PROSTATE ENLARGEMENT, avoiding the surgical burden.

BPH: Symptoms of BPH can interfere with a man's life and cause intolerable psycho-social anguish and stigma. I am sure you have heard, seen or nursed a relative or a friend who has suffered BPH. Benign Prostatic Hyperplasia, also known as Benign Prostatic Hypertrophy is the enlargement of the prostate gland. The prostate is a gland located just below the urinary bladder. Its primary function is to secrete fluids that nourish the sperms. The prostate gland is homologous to the uterus in women. - This embryology topic is a story for another day. The prostate is a small ping-pong like ball located between the base of the penis and the rectum. The prostate gland surrounds the top portion of the tube that drains urine from the urinary bladder. This tube is known as the urethra. Since the prostate is a gland, it has the propensity to enlarge. When it enlarges it blocks the urethra from draining urine and therefore leads to difficulty in passing urine. An enlarged prostate gland compresses the urethra leading to urinary incontinence and urinary system complications. This enlargement is medically known as Benign Prostatic Hypertrophy or Benign Prostatic Hyperplasia (BPH). Several definitions exist in the literature when describing BPH. These include: Bladder outlet obstruction (BOO), Lower urinary tract symptoms (LUTS) Benign prostatic enlargement (BPE) -BPH describes the changes in the cell structures. -Benign prostatic enlargement (BPE) describes the increased size of the gland. -Bladder outlet obstruction (BOO) describes the obstruction to urine flow. When BPE presents together with BOO, it is termed as benign prostatic obstruction. Lower urinary tract symptoms (LUTS) simply describe urinary symptoms shared by disorders affecting the bladder and prostate Please note that BPH is not prostate cancer. These are different. BPH is benign while prostate cancer is malignant. There are several factors why a man ends up with BPH as discussed below: AGE Benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms (LUTS). As a man ages, his testosterone hormone begins declining. When testosterone in men declines, then oestrogen hormone begins rising. Oestrogen has a feminization effect in men. These effects are: Manboobs Obesity Muscle wasting BPH Slower metabolism Manboobs and abdominal obesity are signs of oestrogen dominance. Estrogen is a steroid hormone associated with the female reproductive organs and is responsible for the development of female sexual characteristics. There are three types of oestrogen: - Estriol (E3) - Estradiol (E2) -Estrone (E1) Estradiol (E2) is the most aggressive and responsible for hormonal dysfunction in men especially in the development of BPH. OBESITY Metabolic syndrome is the other reason why men develop BPH. Newer studies are reporting a rising BPH incidence in men below 40 years. Initially, when we were in medical college, we were taught that BPH is a disease of men above 50 years but this is now changing due to the current sedentary lifestyle that leads to obesity and metabolic syndrome. When a man is obese, he has layers of endocrine fats in his tissues. These fat tissues stimulate the secretion of hormones and enzymes. One of the enzymes secreted is known as the AROMATASE ENZYME which causes the aromatization (conversion) of testosterone into the dangerous oestrogen (E2) Too much oestrogen (E2) in men leads to: Low testosterone Production of a hormone known as PROLACTIN. Prolactin is a protein based hormone secreted from the anterior pituitary gland. This hormone is responsible for lactation, breast development, and hundreds of other actions needed to maintain homeostasis. Prolactin hormone in women stimulates breastfeeding by releasing breastmilk. In men, Prolactin hormone leads to the release of breast milk and the active turnover of cells in the prostate gland which then enlarges. Too much prolactin in women is also bad. It leads to excessive cell turnover in the uterus and ovaries thereby predisposing them to uterine and ovarian cancers. A FATTY LIVER Men with fatty liver have a bigger chance of developing BPH because the synthesis of testosterone is slowed or interfered by a fatty liver. Several clinical studies found that a fatty liver was associated with an increased risk of BPH, independent of well-identified metabolic risk factors. Moreover, the severity of a fatty liver was associated with an incremental increase in the risk of BPH. A fatty liver has a messed up cholesterol regulation, therefore, distorting the synthesis of testosterone. Remember, testosterone is synthesized from cholesterol. A fatty liver induces a set of hormonal derangements leading to low serum testosterone. Under conditions of a fatty liver, inflammatory chemicals are released due to chronic liver inflammation which directly affect the pituitary gland, reducing luteinizing hormone secretion, and may directly suppress the secretion of testosterone from Leydig cells in the testicles. Also, a fatty liver signals the release of aromatase enzyme which leads to aromatization of testosterone to oestrogen (E2). Alcohol and fructose are the primary causes of a fatty liver. DHT hormone This hormone is Dihydrotestosterone which is a product of active testosterone metabolism. Too much DHT means there is too much breakdown of testosterone leading to low testosterone. DHT plays a critical function in the sexual development of males, beginning early in prenatal life. The role of DHT differs as males progress through the different stages of development. It has various impacts on their physiology during childhood, puberty, and even throughout adult life. The enzyme that converts testosterone to DHT is known as 5 alpha-reductase. By the way, DHT is responsible for beards growth but ironically responsible for hair loss. That's why you will see men nowadays with beards but with a receding hairline. Such men have low testosterone, low libido and low sex stamina. So don't use hormonal chemicals to raise your beards. They will compromise the metabolic balance between DHT and Testosterone thereby messing with your sex life. - This is a story for another day. I wrote about hair loss here ( Men's hair loss) The most notable effects of DHT are prostate enlargement and male pattern hair loss as they age DHT does not play a significant role in the normal physiology of adults. High levels of DHT also lead to prostate enlargement. Those are the 4 reasons why men develop BPH in their adult life. How can men avoid benign prostatic enlargement? Tetralogy of wellness The most important approach is to Lose weight and live a healthy lifestyle. I call it the TETRALOGY OF WELLNESS. Proper diet Physical workouts Proper rest Positive purpose Healthy Diets Meat and eggs provide vital nutrients that slow the rapid conversion of testosterone to DHT Eat foods that block the secretion of aromatase and 5 alpha-reductase enzymes. These foods are Cabbage, broccoli, cauliflower. Meat and eggs Zinc eg Organ meat, pumpkin seeds Avoid oestrogenic foods ALCOHOL Soy and protein powders Pasteurized milk Sugar and modern fruits Wheat flour and refined grains Fasting Substantial studies have demonstrated that fasting can inhibit the inflammatory response and improve insulin resistance. Several studies have shown that insulin-resistance and hyperinsulinemia could be independent risk factors for BPH. Therefore fasting which corrects insulin resistance could potentially shrink BPH. Resistance training Strength training builds a muscular framework that maintains higher levels of testosterone hormone. Building and strengthening muscle should be the number one priority for any man above 35 years. Resistance training seems to be a promising approach in order to counteract loss of muscle mass, muscle strength, and physical performance in patients suffering from prostate enlargement. There are three supplements I will recommend that will block aromatase and 5 alpha-reductase enzymes: Stinging nettle root DIM ESTRO Saw Palmetto Stinging nettle has proven effecient in shrinking an enlarged prostate due to its specific anti-inflammatory action on the prostate tissues.