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.
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.
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).
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 - 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).
As usual, our selection of nutritional products was purchased from The Nutri Centre in London. Except for one, most cost between lb20 and lb35, 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 lb1.30 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 lb 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.
Price: lb16.45 for 60 vegetable capsules
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 lb of all the supplements, or 200 mg per day, as well as having 182 mg per lb 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).
Manufacturer: Nature's Plus
Price: lb22.95 for 60 softgels
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 lb - 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 lb, this also represents only the fourth best value for money.
Price: lb31.95 for 60 vegicaps
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 lb1.07 per daily serving. But it also contains the second highest quantity of the active ingredient - 280 mg of saw palmetto per lb - as well as an equally high 300 mg per day - 280 mg per lb - 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).
Manufacturer: Vitamin Research Products
Price: lb38.95 for 90 capsules
At lb38.95 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 lb1.30 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 lb 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
Price: lb22.59 for 50 vegicaps
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 lb of saw palmetto, this represents only the fifth highest content per lb of the active ingredient out of the seven, the third highest amount of Pygaeum africanum at 111 mg per lb and zinc at 22 mg per lb.
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).
Manufacturer: Brittania Health Products
Price: lb19.95 for 60 capsules
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.
Price: lb9.95 for 40 capsules
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 lb - the lowest by far of any of the supplements looked at - making Prostanol the most expensive per lb.
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).