The prostate is a walnut-sized gland located below the bladder, and surrounds part of the urethra. It plays an important role as a part of the male reproductive system. Its main job is to produce semen, the fluid that carries sperm. It also plays a role in the urinary system because it is closely linked to the two sphincter muscles that ensure good urinary retention.
The prostate reaches its normal weight in men between 21 and 30 years old, and its weight should remain relatively constant.21, 22 Observational studies, however, found that the prostate grows about 2.0%–2.5% per year as we age.23, 24, 25, 26 When this growth became excessive, a condition called benign prostatic hyperplasia (BPH) takes place. BPH is a nonmalignant enlargement of the prostate gland. When the prostate becomes larger than normal, it squeezes the urethra causing urinary problems including frequent urination, difficulty in starting urination, weak urination stream, inability to urinate, nocturia, and loss of bladder control.
The prevalence of BPH increases from 8 % in men aged 31 to 40, to 40 to 50 % in men aged 51 to 60, to over 80 % in men older than age 80. 21-26 Thus, while not a life-threatening condition, BPH does affect the quality of life of millions of men. Let’s see a couple of ways to mitigate BPH and improve prostate health.
Saw palmetto (Serenoa repens) is the most popular phytotherapeutic agent used in the treatment of urinary problems.
In a systematic review that analyzed the existing clinical database, the authors concluded that extracts of Serenoa repens may be considered a viable first-line therapy for treating lower urinary tract symptoms.1, 2
A number of short, medium and long-term studies showed statistically significant improvement in urinary symptoms and flow measures, and in total international prostate symptom score. This is a widely used scoring system to screen for urinary tract symptoms, and it includes feeling of incomplete bladder emptying, frequency of urination, intermittency, urgency, weak urination stream, straining and nocturia. 1-8
The European Association of Urology guidelines state that Serenoa repens extract significantly reduced nocturia in comparison with a placebo.1, 2 In addition, it may also have a positive effect on sexual function, demonstrated by the statistically significant increase in the International Index of Erectile Function.5
Cranberries (Vaccinium macrocarpon) have been used for centuries in traditional medicine, especially for their ability to fight bladder and kidney infections.
Studies suggest that the proanthocyanidin content in cranberries may help to prevent the attachment of bacteria to the walls of the urinary tract, and thus help prevent and treat infections.9-10
In addition, it has also been found that cranberries can help improve prostate health and may reduce the symptoms of prostatitis, an enlarged prostate.
In a study published in the British Journal of Nutrition, supplementation with 1,500 mg of a cranberry extract for six months exerted significant improvements in prostate symptom score, urination parameters including voiding parameters, such as the rate and amount of urine flow, urinary urgency, frequency, straining, and nighttime urination. The quality of life scores for that group of men also improved, and decreased PSA (Prostate-specific antigen) level.11
Additional Note: What is PSA (Prostate-specific antigen)?
Blood levels of Prostate-specific antigen (PSA) is an approved, and widely used auxiliary diagnostic test in the management of the patients diagnosed as prostate cancer. PSA is a substance produced by the prostate gland, while its elevated levels may indicate prostate cancer, a noncancerous condition such as prostatitis, or an enlarged prostate.12, 13
Studies found a relationship between vitamin D deficiency and prostate growth-associated urinary symptoms14, and showed that 25-hydroxyvitamin D (a marker metabolite of vitamin D) are inversely associated with overall prostate volume and enlarged prostate gland, especially in men with benign prostatic disease.15
In these studies, researchers concluded that vitamin D deficiency may be a marker of BPH, while increasing intake of vitamin D from diet and supplements has shown a correlation with decreased BPH prevalence.14, 15, 16 In a comprehensive review researchers stated that Vitamin D supplementation up to 6000 IU/day have shown to decrease prostate volume in BPH patients.16
Another point of interest for most men is that a consequence of vitamin D deficiency is low testosterone. Studies showed that men with low level of serum testosterone and 25-hydroxyvitamin D had significantly lower testosterone concentrations. In a German study, daily supplementation with 3,332 IU of vitamin D for 1 year increased testosterone levels by 25% in vitamin D deficient men.17, 18, 19, 20
In the Endocrine Society Clinical Practice Guideline, researchers suggested “that all adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for 8 weeks or its equivalent of 6000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25-hydroxyvitamin D above 30 ng/ml, followed by maintenance therapy of 1500–2000 IU/d.”33, 34
According to Institute of Medicine (US) (similarly to the European Food Safety Authority EFSA) a tolerable upper intake level for adults is up to 4000 IU.31-35 Endocrine Practice Guidelines Committee recommends for patients at risk for vitamin D deficiency to set a UL of 10,000 IU/day.31, 33, 34
(Tolerable upper intake level (UL) is the maximum level of total chronic daily intake of a particular nutrient judged to be unlikely to pose a risk of adverse health effects.)
FRUITS AND VEGETABLES
Adequate consumption of vegetables and fruit are vitally important to human health, as they contain high levels of vitamins, minerals, antioxidants, and fiber.
A review of 95 studies, found that there was a 16% reduction in the risk of heart disease, a 28% reduction in the risk of stroke, a 22% reduction in the risk of cardiovascular disease, a 13% reduction in the risk of cancer, and a 27% reduction in the risk of all-cause mortality for an intake of 500 g of fruits and vegetables per day, compared to 0–40 grams per day.29
In addition, higher intake of vegetables and fruit may beneficially influence the disorders underlying BPH in a number of ways. These include inhibiting inflammation and oxidative damage, altering the hormonal or growth-regulatory factors to inhibit cellular proliferation, or modulating sympathetic nervous system and subsequently affect prostate smooth muscle tone.30
In a 4-year longitudinal study from China, researchers found that high levels of total vegetable and fruit intake was associated with lower international prostate symptom score, and thus lower incidence of urinary symptoms and better prostate health.30
High intake of dark and leafy vegetables reduced the risk of lower urinary tract symptom (LUTS) progression by 37% or risk of symptomatic BPH by 34% after 4 years compared with the lower consumption group.30
Fruit and vegetables should make up over a third of the food we eat each day. The World Health Organization (WHO) recommends eating at least five 80 g portions of fruit and vegetables every day (total 400 grams per day)28
- Geavlete P, Multescu R, Geavlete B. Serenoa repens extract in the treatment of benign prostatic hyperplasia. Therapeutic Advances in Urology. 2011;3(4):193-198. doi:10.1177/1756287211418725.
- Oelke, M., Bachmann, A., Descazeaud, A., Emberton, M., Gravas, S., Michel, M.C. et al.: Guidelines on the treatment of non-neurogenic male LUTS. 2011 EAU online Guidelines.
- Debruyne F, Boyle P, Calais Da Silva F, Gillenwater JG, Hamdy FC, Perrin P, Teillac P, Vela-Navarrete R, Raynaud JP, Schulman CC: Evaluation of the clinical benefit of permixon and tamsulosin in severe BPH patients-PERMAL study subset analysis. Eur Urol. 2004 Jun; 45(6):773-9; disucssion 779-80.
- Gerber GS, Kuznetsov D, Johnson BC, Burstein JD: Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001 Dec; 58(6):960-4; discussion 964-5.
- Sinescu I, Geavlete P, Multescu R, Gangu C, Miclea F, Coman I, Ioiart I, Ambert V, Constantin T, Petrut B, Feciche B: Long-term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int. 2011; 86(3):284-9.
- Wilt T, Ishani A, Stark G, MacDonald R, Mulrow C, Lau J.: Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000;(2):CD001423.
- Wilt T, Ishani A, Mac Donald R.: Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423.
- Wilt T, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C.: Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia. A Systematic Review. JAMA. 1998;280(18):1604-1609. doi:10.1001/jama.280.18.1604
- Howell AB1, Reed JD, Krueger CG, Winterbottom R, Cunningham DG, Leahy M.: A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. Phytochemistry. 2005 Sep;66(18):2281-91.
- Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of Bacteriuria and Pyuria After Ingestion of Cranberry Juice. JAMA. 1994;271(10):751–754. doi:10.1001/jama.1994.03510340041031
- Vidlar, A., Vostalova, J., Ulrichova, J., Student, V., Stejskal, D., Reichenbach, R., et al: The effectiveness of dried cranberries (Vaccinium macrocarpon) in men with lower urinary tract symptoms. 2010 British Journal of Nutrition, 104(8), 1181-1189. doi:10.1017/S0007114510002059
- Velonas VM, Woo HH, dos Remedios CG, Assinder SJ. Current Status of Biomarkers for Prostate Cancer. International Journal of Molecular Sciences. 2013;14(6):11034-11060. doi:10.3390/ijms140611034.
- Atan A, Güzel Ö. How should prostate specific antigen be interpreted? Turkish journal of urology. 2013;39(3):188-193. doi:10.5152/tud.2013.038.
- Murphy AB, Nyame YA, Batai K, et al. Does Prostate Volume Correlate with Vitamin D Deficiency Among Men Undergoing Prostate Biopsy? Prostate cancer and prostatic diseases. 2017;20(1):55-60. doi:10.1038/pcan.2016.41.
- Zhang W1, Zheng X2, Wang Y1, Xiao H1.: Vitamin D Deficiency as a Potential Marker of Benign Prostatic Hyperplasia. Urology. 2016 Nov;97:212-218. doi: 10.1016/j.urology.2016.03.070. Epub 2016 Jun 17.
- Espinosa G1, Esposito R, Kazzazi A, Djavan B.: Vitamin D and benign prostatic hyperplasia — a review. Can J Urol. 2013 Aug;20(4):6820-5.
- Wang N, Han B, Li Q, et al. Vitamin D is associated with testosterone and hypogonadism in Chinese men: Results from a cross-sectional SPECT-China study. Reproductive Biology and Endocrinology : RB&E. 2015;13:74. doi:10.1186/s12958-015-0068-2.
- Nimptsch K, Platz EA, Willett WC, Giovannucci E. Association between plasma 25-OH vitamin D and testosterone levels in men. Clinical endocrinology. 2012;77(1):106-112. doi:10.1111/j.1365-2265.2012.04332.x.
- Wehr E, Pilz S, Boehm BO, März W, Obermayer-Pietsch B.: Association of vitamin D status with serum androgen levels in men. Clin Endocrinol (Oxf). 2010 Aug;73(2):243-8. doi: 10.1111/j.1365-2265.2009.03777.x. Epub 2009 Dec 29.
- Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, Wehr E, Zittermann A. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res. 2011;43:223–225.
- Berry SJ, Coffey DS, Walsh PC, Ewing LL.: The development of human benign prostatic hyperplasia with age. J Urol. 1984 Sep;132(3):474-9.
- Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology. 2017;4(3):148-151. doi:10.1016/j.ajur.2017.06.004.
- Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC. Prostate Volume Changes Over Time: Results From the Baltimore Longitudinal Study of Aging. The Journal of urology. 2009;182(4):1458-1462. doi:10.1016/j.juro.2009.06.047.
- Guess H.A., Arrighi H.M., Metter E.J., Fozard J.L. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17:241–246.
- Kok E.T., Schouten B.W., Bohnen A.M., Groeneveld F.P., Thomas S., Bosch J.L. Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study. J Urol. 2009;181:710–716.
- Taylor B.C., Wilt T.J., Fink H.A., Lambert L.C., Marshall L.M., Hoffman A.R. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006;68:804–809.
- GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England). 2017;390(10100):1345-1422. doi:10.1016/S0140-6736(17)32366-8.
- World Health Organization: Healthy diet. Fact Shee Nr. 394. Updated May 2015. Published On-line: http://www.who.int/mediacentre/factsheets/fs394/en/
- Aune D, Giovannucci E, et al.: Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies, International Journal of Epidemiology, Volume 46, Issue 3, 1 June 2017, Pages 1029–1056, https://doi.org/10.1093/ije/dyw319
- Liu Z, Wong CKM, Chan D, Tse LA, Yip B, Wong SY. Fruit and Vegetable Intake in Relation to Lower Urinary Tract Symptoms and Erectile Dysfunction Among Southern Chinese Elderly Men: A 4-Year Prospective Study of Mr OS Hong Kong. Patel. S, ed. Medicine. 2016;95(4):e2557. doi:10.1097/MD.0000000000002557.
- Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, et al., editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
- EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2016. Scientific opinion on Dietary Reference Values for vitamin D. EFSA Journal 2016;volume(issue):NNNN, 179 pp. doi:10.2903/j.efsa.2016.NNN
- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.
- Pramyothin P, Holick MF.: Vitamin D supplementation: guidelines and evidence for subclinical deficiency. Curr Opin Gastroenterol. 2012 Mar;28(2):139-50. doi: 10.1097/MOG.0b013e32835004dc.
- EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA);Scientific Opinion on the Tolerable Upper Intake Level of vitamin D. EFSA Journal 2012;10(7):2813. [45pp.] doi:10.2903/j.efsa.2012.2813