BENIGN PROSTATIC HYPERPLASIA - IS IT POSSIBLE TO SHRINK THE PROSTATE NATURALLY?

Medically Reviewed and Updated by Dr. Sony Sherpa (MBBS) - September 04, 2024

While it is not possible to shrink your prostate in a matter of seconds using natural remedies, there is now enough evidence to suggest that they are an effective complementary approach to tackle prostate enlargement and Benign Prostatic Hyperplasia (BPH).

The following article aims to explain what BPH is, how it develops, as well as how simple lifestyle and dietary interventions can help to reduce prostate enlargement. Treatment options, prostate exercises, and specific foods and nutrients that may aid in BPH prevention are also covered below.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia refers to a male health condition in which the prostate gland exhibits abnormal growth (hyperplasia) indicative of a higher-than-average prostatic cell count.[1] It is usual for the excess growth to occur in the prostate transition zone, which surrounds the urethra. That can lead to urinary tract symptoms and even bladder obstruction in severe cases. It is thought to be a product of hormonal and immune system imbalances, which are often reflective of the aging process.

Prostate Enlargement in BPH. It should be understood that while prostate enlargement is often used interchangeably with BPH, it refers to individually enlarged (swollen) prostate cells and not to the hallmark of BPH, which is increased prostate cell growth. Prostate enlargement may or may not be present in patients with BPH.

Prevalence. More than 70% of males over 80 have BPH, which becomes more prevalent with advancing age. Sub-clinical BPH may affect 30-40% of men in their 40s. The incidence of BPH differs across different cultures and is believed to be the outcome of genetic and environmental factors that lower the risk. 

Signs and Symptoms

Symptoms of BPH are difficult to distinguish from Lower Urinary Tract Symptoms (LUTS). These include:

• Difficulties while emptying the bladder, such as interruptions, straining, irritation, and trouble initiating
• Frequent and urgent need to void, even throughout the night
• Sensation of incomplete emptying
• Incontinence
• Chronic UTIs
• Tenderness of the prostate
• Dribbling at the end of urination
• Blood in the urine

Depending on the underlying causes, other symptoms may reflect in other areas of the body, such as anxiety, infections, sensitivities, erectile dysfunction, and more.

BPH Symptom Severity can vary between men, based on the prostate’s size and the way in which it becomes enlarged. Some men may experience little to no symptoms until the disease is quite advanced, while others may experience symptoms early on that gradually get worse through the course of the disease.

Potential Causes and Mechanisms Driving BPH

 Aging, immune function, and hormonal imbalances, particularly low testosterone levels, are currently the main suspects that potentially cause BPH.[2] These are further elaborated below:

Aging is often acknowledged as the primary cause of BPH in susceptible men. Senescence at the cellular level gives rise to hormonal decline and subsequent metabolic changes that affect the function of all cells. This can contribute to reduced immune function, higher infection risk, increased inflammation, vascular calcification, and faulty repair mechanisms, which encourage BPH progression.

Hormones. Men with prostate enlargement and BPH frequently have low testosterone, which is believed to be the primary underlying cause. The prostate relies on healthy testosterone levels to maintain both the growth and cellular turnover of the gland. When levels dip, the prostate can shrink too much, which causes it to compensate through growth-stimulating hormones. If prolonged, the compensatory mechanisms eventually contribute further to the problem, allowing for perpetual enlargement and growth.

 Below are some of the most well-known hormonal imbalances seen to contribute to BPH:

•  High DHT and 5-Alpha Reductase. When testosterone is low, it leads to increases in the levels of the more potent form of testosterone, DHT (Dihydrotestosterone), which stimulates excessive androgen receptor signaling and growth in the prostate. Unfortunately, the prostate makes use of testosterone to make more DHT, which prevents the low testosterone from normalizing. The enzyme 5-alpha reductase increases the conversion of testosterone to DHT and is commonly targeted with 5-alpha reductase inhibitors in the treatment of BPH. There are three types, with type 2 being the most important for BPH and type 1 to a lesser degree.
• High E2 and Aromatase. When DHT increases and stimulates prostatic growth, the gland begins to make use of estradiol (E2), a potent form of estrogen, to inhibit its growth and regulate the process. E2 is produced from testosterone through the action of aromatase. Despite competing with DHT and lowering the size of the gland, prolonged E2 elevations can cause estrogen receptors to stop responding to the hormone, resulting again in unregulated growth. E2 also inhibits the production of testosterone, which can further exacerbate the problem. Aromatase inhibitors are another common strategy employed in treating BPH, as well as activation of estrogen receptor beta, which helps regulate the growth of the glands.
• Gonadal-Hypothalamic-Pituitary Axis Dysfunction. Many other bodily hormones contribute towards lowering testosterone, including excessive stress hormones like cortisol and the brain hormones (derived from the hypothalamus and pituitary) that signal testosterone production in the testes. Conversely, high DHT levels can cause an increase in stress hormone release as well as inhibit testosterone production. Stress hormones are known to contribute towards increased prostatic muscle contractions and tone, which can worsen the severity of BPH symptoms. Correcting imbalances along the gonadal-hypothalamic-pituitary axis is thus another attractive target for regulating prostate enlargement.
• Immune System Regulation. The immune system contributes to excessive growth and impaired repair mechanisms in BPH through continuous inflammation. Hormonal reductions and age-related immune changes promote lower immune function, which can give rise to chronic UTIs that invade the prostate of men with BPH. Throughout the disease course, excessive growth causes the immune system to attack faulty cells, which eventually culminate in autoimmunity against the prostate gland. This can lead to prostate enlargement due to swelling and irritation and also lower the immune system’s ability to eliminate pathogens or repair faulty cells.

 Risk Factors

 A few of the main risk factors for prostate enlargement in BPH are highlighted below:

• Allergy and Autoimmunity. The immune system imbalance in BPH often tends towards an allergenic immune profile with autoimmune features. This is reflected by an increase in CD4+ lymphocytes in the prostate relative to CD8+ T lymphocytes (which are usually required for dealing with pathogens). Both autoimmune diseases and allergies can increase this immune trend and the relative risk of acquiring BPH later in life.
• Metabolic and Reproductive Diseases. High insulin levels are known to provoke an increase in growth factors, such as insulin-like growth factor 1, as well as affect healthy ratios of reproductive hormones. This is a prime feature of both metabolic and reproductive disorders and has been linked with increasing the risk of developing BPH. The overall health of the male reproductive tract is also very important, as the testes produce the majority of testosterone that goes on to regulate the size of the prostate, amongst other vital functions. Reproductive diseases that affect other parts of the system can, therefore, increase the risk for BPH by lowering testosterone production.

• Genetics. It has been observed that male family members of men with BPH are more prone to the condition later in life. Various genetics may be linked with BPH severity as well, including those for anxiety, stress propensity, autoimmunity, and vascular disease.
• Vitamin D Status and Low Lifetime Sunlight Exposure. Vitamin D3 has been identified as a prime nutrient involved in regulating prostate enlargement. Studies show that higher vitamin D3 levels keep the prostate gland smaller and healthier[3]. Natural light exposure helps to regulate vitamin D3 formation. Inadequate sun exposure has been linked to increasing the risk for prostate cancer[4] and thus may also be associated with developing BPH.

• Cellphone Radiation is linked with exacerbating the risk for cancer, DNA damage, and lowered male fertility. The practice of keeping one’s cell phone in the pant pocket may contribute additively over the lifespan towards the risk of prostate enlargement and BPH.

How to Shrink Your Prostate

For most men seeking help for BPH, how to treat an enlarged prostate is a frequently asked question. Despite being a common concern, prostate enlargement is usually one of the easiest health conditions to prevent by making simple lifestyle changes. Natural remedies for an enlarged prostate are the preferred way to go due to the side effects associated with conventional treatment. Surgery and pharmaceuticals are often only suggested for severe cases of BPH and are implemented along with natural interventions.

Below are suggestions that can be useful for preventing prostate enlargement and may help to shrink the prostate in men with signs of BPH or urinary tract symptoms.

Complementary Natural Remedies for an Enlarged Prostate

Opting for a few of the below dietary modifications can help to prevent prostate enlargement or shrink the prostate naturally.

Plant-Based Whole Food Diet Plan. Diets that prioritize plant-based foods, such as the Mediterranean diet, are higher in antioxidant nutrients and lower in refined foods, both of which are linked with a lower incidence of prostate enlargement or BPH and an enhanced hormonal status. It is important to focus on protein-rich foods as well, such as grains, legumes, and (if permissible) moderate amounts of good-quality meat. Nuts and seeds, especially pumpkin seeds, are known to contain a variety of components (phytosterols, lignans, vitamin E, and trace minerals) that help to shrink the size of the prostate and keep hormones regulated after treatment. Vitamin C and A-rich fruits and vegetables can help to lower the inflammatory immune response seen in BPH as well as keep the tract clear of pathogens. Probiotics and other foods containing digestive enzymes can also enhance digestion, reduce inflammation and improve metabolic health.

Anti-BPH Foods and Plant Extracts. The following natural extracts and food supplements can help to shrink your prostate naturally by inhibiting the conversion of testosterone into DHT or E2, minimizing the risk for UTIs, and helping to regulate stress levels:

• Isoflavones are a class of flavonoids with anti-inflammatory and estrogenic properties that have proven to be beneficial in moderation for preventing BPH and lowering prostate size. Genistein, daidzein, and biochanin A can inhibit 5-alpha reductase type 2 and aromatase[5]. They preferentially bind to estrogen receptor beta (ERb), which promotes prostate shrinkage, as opposed to ER-alpha, which promotes its growth. Their estrogenic potential is 100-1000 times weaker than that of estradiol, ensuring that their actions do not unbalance the male hormone system. The prostate appears to bioaccumulate isoflavones more than other bodily tissues, further adding to their therapeutic potential. Good sources of isoflavone include traditionally fermented soy products (without additives) and red clover extract. Despite their prostate benefits, overdosing on isoflavones is not recommended due to their potential for promoting thyroid disease.
• 5-Alpha Reductase (type 2) Inhibitors. As mentioned above, nuts and seeds, as well as some grains, fruits, and vegetables, contain phytosterols, several of which can inhibit 5aR (1 and 2). Quercetin, fisetin, and kaempferol are other nutrients capable of inhibiting 5aR that can be found prolifically in whole fruits and vegetables or sold as nutraceuticals. Healthy cooking oils also contain compounds that can inhibit 5aR, such as coconut oil, olive oil, and most other non-hydrogenated vegetable oils.[6]
• Aromatase inhibitors. Foods containing phytoestrogens are known to be potent aromatase inhibitors, capable of suppressing aromatase-expressing genes. Examples include lignans (found in seeds and nuts), caffeic acid (in caffeinated beverages), hydroxycinnamic acids (in cinnamon and fruits), gallic acid, quercetin, naringenin (in citrus), apigenin (in chamomile and celery), anthocyanins (in stone fruits and brightly colored vegetables), resveratrol (found in dark red berries, tea, and groundnuts) and equol (a soy isoflavone)[7]. Ginger and exotic types of mushrooms, such as reishi and shitake, also possess aromatase inhibitors as well as nutrients capable of boosting immunity and supporting defense against pathogens.
• Natural UTI Prevention. As mentioned, vitamin C is a great preventive nutrient for UTIs. When coupled with natural cranberry or tart cherry concentrate, it is known to be a potent aid for those with urinary symptoms. Bitter herbs with immune-boosting properties may also be useful for men with BPH for preventing UTIs, improving digestive health, lowering inflammation, and promoting hormonal balance. These include echinacea and olive leaf extract.
• Stress-Relieving Botanicals. When considering how to shrink an enlarged prostate naturally, general stress management becomes important. Many of the above examples of antioxidant nutrients can serve to cut out possible causes of physiological stress for men with BPH, and thus, additional compounds aimed at lowering stress levels may not be necessary. After changing your diet and lifestyle, if stress and hypertension still persist, it is advisable to speak with a nutritionist to get personalized recommendations.

Nutritional Supplements for Prostate Health. The majority of essential vitamin and mineral supplements can help to improve BPH due to their antioxidant actions that support overall metabolism and immunity. The most significant dietary supplements for an enlarged prostate include:

• Vitamin D3 and K2. Studies reveal that vitamin D3 supplementation up to 6000 IU per day can help lower the size of the prostate in men with BPH. Other benefits include lowering DHT levels, regulating testosterone, reducing prostatic inflammation, and decreasing growth factor levels. [8] A vitamin K2 supplement could be a useful complement as it serves to regulate vitamin D3 metabolism.
• Zinc is known to help regulate male fertility in several ways. It supports optimal testosterone production from the testes while protecting them from DNA damage induced by heavy metals and radiation. Zinc deficiency has been linked to BPH development[9], excessive conversion of testosterone into estradiol, and reduced immunity. However, excessive zinc levels may increase DHT production[10] without a 5-alpha reductase inhibitor. Balanced supplementation has directly been shown to help reduce symptoms in men with BPH by serving to shrink the size of the prostate, balancing the corresponding autoimmune profile, and helping the immune system keep the area free of infection. Zinc is also found bound to amino acids in protein-rich foods such as meat, grains, and legumes.[11]

Prostate Exercises

Prostate exercises may help to lower the risk of developing urinary incontinence, especially that pertaining to excessive stress. Other names for these exercises include pelvic floor exercises, bladder control exercises, or male Kegel exercises.[12]

• Prostate Exercises Improve Bladder Control. There is limited evidence to suggest that prostate exercises can help to lower the risk of contracting BPH or that they help to reduce the size of the prostate. The reason prostate exercises are recommended for those with BPH is to strengthen bladder control in men, especially after removal or treatment of prostate enlargement, BPH, or cancer. This has proven to be particularly useful, as bladder control does not necessarily return even after the prostate has been removed or treated. It may also improve symptoms of erectile dysfunction.[13]
• Exercises for BPH

Simple pelvic floor exercises involve contracting and relaxing the muscles in the anus and urinary tract. While practicing prostate exercises, it is important not to work any other muscles and to only use the specific pelvic floor muscle being worked. Verbal instructions may be useful to help identify the right muscles to exercise.

Breathing appears to be a core component of working the pelvic floor muscles, with muscles contracting during exhalation and relaxing during inhalation.[14]

• Double Voiding: Double voiding is a technique that involves urinating, then waiting a few moments, and trying to urinate again. This practice helps ensure that the bladder is completely emptied, which can reduce the feeling of needing to urinate frequently and improve bladder function.
• Kegel Exercises: Kegel exercises involve repeatedly contracting and relaxing the pelvic floor muscles, which strengthen them and can help control urination and improve bladder control. To perform Kegel exercises, tighten the muscles you would use to stop urine flow, hold for a few seconds, and then release. Repeat this process several times a day for the best results. It is recommended to aim for 10 reps three times a day.[15]

• Regular Physical Activity also appears to lower the risk of developing incontinence by roughly 25% and has proven helpful for alleviating such symptoms in susceptible men. In men over 60 with BPH, Tai-chi has shown great results in helping reduce the severity of urinary tract symptoms by as much as 31%, lower insulin levels, and boost testosterone (not DHT). The men performed 1 hour of tai-chi 3 times per week for 12 weeks.[16] Some forms of exercise ought to be avoided by men with prostate enlargement, such as cycling[17], as this can place pressure on the area and increase symptoms.

 Conventional Treatment Options

The most commonly prescribed treatment options for BPH are briefly discussed below. Due to their side effects, they are usually only sought out when the symptoms are severe and the patient cannot find relief through simple lifestyle modifications.

• Ultrasound might be a viable treatment option capable of shrinking your prostate, especially when coupled with some of the targeted lifestyle and dietary interventions suggested above. Some clinics have recommended ultrasound over surgery due to its high degree of success, non-invasiveness, lower expense, and better overall outcome.
• Pharmaceuticals.

5-alpha reductase blockers: Finasteride and dutasteride are common medications prescribed to patients with BPH, both of which block 5-alpha reductase 2 (dutasteride blocks type 1 and 2). They have been shown to lower prostate enlargement by as much as 20% and slow down the progression of the disease. Side effects include male sexual dysfunction. In men with severe urinary incontinence, alpha-blockers may also be prescribed to relax the muscles in the bladder and improve urination.[18]

Use of Alpha-Blockers such as Terazosin (Hytrin) or Tamsulosin (Flomax): Alpha-blockers are medications commonly prescribed to treat symptoms of an enlarged prostate. These medications relax the prostate and bladder neck muscles, which makes it easier to urinate and helps to alleviate symptoms such as difficulty starting, weak flow, and the need for urgent or frequent urination

Terazosin (Hytrin): It is usually taken once daily, and the dosage may be gradually increased by a healthcare provider to achieve the desired effect. Common side effects include dizziness, lightheadedness, and weakness, particularly when standing up quickly, due to its blood pressure-lowering effects.

Tamsulosin (Flomax): It is typically taken once daily, about 30 minutes after the same meal each day. Tamsulosin is generally well-tolerated, but side effects can include dizziness, headaches, and sometimes issues with ejaculation. Unlike some other alpha-blockers, tamsulosin has less impact on blood pressure, making it a suitable option for patients who may be concerned about this side effect.

Both medications help improve urine flow and reduce BPH symptoms, significantly enhancing the quality of life for many men with an enlarged prostate. However, they do not reduce the size of the prostate; rather, they alleviate the symptoms associated with BPH.

• Surgery is usually a last resort for older men who are suffering from bladder obstruction as a result of prostate enlargement, to which transurethral resection of the prostate is the gold standard. Nowadays, the best surgical techniques make use of non-invasive surgical devices such as HoLEP (x-ray laser surgery) and REZUM (steam ablation)[19]. These show equal or better results without requiring an incision. After the prostate is removed, it is normal for men to still suffer from lower urinary tract symptoms, to which the above dietary recommendations are still largely valid.

Food and Diet to Treat BPH

Diet plays a crucial role in managing BPH symptoms. While certain foods can help alleviate symptoms, others might exacerbate them. Adopting a diet that supports prostate health can be an effective complementary approach to conventional treatments.

Foods to Include in Your Diet

• Fruits and Vegetables: Antioxidant-rich fruits and veggies can help reduce inflammation and oxidative stress. Tomatoes, which contain lycopene, are particularly beneficial for prostate health. Other good options include berries, leafy greens, and cruciferous vegetables like broccoli and cauliflower.
• Healthy Fats: Omega-3 fatty acids can benefit prostate health due to their anti-inflammatory properties. Fish, such as salmon, sardines, and mackerel, as well as flaxseeds and walnuts, are good sources of omega-3 fatty acids.
• Nuts and Seeds: Certain varieties of nuts and seeds (E.g., pumpkin seeds and Brazil nuts) are excellent sources of zinc, which is important for prostate health. They also provide essential fatty acids and antioxidants.
• Whole Grains: Whole grains high in fiber, such as oats, brown rice, and quinoa, can help regulate hormone levels and improve overall health.
• Legumes: Beans, lentils, and soy products contain plant-based proteins and phytoestrogens, which may help balance hormone levels and reduce the risk of BPH progression.
• Herbs: Herbs can support prostate health and manage BPH symptoms. Saw Palmetto may help reduce prostate enlargement by inhibiting hormone conversion. Nettle Root supports urinary tract health and may alleviate BPH symptoms. Pygeum improves urinary flow and reduces inflammation[20].

Foods to Avoid

• Red and Processed Meats: Reduce intake of red and processed meats as these have been linked to increased prostate cancer risk and may exacerbate BPH symptoms. Opt instead for lean proteins like poultry, fish, and plant-based options.
• Dairy Products: Some studies have indicated a potential link between high dairy consumption and an elevated risk of BPH. Limiting dairy intake and choosing alternatives such as almond or soy milk might be beneficial.
• Caffeine and Alcohol: Consuming caffeine and alcohol can irritate the bladder and increase urinary symptoms. Limiting or eliminating these from your diet can help manage BPH symptoms.
• Sodium: High intake of salt can increase blood pressure and contribute to swelling and inflammation. It can be helpful to reduce salt in your diet by avoiding processed foods and using herbs and spices instead for flavor.
• Sugary Foods and Drinks: Excess sugar can lead to weight gain and inflammation, which can aggravate BPH symptoms. Choosing whole fruits over sugary snacks and drinks can make a significant difference.
• Spicy and Acidic Foods: These can irritate the bladder and prostate, triggering or worsening symptoms. Curries, chili peppers, and hot sauces are examples of foods to stay away from with an enlarged prostate. To manage symptoms, consider limiting your intake of spicy and acidic foods.

Lifestyle Changes to Manage an Enlarged Prostate

Certain lifestyle changes can significantly help in managing the symptoms of BPH. Integrating these changes into your daily routine can reduce discomfort and improve quality of life.

• Reducing Water Intake at Night: Limiting fluid intake in the evening can serve to reduce the frequency of nighttime urination (nocturia). This can lead to better sleep quality and less disruption during the night. Try to drink the majority of your fluids earlier in the day and reduce intake a few hours before bedtime.
• Urinating When You Have the Urge: It’s important to respond to the urge to urinate promptly. Holding in urine can stretch the bladder and exacerbate symptoms. Try to urinate regularly and completely empty your bladder each time to avoid retention and reduce the risk of urinary tract infections.
• Avoiding Antihistamines and Decongestants: Certain medications, including antihistamines and decongestants, can worsen BPH symptoms by tightening the muscles around the urethra and making it more difficult to urinate. If you are experiencing BPH symptoms, consult your doctor before using these medications. They may be able to recommend alternatives that do not affect the prostate.

Frequently Asked Questions

How to Check For An Enlarged Prostate At Home?

While a definitive diagnosis of an enlarged prostate (BPH) should be made by a healthcare professional, there are some signs you can look for at home. These include symptoms discussed above, such as experiencing a weak urine stream, difficulty starting urination, frequent urination (especially at night), a feeling that your bladder is not completely empty after urination, and dribbling at the end of urination. If you notice these symptoms, it's important to consult a doctor for a proper evaluation and diagnosis.

How Do I Maintain Prostate Health?

Maintaining prostate health typically involves adopting a healthier lifestyle and diet. As mentioned previously, consuming foods rich in antioxidants, such as fruits and vegetables, can help reduce inflammation. Staying hydrated, reducing alcohol and caffeine intake, and avoiding processed foods are also beneficial. Some natural supplements like saw palmetto, green tea, and lycopene are thought to support prostate health. Regular exercise and maintaining a healthy weight are also important. Always consult with a healthcare provider before starting any new supplements or drastic dietary changes.

Conclusion

Benign prostatic hyperplasia refers to excessive non-cancerous prostatic growth that typically encroaches on the male urinary tract, resulting in urinary tract symptoms and bladder obstruction. It usually affects aged men, yet may begin in younger men aged 30-40 and older. If detected early on, many men are able to control the condition through lifestyle and dietary modifications that serve to correct hormonal imbalances and shrink the size of the prostate. Among these, consuming a healthy diet, engaging in regular physical activity, making use of prostate exercises, and including various foods with anti-BPH properties have proven to be effective. If lifestyle changes do not help, ultrasound, pharmaceuticals, or surgery can also help to resolve the problem.

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Sources:

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• [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303144/
• [4] https://pubmed.ncbi.nlm.nih.gov/33969413/
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• [13] https://pubmed.ncbi.nlm.nih.gov/16301945/
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• [20] https://pubmed.ncbi.nlm.nih.gov/34885733/

 

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