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
- 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:
Stool / Bowel
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.
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).
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.
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.