Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

Need to Know

Benign Prostatic Hyperplasia
Also known as BPH, this common condition is characterized by frequent urges to urinate. What can you do to relieve prostate pressure? According to research or other evidence, the following self-care steps may be helpful.
  • See what saw palmetto has to offer

    Control BPH symptoms with this effective herbal remedy; take 320 mg a day of a liposterolic extract, standardized for 80 to 95% fatty acids

  • Discover the benefits of beta-sitosterol

    Take 130 mg a day of this edible plant compound to improve urinary flow and other symptoms

  • Try flower pollen

    Take several tablets or capsules a day of flower pollen extract to reduce symptoms

  • Get to know pygeum

    Try 100 to 200 mg a day of this evergreen tree bark extract, standardized for 13% total sterols

  • Focus on physical fitness

    Increase your physical activity by walking more or adding other exercise

About

About This Condition

Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland.

The prostate is a small gland that surrounds the neck of the bladder and urethra in men. Its major function is to contribute to seminal fluid. If the prostate enlarges, pressure may be put on the urethra, acting like a partial clamp and causing a variety of urinary symptoms. Half of all 50-year-old men have BPH, and the prevalence of the condition increases with advancing age. The name “benign prostatic hyperplasia” has replaced the older term “benign prostatic hypertrophy”; both terms refer to the same condition.

Symptoms

A man with BPH has to urinate more often, especially at night, and experiences less force and caliber while urinating, often dribbling. If the prostate enlarges too much, urination is difficult or impossible, and the risk of urinary tract infection and kidney damage increases. A doctor can usually detect an enlarged prostate during a rectal exam.

Supplements

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


Supplement Amount Why
Beta-Sitosterol
 60 to 130 mg daily 3 stars   Men taking beta-sitosterol, a compound found in many edible plants, have reported improved BPH symptoms and urinary flow.

3 stars  Beta-Sitosterol

60 to 130 mg daily

Beta-sitosterol , a compound found in many edible plants, has also been found to be helpful for men with BPH. In one double-blind trial, 200 men with BPH received 20 mg of beta-sitosterol three times a day or a placebo for six months. Men receiving beta-sitosterol had a significant improvement in urinary flow and an improvement in symptoms, whereas no change was reported in men receiving the placebo.1 Another double-blind study reported similarly positive results using 130 mg per day of beta-sitosterol.2

Supplement Amount Why
Nettle
 120 mg of root extract (capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day 3 stars   A concentrated extract made from the roots of the nettle plant may increase urinary volume and flow rate in men with early-stage BPH.

3 stars  Nettle

120 mg of root extract (capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day

In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

A concentrated extract made from the roots of the nettle plant may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH.3 It has been successfully combined with both saw palmetto and pygeum to treat BPH in double-blind trials.4 It has also been shown in a double-blind trial, when used by itself, to relieve symptoms of BPH and to improve disease severity.5 An appropriate amount appears to be 120 mg of nettle root extract (in capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day.


Supplement Amount Why
Rye Pollen Extract
 126 mg three times daily 3 stars   Rye pollen extract has been shown to improve BHP symptoms.


3 stars  Rye Pollen Extract

126 mg three times daily

Rye pollen extract has improved the symptoms of BPH in preliminary trials.6 , 7 , 8 Double-blind trials have also reported that rye pollen extract is effective for reducing symptoms of BPH9 , 10 This rye pollen extract was shown to be comparable in effect to an amino acid mixture used for BPH in a double-blind study.11 A double-blind comparison with pygeum resulted in significant subjective improvement in 78% of those given the rye pollen extract compared with 55% using pygeum.12 Research on this commercial rye pollen extract has used three to six tablets, or four capsules, per day; the effect of other pollens in men with prostate conditions has not yet been studied.

Supplement Amount Why
Saw Palmetto
 320 mg per day of herbal extract standardized to contain approximately 80 to 95% fatty acids 3 stars   Saw palmetto, the leading natural treatment for BPH, has been shown to help keep symptoms in check when used regularly.


3 stars  Saw Palmetto

320 mg per day of herbal extract standardized to contain approximately 80 to 95% fatty acids

In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

The fat-soluble (liposterolic) extract of the saw palmetto berry has become the leading natural treatment for BPH. This extract, when used regularly, has been shown to help keep symptoms in check.13 , 14 Saw palmetto appears to inhibit 5-alpha-reductase, the enzyme that converts testosterone to its more active form, dihydrotestosterone (DHT). Saw palmetto also blocks DHT from binding in the prostate.15 Studies have used 320 mg per day of saw palmetto extract that is standardized to contain approximately 80 to 95% fatty acids.

A three-year preliminary study in Germany found that 160 mg of saw palmetto extract taken twice daily reduced nighttime urination in 73% of patients and improved urinary flow rates significantly.16 In a double-blind trial at various sites in Europe, 160 mg of saw palmetto extract taken twice per day treated BPH as effectively as finasteride without side effects, such as loss of libido.17 A one-year dose-comparison study found that 320 mg once per day was as effective as 160 mg twice per day in the treatment of BPH.18 A review of all available double-blind trials has concluded that saw palmetto is effective for treatment of men with BPH and is just as effective as, with fewer side effects than, the drug finasteride.19 One study found saw palmetto to be ineffective as a treatment for BPH. However, the study excluded men with mild BPH, even though previous studies had found the herb effective for mild to moderate BPH.20

Supplement Amount Why
Amino Acids
 760 mg of a combination of glycine, alanine, and glutamic acid three times per day for two weeks, then 380 mg three times per day 2 stars   In one study, supplementing with amino acids reduced urgency, frequency, and delay starting urine flow.


2 stars  Amino Acids

760 mg of a combination of glycine, alanine, and glutamic acid three times per day for two weeks, then 380 mg three times per day

In a controlled trial, men with BPH received a supplement containing three amino acids (glycine, alanine, and glutamic acid) totaling about 760 mg three times per day for two weeks, then 380 mg three times per day for a total of three months. After three months, about half of these men reported reduced urgency, frequency, and/or less delay starting urine flow, compared to 15% or less of the men who received a placebo.21 Another similar controlled trial of this combination also reported positive results22 Although it is not known how the amino acid combination works, it is believed to reduce the amount of swelling in prostate tissue.

Supplement Amount Why
Garlic
 1 ml aged extract per 2.2 lbs (1 kg) of body weight daily 2 stars   A special garlic extract (Kastamonu Garlic) reduced prostate size and significantly improved urinary symptoms in one study.


2 stars  Garlic

1 ml aged extract per 2.2 lbs (1 kg) of body weight daily

In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

In a preliminary study, supplementation with a special aged garlic extract (Kastamonu Garlic) in the amount of 1 ml per 2.2 pounds of body weight per day for one month resulted in a 32% reduction in the size of the prostate gland and a significant improvement in urinary symptoms.23 It is not known whether other forms of garlic would have the same effect.

Supplement Amount Why
Pumpkin Seed Oil
160 mg oil three times daily 2 stars   Pumpkin seed oil has been shown to relieve BPH symptoms, possibly because it improves bladder and urethra function.

2 stars  Pumpkin Seed Oil

160 mg oil three times daily

In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

Pumpkin seed oil has been used in combination with saw palmetto in two double-blind human studies to effectively reduce symptoms of benign prostatic hyperplasia (BPH).24 , 25 Only one group of researchers has evaluated the effectiveness of pumpkin seed oil alone for BPH, but the results of their large preliminary trials have been favorable.26 , 27 Researchers have suggested the zinc, free fatty acid, or plant sterol content of pumpkin seeds may account for their benefit in men with BPH, but this has not been confirmed. Animal studies have shown that pumpkin seed extracts may improve the function of the bladder and urethra; this might partially account for BPH symptom relief.28 Pumpkin seed oil extracts standardized for fatty acid content have been used in BPH studies in the amount of 160 mg three times per day with meals.

Supplement Amount Why
Pygeum
 50 to 100 mg of an herbal extract standardized to contain 13% total sterols twice per day 2 stars   Safe and effective for men with mild to moderate BPH, pygeum contains compounds that have anti-inflammatory activity and help rid the prostate of any cholesterol deposits.


2 stars  Pygeum

50 to 100 mg of an herbal extract standardized to contain 13% total sterols twice per day

In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.

Pygeum , an extract from the bark of the African tree, has been approved in Germany, France, and Italy as a remedy for BPH. Controlled studies published over the past 25 years have shown that pygeum is safe and effective for men with BPH of mild or moderate severity.29 These studies have used 50 to 100 mg of pygeum extract (standardized to contain 13% total sterols) twice per day. This herb contains three compounds that may help the prostate: pentacyclic triterpenoids, which have a diuretic action; phytosterols, which have anti-inflammatory activity; and ferulic esters, which help rid the prostate of any cholesterol deposits that accompany BPH.

Supplement Amount Why
Reishi
 6 mg per day for 8 weeks 2 stars   A double-blind trial found that an extract of Ganoderma lucidum mushroom was significantly more effective than a placebo in improving urinary symptoms in men with BPH.


2 stars  Reishi

6 mg per day for 8 weeks

In a double-blind trial, an extract of Reishi mushroom (Ganoderma lucidum; 6 mg per day for 8 weeks) was significantly more effective than a placebo in improving urinary symptoms in men with BPH. Reishi extract appears to work by inhibiting 5-alpha-reductase, the enzyme that converts testosterone to its more active form, dihydrotestosterone (DHT).30

Supplement Amount Why
Copper
 Refer to label instructions 1 star   If you are taking large amounts of zinc (such as 30 mg per day or more) for BHP, most doctors recommend supplementing with copper to avoid copper deficiency.

1 star  Copper

Prostatic secretions are known to contain a high concentration of zinc; that observation suggests that zinc plays a role in normal prostate function. In one preliminary study, 19 men with benign prostatic hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100 mg daily. In 74% of the men, the prostate became smaller.31 Because this study did not include a control group, improvements may have been due to a placebo effect. Zinc also reduced prostatic size in an animal study but only when given by local injection.32 Although the research supporting the use of zinc is weak, many doctors recommend its use. Because supplementing with large amounts of zinc (such as 30 mg per day or more) may potentially lead to copper deficiency, most doctors recommend taking 2 to 3 mg of copper per day along with zinc.

Supplement Amount Why
Flaxseed Oil
 Refer to label instructions 1 star   People with BPH have benefited from essential fatty acids, including flaxseed oil. EFAs increase the need for vitamin E, so take a vitamin E supplement along with flaxseed oil.

1 star  Flaxseed Oil

In a 1941 preliminary report, 19 men with BPH were given an essential fatty acid (EFA) supplement.33 In every case, the amount of retained urine was reduced, and nighttime urination problems stopped in 69% of cases. Dribbling was eliminated in 18 of the 19 men. All men also reported improved libido and a reduction in the size of the enlarged prostate, as determined by physical examination. Because this study did not include a control group and the amount given was surprisingly small, the possibility of a placebo effect cannot be ruled out.

Despite the lack of good published research, many doctors have been impressed with the effectiveness of essential fatty acids (EFAs) in cases of BPH. A typical recommendation is one tablespoon of flaxseed oil per day, perhaps reduced to one or two teaspoons per day after several months. Because taking EFAs increases the requirement for vitamin E, most doctors recommend taking a vitamin E supplement along with EFAs. However, controlled research is needed to establish whether EFAs are helpful for BPH.

Supplement Amount Why
Zinc
 Refer to label instructions 1 star   Zinc has been shown to reduce prostate size in some studies. If you are taking 30 mg or more of zinc per day, most doctors recommend adding 2 to 3 mg of copper to avoid deficiency.

1 star  Zinc

Prostatic secretions are known to contain a high concentration of zinc; that observation suggests that zinc plays a role in normal prostate function. In one preliminary study, 19 men with benign prostatic hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100 mg daily. In 74% of the men, the prostate became smaller.34 Because this study did not include a control group, improvements may have been due to a placebo effect. Zinc also reduced prostatic size in an animal study but only when given by local injection.35 Although the research supporting the use of zinc is weak, many doctors recommend its use. Because supplementing with large amounts of zinc (such as 30 mg per day or more) may potentially lead to copper deficiency, most doctors recommend taking 2 to 3 mg of copper per day along with zinc.

References

1. Berges RR, Windeler J, Trampisch HJ, et al. Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.

2. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997;80:427–32.

3. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.

4. Metzker H, Kieser M, Hölscher U. Efficacy of a combined Sabal-Urtica preparation in the treatment of benign prostatic hyperplasia (BPH). Urologe B 1996;36:292–300.

5. Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother 2005;5:1–11.

6. Horii A, Iwai S, Maekawa M, Tsujita M. Clinical evaluation of Cernilton in the treatment of the benign prostatic hypertrophy. Hinyokika Kiyo 1985;31:739–45 (in Japanese).

7. Ueda K, Jinno H, Tsujimura S. Clinical evaluation of Cernilton® on benign prostatic hyperplasia. Hinyokika Kiyo 1985;31:187–91 [in Japanese].

8. Hayashi J, Mitsui H, Yamakawa G, et al. Clinical evaluation of Cernilton in benign prostatic hypertrophy. Hinyokika Kiyo 1986;32:135–41 [in Japanese].

9. Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study. Br J Urol 1990;66:398–404.

10. Becker H, Ebeling L. Conservative therapy of benign prostatic hyperplasia (BPH) with Cernilton. Urologe (B) 1988;28:301–6 [in German].

11. Maekawa M, Kishimoto T, Yasumoto R, et al. Clinical evaluation of Cernilton on benign prostatic hypertrophy—a multiple center double-blind study with Paraprost. Hinyokika Kiyo 1990;36:495–516 [in Japanese].

12. Dutkiewicz S. Usefulness of Cernilton® in the treatment of benign prostatic hyperplasia. Int Urol Nephrol 1996;28:49–53.

13. Schneider HJ, Honold E, Mashur T. Treatment of benign prostatic hyperplasia. Results of a surveillance study in the practices of urological specialists using a combined plant-base preparation. Fortschr Med 1995;113:37–40.

14. Shi R, Xie Q, Gang X, et al. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. J Urol 2008;179:610–5.

15. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.

16. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia—results of a prospective 3-year multicenter study using Sabal extract IDS 89. Phytomedicine 1996;3:105–11.

17. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231–40.

18. Braeckman J, Bruhwyler J, Vandekerckhove K, Géczy J. Efficacy and safety of the extract of Serenoa repens in the treatment of benign prostatic hyperplasia: therapeutic equivalence between twice and once daily dosage forms. Phytotherapy Res 1997;11:558–63.

19. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA 1998;280:1604–9.

20. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med2006;354:557–66.

21. Damrau F. Benign prostatic hypertrophy: amino acid therapy for symptomatic relief. J Am Geriatr Soc 1962;10:426–30.

22. Feinblatt HM, Gant JC. Palliative treatment of benign prostatic hypertrophy: value of glycine, alanine, glutamic acid combination. J Maine Med Assoc 1958;46:99–102.

23. Durak I, Yilmaz E, Devrim E, et al. Consumption of aqueous garlic extract leads to significant improvement in patients with benign prostatic hyperplasia and prostate cancer. Nutr Res 2003;23:199–204.

24. Carbin BE, Eliasson R. Treatment by Curbicin in benign prostatic hyperplasia (BPH). Swed J Biol Med 1989;2:7–9 [in Swedish].

25. Carbin BE, Larsson B, Lindahl O. Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 1990;66:639–41 [in Swedish].

26. Schiebel-Schlosser G, Friederich M. Phytotherapy pf BPH with pumpkin seeds—a multicenter clinical trial. Zeits Phytother 1998;19:71–6.

27. Friederich M, Theurer C, Schiebel-Schlosser G. Prosta Fink Forte capsules in the treatment of benign prostatic hyperplasia. Multicentric surveillance study in 2245 patients. Forsch Komplementarmed Klass Naturheilkd 2000;7:200–4 [in German].

28. Zhang X, Ouyang JZ, Zhang YS, et al. Effect of the extracts of pumpkin seeds on the urodynamics of rabbits: an experimental study. J Tongji Med Univ 1994;14:235–8.

29. Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res 1995;56:796–817.

30. Noguchi M, Kakuma T, Tomiyasu K, et al. Effect of an extract of Ganoderma lucidum in men with lower urinary tract symptoms: a double-blind, placebo-controlled randomized and dose-ranging study. Asian J Androl 2008;10:651–8.

31. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.

32. Fahim MS, Fahim Z, Der R, Harman J. Zinc treatment for reduction of hyperplasia of prostate. Fed Proc 1976;35(3):361.

33. Hart JP, Cooper WL. Vitamin F in the treatment of prostatic hypertrophy. Report Number 1, Lee Foundation for Nutritional Research, Milwaukee, Wisconsin, 1941.

34. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.

35. Fahim MS, Fahim Z, Der R, Harman J. Zinc treatment for reduction of hyperplasia of prostate. Fed Proc 1976;35(3):361.

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