Benign Prostatic Hyperplasia or BPH
BPH is a highly prevalent imbalance in aged men, characterized by dysregulation of cell growth of the prostate epithelium and stroma. The prevalence increases from 8% to 50% once a man reaches 50 years of age. Symptoms include urinary frequency, urgency, straining, and incomplete voiding of urine. BPH can lead to prostate cancer in some men, and so it is important to take preventative measures, and make changes to reverse or minimize the risk factors.
Metabolism, or breakdown of testosterone
Testosterone is metabolized to DHT via an enzyme called 5-alpha reductase, and is metabolized to estrogen via aromatase enzyme. There is research showing both DHT 
and estrogen directly contribute to BPH. Normal regulated metabolism of testosterone in a healthy man does not create the environment for BPH. Answers to healing or preventing BPH lie in reducing the metabolism, or rather, reducing the overstimulation of metabolism to these downline metabolites – estrogen and DHT and in addition to reducing inflammation in the body overall.
Stress and BPH
Harvard study showed two mechanisms are involved. Stress increases both adrenaline and testosterone. Adrenaline is triggered to release by the sympathetic nervous system and constricts blood vessels in smooth muscle including the prostate and bladder. This mechanism can make it difficult for a man to urinate. Testosterone is produced in addition to other stress hormones triggered by the hypothalamus and the Hypothalamus-Pituitary-Gonadal (HPG axis).
Testosterone replacement therapy
There has been much debate over testosterone therapy and BPH. Low testosterone in men has been recognized and treated with testosterone replacement therapy for many years now. Low testosterone can contribute to erectile dysfunction, low mood, insulin resistance and obesity in men. Testosterone therapy in hypo gonadal men (those with low testosterone) who have BPH, showed improvement in 31% of the 120 patients. This is a small study, however, it shows that clearly there are other factors than testosterone alone involved in the development of BPH. Another study of Japanese men showed those with the highest testosterone levels had the smallest prostates, and those with the highest estrogen levels, had the largest. Alcohol increases aromatase enzyme which creates more estrogen from testosterone. So the combination of frequent alcohol consumption and testosterone therapy may lead to BPH symptoms.
Exercise and BPH
Harvard study of 3743 participants, found an inverse relationship between physical activity and BPH, even low to moderate activity. The reason is unknown, one theory is that exercise ultimately lowers activity of the sympathetic nervous system. Also, the study showed that those who spent the most time watching television were twice as likely to have BPH symptoms.
Obesity
BPH is highly likely in a man who is obese. Obesity can be measured by height/weight ratio or BMI (body mass index) over 30. A Harvard study of over 25,000 men concluded that if a man’s waist is more than 43 inches in circumference, they are 2.4 times more likely to need surgery for their BPH than a man whose waist is less than 35 inches. Obesity, sedentary lifestyle, cardiovascular disease and increased inflammation in the body all are strongly associated with BPH. Excess adipose tissue on the body (fat) alone, without the other factors, can cause BPH due to the estrogenic activities in the fat tissue, especially abdominal fat. Obesity and insulin resistance are associated with increased 5-alpha reductase activity, which metabolizes testosterone to DHT and stimulates prostate growth.
Understanding insulin resistance
Cells of the body need glucose to grow and function. Insulin is responsible for helping the glucose get into the cells. When a diet rich in carbohydrates or is eaten on a regular basis, the baseline insulin levels rise to lower the blood glucose level. The cells then become resistant to the “call” of insulin. This leads to higher and higher levels of insulin, which signals the body to store make triglycerides to store fat. Insulin resistance causes abdominal fat deposits, and obesity.
Prolactin levels
The hormone prolactin in men is involved in BPH. Prolactin increases the effect of the androgens, both testosterone and DHT on the proliferation of sexual organs, including prostate. Ones level of sexual satisfaction in both men and women has correlated with levels of prolactin. Drinking beer can also increase prolactin levels, and also increases the conversion of testosterone to estrogen, which can worsen BPH. Prolactin is also increased by hypothyroidism and by smoking marijuana. High dose pyridoxine or B6 has been found to lower prolactin levels in men.
Zinc
Prostate cells contain the highest amount of zinc of any cell in the body. Zinc has been shown to dramatically reduce the prostate cell’s rate of growth. Zinc plays an important role in regulating prostate cell growth. Pumpkin seeds contain a high amount of zinc. They also contain beta-sitosterol which is a fatty compound that blocks the conversion of testosterone to DHT. A German study of over 2500 patients showed pumpkin seed extract reduced BPH symptoms by 41%. An Australian study linked heavy metals in the body to BPH. Heavy metals block zinc. Other toxins linked to BPH are poly aromatic hydrocarbons and BPA, BPA was found to bind to zinc.
Inflammation and NFkB and how to reduce it naturally
NFkB is a naturally occurring chemical in our bodies that is activated in immune cells and increases the production of cytokines (inflammatory) and growth factors (can cause BPH) that can cause a normal cell to lose its regulatory mechanisms and become a cancer cell. To prevent BPH and cancer, it is important to inhibit or reduce the level of NFkB in our bodies. NFkB is increased when cells are exposed to high glucose for prolonged periods of time, such as in obesity, diabetes, and insulin-resistance. Eating a Mediterranean diet, meditation and yoga have shown to inhibit NFkB.
Much research has been done on vitamins and nutrients that reduce inflammation and NFkB activation. These include vitamin C, vitamin E, N-acetylcysteine, S-adenosyl-methionine (SAMe), Alpha Lipoic Acid, Zinc, and EPA/DHA (omega 3 fatty acids). Also curcumin, lycopene, resveratrol, EGCG from green tea, capsaicin, licorice root extract, clove extract, basil, rosemary extracts, ginger and pomegranate fruit extract have studies that show they decrease or inhibit NFkB. Plants and vitamins all affect NFkB in different ways to exert the health benefits and modulate these inflammatory processes.
Plant medicine
Botanicals with multiple positive studies showing effectiveness in reducing the mechanisms involved in BPH. Saw palmetto berry extract, when taken with selenium and lycopene, blocks conversion of testosterone to DHT. Pygeum africanum blocks DHT’s activation of the receptors on the prostate cell. Stinging nettle reduces the size of epithelial cells of the prostate. It has shown effectiveness equal to the drug finasteride and does not have side effects. Remember to find products with these in combination. Botanicals work best together, as they are synergistic and have different modes of action on the prostate. Standardized extracts of botanicals are more potent forms, as opposed to raw herb powder.
In conclusion, BPH can be prevented and or healed by making a few simple changes in our life. I hope you are inspired to take some of this into consideration and share the information with your loved ones. Here is where we can make a difference, by working with our body to create an environment that will promote health, rather than disease. Natural medicine can play a role. As always, if you have questions, please Contact Me. Be well!