By Dr. Stephanie Millett, ND

For all the men out there, this one’s for you! In honor of Movember, this week’s article is all about your prostate with valuable and easy lifestyle changes you can make to reduce your risk of prostate related illness. Before we get into these healthy lifestyle tips, let’s first explore the function of the prostate and why it’s so important to take care of.

This male reproductive gland is approximately the size of a walnut and is located at the origin of the urethra, just below the bladder. The primary function of the prostate is to produce and secrete prostate fluid—which combines with sperm cells and other fluids to make up semen. The prostate fluid is full of compounds and enzymes that help protect the safe travels of the sperm to the female egg. Additionally, muscles in the prostate help to expel the semen through the urethra during ejaculation.  As such, a healthy prostate is very important for male fertility. As men age, the risk of prostate illness drastically increases. You may already be familiar with the common prostate related illnesses, but for the sake of being thorough, we will briefly discuss these conditions and their related signs and symptoms. If you are familiar with BPH, prostatitis and prostate cancer–and haven’t already skipped ahead to the 10 tips, feel free to do so now  ☺

BHP: Benign Prostatic Hyperplasia

This is a very common condition in men over 50, and virtually all men over 70 present with some degree of hyperplasia. BPH is essentially an enlargement of the prostate due to overgrowth in prostate cells.  

Causes: There are many factors that may influence the health and size of your prostate. As mentioned above, age is strongly and positively correlated with risk of BPH. This is, in part, due to hormonal changes occurring in aging men where testosterone is increasingly converted to dihydrotestosterone (DHT). Hyperplasia of the prostate is stimulated by increased levels of DHT as the prostate is more sensitive to DHT than it is testosterone. Other influential factors include diet, activity level, BMI, family history and environment—which we will explore more in the 10 tips!

Signs and symptoms: The majority of signs and symptoms associated with BPH are related to urinary function. Most men with this condition describe increased urinary frequency and urgency (daytime and nighttime). Many men also experience urinary hesitancy (difficulty initiating urination), weak urinary stream, incomplete voiding and urinary incontinence. 

Diagnostic testing: Assessment of prostate health includes a thorough history and often physical exam and laboratory testing. A digital rectal exam may be performed in order to assess the size and contour of the prostate. Laboratory tests may include a urinalysis to rule out other potential causes of urinary symptoms and PSA levels in the blood. PSA (prostate specific antigen) is a protein produced by prostate cells. It may be elevated in men with BPH, prostatitis and prostate cancer. 

Prostatitis

Prostatitis is another common condition of the prostate affecting approximately 50% of the male population at some point in their lives. It is defined as either infection or inflammation of the prostate gland. The majority of cases are non-infectious in nature (approximately 90%), while acute and chronic bacterial prostatitis present in approximately 10% of cases. 

Causes: Variable. They may include dietary factors, environment, or infectious agents (including both yeast and UTI-associated bacteria)

Signs and symptoms: Dysuria (pain on urination), painful ejaculation, fever and chills, incomplete voiding and pain located in the perineum, penis, testicles or hypogastrium.

Diagnostic testing: A thorough history will be completed by your doctor. Laboratory testing may include a urinalysis, PSA, CBC (complete blood count—to look for signs of infection), urine culture and possibly semen analysis. In some cases a biopsy, CT scan or trans-rectal ultrasound may be requested to rule out other pathologies.

Prostate Cancer

 Prostate cancer is uncommon in men under the age of 50. Similar to BPH, incidence of prostate cancer is positively correlated with age. It is the third most common cancer in men and is a relatively slow growing form of cancer. The 5-year survival rate in men diagnosed with prostate cancer is 95%.

Causes: Once again, many factors have been associated with increased risk of prostate cancer. Genetics, lifestyle choices such as smoking, diet, environmental exposures and history of vasectomy are all associated with prostate cancer. Important to note—there is no evidence that history of prostatitis OR BPH increase ones risk for developing prostate cancer. 

Signs and Symptoms: Frequent nighttime urination, weak urine stream, urinary hesitancy and dribbling, blood at end of urination.

Diagnostic testing: Your doctor may recommend routine PSA and digital rectal exam for early detection and screening for prostate cancer. Urine and blood samples may be assessed to further assess health status. If prostate cancer is suspected, further diagnostic tests are often ordered such as pelvic CT scans, bone scans, pelvic MRI or endorectal MRI. 

*If you are presenting with the above signs/symptoms or are concerned about the health of your prostate, please schedule an appointment with your ND or MD for further assessment. 

10 tips for supporting your prostate health 

1. Smoking cessation:

Research has shown that smoking can increase your risk for cancer, including prostate cancer. In order to reduce toxins and exposure to free radicals, think about quitting. There are many naturopathic tools to help support smoking cessation from acupuncture to herbal medicines. Also, you can check out https://tobaccofree.novascotia.ca for additional support and to get started on your quit plan. 

2. Cut back on the fats:

High fat diets have been correlated with higher incidence of prostate cancer and BPH. Beef and dairy products specifically may also increase your risk for developing BPH. Instead, opt for whole foods with plenty of antioxidant rich fruits and vegetables. Some research suggests that yellow colored veggies may in fact protect against prostatic hyperplasia.

3. Increase cooked tomatoes :

Tomatoes are rich in an antioxidant called lycopene. In vitro (“test-tube”) studies suggest that lycopene has anti-cancer effects on prostate cells. While human studies are limited, there are some epidemiological studies which demonstrate that populations with a high dietary lycopene intake have lower incidence of prostate cancer. Keep in mind that cooking the tomatoes can drastically increase the amount of bioavailable lycopene. So pull out that recipe for homemade pasta sauce or spicy salsa your grandmother gave you a decade ago and start cooking! 

4. Think about zinc:

A large amount of zinc is concentrated in the prostate and is important for healthy function of the prostate. Zinc also plays a role in the balance of testosterone and DHT. The research is inconclusive regarding the benefits of long term zinc supplementation for prostate health—one cohort study found increased risk of advanced prostate cancer in men who were on prolonged high dose oral zinc supplements (10 years or more). This certainly indicates a need for further research in this area. By eating a healthy, whole foods diet with plenty of zinc rich foods, you will likely be able to obtain sufficient amounts of zinc to support prostate health. Foods high in zinc include nuts and seeds—especially pumpkin seeds, oysters, lamb, beef, pork, chicken, beans, spinach, chickpeas and others. For men who are unable to consume sufficient dietary zinc (whether due to food allergies or sensitivities, ethical reasons or others) low-moderate dosing of oral zinc supplementation appears to be safe based on current research.  Talk to your naturopathic doctor if you are considering zinc supplementation to find out if it is right for you!

5. Stay active

Exercise and physical activity is a crucial part of overall health and wellness. Specifically, in regards to prostate health, men who spend more time being sedentary have increased risk of BPH and prostate cancer. Interesting, though perhaps not surprising, physical activity also helps to improve/reduce nocturia (nighttime urination) associated with BPH. Specific exercises (often to relax the pelvic floor) may help increase blood flow to the urogenital area and manage lower urinary symptoms associated with BPH and prostatitis. So, whether you’re currently managing a prostate condition or are working on disease prevention, exercise will be a key factor for health maintenance.

6. Maintain healthy body weight

We now know that healthy eating and exercise can improve prostate health. But specifically maintaining a healthy body mass index can help to prevent prostate disease. Obesity has been shown to increase both incidence of prostate cancer and morbidity associated with prostate cancer.

7. Identify food allergies/intolerances

For individuals with either acute or chronic prostatitis, identifying and eliminating food allergies and intolerances can help profoundly in reducing inflammation and aggravations. I would argue—though, to date, I have not seen any research to support or reject this theory—addressing food intolerances may also reduce risk of BPH, prostatitis and prostate cancer through reduction in systemic inflammation! If you’re wondering whether YOU have unidentified food intolerances, talk to your ND about available testing. 

8. What’s the story on soy? 

Soy foods contain isoflavones—genistein, daidzein and glycitein. These isoflavones are phytoestrogens which appear to have an effect on the growth and proliferation of prostate cancer cells. While some of the research is conflicting, it appears that soy may protect against prostate cancer and lower PSA levels in men diagnosed with prostate cancer. Soy and the phytoestrogens in soy, do NOT appear to have any effect on hormone balance, sexual development or fertility in boys or men. Needless to “soy”…it may be time to learn how to cook tofu!

9. Avoid exposures to environmental chemicals

Xenoestrogens, such as bisphenol-A (BPA), parabens, phthalates, polychlorinated biphenyls (PCBs), pesticides/insecticides and some red dyes and preservatives in food, are known endocrine disruptors than can have immense impacts on the health of both men and women. Xenoestrogens appear to increase risk for prostate cancer and BPH. Complete avoidance of all endocrine disruptors is challenging as they are so widespread. Below is a list of things you can do to help minimize your exposure:

1. Avoid using plastics. Try glass food containers instead! If you are using plastics, avoid microwaving, freezing, or leaving containers in the sun as temperature changes can cause those toxins to leech out of the plastic and into your food. 
2. Buy organic foods (especially for those “dirty dozen” foods) whenever possible to limit pesticide exposure.
3. Opt for hormone-free animal products
4. Choose chemical free cleaners for your home and your body! Check for “phthalate and paraben free” on your labels.

10. Stress management

Stressed out? Chronic stress is something that plagues a large portion of today’s population. The link between stress and the health of our mind and body is extensive and only partially explored. However, according to current data, stress can perpetuate and intensify urinary symptoms associated with conditions of the prostate. It is a two-way street when it comes to stress and BPH symptoms. While stress can trigger aggravation of urinary symptoms, many men who are coping with these urinary changes report heightened levels of stress and mood disorders due to their diagnosis and symptoms—it can have a bit of a snowball effect. Learning strategies and skills to help manage stress can ultimately help to reduce that snowball effect. Stress management looks different for everyone so a little trial and error can allow you to find what works for YOU! Here are some suggestions that you may want to try:

• Yoga/Tai Chi/Qi Gong
• Meditation
• Journaling
• Spending time with friends and family
• Vacations!
• Walking in nature
• Sex and intimacy
• Sports and athletics
• Listening to or creating music
• Reading a book
• Creating art

Setting small and achievable goals to work towards greater lifestyle changes can drastically change disease outcomes. If you have questions about what else you can do to support your health naturopathically, come visit me at the Legge Health Clinic! Have a great Movember and don’t forget to protect your prostate ☺ 

The content in this presentation is for general information purposes only and should not be used to diagnose or treat any health condition. This information is not intended to replace professional medical advice.

References:

Ballon-Landa E. and Parsons JK. Nutrition, physical activity, and lifestyle factors in prostate cancer prevention. Curr Opin Urol. 2017 Oct 18.

Gaby, Alan R. Nutritional Medicine. 2011. Fritz Perlberg Publising, Concord, NH.

Hahn J. 2011. Management of BPH and Urinary Tract Symptoms. Naturopathic Doctor News and Review.

Jeong WS, Choi HY, Nam JW, Kim SA, Choi BY, Moon HS and Kim KS. Men With Severe Lower Urinary Tract Symptoms Are at Increased Risk of Depression. Int Neurourol J. 2015 Dec;19(4):286-92. 

Rev Urol. 2008 Summer; 10(3): 192–206. 

Lazúrová Z and Lazúrová I. The environmental estrogen bisphenol A and its effects on the human organism. Vnitr Lek. 2013 Jun;59(6):466-71.

Lee HW, Kim SA, Nam JW, Kim MK, Choi BY and Moon HS. The study about physical activity for subjects with prevention of benign prostate hyperplasia. Int Neurourol J. 2014 Sep;18(3):155-62. 

National Cancer Institute. 2017. Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®)–Health Professional Version. Retrieved from https://www.cancer.gov/about-cancer/treatment/cam/hp/prostate-supplements-pdq

Nickel JC, Shoskes D,  Roehrborn CG and Moyad M. Nutraceuticals in Prostate Disease: The Urologist’s Role. Rev Urol. 2008 Summer; 10(3): 192–206. 

Wetherill YB, Fisher NL, Staubach A, Danielsen M, de Vere White RW and Knudsen KE. Xenoestrogen action in prostate cancer: pleiotropic effects dependent on androgen receptor status. Cancer Res. 2005 Jan 1;65(1):54-65.

Yarnell E. 2016. Chronic Prostatitis & Pain: Getting To the Root and Resolving It. Naturopathic Doctor News and Review.