BPH Is Not Inevitable

BPH Is Not Inevitable

Most clinicians may assume that BPH is among the unavoidable consequences of aging because the condition is so common, but it wasn’t always so. In the 1920s and 1930s, for example, a physician colleague from China reported that BPH affected not 80 percent of male patients, but only about 80 individual cases in 15 years. The fact that both BPH and prostate cancer were so rare in China and Japan back then was attributed to the traditional plant-based diet in those countries. More recent studies of Tsimane men, Bolivian subsistence farmers who mainly eat starchy foods like plantains, found that there are virtually no cases of advanced BPH, confirming that it is not inevitable.

Population studies suggest that low intake of animal protein, along with lots of fruits and vegetables, may have a protective effect. Compared with men who ate meat less than once a week, those who ate it daily were twice as likely to have BPH-like symptoms. In a more detailed study, researchers found that poultry, eggs, and refined grains are the worst, but they found no association with red meat or dairy products. Among plant foods, onions and garlic are associated with a significantly lower risk of BPH. In general, cooked vegetables work better than raw; legumes—beans, split peas, lentils, and chickpeas—also mean a lower risk. When men consumed isoflavones through a daily cup of soy milk, they too had a reduced risk. TVP, textured vegetable protein, is a soy-based product often used for veggie chili and pasta sauces. Even though I prefer less processed soy foods, I recommend this kind of TVP over the urology TVP: There it stands for transurethral vaporization of the prostate.

Feed Your Prostate Plants

In How Not to Die, I explain in detail a series of experiments by Ornish and colleagues in which they drew blood from participants before and after eating a plant-based diet and exposed cancer cells to it in a petri dish. The blood of the men on the standard American diet slowed the growth rate of prostate cancer cells by 9 percent. But after the men ate a plant-based diet for a year, their blood was able to suppress the growth of the cancer cells by 70 percent. So nearly eight times the cancer-fighting power from a mostly plant-based diet rather than one with meat. (Similar studies found that women eating a plant-based diet could significantly boost their breast cancer defenses in two weeks.) And what happens when you run the same experiment with the normal prostate cells whose growth obstructs urine flow?

After just two weeks, the blood of men eating a plant-based diet was able to suppress abnormal growth of noncancerous prostate cells. What’s more: The effect persisted if the men kept eating plant-based, and it was still present after 28 years. So as long as we eat healthfully, the growth rate of prostate cells goes down—and stays down. However, some plants seem to be especially good for the prostate.

Saw Palmetto and a Supplement That Actually Works

Saw palmetto berry is “undisputedly” the most commonly used botanical remedy for BPH, but it doesn’t work. A supplement that prevents and cures BPH is vitamin D. Details on both at see.nf/saw.

It’s All About the Seeds

Flaxseed can be used to treat BPH. Men who ate the equivalent of about three tablespoons of flaxseed a day did so much better, as if they had taken the commonly prescribed medications like Flomax or Proscar—just without side effects. Pumpkin seeds work too; details at see.nf/seeds, which led the European Medicines Agency to conclude that pumpkin seeds could “contribute to the relief of symptoms of the lower urinary tract associated with an enlarged prostate, if more serious causes have been excluded by a doctor.”

Everything Flows—In the Middle of the Night

Among the most bothersome BPH symptoms is nocturia, nighttime urinary urgency that often forces you to get up at night and go to the bathroom. Common sense might tell us we should simply drink less before bed, but interestingly, there is no clear relationship between fluid intake and nighttime urinary urgency. A study of about 150 men found an association between nocturia frequency and evening water drinking; there also seemed to be an effect from how much water subjects drank in the four hours before bedtime, but another study of more than 1000 older adults found no relationship between the amount of fluids and repeated nighttime waking to urinate. It surprised me that restricting fluids has never been properly tested. There was a study in which a few older men who, on average, peed four times per night were instructed to drink only about five cups instead of seven per day, which cut their bathroom trips to three, but in neither that study nor further similar ones was there a control group to properly establish cause and effect.

Even harder is getting people off salt. Nocturia investigations with titles like “Which weighs more, the water or the salt?” find that with salt, nocturia frequency increases, presumably because you get thirstier and drink more. That led to the recommendation to reduce salt to ease nighttime complaints, but a salt-reduction study is difficult because participants usually ignore the instructions. Still, you can compare the change in nocturia episodes among those who eat less salt with the others. Accordingly, it looks like even a half teaspoon less salt per day reduces nighttime trips by 40 to 60 percent.

Even the protein you eat in the evening can affect nocturia. What drives urine accumulation is not sodium but urea, a breakdown product of protein excretion. A high-protein dinner is associated with additional nighttime urine production, leading to the as-yet unproven conclusion that “reducing protein intake in the evening can be an efficient behavioral intervention for managing nighttime urinary urgency …”.

Make It Sour

What other foods help? It is known that Native Americans used cranberries to treat urinary complaints. Cranberries can shrink the prostate in rodents by up to 33 percent, but the first human study, “The effect of dried cranberries (Vaccinium macrocarpon) in men with lower urinary tract symptoms,” was not published until 2010. The dried cranberries were not the sugary, oily Craisins from the supermarket, but whole-food cranberry powder. After taking about three quarters of a teaspoon a day, subjects reported a significant improvement in BPH symptoms, quality of life, and all measured urination outcomes.