Prostate Enlargement

Prostate Enlargement

The prostate is a small gland that only men have. It sits just above the rectum and provides a good deal of the fluid in semen. Unlike most body parts, the prostate gland grows larger as men age, a condition known as benign prostatic hypertrophy (BPH). By age 40, 10 percent of men have some degree of prostate enlargement. But at age 50, the figure is 50 percent, and it keeps increasing as the years pass. Why is this cause for concern?

The male urethra, the tube through which urine passes, is encircled by the prostate gland. As the prostate grows larger, it pinches the urethra, causing BPH symptoms. It becomes harder to urinate forcefully, and men with BPH have difficulty emptying the bladder completely. The hallmark symptom is having to get up at night to urinate.

Throwing Down the Gauntlet

I'm betting my own prostate gland that herbal treatments work better than the most commonly prescribed drugs or surgery for controlling BPH, also called noncancerous prostate enlargement.

The prescription drugs finasteride (Proscar) and terazosin (Hytrin) have become big moneymakers because they are the only pharmaceuticals that are approved to prevent prostatic proliferation, the growth of new prostate cells that causes BPH in men over 50.

I announced my intentions to challenge Proscar with the herbal alternatives, saw palmetto, licorice and pumpkin seeds, in the early 1990s, shortly after the Food and Drug Administration (FDA) approved the drug. I did it publicly at a conference in front of dozens of officials from the FDA and the National Institutes of Health (NIH). I wanted all of the "magic bullet" proponents to see that not everyone thought that a prescription drug was the best answer for BPH.

I publicly bet my prostate gland that my mixture of saw palmetto, licorice and pumpkin seeds, which I blend into something I call Prosnut Butter (see page 370), would do the same thing that Proscar does. I also declared that it was cheaper and probably safer.

The other reason that I bet my prostate in public was that I wanted to make some progress toward fulfilling my life's ambition, which is getting the FDA to make the drug companies test their new synthetic drugs not only against an inactive substance (a placebo) but also against any known or suspected herbal alternative.

If the synthetic proves to be better than the placebo and the herbs, then, fine, approve the drug. But if the herbs prove to be better, or even reasonably close in effectiveness, then both should be approved. To recoup its investment in the research, the pharmaceutical firm could get some marketing privileges for the processed herb extract as well as its new synthetic. This way, people could have a choice between the pharmaceutical, which is always much more expensive, and the herbal alternative, which is always cheaper.

A year's supply of Proscar costs about $800. A year's supply of saw palmetto and licorice would be only a small fraction of that, and if you stocked up on pumpkin seeds around Halloween, you could get them dirt cheap, possibly even for free.

Until Proscar and Hytrin came along, the only medically recognized treatment for BPH was surgery. One procedure is known as transurethral resection of the prostate (TURP). TURP is the most common operation performed on men over 65. During a TURP, the urologist threads an instrument up the urethra and cuts away part of the prostate gland to enlarge the opening for the urethra, thus easing urine flow. TURP generally works well, but it is expensive and carries the usual risks of surgery, and recovery takes a week or two.

Proscar and Hytrin have been widely hailed as alternatives because they're cheaper and less traumatic than surgery. But herbs are cheaper still.

Herbs on Trial

The drugs keep prostate cells from proliferating by preventing the gland from converting the male sex hormone testosterone into a related compound, dihydrotestosterone, that stimulates prostate cell proliferation.

While the drugs do indeed prevent this process from occurring, the natural alternatives that I mentioned work at least as well. In fact, in my opinion, and in the opinions of many naturopathic physicians, the herbs work a whole lot better.

Proscar, especially, has definite drawbacks. Most men must take it for at least six months before any significant improvement becomes apparent. And it doesn't work for everyone. Fewer than half of men taking Proscar experience significant clinical improvement even after one year.

Proscar also has some disturbing side effects, among them decreased libido, ejaculatory problems and erection loss. In contrast, herbs like saw palmetto, licorice and pumpkin seeds are not reported to cause any of these problems.

Green Pharmacy for Prostate Enlargement

Here are the details about the herbs that I can say without reservation provide the best results.

Licorice (Glycyrrhiza glabra). Licorice contains a compound that prevents the conversion of testosterone to dihydrotestosterone. Taking very large doses of licorice for a long period of time can produce headache, lethargy, sodium and water retention, excessive loss of potassium and high blood pressure. Some 25 cases have been documented in the world medical literature, and the people who developed problems ate two to four ounces of real licorice candy a day for years.

I doubt that the licorice extract in my Prosnut Butter would cause any problems. I've personally experienced no symptoms. But if you try the herbal approach to BPH, be alert to any symptoms and cu t down drastically on your licorice intake if you experience them.

Pumpkin (Cucurbita pepo). Pumpkin seeds were the traditional treatment for BPH in Bulgaria, Turkey and the Ukraine. The recommendation was a handful of seeds a day throughout adulthood.

The fatty oil in pumpkin seeds is a powerful diuretic, a fact that has caused some nay-sayers to assert that any increased urine flow has nothing
to do with relief from BPH. Pumpkin seeds, however, also contain chemicals called cucurbitacins that appear to prevent some transformation of testosterone into dihydrotestosterone.

In addition, pumpkin seeds can contain as much as eight milligrams of zinc per half-cup serving. Naturopaths Joseph Pizzorno, N.D., president of Bastyr University in Seattle, and Michael Murray, N.D, co-authors of A Textbook of Natural Medicine, suggest taking 60 milligrams of zinc per day for treating BPH. (This is much more than the Daily Value, so be sure to check with a doctor before you begin taking this much zinc.)

Zinc has been shown to reduce the size of the prostate, presumably by inhibiting the conversion process mentioned earlier. Pumpkin seeds are also high in certain Amino acids--alanine, glycine and glutamic acid. Dr. Murray and Dr. Pizzorno report that in a study of 45 men who were given supplements of these Amino acids (200 milligrams of each) every day, the regimen significantly relieved BPH symptoms.

A half-cup serving of pumpkin seeds can have 1,150 to 1,245 milligrams of alanine, 1,800 to 1,930 milligrams of glycine and 4,315 to 4,635 milligrams of glutamic acid. That's anywhere from 5 to 20 times the doctors' daily recommendation.

For all of these reasons, plus good flavor, I stress a good quantity of pumpkin seeds in Prosnut Butter.

There are some other seeds that contain these beneficial Amino acids. Buffalo gourd seeds contain generous amounts of all three, peanuts and sesame seeds are high in glycine, and almonds, butternuts and peanuts are high in glutamic acid.

Pumpkin This orange fruit is more than a Halloween prop: Its seeds contain a substance that can help relieve prostate problems.

Saw palmetto (Serenoa repens). Shortly after Proscar was approved by the FDA, the agency banned all nonprescription drugs for BPH. The ban was imposed for two reasons, according to Varro Tyler, Ph.D., dean and professor emeritus of pharmacognosy (natural product pharmacy) at Purdue University in West Lafayette, Indiana. First, the FDA said that no credible evidence was presented to show that any over-the-counter (OTC) products were effective. Second, the agency expressed the view that people who used the OTCs might delay getting proper medical treatment as their condition worsened.

"What the FDA overlooked," says Dr. Tyler, "was the considerable evidence in Western Europe that certain phytomedicinals (plant-based medicines) are effective in treating BPH and that people using them experience an appreciable increase in their comfort level. Perhaps the most popular of these is saw palmetto. . . . The beneficial effects include increased urinary flow, reduced residual urine and decreased frequency of urination."

Saw palmetto is a small palm tree that grows in the southeastern United States, particularly in Florida around the Everglades. Seminole Indians ate the saw palmetto seed as food; perhaps they noticed that it helped urinary problems. Whites adopted it as a diuretic to help flush excess water from the body, and over time it came to be used for BPH.

It works because it contains a compound that inhibits the action of the enzyme (testosterone-5-alpha-reductase) that turns testosterone into dihydrotestosterone. Preventing this transformation of testosterone is also the way Proscar works, but saw palmetto does the job in a different and apparently more effective way.

To date, a half-dozen well-designed studies have shown the effectiveness of saw palmetto. In one study, a clinical trial involving more than 2,000 Germans with BPH, a daily dose of one to two grams of saw palmetto seeds (or 320 milligrams of its hexane extract) produced substantial easing of BPH symptoms.

Pygeum (Pygeum africanum). In one study, German researchers gave either pygeum or a placebo to 250 men with BPH. In the placebo group, 31 percent reported improvement, a typical response rate for a placebo. In the pygeum group, the figure was 66 percent.

The recommended dose is 50 milligrams of bark extract twice a day. Depending on the method and concentration of the extract, this could represent a gram or a kilogram of bark. Although the extracts are still available in health food stores, they are made from a species that could be endangered by overharvesting. So you might want to try the other alternatives listed in this chapter before resorting to this one.

stinging nettle (Urtica dioica). According to the results of another study, extracts of stinging nettle roots have successfully treated BPH. Researchers gave a few teaspoons of the extract daily to 67 men over age 60 with BPH and found that the herb significantly reduced their need to get up at night to urinate. The herb apparently has some inhibitory effect on the conversion of testosterone. German medical herbalists recommend two to three teaspoons of extract a day to treat BPH.