Dr Matthias Rath - When the Prostate becomes a problem

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Dr. Rath Health Foundation

When the

Prostate

Becomes a Problem ... Natural plant extracts against benign prostate enlargement

Content Study overview on prostate health

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When the prostate becomes a problem …

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Structure and function of the prostate

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In addition: an illustrative story

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Possible causes of Benign Prostatic Hyperplasia

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Prostate growth: Implications

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Degrees of severity of BHP

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Therapies for the treatment of BPH 11 Natural substances to support a healthy prostate 13 When the Prostate Becomes a Problem

1st Edition © 2013 Dr. Rath Health Foundation Distribution: Dr. Rath Education Services B.V. Postbus 656, NL-6400 AR Heerlen Tel.: 0031-457-111 222 Fax: 0031-457-111 229 Email: [email protected] [email protected] Internet: www.rath-eduserv.com All rights reserved. Editor: Dr. Rath Health Foundation. Individual pages of this brochure can be copied for private and non-commercial purposes only. Any direct or indirect commercial use of this brochure or of its parts in any way is strictly forbidden without the written permission of the authors.

Studies reveal benefits of phytobiologicals

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Studies indicate benefits of phytobiologicals for prostate health The benefits of plant compounds are frequently called into question. Even though they have successfully been applied for generations by our ancestors, professionals do hardly accept them. In addition to empirical values, a host of studies reveal that plant compounds do play an important part in sustaining and promoting prostate health.

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Barb Mickelson, Ph.D. Nutritionist 608.230.2198 [email protected]

THE JOURNAL OF NUTRITION

Dave Robbins, M.S. Nutritionist 608.230.2213 [email protected]

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January 2008 • Volume 138 • Number 1

THE JOURNAL OF NUTRITION A Publication of the American Society for Nutrition • www.nutrition.org

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• Lycopene can stop the progression of benign prostatic hyperplasia (BPH) Schwarz, S. et al.: Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J Nutr. (2008) Jan;138(1):49-53. • Saw palmetto extract decreases the symptoms caused by benign prostate enlargement Sinescu, I. et al.: Long-term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int. (2011);86(3):284-9. • Nettle eases discomfort caused by benign prostate enlargement Safarinejad, M.R.: Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, doubleblind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.

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Access to excellence P.O. Box 44220 • Madison, WI 53744-4220 800.483.5523 • FAX: 608.277.2066 [email protected] • www.tekladcustomdiets.com

JANUARY 2008 VOLUME 138 NO. 1

Researchers around the world discuss their diverse custom research diet needs with Harlan Teklad nutritionists. Whether adding a compound to a diet, or developing a unique formula, Harlan Teklad nutritionists can help you achieve your research objectives. Contact Harlan Teklad today, and together, your input and our expertise will enhance your work.

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Bioactive food components and γδ T cell functions CLA and gene expression during muscle inflammation Vitamin E and immune response to HSV encephalitis

• Pumpkin seeds and saw palmetto oil used as effective therapies against benign prostatic hyperplasia Hong, H. et al.: Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. 2009 Winter;3(4):323-7. • Isoflavones reduce the risk of diseases of the lower urinary tract Wong, S.Y. et al.: The association between isoflavone and lower urinary tract symptoms in elderly men. Br J Nutr. (2007) Dec;98(6):1237-42.

From page 18 on you will find a detailed description of the study results. The complete studies are available online at www.ncbi.nlm.nih.gov

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When the prostate becomes a problem ... Natural plant extracts against benign prostate enlargement Benign enlargement of the prostate, also commonly known as benign prostatic hyperplasia, concerns men from 50 years onwards. It can provoke discomfort, restriction of quality of life and every day life, or – depending on its severity – even more serious consequences.

Nonetheless, most men do not concern themselves with BPH, but rather conceal their condition or regard it as age-typical. And despite the discomfort and the restrictions that come with it, it is being widely ignored, especially in its initial stages.

More than 3 million men in the UK experience symptoms of benign prostate hyperplasia (BPH). Typical initial symptoms are problems while urinating, sometimes with sudden and strong pressure and consequently an increasing urge to release oneself – even at night. If residual urine stays in the bladder, unfortunately, the risk of germs and infections increases. This has the following reason: The enlarged prostate restricts the urethra that hinders the urine from draining away.

In this brochure we want to talk about the problems of benign prostate enlargement, discuss causes and show how the use of plant extracts can help, even in the early stages, to limit the extent of BPH.

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Dr. Rath Health Foundation 5

Structure and function of the prostate The prostate, a gland, is part of the male sexual organs. Form and size of an adult’s prostate are more or less those of a chestnut. Its structure is composed of many individual gland cells, muscles and connective tissue. It produces a milky secretion, which is part of the sperm fluid and keeps the sperms flexible.

Now the second phase of growth is about to start. In most cases this happens slowly and without significant discomfort. By the years, though, and with further enlargement of the prostate discomfort can increase considerably.

The prostate has two phases of growth: In young adulthood, the prostate grows up to its normal size and further enlargement ends with puberty. This changes again between the age of 40 and 45.

Kidney

Ureter

Bladder Prostate Urethra

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Ramu

In addition: an illustrative story Ramu lives in Germany, he was born there too. The roots of his ancestors are in Asia. Five decades ago it was his grandfather who brought the family to Germany. Ramu still remembers his grandfather very well. A wiry man, healthy and active to his last days at the age of 96. His grandparents, parents, Ramu, his brothers and sisters – they all lived under the same roof. Traditional asian cuisine kept his family healthy. Dishes with soya, rice, fish, pumpkin and delicious dessert with pomegranate were often on the table. When his grandfather died Ramu was 21. It was time to grow up. This was 38 years ago. However, different from his grandfather and father Ramu cannot seize the day so easily. He has to cope with some discomfort. Especially regarding his prostate. Urinating isn’t that easy any more and often he has to get out of bed at night. Never, Ramu thought, would he have to cope with such problems. What happened? Why him? His ancestors had such a strong health!

 This isn’t a true story, but it shows what happens to a lot of immigrants in the second or third generation: They adapt to the eating habits of their new homeland and therefore share the culture-related health problems. A comparison of the proliferation of the benign prostate enlargement (benign prostatic hyperplasia – BPH) shows: While in Western Europe more than 80 % of all men older than 70 years have BPH, this only happens to 10% of men in China and Japan. Another story? Certainly not. It is a scientifically proven fact. http://www.ncbi.nlm.nih.gov/pubmed/10325492 Dr. Rath Health Foundation 7

Possible causes of BPH Until today there is hardly any consensus on possible causes for resurgent prostate growth. A couple of triggers, alone or in combination, could be responsible. Last but not least, a change in hormones could play a major role. Experts discuss that the changing relation between oestrogen und testosterone could be a reason: Men also produce oestrogens, which are hardly noticed in relation to the higher amount of testosterones. With growing age, though, the level of testosterone diminishes, while oestrogens keep their level. The consequences: An imbalance of testosterone and oestrogen compared to its previous status. Estrogens can now flourish resulting in the growth of the prostate’s tissue.

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Furthermore, it is discussed whether dihydrotestosteron (DHT) can cause an enlargement of the prostate. DHT is a metabolic product, built with the help of the enzyme 5α-reductase. DHT in turn is a highly effective molecule that stimulates the growth of the prostate cells. Different pharmaceutical medication to treat a benign enlargement of the prostate is based on blocking the 5α-reductase enzyme. A connection between the enlargement of the prostate and infection is being noticed, without it being considered as a possible cause.

Prostate growth: Implications Some time might pass until the mystery of the benign enlargement of the prostate will eventually be solved. However, it is clear why the enlargement of the prostate is related to the discomfort of passing water as well as to a lot of problems involving the kidney and the bladder. In this context the prostate’s position in the male body is crucial: directly below the bladder, the urethra runs through the prostate or, from another point of view, the prostate surrounds the upper part of the urethra like a fist. Why can this position cause severe problems?

The bladder collects urine up to a certain amount, which then flows out of the body through the urethra, positioned within the prostate. Once the prostate is growing again it puts pressure upon the urethra. Further growth of the prostate means further pressure on the urethra. In the early stages, the outflow of the urine is hindered, it becomes harder to excrete the urine and the originally strong stream gets weaker. A benign enlargement of the prostate is not the same as prostate cancer. Should problems of the prostate appear it is a good advice to contact a doctor for a diagnosis. Problems while urinating, even though a typical sign of benign prostate enlargement, can emerge as a result of different diseases. Therefore a solid diagnosis is crucial!

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Degrees of severity of BPH By far not every man from the age of 40 is concerned with benign prostate enlargement. Some have a slowly growing prostate while the minimal enlargement of their prostate stays nearly unnoticed. Other men’s prostate grows fast and subsequently, according to the level and way of enlargement, may lead to different problems. • Slight narrowing of the urethra If the urethra is slightly narrowed, it can cause problems while urinating: the urinary stream becomes weaker; the outflow of the urine happens in stages; the man might feel that the bladder is never fully emptied; the urinary frequency increases – even at night – disturbing the night’s sleep. • Severe narrowing of the urethra Further growth of the prostate leads to further narrowing of the urethra: the bladder cannot be emptied totally and urine stays behind; affected men constantly feel the need to urinate; additionally there is a risk of infection. • Increased narrowing of the urethra Men affected by a strong enlargement of the prostate and already troubled by problems need medical help and treatment. Advanced suffering can go along with a tailback of urine in the bladder and up to the kidney, which can severely harm the kidney. Should this situation progress even surgery may be necessary.

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Not only serious but also benign enlargement of the prostate can cause on-going discomfort and lower the quality of life. Frequent uneasiness, tiredness due to breaks in the night’s sleep, abstaining from social activities are just a few examples. Unfortunately, men often only seek supportive measures if discomfort is significantly increasing.

Bladder Prostate Urethra

Therapies for the treatment of BPH Medical treatment of the benign enlargement of the prostate depends upon the severity of the disease. With advanced stages, or if severe damage occurred or is likely to occur, surgery can be inevitable. In earlier phases, different medication is being used, for example alpha-adrenoreceptor blockers or alpha-reductase inhibitors. Alphareductase inhibitors hinder the production of the metabolite dihydrotestosteron (DHT) as explained above. They inhibit the action of the 5α-reductase-enzyme, consequently the production of the DHT. But the list of side effects is considerably long and should be considered.

However, surgery and medication is not the subject of this brochure. We rather want to concentrate on different plant compounds and groups of plant compounds that can already help in an early stage of the benign prostate enlargement.

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Ramu, our immigrant in the second generation, knows some of the plants and fruits that we will describe here. He knows them from the time when his family still lived under one roof and his grandmother prepared traditional food from their country of origin. He would soon understand why his ancestors, as much as most men in his hometown, did not suffer from diseases of the prostate.

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Natural substances to support a healthy prostate Natural components from plant extracts are important measures of prevention and support the treatment of prostate complaints. Most of the knowledge on plants derives from traditional experiences with plant extracts and seeds like nettle roots and pumpkin seeds. In the meantime, many of the active plant components are known and their effect mechanisms are decoded. Additional plant compounds are brought into the focus of scientists. The plant world is so full of components that we will never be able to decode it totally. However, today our knowledge on plants is extensive enough to effectively treat the problems of a benign prostate enlargement in a natural way.

All these biologically active plant substances are summarized under the term “phytobiologicals”. Their original purpose is to protect and heal the plants themselves. Their strong antioxidant potential as well as their strong effect against bacteria, viruses and other harmful influences is very helpful for humans too. In addition, the group of phytobiologicals support and regulate the hormone balance, precursor molecules in cellular metabolism and last but not least, provide anti-inflammatory factors.

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Phytosterols Phytosterols are found in the compounds of plants rich in fat and oil. They are important precursors of vitamins and hormones, have anti-inflammatory quality and even show hormone-like effects, according to their structure and natural condition. Phytosterol, for example, can block the 5α-reductase enzyme responsible for building dihydrotestosterone, which is discussed as a possible cause of prostate enlargement. • Pumpkin seeds contain a large number of valuable substances. On top of unsaturated fatty acids, they also contain tocopherols (vitamin E), carotinoids and minerals. Furthermore, the phytosterols in pumkin seeds support the health of the prostate. • The saw palmetto is a further supporter of the prostate’s health. This palm tree can be found in Mediterranean countries and the costal marsh landscape of the southern US States. It contains fatty acids, gamma-linolenic

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acids, flavonoids and phytosterols. The active substances of the saw palmetto can have antiinflammatory and anti-androgene effects. They block – as described above – the production of dihydrotestosterone. • Another member of the phytosterols is betasitosterol. This plant extract is widely spread in fruits and seeds and appears in soya bean oil, different nuts, pumpkin seeds and avocados. Beta-sitosterol has been examined in some studies, which confirm the positive effect on typical symptoms of prostatic hyperplasia: For example, one could observe a stronger urinary flow and a decrease in the residual urine volume.

Phytoestrogens The phytoestrogens, as well, foster the prostate’s health. Isoflavones (yellowish plant dyes) and lignanes (colourless or white crystalline plant compounds) belong to the phytooestrogens and have a similar structure to estrogen hormones. They therefore attach to different receptors and block the enlargement of certain cells and tissue. Looking at the prostate, this means that the phytoestrogens block its receptors and therefore also block the attachment of endogenous hormones onto receptores which would effect the enlargement of the prostate’s tissue. • A further phytoestrogene is genistein. This isoflavone occurs mainly in soya beans. On top of being able to block receptors in the body and inhibit hormones, genistein is an antioxidant.

• The nettle is another important source of phytoestrogenes, especially the nettle root that is a traditional medical plant often used as diuretic. For some years, the nettle root has increasingly been used to support the prostate’s health: Extracts of the nettle root contain important components like phytosterols that – as described above – can indirectelly affect the enlargement of the prostate. The nettle additionaly contains lignans, which exactly like the phytoestrogen genistein occupy receptors and combat a benign enlargement of the prostate. Studies discuss the nettle root in regard of its inhibitory effects on inflammatory substances in the human body, the so-called inflammatory mediators. This is another important aspect to the prostate’s health.

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Phyto antioxidants The third important group next to phytosterols and phytoestrogens are biologically active plant substances that have a highly antioxidant potential. The cell protecting and regulating properties of this phytoantioxidant have a positive effect on the human body, especially the prostate. In this context we need to take a closer look at pomegranade extracts as well as special extracts of the tomato. • The pomegranate, also called “apple of paradise”, has a high amount of different ingredients. It contains vitamins und minerals as well as organic plant material full of cell protecting antioxidants. One of its highly important ingredients is the ellagic acid which is rich in polyphenols. Ellagic acid protects the pomegranate itself and is responsible for its slighty bitter taste. The ellagic acid has a very high potential to bind pollutants or free radicals and make them harmless. It is its cell protecting and regulating properties that have a positive effect on metabolic processes of most organs as well as the prostate.

• Tomatoes consist of colour-producing carotinoids. One of these carotinoids ist lycopene. It is highly antioxidant and cell protecting. As opposed to most nutrients that get lost during food processing, the availability of lycopene is by far higher in processed food than – as usual – in unprocessed food. This is because the heat can break plant structures in order for lycopene to be extracted. Lycopene and beta-carotene are the most important carotinoids in human blood and tissue. As opposed to beta-carotene, lycopene has no activity of provitamin-A, hence does not serve as a precursor to the natural endogene synthesis of vitamin A. High concentrations of lycopene can mainly be found in adrenal glands, testicles, liver and prostate. Here the lycopene can – if sufficiently delivered – develop its protecting and regulating power. Also studies reveal that lycopene can cause a loss of growth of the prostate.

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Of course there is no rational proof on whether Ramu would suffer from prostate-related problems today or not, if he had stuck to the traditional cuisine of his country of origin. However, it is likely that his benign growth of the prostate would be less problematic. These facts lead us to the conclusion that we can prevent BPH through consuming food rich in plants and fruits full of phytoestrogens, phytosterols und phyto antioxidants.

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Studies reveal benefits of phytobiologicals for prostate health There is scientific proof on the positive effects of phytobiologicals. Renowned research institutes have documented the benefit of certain plant extracts for the prostate. On the following pages we present a small selection of scientific studies. Of course, there are by far more studies on the effect of plants on the prostate than we can possibly show. Do engage yourself to read some more studies. Right now, institutes publish further research efforts showing the benefits of phytobiologicals in special publications as well as on the internet. • Lycopene can prevent the progress of benign prostatic hyperplasia (BPH) This results from a study on the effect of lycopene among older men that suffered from BPH. 20 out of 40 patients with histologically proven BPH received 15 mg lycopene daily, over a period of 6 months. The others were offered a placebo without knowing. The patients consuming lycopene had decreasing PSA (prostate-specific antigen) levels, an indicator for benign prostatic hyperplasia. Those treated with placebo did not show any improvement. Furthermore, the lycopene could stop continuous growth of the prostate. Symptoms of disease were decreased as compared to the placebo group. (Schwarz, S. et al.: Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J Nutr. (2008) Jan;138(1):49-53.) • Saw palmetto improves the symtoms of benign prostate enlargement The study investigated the long-term effectiveness of an ethanol extract of the saw palmetto (Serenoa repens) in regard to problems with the lower urinary tract of patients suffering from benign prostatic hyperplasia. 120 participants were treated daily during a period of 24 month with 320 mg saw palmetto extract. The analysis of the results was based on the “International Prostate Symptom Score“ (IPSS), the “Quality of Life Index”, the measure of maximum urinary flow (Qmax) and the “International Index of Erectile Function“ (IIEF). In all 4 evaluation areas, a treatment with serenoa repens showed a substantial improvement of the symptoms. Urinary flow disturbances were mitigated and symptoms and life quality of the BPH patients were improved. The evaluation of “IIEF“ revealed a positive effect of the plant extracts on the sexual functions of the patients. (Sinescu, I. et al.: Long-term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int. (2011);86(3):284-9.)

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• Nettle relieves discomfort caused by benign prostatic hyperplasia The study aimed at evaluating the effectiveness of the stinging nettle (urtica dioica) in alleviating discomforts in the lower urinary tract as a consequence of benign prostatic hyperplasia. Either the plant compound or a placebo were administered to 620 patients over a six month period of time. The results were evaluated using “International Prostate Symptom Score” (IPSS). Additionally, postvoid residual urine (PVR), urinary flow (Qmax), PSA and testosterone levels as well as prostate size were examined. After six months, 81% of patients in the compound group found discomfort in their urinary tract had receded, with only 16% in the placebo sample experiencing improvement. The study showed IPSS and Qmax improvement in the compound cluster when compared to the control group. The same held true for PVR levels. Conclusion: Stinging nettle compounds do have favourable effects on the urinary tract and are a suitable agent in mitigating symptoms of benign prostatic hyperplasia. (Safarinejad, M.R.: Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.) • Pumpkin seeds and saw palmetto oil as effective therapies for benign prostatic hyperplasia To assess the efficiency of natural healing methods for benign prostatic hyperplasia 47 subjects, with a median age of 53.3 years, were administered 320 mg of a plant compound each day for 12 months. Group A was given a starch-based placebo, group B received pumpkin seed oil, group C saw palmetto oil, while group D received a combination of pumpkin seed and saw palmetto oil. The “International Prostate Symptom Score“ improved for clusters B, C and D. After a period of three (groups B,C) and six months (group D) respectively, patients outside the placebo cluster felt their quality of life had improved significantly. Furthermore, PSA levels in the pumpkin seed oil / saw palmetto oil group decreased. In groups B and C, urinary flow (Qmax) improved considerably after six and 12 months respectively. The study concludes that pumpkin seed oil and saw palmetto oil are safe and effective natural therapies for benign prostatic hyperplasia. (Hong, H. et al.: Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. 2009 Winter;3(4):323-7.) • Isoflavones reduce risk of disease in the lower urinary tract This study examined correlations between nutritional intake of isoflavones and the risk of ailments of the lower urinary tract as a consequence of benign prostate enlargement. 2000 male subjects were interviewed on their nutritional habits and complaints of the lower urinary tract using standardized questionnaires. 96.2% of the participants had a regular intake of the isoflavones genistein, glycitein or daidzein. In those subjects whose daily intake of these isoflavones exceeded 5.1mg, discomfort in the lower urinary tract was significantly scarcer. (Wong, S.Y. et al.: The association between isoflavone and lower urinary tract symptoms in elderly men. Br J Nutr. (2007) Dec;98(6):1237-42.)

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