supplements they're everywhere in fact as you age particularly over the age of 60 people are likely to report taking four or more dietary supplements so can supplements help your prostate I'm Dr Reena Malik urologist and pelvic surgeon and today we're going to cover what supplements there are that might help with prostate enlargement or symptoms related to prostate enlargement and what is the data behind them benign prosthetic hyperplasia BPH or prostate enlargement is a very common condition in fact 80% of men at the age of 80 will have prostate enlargement so people often have symptoms related
to prostate enlargement and these can be things like having a weak urinary stream having difficulty emptying your bladder having to wait for your stream to start or your stream having to stop and start during urine flow in some cases it can also cause going to the bathroom very often during the day or even at night and it can cause the urge to go got to go got to go and sometimes not even make it so wouldn't it be great if we had natural supplements to help with these symptoms now before I get into the data
on the variety of supplements that are available I want to let you know what supplements are they're what we call phyto Therapeutic products meaning that they come from plants and so plants themselves will have variability and so often times even if you get the same supplement from the same manufacturer sometimes they may work better than others also companies use different processes when they extract the ingredient from the plants and so that can also vary the efficacy and the amount of the product within the supplement can vary in one study looking at 27 saw palmetto products
they saw huge variability in the active ingredient which is the free fatty acid within the saw palmetto and that ranged from anywhere from none in the supplement to 95% the amount that was needed and only 17 met the the criteria for a Sal paletto supplement which was to have 85% of that free fatty acid component or more in the supplement so the way these supplements typically work is they have anti-inflammatory effects and if you watched my last video last week you know that inflammation is one of the causes of prostate enlargement so they have an
anti-inflammatory effect sometimes they also interact with some of those growth factors I told you that are involved in cell proliferation like IL GF or insulin like growth factor and other growth factors that cause cell growth and lastly sometimes they interact with the hormones DHT or the enzymes that convert them five Alpha reductase now one of the pharmaceutical drugs that we use for BPH does also affect that same enzyme called five Alpha reduct paste and it inhibits the conversion of testosterone to DHT and this is actually quite effective in reducing prostate size and growth so some
of these medications are similar in that way and if you want to learn more about that medication check out my video where I talk about medications for enlarged prostate in quite detail including the side effects that you may experience if you're taking them so let's start off with the most rigorously studied supplement in probably all of Urology and that's called sanoa reppin or saw palmetto this is a berry from a dwarf plant tree and while the mechanism of action is not 100% clear it's thought to reduce in inflammation it's also thought to reduce the conversion
of testosterone to DHT by acting on the 5 Alpha reductase enzyme it s to inhibit The Binding of dihydrotestosterone which is the most concentrated Androgen in the prostate how this supplement works is one it reduces prostate inflammation two it's thought to inhibit the conversion of testosterone to DHT by its effect on five Alpha reductase and lastly if it also may affect The Binding of dihydrotestosterone to receptors in the prostate now I'm going to go over the abundance of data on sa paletto so I want to start by saying this was used very often in the
'90s in Europe and the United States because the early studies were very very promising and of course people like taking supplements over taking Pharmaceuticals and so the first study was published in the New England Journal of Medicine now I have not seen many studies supplements with the exception of like vitamin D and magnesium in the large journals like the New England Journal and jamama these are sort of the top tier medical journals that clinical doctors and clinical Physicians use to assess the medical literature and these are the type of articles that cause changes in our
practice in our clinical practice of how we take care of patients so all the studies I'm going to talk about are randomized control trials now this study was also a double blinded randomized controlled trial of 225 men and this is important because not only did they not know what they were getting but the people who were giving the medication didn't know what they were giving and these men had to have moderate to severe symptoms and they had to take saw paletto for one year during the duration of the study at 160 milligram dose twice daily
and all these studies look at different factors obviously they look at symptom scores so they use validated questionnaires that correlate with the sever of symptoms and they use these to sort of standardize the outcome and they use those they look at your flow rate which is how fast your urine flows out how quickly it hits the toilet in milliliters per second they sometimes look at prostate size and often times they also look at how well your bladder is emptying so how much urine is left over after urinating and in this trial they also looked at
quality of life and so in all of these measures they found no statistically significant difference between those who took the saletto and those who took a placebo pill now the reason I've said this many times the reason these studies are so important is because every time you take a pill there is a placebo effect meaning you think it's going to work and your brain is quite powerful and it will tell your body that your symptoms are better or it may help even with some symptoms but it's all based on just a placeo there's no active
ingredient in that pill and so it's important to differentiate what is a placebo effect and what is a true effect of the actual treatment that you're giving so in the next study which was published in jamama the Journal of the American Medical Association in 2011 now this was also a double blind randomized control trial it was over 11 different centers in North America and it recruit over 300 men and in this day they were dose escalated meaning that they started with getting 320 milligram a day of s paletto which is the same that they were
getting in that last study they then increased the dose to double that and then triple that that to see if there was any difference and they followed the study over 72 weeks so it was not a short study and what they found over those three years was that there was really again no statistically significant difference in all the parameters that they investigated now remember the last study in the New England Journal was moderate to severe Luts this study was actually a group of people who probably had more mild symptoms they were younger overall they were
less symptomatic they had better flow rates and lower PSAs now PSA is a blood test that is often used for screening of prostate cancer but it also can be used as a surrogate for prostate size because the larger your prostate is the more PSA it makes this has also been studied so much that they created what's called a Cochran review Cochran reviews are sort of a well-respected organization the Cochran review organization that creates systematic reviews of all the data and literature and in fact sa paletto went through I think three Co reviews the last one
being in 2012 because once they saw this new jamama article they had to incorporate it into the systematic review into and analyze all the data from all the studies together to come up with a definitive plan is sa paletto actually helpful in this review they include 17 randomized control trials with over 2,000 patients these patients were about 64 years of age most of them were white and they had moderate to severe symptoms based on their symptom scores when they focused on the high quality long duration studies and analyzed those specifically they again saw no significant
difference in symptom score or flow rate with saw paletto compared to Placebo so I will say this is actually a really good example of what happens in the field of science right we start off with smaller studies usually they're less you know they receive less funding they're less of interest and so they there're smaller duration studies and we may see promising results but when we follow this data for years with larger numbers of patients that difference may become diluted and actually not be significant it means that it may not make a difference that's clinically meaningful
to patients what do I do with supplet I still offer it to patients if they are wanting to try a supplement option because I do find that some patients still do see a benefit however that I always tell them the data did not show a benefit so this is essentially maybe a drain on your wallet and may not be helpful but for some people they would much rather take either that or take that with other medications to avoid a surgical procedure for an enlarged prostate and again this is about what you want and what you
need now s petto is generally very very safe has very little side effects it can affect blood climing so if you're going to have a major procedure generally it's a good idea to stop it two weeks before but otherwise it's pretty safe most people tolerate it pretty well and I will say that generally speaking any supplement or anything you take can have GI side effects so nausea vomiting changes in bowel habits so if that occurs with anything obviously you can stop it and make sure that those symptoms improve and if they persist it's important to
see your primary care doctor to make sure it's nothing more serious the next supplement is called pigum africanum now this is from the bark of an African cherry tree and the fruit that it produces are African cherries or African plums however you want to call it but that's where the word Pidgeon comes from and this works by a mult itude of actions first off it reduces five Alpha reductase activity so it prevents the conversion of testosterone to dihydro testosterone also inhibits the anid receptor from binding so that it reduces signaling and by that way it's
supposed to reduce prostate cell growth there was also so many studies on this that they also had a cockr intereview that was published in 2002 this also included 18 randomized control trials with over 1,500 men and however it's important to note that these studies were really really short in duration it was about 64 days and in this interview they actually did see a benefit people who took the Pidge at least in this short duration were it twice as likely to show an improvement in overall symptoms they reduced the need to urate at night by about
19% the amount of volume of urine left over after uating in the bladder by about 24% and they increased the peak urinary Flow by another 23% so it did see an improvement and the dose they took range from 100 to 200 Mig now there were some side effects again most common were GI side effects and nausea abdominal discomfort things like that but despite this positive review so while they saw a positive Improvement I don't believe there's been any subsequent longer term studies that have shown benefit with this particular supplement now I see it a lot
in combination with sa pometto in terms of those supplements that have multiple ingredients in them and so perhaps maybe together they do see a better benefit but generally speaking like I said these C are really small the outcomes were not standardized it was a really short duration so hard to tell if it's really going to help in the long term and generally speaking when you take supplements that's usually not a quick onset like when you take a pharmaceutical sub medication those are really sort of concentrated to have just the active ingredient in them and so
they work a lot quicker whereas supplements you generally have to take couple months or at least a month to see a true benefit so I'm not really sure if this would be replicated in longer term studies the next supplement is called churb pppo or pumpkin seed and so pumpkin seed usually comes an extract either an oil or a supplement pill form and it works by again affecting the five Alpha reductase enzyme it also has a huge anti-inflammatory component and in fact in Rat studies it has been shown to increase nitric oxide which can then allow
for smooth muscle relaxation so that can also help relax the prostate and allow for improvement in symptoms additionally pumpkin seeds have really high levels of zinc and the prostate is one of the organs in the body that has high concentration of zinc so the zinc itself is thought to ameliorate some of the BPH symptoms now it's important to note in your extract that you decide to take if you decide to take it after watching this that there are high levels of phosphate zinc as I mentioned magnesium and manganese and a lot of pumpkin seed extract
so if you for example are taking another magnesium supplement you don't want to take both or if you have kidney issues you don't want high levels of phosphate so you want to avoid something like this so always no matter what supplement you take check the ingredients on the back because you don't want to excessively take any one ingredient again we're focusing on studies that are randomized controlled trials so here they had a randomized control trial looking at men getting two 500 Mig of pumpkin seed extract versus the the control over 12 months and they recruited
about 476 men they did see a significant Improvement in symptoms based on validated questionnaires a 65% Improvement in the pumpkin seed group versus a 54% Improvement in the control group now look that's a huge placebo effect 54% that's pretty high they didn't see an improvement in other factors like flow rate residual urine leftover PSA levels and the size of the prostate there was again another study very similar to this for 1400 patients that were randomized to receive either the pumpkin seed extract of 500 Mig or the pumpkin seed itself of 5 G twice a day
compared to Placebo and again they did see an improvement in symptom scores but they weren't sure if it was really clinically significant so generally speaking I think um in terms of pumpkin seed I've seen a lot of stuff on social media about pumpkin seed extract pumpkin seed oil and I think there may be a benefit but if we're not seeing changes in the other parameters like how quick your urine is Flowing which is usually the big one that I like to see is that your flow is better then it may not be useful but I
think that also it does have some beneficial effects on the bladder itself so it may improve some of the overactive bladder symptoms like going often or got to go got to go or having to wake up at night which isn't really assessed by these other parameters like prostate volume and residual urine but it may overall help with those symptoms the next one is beta cyto sterol so this is a very common molecule that's found in a lot of cell membranes that's similar to cholesterol and it's found in plants cereals it's very highly abundant but it
works in in one way as an anti-inflammatory and it also has what we call pro-apoptotic mechanism so it actually helps sort of kill off some of the cells that are growing in the prostate and that's the theory anyways again this is also seen most commonly in sort of combination supplements but this was studied again in a Cochran review this was published in 1999 and it had five randomized control trials included in it with over 500 men and so in these two in the both control and the supplement group they saw an improvement in symptoms but
they also saw an improvement in flow rate is important but they did not see an improvement in overall prostate size so it doesn't cause prostate shrinkage it may improve urinary flow rate side effects again are GI related so gas constipation diarrhea but otherwise generally pretty well tolerated and that moves us on to the last one for today which is stinging nettle or Tica diosa I might be saying that wrong so this is a perennial plant that's usually found in damp soils and abandoned fields and typically people will use the root extract for the benefit of
BPH symptoms so similar to Beta cytool it has anti-inflammatory and anti-growth essentially factors it will inhibit some of the growth factors that are responsible for BPH growth it may even inhibit the connection of sex hormone binding globulin two receptors in the prostate itself there was no good high quality study with sticking nettle by itself but there was one where it was combined with s Palmetto or in the study called Sabal fruit in the study they randomized to receive 160 Mig of sa paletto with 120 Mig of the root extract of St stinging nettle twice a
day compared to the placebo and they follow these people for up to 48 weeks and after 48 weeks they were then all given the active supplement to up to 96 weeks and So based on this they again saw an improvement in symptoms and urinary flow rates with both together over 96 weeks and so that does again show a PR that's a pretty good rigorous long-term study that's shown a benefit sing nettle has a little bit more sort of reactions that you need to be aware of one is that it can interact with iron so if
you're taking iron it can reduce the efficacy of the iron you're taking it of course can cause the same GI effect some people do get swelling or hives or other sort of dermatologic issues although that's quite rare and if you're taking Lithium or blood thinners you want to avoid taking stinging nettle also if you're diabetic stinging nettle can have sort of a hypoglycemic effect so you want to watch that with your diabetes medications it may not be a good idea to take those together if you're taking diuretics tigy nle can also decrease your body's potassium
which can be dangerous if combined with the wrong diuretic so if you're any of those categories I would just avoid taking stingy nettle altogether now in my last video I talked about lopine so lycopene is a powerful keratinoid that has an anti-inflammatory effect it also is a strong antioxidant and it can slow prostate growth by the way it interacts with certain growth factors like igf-1 to help reduce the growth of the prostate so in terms of studies with lycopene there's no randomized control trials on lycopene by itself but there have been reviews looking at sort
of all the published literature and I will say it's extremely variable they've seen doses from anywhere to 10 milligrams twice a day up to 500 milligram twice a day they follow people for up to 6 months and they've done it on a large number about 2,000 patients if you look at all the data together and they've shown some benefit but again these studies are really variable and you cannot confirm this without a randomized control trial so until there are randomized control trials that go head to-head with lycopene and Placebo it's really hard to say if
this truly works and if you are going to try lopine I'd say start with the food grade first rather than taking supplements so add some tomato paste into your diet or tomatoes or watermelon or any other food that has lopine and see if that helps with your symptoms again lopine in terms of tomato based products can be a bladder irritant so if you are experiencing irritation from eating those things and maybe taking a supplement may be better but but again I can't say if it's truly effective the only randomize control trials we have as I
mentioned are with other things like saw petto and selenium where they did see a benefit and also just know that lycopene can affect blood clotting so if you are taking lycopene to stop at a couple weeks before surgery so that you don't have any adverse bleeding during surgery so in terms of BPH these are probably the most rigorously studied supplements and the one that has the most that is s pletto ultimately did not show a benefit but still I think being highly used and it does help for some individual patients and then the other ones
you know there's some data but not as robust as s petto and ultimately I think if you are having bothersome BPH symptoms of course my concern is your quality of life and improving that quality of life and so if these supplements help you get there that's great there's also of course a number of medications that you can take or procedures that you can get done if it's becoming too bothersome really the biggest concern as a urologist is that over time when you have a large prostate blocking the bladder it can affect bladder function it can
make the bladder not squeeze as strongly as it used to because it keeps pushing urine through the prostate for years and years which can create a problem and so in terms of that if you are symptoms are getting worse or you're having symptoms very young I encourage you to consider doing something to alleviate those symptoms and either start medication or consider a procedure because you're young and you've got many many years to live and it could become a problem as you age but at the end of the day we just want you to feel better
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