The prostate is an essential part of the male reproductive system, protecting sperm and producing about one-third of the fluid in semen. A small gland about the size of a walnut, the prostate typically expands with age. Still, excessive growth can trigger urinary symptoms: urgency, frequency, and a sensation of fullness, even after emptying the bladder.1Enlarged Prostate (Benign Prostatic Hyperplasia). Yale Medicine. Accessed September 1, 2023. https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph
Benign prostatic hyperplasia (BPH) affects about 8% of men in their 40s. BPH affects nearly half of men in their 60s and approximately 80% of men in their 90s.2GBD 2019 Benign Prostatic Hyperplasia Collaborators. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Healthy Longev. 2022;3(11):e754-e776. https://doi.org/10.1016/S2666-7568(22)00213-6
“Eventually, your pee will slow down,” says urology and men’s health expert Eric Yarnell, ND, RH (AHG). “That happens to everyone with a prostate [who doesn’t take] action. And prostate enlargement could cause kidney failure if it becomes bad enough. There’s high awareness, but there is a false message that prostate enlargement is inevitable. There’s no discussion on prevention.”
What Is Benign Prostatic Hyperplasia?
BPH and prostatitis are the leading causes of urinary symptoms like slow flow, getting up at night to urinate, urinary urgency, and daytime frequency. What’s the difference between BPH and prostatitis? As Dr. Yarnell notes, the prostate gland has five different areas. BPH occurs in the transition zone, which surrounds the urethra. In hyperplasia (the H in BPH), normal cells (not cancerous cells) have divided excessively, making too many copies of themselves.
“The urethra goes right through the middle, so it can be crushed and compressed,” explains Yarnell. Just as a bent garden hose will reduce water flow, compression can interfere with the passage of urine. This may be due to the prostate’s sheer mass or to excess cells (some of which are called smooth muscle cells) overreacting and going into spasm in response to even small amounts of urine in the bladder. Prostatitis or inflammation is restricted to the prostate’s central zone and does not cause enlargement. In addition to the urinary symptoms described above, prostatitis commonly causes pain—a big difference from BPH. Both conditions can affect some men at the same time.
Many factors influence prostate growth, including hormones and lifestyle. “As we get older, the ratio of testosterone to estrogen shifts,” says Yarnell. “More testosterone is converted to estrogen, and it’s a more gradual shift over many years. When that’s been going on for 20 years, [there is] a huge effect.”
Xenoestrogens are chemicals that act like estrogen in the body, causing cells to make multiple copies. “Xenoestrogens are a growing problem,” Yarnell notes. “Companies can make and sell chemicals without proving they’re safe. They have unexpected effects.”
Even with organic products, xenoestrogens appear in plastics (food and produce wrappings). They are in the water we drink, cook with, and bathe in; they’re in the air we breathe. Even with water and air filters, xenoestrogens are nearly impossible to avoid. “Look at Inuit people who don’t eat Western food and live near the Arctic Circle. They have some of the highest levels of these chemicals in the world because xenoestrogens bioconcentrate across the food chain into seals and fish,” explains Yarnell. With bioconcentration, an animal’s exposure to water and air and ingestion of smaller organisms leads to a buildup of chemicals.
Research suggests that xenoestrogens (such as bisphenol A) found in plastic food containers, aluminum cans, and thermal paper receipts3Canada H. Bisphenol A (BPA). Published April 16, 2013. Accessed September 1, 2023. https://www.canada.ca/en/health-canada/services/home-garden-safety/bisphenol-bpa.html, even in small doses, can worsen BPH symptoms.4Wu JH, Jiang XR, Liu GM, Liu XY, He GL, Sun ZY. Oral exposure to low-dose bisphenol A aggravates testosterone-induced benign hyperplasia prostate in rats. Toxicol Ind Health. 2011;27(9):810-819. https://doi.org/10.1177/0748233711399310
Lifestyle factors also contribute to BPH. Research comparing enlarged prostate rates among Japanese men who eat a traditional diet with Japanese men in other parts of the world who adopt a Western diet shows climbing rates of BPH in the latter. “There’s something about the Western lifestyle,” says Yarnell. “BPH rates go up exactly as you become more Westernized. Some combination of food, exercise, staying up too late, pollution … there are hundreds of changes. There’s no question that this constellation of things makes [BPH] worse.”
What are BPH rates like in other countries? “All around the world, prostate cells divide too much,” Yarnell notes. “But the rate of symptomatic disease that causes problems is what changes—in the West, that’s what really starts to go up. It’s much rarer in Japan and Africa.”
Herbal Supplements for an Enlarged Prostate Gland
Dr. Yarnell has a clear message for men in their 30s and 40s: “If you wait until you get symptoms and you’re in your 50s, you have already missed a huge opportunity of 10–20 years of prevention. The main role of herbs in an enlarged prostate is prevention.”
Saw Palmetto and Stinging Nettle
Saw palmetto is a popular herb for men’s health, long used by indigenous people in North America for urinary tract infections. The extract of saw palmetto may reduce prostate inflammation and prevent a more powerful kind of testosterone from forming.5Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
Another herbal remedy for BPH is stinging nettle root (not the leaf, which is a diuretic and could make BPH symptoms worse). Research suggests it can help fully empty the bladder and block excess levels of sex hormone–binding protein, another contributor to enlarged prostate.6Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
“The sooner you start, the better [these herbs] can prevent an enlarged prostate,” advises Dr. Yarnell. “They work to block estrogens and xenoestrogens and reduce inflammation. I advise patients to take them as a preventive measure, and the good news is you only have to take them once a day.”
Pumpkin Seeds
Like saw palmetto and stinging nettle root, pumpkin seeds can boost prostate health. Taking a supplement works well, but Yarnell suggests a more palatable option: eating a couple of ounces of pumpkin seeds daily.
Cucurbita pepo (pumpkin seed oil) is available in capsule and liquid form. When combined with saw palmetto, pumpkin oil’s anti-inflammatory properties are even more effective in reducing enlarged prostate symptoms.7Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
Kava
When symptoms include those caused by spasms of the overgrown smooth muscles (characterized by frequent urination, urgency, and getting up at night to urinate), Dr. Yarnell turns to natural smooth muscle relaxants, such as kava. South Pacific Islanders have long used kava, a member of the pepper family, to ease spasms, lessen stress, and calm anxiety.8Kava — an overview. ScienceDirect Topics. Accessed September 1, 2023. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/kava
Adopting Lifestyle Changes for Optimal Prostate Health
Dr. Yarnell encourages his patients with enlarged prostate to eat a mostly plant-based diet, reducing processed foods and incorporating organic fruits and vegetables when possible. “Animal products contain estrogens, and we get some of [those estrogens] by eating them,” says Yarnell. “Going organic will mitigate your xenoestrogen intake.” Specific foods may alleviate prostate enlargement:
- Vegetables (β-carotene, vitamin C, and vitamin E)
- Fish (essential fatty acids EPA and DPA)
- Tomatoes (lycopene)
- Soy and all beans/peas (isoflavones)
Beans and Flaxseeds
Eating more beans and flax is essential for men with an enlarged prostate, as these foods contain estrogen- and xenoestrogen-blocking phytoestrogens. Yarnell allays fears that soybeans increase estrogen, noting that our body’s estrogen is different from the type in soy.
Flaxseed can alleviate urinary discomfort, while isoflavones (in soybeans) may relax prostate muscles and improve urinary tract symptoms.9Zhang W, Wang X, Liu Y, et al. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food. 2008;11(2):207-214. https://doi.org/10.1089/jmf.2007.602
Reducing Body Fat
Dr. Yarnell also encourages his patients to exercise daily, focusing more on body fat than overall weight. The key, he notes, is that fat turns testosterone into estrogen. “I have a machine that measures body fat percentage—that’s what I want to see change: more muscle and less fat. You can’t see that on a scale. Even if your weight doesn’t change, lowering fat percentage still works.”
Research shows that a large waist circumference, high body mass index, and sedentary lifestyle all contribute to BPH.10Wang YB, Yang L, Deng YQ, et al. Causal relationship between obesity, lifestyle factors and risk of benign prostatic hyperplasia: a univariable and multivariable Mendelian randomization study. J Transl Med. 2022;20(1):495. https://doi.org/10.1186/s12967-022-03722-y
Prescription Medications That Shrink an Enlarged Prostate
When should men with an enlarged prostate consider conventional treatment options? Dr. Yarnell points to obstructive symptoms, which occur when the prostate gland has expanded so much that urine can’t get out. Urinating and fully emptying the bladder may become difficult.
Yarnell has seen several patients whose kidneys have failed because they didn’t know how large their prostate had grown. “It’s like that metaphor of the frog in boiling water,” he says. “If you turn the heat up slowly, you get used to it and don’t notice until it’s too late. That’s what happens. Symptoms develop over many years, and you get used to them. When the prostate has gotten too big, medications are the best way to shrink it.”
Yarnell points to two medications that can reduce prostate size by about 50%: finasteride and dutasteride. “When testosterone gets to the prostate, it turns into what I call super testosterone (dihydrotestosterone), which is ten times more intense than androgen. These drugs block amplification. There’s a myth that [they] block testosterone—they don’t. They just stop this super testosterone process, and that’s when the prostate shrinks.”
It can take anywhere from six months to two years for the prostate to return to a reasonable size. At that point, medication may no longer be necessary, and with naturopathic treatment, the focus will shift to preventing future growth. In extreme cases, when the prostate has gotten too big for even medications to help, surgery may be a viable option.
Healing the Prostate Naturally
Why should men with an enlarged prostate consider seeing a naturopathic doctor? Yarnell finds most urologists go straight to medication and surgery without fully exploring potential root causes and lifestyle impacts. “We think about everything,” he says. “We don’t just think about herbs and lifestyle; we assess you as an individual. If you do need conventional treatments, what’s the right one? It’s individualized care and holism, which includes conventional therapies.”
Footnotes
- 1Enlarged Prostate (Benign Prostatic Hyperplasia). Yale Medicine. Accessed September 1, 2023. https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph
- 2GBD 2019 Benign Prostatic Hyperplasia Collaborators. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Healthy Longev. 2022;3(11):e754-e776. https://doi.org/10.1016/S2666-7568(22)00213-6
- 3Canada H. Bisphenol A (BPA). Published April 16, 2013. Accessed September 1, 2023. https://www.canada.ca/en/health-canada/services/home-garden-safety/bisphenol-bpa.html
- 4Wu JH, Jiang XR, Liu GM, Liu XY, He GL, Sun ZY. Oral exposure to low-dose bisphenol A aggravates testosterone-induced benign hyperplasia prostate in rats. Toxicol Ind Health. 2011;27(9):810-819. https://doi.org/10.1177/0748233711399310
- 5Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
- 6Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
- 7Antoniou V, Gauhar V, Modi S, Somani BK. Role of phytotherapy in the management of BPH: A summary of the literature. J Clin Med. 2023;12(5):1899. https://doi.org/10.3390/jcm12051899
- 8Kava — an overview. ScienceDirect Topics. Accessed September 1, 2023. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/kava
- 9Zhang W, Wang X, Liu Y, et al. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food. 2008;11(2):207-214. https://doi.org/10.1089/jmf.2007.602
- 10Wang YB, Yang L, Deng YQ, et al. Causal relationship between obesity, lifestyle factors and risk of benign prostatic hyperplasia: a univariable and multivariable Mendelian randomization study. J Transl Med. 2022;20(1):495. https://doi.org/10.1186/s12967-022-03722-y