Sunday, April 17, 2011

Benign Prostate Hyperplasia

Above are pictures of normal and enlarged prostates. An enlarged prostate (Benign Prostate Hyperplasia or BPH) is very common among  older men.  I was diagnosed with this condition several years ago.  Some of my friends are also dealing with this condition, so I refreshed my memory by doing some research.  One of the best brief discussions is in John McDougall's newsletter of October 10, 2010.   I will summarize Dr. McDougall's advice here, plus add some of my own experiences.  

According to Dr. McDougall, "Estimates are that 50 percent of men by 50 years of age, 60 percent by age 60, and as high as 80 percent by age 70 have clinically significant prostate hyperplasia. By age 80 nearly one man in four has undergone some type of surgery to relieve symptoms."

Hyperplasia is a condition whereby there is an increase in the number of cells in the prostate, thus enlarging the gland.  The cells are not cancerous.  Depending upon how large the prostate becomes, there is pressure added to the Urethra, which to varying degrees can produce symptoms such as weak stream, dribbling, frequent urination and hesitancy.  In some men these symptoms are tolerable and we learn to cope.  In others, the symptoms are serious, very uncomfortable and medical treatment is sought including medications and perhaps surgical procedures.  

Dr. McDougall, always the champion of conservative medicine, advises that men attempt to cope and try conservative approaches before heading to the Urologist for more invasive treatments.  I want to emphasize Dr. McDougall's conservative approach.   My experience is that acting slowly and conservatively to deal with chronic conditions is the best approach.  My general approach when I suspect a chronic condition is:

  1. Do my own extensive research on websites like Dr. McDougall's and Dr. Fuhrman's.  I trust both of these sources.
  2. Make absolutely sure the diagnosis is correct, often including getting a second opinion.
  3. Work with a provider who is conservative and whom I trust.
  4. Start by coping with the condition naturally in the most conservative manner available.
  5. If necessary, start with low doses of medication, and gradually increase, if needed.
  6. Only resort to surgical intervention as a very last resort.

Dr. McDougall blames the standard American diet (SAD) on the high frequency of BPH.    Americans eat too much meat, dairy and other processed foods that are high in fat and low in fiber.  The prostate gland is overstimulated with growth hormones (IGF-1) resulting in abnormal enlargement.    BPH can be prevented with a low fat, high fiber, starch based diet plus moderate exercise.

He recommends the following steps to cope with the symptoms of BPH:

  • Diet, although he has had mixed results in relieving symptoms of BPH sufferers who change to a healthy diet after a lifetime of SAD eating.
  • Restrict fluids, especially within several hours of bedtime to relieve frequent nighttime urination.
  • Avoiding spicy foods, caffeine, alcohol and any aggravating medications.  Many prescription and over-the-counter drugs enhance the symptoms of BPH.
  • Natural remedies such as saw palmetto, plant sterols, Cemilton, and Pygieum seem to work for some men.
  • Medications if the above steps don't yield satisfactory results.
  • Surgery, as a last resort
My experience supports Dr. McDougall's recommendations.  Before I changed from a traditional vegetarian to a whole foods plant-based diet with no meat and dairy and with very few processed foods, my symptoms were bad enough to motivate me to visit a Urologist, who prescribed Avodart and Flomax.  I couldn't tolerate those medications.  At about this time I moved to the high fiber, lower fat, plant-based diet and I started taking a Saw Palmetto supplement.  Although my symptoms are manageable now, I still experience occasional periods of more frequent and sometimes urgent urination.
I am not sure, but my symptoms seem to get worse when I eat spicy foods or foods that irritate my bladder, such as pure cranberry juice.  Also, symptoms are definitely a bit more intense in cold weather. For the most part, I can cope with the minimal symptoms I now have, which mainly involving waking 1-2 time per night to urinate.  I see no reason seek medical care at this point. 

If you are interested in more information, take a look at Dr. McDougall's newsletter article.

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