A number of herbal and vitamin supplements claim to provide relief
for an enlarged prostate (also known as benign prostatic hypertrophy,
or BPH), a non-cancerous condition that affects over 50 per cent of men
at some time during their lifetime.
The prostate is a
walnut-sized gland lying just below the base of the bladder and
surrounding the urethra. When it becomes enlarged to about the size of
a lemon, it blocks the flow of urine and leads to a range of problems
including pain, frequent urination, waking up at night and other
urinary difficulties.
Saw palmetto
You’re more likely to
obtain relief if the supplement you take has the correct amount of the
main active ingredient. Perhaps the most well-tested and successful of
these is saw palmetto (Serenoa repens or Sabal serrulata) berry
extract.
This herbal remedy has been used for many years to
treat BPH (Rozhl Chir, 1993; 72: 75-9), and several studies attest to
its effectiveness. It has been shown to substantially improve the
quantity of urinary flow and size of the prostate (Intern Urol Nephrol,
1996; 28: 767-72; Curr Ther Res, 1994; 55: 776-85).
The recommended dosage is 160 mg twice daily.
Pygaeum tree bark
The
extract of the bark of a tropical African evergreen tree - Pygaeum
africanum - has also been found to be effective. In an experimental
double-blind study carried out in Austria, those receiving 50 mg twice
daily for 60 days of this herbal remedy showed significant improvement.
However, five of the patients experienced gastrointestinal
side-effects that were sufficiently severe as to cause two of them to
discontinue the study treatment (Wien Klin Wochenschr, 1990; 102:
667-73).
The optimal dose of Pygaeum bark is 50-100 mg twice daily.
Zinc and amino acids
Several
of our nutritional experts say that men with frequent prostate problems
do tend to have essential fatty acid (EFA) and zinc deficiencies.
Although EFA and zinc regimes have mainly benefited men with a
prostatic infection, there is evidence that it can also be helpful in
cases of an enlarged prostate as well.
Many studies have shown
that a moderate zinc supplementation can prevent or improve BPH (30-45
mg daily is considered therapeutic). A healthy prostate contains higher
levels of zinc than any other organ because the mineral is required for
the production of male hormones. Zinc provides protection from the
toxic effects of the metal cadmium, which has been shown to stimulate
growth of the prostate at low concentrations.
Other evidence
shows that certain amino acids - such as l-glutamic acid, l-alanine and
glycine - may also prove helpful for the condition (Hinyokika Kiyo,
1970; 16: 231-6).
The recommended dosage is two 360-mg capsules, three times daily for two weeks, and one capsule daily thereafter.
To
make sure that you get all your EFAs, you could also take 10-15 mL of a
combination of safflower oil and linseed or walnut oil twice a day, and
50 mg of zinc last thing at night. However, given such a high level of
zinc, it is prudent to have a doctor who is experienced in nutritional
medicine to monitor you and your progress.
Stinging nettles
Herbalists
in Germany often prescribe the roots of stinging nettles (Urtica
dioica) for BPH - and with good reason. Testosterone levels decrease
with age after 50, while ‘female’ hormones, such as oestradiol, are
increased. There is a potent androgen derived from testosterone called
dihydrotestosterone (DHT). Both of these male hormones are normally
metabolised through hydroxylation. But oestradiol, which has now become
more plentiful, inhibits this hydroxylation process. The end effect is
a greater concentration of DHT in the prostate, which is thought to be
the reason for prostatic enlargement.
Studies have found that
300 mg daily of the extract will beneficially influence the binding of
DHT (Fortschr Med, 1983; 101: 713-6).
Pollen
For more than 35
years, flower pollen has been successfully used in Sweden to treat BPH.
As pollen is the plant equivalent of the male fertilising element, it
is probable that the beneficial effect is due to plant hormones. So
far, five successful studies of pollen have been reported (Br J Urol,
1990; 66: 398-404).
Soy, selenium and vitamin E
The
nutritional supplements used in BPH preparations could also help to
treat and prevent prostate cancer, the third most common cancer among
men in the UK (Lancet, May 22, 1993). This type of cancer predominantly
affects men over 50 years of age.
In Japan and other Asian
countries, the number of deaths due to prostate cancer is low (Int J
Cancer, 1982; 29: 611-6) because, in such countries, the diet is
generally not only low in fat, but also contains a high content of soy
products, a rich source of isoflavonoids, purported to inhibit the
growth of prostate cancer (Lancet, 1993; 342: 1209-10).
Earlier
this year, the National Cancer Institute and the Southwest Oncology
Group in the US launched the first study looking directly at the
effects of vitamin E and selenium in preventing prostate cancer (J Natl
Cancer Inst, 2001; 93: 1132).
A study of selenium in the
prevention of skin cancer in 1000 men and women found that, although
the supplement did not reduce skin cancer, there was a more than 60 per
cent decrease in the incidence of prostate cancer in men (JAMA, 1996;
276: 1957-63).
Another trial looked at the effectiveness of
beta-carotene and vitamin E in the prevention of lung cancer in 29,000
Finnish male smokers. This study found that those who took vitamin E
had 32 per cent fewer prostate cancers (J Natl Cancer Inst, 1998; 90:
414-5, 416-7).
Lycopene
Lycopene - the pigment causing the
red colour in fruits and vegetables, especially tomatoes - is the
primary carotenoid involved in maintaining the health of the prostate
gland. This substance is present in all but two of the supplements
included in our test - Prostanol and Prosta Brit.
A study
carried out earlier this year also suggested that lycopene
supplementation might reduce the growth of prostate cancer (Cancer
Epidemiol, 2001; 10: 861- 8).
The products
As usual, our
selection of nutritional products was purchased from The Nutri Centre
in London. Except for one, most cost between £20 and £35, and thus
represent a serious purchasing decision.
At the very least, it
is not unreasonable to have expected that most, if not all, of the
products tested contained the main plants, herbs and minerals known to
be beneficial for BPH. Yet, only three out of the seven reviewed
comprised a good overall combination of ingredients - Solgar’s Prostate
Support and Saw Palmetto Pygeum Lycopene Complex, and ProstActin from
Nature’s Plus.
Daily serving costs ranged from 55 p to £1.30
and, once again, the products varied enormously in terms of the value
for money they offered. We arrived at the price per serving by using
the supplier’s stated daily dose and the price tag on the bottle. We
also examined the price per £ of each supplement’s active ingredient -
saw palmetto - as well as the main co-ingredients thought to be
beneficial in BPH treatment - Pygaeum africanum and zinc - in order to
provide you with a reasonable value-for-money estimate.
Prostate Complex
Manufacturer: BioCare
Price: £16.45 for 60 vegetable capsules
Rating: ****
Birmingham-based
BioCare has put together the lowest cost per serving of all the
products - 55 p for two tablets per day. It is one of the three
products that doesn’t contain Pygaeum, but more than makes up for it by
providing the highest amount of saw palmetto - 364 mg - per £ of all
the supplements, or 200 mg per day, as well as having 182 mg per £ of
zinc.
Suitable for vegetarians and vegans, each tablet also
contains vitamins B6 and A, and selenium, as well as celery seed
extract, which is thought to have natural soothing properties for the
body’s tissues and to promote normal urinary flow. A small amount (100
mg each) of the amino acids found in seminal fluid - l-glycine and
l-alanine - complements the zinc.
Along with ProstaCol (see
below), Prostate Complex also contains beta-sitosterol, a natural
phytosterol that helps to maintain a healthy prostate. This can be used
either as a complement to saw palmetto, Pygaeum and stinging nettle, or
on its own (Br J Urol, 1997; 80: 427-32). A number of studies have
indicated that beta-sitosterol itself may have powerful anticancer
properties, and it has been found to reduce cell growth in the prostate
(Nutr Cancer, 1998; 32: 8-12).
ProstActin
Manufacturer: Nature’s Plus
Price: £22.95 for 60 softgels
Rating: ***
Each
capsule contains extracts of saw palmetto and Pygaeum africanum, with
zinc and vitamin E as well as pumpkinseed oil. This also contains the
amino acids alanine, glycine and glutamine.
ProstActin provides
a huge 500 mg daily serving of Pygaeum - or 649 mg per £ - and offers
the fourth most expensive serving per day at 77 p. But with two
capsules daily, it can only serve up a daily dose of 160 mg of saw
palmetto and, at 208 mg per £, this also represents only the fourth
best value for money.
Prostate Support
Manufacturer: Solgar
Price: £31.95 for 60 vegicaps
Rating: ***
This
product is based on the idea that if saw palmetto, Pygaeum africanum,
zinc and stinging nettle on their own are beneficial for BPH, then in
combination, they should be even more effective.
Solgar’s
Prostate Support is the second most expensive of our seven supplements
to buy and, at two tablets a day, the second highest cost at £1.07 per
daily serving. But it also contains the second highest quantity of the
active ingredient - 280 mg of saw palmetto per £ - as well as an
equally high 300 mg per day - 280 mg per £ - of Pygaeum africanum.
It’s
also the only one of our seven supplements to contain soy (in the form
of seeds), which has been proved to be effective in the treatment and
prevention of prostate cancer.
This is one of three products
containing stinging nettle to complement the Pygaeum africanum and saw
palmetto. The manufacturer has also included pumpkinseed (in powder
form), a powerful antioxidant often found in such supplements and
thought to be beneficial for BPH in some cases (Pharmacol Res, 2000;
41: 555-63; Pharmacol Res, 1997; 35: 403-8; Urol A, 1997; 36: 10-7).
Each
tablet also boasts a complement of carotenoids, vitamin C and selenium
- dietary antioxidants that are involved in DNA, cell maintenance and
repair - as well as rosemary, which contains natural anti-inflammatory
compounds thought to prevent cancer (J Nutr, 2001; 131 [Suppl]:
3034S-6S).
ProstaCol
Manufacturer: Vitamin Research Products
Price: £38.95 for 90 capsules
Rating: **
At
£38.95 for 90 capsules, this is the most expensive of all of our test
supplements to buy and, at three tablets per day, the daily serving of
£1.30 is also the most costly. Vitamin Research has chosen to leave
zinc completely out of the supplement and, at 51 mg, provides a
derisory daily serving of Pygaeum.
However, this combination of
saw palmetto, Pygaeum africanum, stinging nettle and beta-sitosterol
provides the third highest serving - 247 mg - per £ of saw palmetto
and, with a total daily intake of 321 mg, is the only one of our test
supplements to provide more than the minimum daily allowance of this
ingredient.
Despite its claim to be 'one of the most complete
and advanced prostate support formulas available', the absence of zinc
and vitamins does call into question its value compared with many of
the other, cheaper supplements.
Saw Palmetto Pygeum Lycopene Complex
Manufacturer: Solgar
Price: £22.59 for 50 vegicaps
Rating: **
This
is the second of two remedies we looked at from the US vitamin giant
Solgar (see above). Both products are suitable for vegetarians as they
use vegetable cellulose and vegetable magnesium stearate as binding
agents.
With a daily serving of two capsules costing 90 p, this
is the third most costly supplement per day. At first glance, you would
be forgiven for thinking that this product provides a decent, balanced
serving of the active ingredients you need. However, inspect them more
closely and you find that, although you have an acceptable 100 mg of
Pygaeum africanum per day, the Complex can only summon up a daily
helping of 100 mg of saw palmetto, well below the recommended daily
dose of 320 mg, and a paltry 20 mg of zinc.
Consequently, at 111
mg per £ of saw palmetto, this represents only the fifth highest
content per £ of the active ingredient out of the seven, the third
highest amount of Pygaeum africanum at 111 mg per £ and zinc at 22 mg
per £.
The capsules also contain Opuntia ficus-indica (cactus
flower), thought to be helpful in the treatment of BPH (Urol Res, 1998;
26: 265-70), but with no published clinical evidence to back this idea
up. The antioxidant selenium is also included, as is 8 mg of another
antioxidant, the Mediterranean food spice annatto, from the seeds of a
tropical tree (Bixa orellana).
However, unlike the other
supplements (with the exception of Prostanol), both Solgar products
also contain titanium dioxide as a colouring agent. A recent study in
animals referred to 'limited evidence' of a link with cancer, but there
are no data on the effects of this metallic element in humans (Scand J
Work Environ Health, 2001; 27: 227-32).
Prosta Brit
Manufacturer: Brittania Health Products
Price: £19.95 for 60 capsules
Rating: *
For
this supplement, Brittania Health has opted for extracts of rye plants
and cottonseed oil, something of a departure from the usual saw
palmetto, bark, zinc and herbs used in the other supplements.
A
recent report in The American Journal of Natural Medicine (October 31,
1997; 4: 20) says that rye pollen extracts have been used in Europe in
the treatment of enlarged prostate as well as prostate cancer. One
recent article has shown this pollen to contain a biologically active
family of glycosides called secalosides (J Nat Prod, 1997; 60: 356-60).
In a number of studies carried out in mice, several of these
rye pollen extracts exhibited antitumour activity. As usual, however,
such findings in animals do not necessarily translate to the same
effects in humans. More research is needed on these natural antitumour
compounds to find out whether they really do offer effective relief.
So,
if you have a tumour and as this is the second cheapest serving at 67 p
a day, you may want to give this less-studied herbal extract a try.
However, you should probably do so in conjunction with the more
tried-and-tested saw palmetto and zinc supplements, as well as with
foods rich in soy.
Prostanol
Manufacturer: Bional
Price: £9.95 for 40 capsules
Rating: *
Although
the cheapest to buy, and the third least expensive serving at 75 p per
day, you only get a negligible 10 mg of saw palmetto per £ - the lowest
by far of any of the supplements looked at - making Prostanol the most
expensive per £.
Each capsule also contains vitamin E, and a
generous quantity of pumpkinseed oil (428 mg), stinging nettle (100 mg)
and Echinacea (20 mg), all of which can promote wellbeing. But this
concoction is nevertheless disappointing, primarily because of the
pitifully small amount of its active ingredient, saw palmetto.
Like Solgar’s two supplements, it also contains the additive titanium dioxide.
According to PROOF! resident homoeopath Harald Gaier, rectal
irrigation using cold saltwater is a safe and useful procedure to help
decongest the prostate, and can be carried out in your own home.
In
Dr Gaier’s experience, the following series of applications has been
shown to greatly improve the blood circulation within the prostate.
*
Simply dissolve two teaspoonfuls of household table salt in one litre
of water and chill the solution to 13-15 degrees Celsius (55-60 degrees
Fahrenheit).
* Bedtime is the best time for carrying out the
following: While sitting upright on the toilet, introduce about 125 mL
(around 4 oz) of the cold saline solution into the rectum, using the
rectal tip of an enema kit. Retain the fluid for about 40 seconds and
then expel. After one-and-a-half minutes, repeat the procedure and
continue for a total of around eight irrigations, which should use up
the saline solution.
* Make sure the salt water is not too
cold and don’t keep it too long in the rectum. Carry out this
irrigation process three times per week, reducing the frequency as you
get better (Hoag JM et al., Osteopathic Medicine, New York &
London: McGraw-Hill, 1969).