When it comes to relationships, they say that women are from Venus and men are from Mars and there are differences of that magnitude between the sexes when considering awareness of sexual health. With prostate health, few men really grasp the importance, and even less understand the impact that a decline in prostate health can have on their overall health and wellbeing. The prostate, a small walnut-sized gland that surrounds the urethra sitting snugly at the base of the bladder, functions to control the release of urine and provide fluids that not only lubricate the urethra (helping to prevent infections), but also enhance sperm motility thereby contributing to a man’s fertility potential.
Benign prostatic hyperplasia
Benign prostatic hyperplasia or BPH, an extremely common condition where the prostate becomes enlarged, affects around 50% of all men and 90% of men over the age of 85. As BPH involves hyperplasia (an increase in the number of cells) rather than hypertrophy (a growth in the size of individual cells) it does not necessarily lead to prostate cancer, but does come with some potentially unpleasant or inconvenient side effects. An enlarged prostate gland will, for example, put increased pressure on the urethra and bladder resulting in an inability to hold in urine or an increase in the urgency to urinate (hence the increase in nightly visits to the loo). In addition, the inability to fully empty urine out of the bladder can cause bacteria to grow within the bladder which can then lead to potentially nasty urinary tract infections (UTIs). Whilst many men find it difficult to talk about prostate health, there are a few key health tips that they can take on board to help maintain good prostate health and reduce their risk of developing BPH.
Understanding the development of benign prostatic hyperplasia
Dihydrotestosterone (DHT) is the key hormone that plays a beneficial role in the developing prostate (during puberty), but is detrimental in the adult prostate where it plays a central role in the development of BPH. This is because as men get older, the enzyme 5-a reductase converts testosterone into DHT, thereby raising DHT, causing a drop in testosterone levels and a decline in prostate health. DHT is found primarily in skin, hair follicles, and in the prostate. Interestingly, the actions of DHT and the sensitivity of hair follicles to DHT is what leads to hair loss in male pattern baldness. BHP (and balding) is generally not regarded as a preventable condition, but accumulating evidence suggests that certain modifiable factors may influence the risk of BHP. For example, there is an overwhelming body of literature that supports an association between obesity, type II diabetes and BHT, implying that both diet and lifestyle are key players in its development. Both obesity and diabetes are considered to be ‘inflammatory’ conditions fuelled by our typical nutrient-depleted (energy dense) western diets and men with higher levels of inflammation are more likely to develop BHT.  As such, adopting a diet rich in natural anti-inflammatory nutrients may be of significance for helping to maintain optimal prostate health. By focusing on blocking the actions of DHT via dietary modifications it is possible to help maintain a variety of male associated health areas.
Polyphenols are potent antioxidant compounds found in abundance in plants and it is therefore important to eat lots of unrefined fruits, vegetables, whole grains and legumes. As refining processes remove polyphenols, eating fresh fruits, vegetables, whole grains and legumes instead of refined foods will provide an abundance of these health promoting compounds. Interestingly, and unlike some vitamins and minerals, polyphenols tend not to be destroyed by moderate cooking or heating, and cooked, concentrated foods may offer a more bioavailable source of polyphenols. An excellent example of this is lycopene, a carotene polyphenol which gives food such as tomatoes, strawberries and cherries their characteristic red colour. Tomatoes are a particularly rich source of lycopene and the processing (not to be confused with refining) of tomatoes increases both the concentration and bioavailability of lycopene. The lycopene content of tomato puree is, for example, up to four times more bioavailable than in fresh tomatoes! Lycopene has been shown to block the activity of DHT, with studies supporting the use of lycopene for prostate health  and if tomatoes are not your favourite fruit you can always opt for a lycopene supplement.
Phytosterols are compounds that are similar in their structure to cholesterol and can block the conversion of testosterone to DHT by inhibiting 5-a reductase. One of the richest sources of phytosterols is found in the fruits of saw palmetto, a small palm-like plant. The berries were a staple food and medicine for Native Americans and used in the early 1900s to treat urinary tract problems, and even to increase sperm production and boost libido! Saw palmetto extract is now one of the most researched non-pharmaceutical interventions for managing BPH, with some (but not all) studies suggesting that intake of saw palmetto is effective for reducing prostate size and improving symptoms related to urination. The outcomes of the latest reviews on saw palmetto and DHT are, however, far from conclusive, even suggesting that saw palmetto is actually no better than placebo,  yet the product remains a best seller in terms of maintaining prostate health and it is likely that some (but not all) men will find it beneficial.
Zinc is particularly important for the normal functioning of the prostate, with concentrations in a healthy prostate more than 3 times higher compared with other tissues and 500 times higher than in any other body fluid. At high tissue concentrations, zinc inhibits the conversion of testosterone to DHT and plays an important role in maintaining the normal prostate function and healthy tissue structure. Given these important roles, it is not surprising that levels of zinc are known to be significantly lower in prostate diseases, with reports suggesting that zinc levels are as much as 83% lower in prostate cancer and 61% lower in BPH.  A wide variety of foods contain zinc with oysters (the well-known aphrodisiac!) coming out on top alongside red meat and poultry. Other food sources high in zinc include beans, nuts and whole grains.
Green tea offers a number of health-promoting benefits and is normally associated with appetite regulation and weight loss. A specific active constituent of green tea known as epigallocatechin-3-gallate (EGCG) can also influence the production and actions of hormones including DHT. Not only does EGCG have potential benefits for managing BPH, but research shows that men who drink at least 5 cups of green tea per day have a reduced risk of prostate cancer compared to men who drink less than one cup of green tea per day.  A cup of fresh good quality green tea can deliver as much as 180mg EGCG, with a number of excellent supplements available as an alternative if green tea isn’t for you.
Whilst vitamin D is found in foods such as eggs and oily fish, we actually get most of our vitamin D from exposure to sunlight. Vitamin D deficiency is quite common in the UK, and a growing list of diseases and conditions are being linked with it. The association between low vitamin D and poor prostate health is linked to its role in regulating the way cells replicate and die (the process of normal cell turnover). As vitamin D regulates the normal cell cycle, preventing unregulated cell turnover, low vitamin D status is linked to an increase in prostate size. Indeed, studies show that populations who have the lowest exposure to sunlight have higher rates of both BPH and prostate cancer. [7,8] With the British weather unpredictable with regard to quality sunlight hours, supplementing with vitamin D to optimise vitamin D status may be prudent, not only for prostate health, but for the other numerous health benefits, such as mood regulation, improved immune function and for cardiovascular and bone health that are all attributed to the ‘sunshine’ hormone.
The omega-3 fatty acids associated with seafood and fish oil are best known for their anti-inflammatory health benefits, with low levels of the key omega-3 fatty acids EPA and DHA associated with a number of health issues including cardiovascular disease, mood disorders, diabetes, arthritis and many types of cancer. Omega-3 EPA and DHA levels are significantly decreased in patient with BPH  and in addition to EPA’s anti-inflammatory benefits, this key fatty acid is also a direct inhibitor of 5-α reductase and can therefore block the actions of the enzyme responsible for converting testosterone to DHT.  Increasing oily fish consumption not only increases omega-3 intake, but is also an excellent source of vitamin D and other important nutrients known to be of benefit to prostate health (such as selenium and B vitamins). For individuals who are not fans of oily fish, 2 capsules of Pharmepa RESTORE, providing 1g EPA, will help boost EPA levels.
There are a number of supplements available that are aimed at maintaining prostate health; whilst some are supported by more evidence than others, it is important that men of all ages are aware of the ways they help maintain optimal prostate health. Diets that are nutrient rich (and low in refined, processed foods) can keep the prostate healthy, lowering the risk of BPH. Food choices should therefore focus on fresh fruit and vegetables, whole grains, nuts and seeds, lean meat and oily fish and quality organic dairy products. Being overweight is a direct risk factor for BPH; making nutritious food choices and keeping active are great ways to maintain a healthy weight and lower that risk.
- Zlotta AR, Egawa S, Pushkar D, Govorov A, Kimura T, Kido M, Takahashi H, Kuk C, Kovylina M, Aldaoud N, Fleshner N, Finelli A, Klotz L, Lockwood G, Sykes J, Kwast Tv. Prevalence of inflammation andbenign prostatic hyperplasia on autopsy in Asian and Caucasian men. Eur Urol. 2014 Oct;66(4):619-22
- Schwarz S, Obermüller-Jevic UC, Hellmis E, Koch W, Jacobi G, Biesalski HK. Lycopeneinhibits disease progression in patients with benign prostate hyperplasia.
J Nutr. 2008 Jan;138(1):49-53.
- Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. Serenoarepens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012 Dec 12;12:CD001423.
- Christudoss P, Selvakumar R, Fleming JJ, Gopalakrishnan G. Zincstatus of patients with benign prostatic hyperplasia and prostate carcinoma. Indian J Urol. 2011 Jan;27(1):14-8. doi: 10.4103/0970-1591.78405.
- Liao S. The medicinal action of androgens andgreen tea epigallocatechin gallate. Hong Kong Med J. 2001 Dec;7(4):369-74. Review.
- Kurahashi N, Sasazuki S, Iwasaki M, Inoue M, Tsugane S; JPHC StudyGroup. Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol. 2008 Jan 1;167(1):71-7. Epub 2007 Sep 29.
- Schwartz GG Vitamin D and the epidemiology of prostate cancer. Semin Dial.2005 Jul-Aug;18(4):276-89.
- Zhang W,Zheng X, Wang Y, Xiao H. Vitamin D Deficiency as a Potential Marker of Benign Prostatic Hyperplasia. 2016 Jun 17. pii: S0090-4295(16)30308-9. doi: 10.1016/j.urology.2016.03.070
- Yang YJ, Lee SH, Hong SJ, Chung BC.Comparison of fatty acid profiles in the serum of patients with prostate cancer and benign prostatic hyperplasia. Clin Biochem. 1999 Aug;32(6):405-9.
- Pham H, Ziboh VA. 5 alpha-reductase-catalyzed conversion of testosterone to dihydrotestosterone is increased in prostaticadenocarcinoma cells: suppression by 15-lipoxygenase metabolites of gamma-linolenic and eicosapentaenoicacids. J Steroid Biochem Mol Biol. 2002 Nov;82(4-5):393-400.