations sometimes not only can help to prevent the transformation of cells from precarcinogenic stages to active cancer, but also can interfere with or eliminate entirely cancer stem-cell characteristics. Cancer stem cells are the ultimate source of cancer self-renewal, so this action by the combination of quercetin and EGCG is a warm recommendation.11

    Bitter Melon
    Bitter melon has received quite a bit of publicity recently with regard to pancreatic cancer. It would be unfortunate were the exploration to end there. Several researchers have reported that treatment of bitter-melon-related products in a number of cancer cell lines induces cell cycle arrest and apoptosis without affecting normal cell growth.12 Researches targeted specifically at prostate cancer have demonstrated that the impact of bitter melon extends to this area.13 Admittedly, bitter melon is not a staple at the American table. Perhaps that should change. See my earlier article, “Going WILD with Bitter Melon for Blood Sugar Support.”14

    Pomegranate is a fruit long associated with healing and medicine. Indeed, the pomegranate is on the crest-of-arms of the British Royal Society of Medicine and of many other ancient organizations devoted to healing. A quick look at the PubMed database shows that the keywords “pomegranate” and “prostate” bring up 60 studies. Many of these studies have been promising, especially when pomegranate was added to other ingredients with related and differing mechanisms of action. For instance, in 2013 the polyphenol rich whole food supplement Pomi-T® (pomegranate seeds, green tea, broccoli, and turmeric) was reported to have a direct anti-cancer effect in men with prostate cancer.15 These results were confirmed in a larger clinical trial published in 2014.16

    Thymoquinone and Black Seed
    Few Americans have heard either of black seed or thymoquinone (TQ). The former is famous for healing in the areas in which it grows naturally, meaning much of the eastern Mediterranean through the Near and Middle East all the way to India. Mohammed is reputed to have said that the seed cures every condition except death itself.

    With regard to the prostate, black seed is useful for both BPH and in preventing prostate cancer induction. One of the important ingredients in black seed oil, thymoquinone, promotes healthy apoptosis in prostate cells and therefore helps the body to regulate the size and health of the prostate.17,18 Similar effects have been found in, for example, breast cancer, so TQ has a broad spectrum of applications.19

    Cactus Flower
    A couple of decades back, the herbal extract chrysin was introduced to the athletics and body building world as an answer to improving free testosterone levels and reducing the pathway (aromatase) that transforms testosterone to estrogen. Chrysin has some benefits, as long as one does not expect too much and is willing to focus on the anxiolytic qualities of the compound (found in passion flower). However, much more successful compounds for this purpose of increasing free testosterone, and so forth, have been found. One of these is an extract of cactus flower (Opuntia ficus-indica).

    I ran across this almost a decade ago being sold in Germany and Israel for BPH,20 but at the time could not find a reliable source of supply. Since then, a friend with whom I was working took this item and continued to dig until he found a reliable source that he could market as increasing serum free testosterone levels and reducing aromatase (reducing estrogen production and inhibiting the binding of dihydrotestosterone/DHT.) As my friend writes at his website, based on preliminary laboratory research, “Opuntia flower extract (1 mg/ml concentration) inhibited over 80% of the activity of 5-alpha reductase in human prostate tissue homogenate and inhibited over 80% of aromatase activity in human placenta tissue homogenate.”21 This particular product also contains supporting ingredients, such as an extract of stinging nettle root.

    Some Prostate-Questionable Foods and Pharmaceuticals Now for a few items that men may want to remove from their daily habits or environment.

    • Non-and low-fat milk (but not whole milk or other dairy products) intake by men is linked to higher rates of prostate cancer22
    • Long-term use of statins increases the risk of prostate cancer23
    • Oral contraceptive use is associated with prostate cancer—this refers to these contraceptives getting into the environment at large and not to use by one’s partner24

    There are protective foods, nutrients and herbs of which men should take advantage to maintain and regain prostate health as well as improve other parameters of health and performance. Omega-3 fatty acids and the active compounds found in red wine (grape skin anthocyanidins and other compounds, resveratrol, grape seed proanthocyanidins, quercetin), green tea (EGCG) and bitter melon are on this short list. More exotic are black seed and thymoquinone as well as cactus flower extract. For the most part, these can be characterized as special foods since they can be consumed over the long term and have few or no downsides even when consumed chronically in large amounts. Indeed, this should be the goal—a little prevention is always worth a whole lot of cure.

    1. 1. F. Hinman, Benign Prostatic Hypertrophy. New York: Springer-Verlag, 1983.
    2. 2. Brasky TM, Darke AK, Song X, Tangen CM, Goodman PJ, Thompson IM, Meyskens FL Jr, Goodman GE, Minasian LM, Parnes HL, Klein EA, Kristal AR. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst. 2013 Aug 7;105(15):1132– 41. doi: 10.1093/jnci/djt174.
    3. 3. Experts slam omega-3 link to prostate cancer as overblown ‘scaremongering.’
    4. 4. Ibid.
    5. 5.
    6. 6. Williams CD, Whitley BM, Hoyo C, Grant DJ, Iraggi JD, Newman KA, Gerber L, Taylor LA, McKeever MG, Freedland SJ. A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer. Nutr Res. 2011 Jan;31(1):1–8. doi: 10.1016/j.nutres.2011.01.002.
    7. 7.
    8. 8. A glass of red wine a day keeps prostate cancer away?
    9. 9. Hudson TS, Hartle DK, Hursting SD, Nunez NP, Wang TT, Young HA, Arany P, Green JE. Inhibition of prostate cancer growth by muscadine grape skin extract and resveratrol through distinct mechanisms. Cancer Res. 2007 Sep 1;67(17):8396–405.
    10. 10. Raina K, Singh RP, Agarwal R, Agarwal C. Oral grape seed extract inhibits prostate tumor growth and progression in TRAMP mice. Cancer Res. 2007 Jun 15;67(12):5976-82.
    11. 11. Tang SN, Singh C, Nall D, Meeker D, Shankar S, Srivastava RK. The dietary bioflavonoid quercetin synergizes with epigallocathechin gallate (EGCG) to inhibit prostate cancer stem cell characteristics, invasion, migration and epithelial-mesenchymal transition. J Mol Signal. 2010 Aug 18;5:14. doi: 10.1186/1750–2187–5–14.
    12. 12. Nerurkar P, Ray RB. Bitter melon: antagonist to cancer. Pharm Res. 2010 Jun;27(6):1049–53. doi: 10.1007/s11095–010–0057–2.
    13. 13. Ru P, Steele R, Nerurkar PV, Phillips N, Ray RB. Bitter melon extract impairs prostate cancer cell-cycle progression and delays prostatic intraepithelial neoplasia in TRAMP model. Cancer Prev Res (Phila). 2011 Dec;4(12):2122–30. doi: 10.1158/1940–6207.
    14. 14.
    15. 15. Goodman A. High Marks for Nutritional Supplement in Patients with Localized Prostate Cancer. Value-Based Cancer Care. September 2013 Vol 4, No 7.
    16. 16. Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. A doubleblind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer-the UK NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 2014 Mar 11. doi: 10.1038/pcan.2014.6.
    17. 17. Kaseb AO, Chinnakannu K, Chen D, Sivanandam A, Tejwani S, Menon M, Dou QP, Reddy GP. Androgen receptor and E2F-1 targeted thymoquinone therapy for hormone-refractory prostate cancer. Cancer Res. 2007 Aug 15;67(16):7782–8.
    18. 18. Kumar AP, Sethi G, Tan KH. Thymoquinone: potential cure for inflammatory disorders and cancer. Biochem Pharmacol. 2012 Feb 15;83(4):443–51. doi: 10.1016/j.bcp.2011.09.029.
    19. 19. Rajput S, Kumar BN, Sarkar S, Das S, Azab B, Santhekadur PK, Das SK, Emdad L, Sarkar D, Fisher PB, Mandal M. Targeted apoptotic effects of thymoquinone and tamoxifen on XIAP mediated Akt regulation in breast cancer. PLoS One. 2013 Apr 17;8(4):e61342. doi: 10.1371/journal.pone.0061342.
    20. 20. Palevitch D., Earon G., Levin I., Treatment of benign prostatic hypertrophy with Opuntia ficus-indica (L.) Miller. Journal of herbs, spices & medicinal plants. J. herbs spices med. plants 1993;2(1):45–49.
    21. 21. drawing upon Jonas A, Rosenblat G, Krapf D, Bitterman W, Earon G, Neeman I. Efficacy of cactus flowers miller treatment in benign prostatic hyperplasia due to inhibition of 5a reductase activity, aromatase activity and lipid peroxidation. HerbaMed paper; undated. Available at:
    22. 22. Park SY, Murphy SP, Wilkens LR, Stram DO, Henderson BE, Kolonel LN. Calcium, vitamin D, and dairy product intake and prostate cancer risk: the Multiethnic Cohort Study. Am J Epidemiol. 2007 Dec 1;166(11):1259–69.
    23. 23. Chang CC, Ho SC, Chiu HF, Yang CY. Statins increase the risk of prostate cancer: a population-based case-control study. Prostate. 2011 Dec;71(16):1818–24. doi: 10.1002/pros.21401.
    24. 24. Margel D, Fleshner NE. Oral contraceptive use is associated with prostate cancer: an ecological study. BMJ Open. 2011 Nov 14;1(2):e000311. doi:10.1136/bmjopen–2011–000311.