Can dietary botanicals reduce symptoms of BPH?

Most men, age fifty and older, are likely dealing with benign prostatic hyperplasia (BPH). BPH is a common condition in which the prostate grows larger as men age. Why the prostate enlarges with age is not well-understood, but it’s believed that the hormone DHT (dihydrotestosterone), the active form of testosterone, is involved in this process.

Standard therapy for treating BPH is either prescribing medication or, in more severe cases, surgical intervention. However, many men would rather avoid surgery, and medications can have side effects. 

Yet, symptoms of an enlarged prostate – frequent urination, nocturia, dribbling, and urinary urgency – can be so frustrating that some men are willing to resort to less traditional treatment methods, such as herbal supplements. Step into any health food or drugstore, and shelves offer numerous dietary and herbal supplements for “men’s health,” code words, for prostate care. Herbal supplements tout how they can relieve the hassle of fighting an aging prostate.  But do they deliver on their promises, and how safe are they to use?

The issue with supplements

Why would men with BPH resort to herbal supplements for symptom relief? There are prescription medications to treat the symptoms, but some men have difficulty tolerating the side effects of these drugs. That’s why men tired of urinary frequency, nighttime trips to the toilet, a weakened urine stream, or dribbling want relief, and if an herbal supplement can help, many are willing to try them. 

Half of all men have symptoms of BPH by age 60, and the rate rises to 9 out of 10 by age 70.  By age 80, about 20 to 30 percent of men get some form of medical treatment (drugs or surgery) for BPH.

Men from thousands of years ago also suffered from symptoms of BPH but would not have known the function of the prostate.  Instead, their remedies came from traditional Chinese and Japanese medicine, which commonly used many herbs to treat urinary symptoms of BPH.

Today, almost three dozen plant compounds boast of helping manage BPH, according to a review paper in 2015. In European countries of Germany, France, and Austria, plant-based products are considered the first line of treatment for mild to moderate urinary symptoms of BPH. However, remember that many of these supplements are proprietary formulas in which the manufacturers have sponsored research blurring their objectivity and making comparisons with other products difficult to assess.

However, dietary and herbal supplements found in various stores lack adequate regulation as prescription medications a doctor prescribes. This means their quality, safety, and effects may vary. Therefore, before using an herbal supplement for BPH, men should ask their doctor for advice. In addition, herbal supplements may react and cause problems with prescription medications or medical treatments, such as cancer. 

Common herbal supplements promoted to help BPH

Here is a listing of the best-studied and most commonly used herbal supplements for treating BPH:

• Saw Palmetto

This herbal supplement comes from the purple berries of the American saw palmetto plant. It may shrink the prostate size, which automatically helps improve urinary symptoms.

Some studies recommend saw palmetto for BPH symptom relief. However, several large studies have not shown the benefits of using saw palmetto to reduce the prostate size or symptoms of BPH. Some men who’ve used saw palmetto to reduce BPH symptoms have had some symptom relief of reduction in nighttime urination. For men who have success with saw palmetto, it takes about 4 to 6 weeks to see results. 

Men who have used saw palmetto might see improvements in the following:

• Reduced urinary frequency and urgency
• Stronger urine flow

• Beta-sitosterol 

A key compound in saw palmetto is beta-sitosterol, a phytosterol marketed on its own and in various prostate formulas. This substance is found in many fruits, vegetables, soybeans, seeds, nuts, and other plant products.  Phytosterols are related to cholesterol found in animal cells and when consumed in large amounts, help lower cholesterol by blocking cholesterol absorption in the intestine.  Plant sterols also have effects on the hormone system and prostate.

Beta-sitosterol does not reduce prostate enlargement, but it may help the bladder to empty with a stronger urine flow and possibly improve BPH symptoms.  One study found some potential in beta sitosterol for treating BPH and other prostate disorders, but there are many uncertainties.  This same study also warned that herbal preparations might have drastically different compositions, durability, contaminants, and efficacy. Therefore, beta-sitosterol should be used with caution by people who have diabetes or bleeding disorders or are taking blood thinners, hormone therapy, or drugs that affect blood sugar. 

      Men, who have used beta-sitosterol, may see improvements in the following:

• Improved bladder emptying
• Stronger urine flow

• Rye grass pollen

A pollen extract from rye grass, claims to treat BPH symptoms such as painful urination, frequent urination, weak urine stream, or urinary urgency. However, the evidence has been inconsistent, with most of the studies being small and methodologically flawed. Nevertheless, Natural Medicines rate rye grass extracts as possibly effective for treating BPH.  Side effects include allergic reactions as well as gastrointestinal distress. 

      Men, who have used rye grass pollen, may see improvements in the following:

• Less dribbling after urinating
• Reduced urinary frequency and urgency
• Stronger urine flow
• Reduced painful urination

Takeaway message

Any man experiencing urinary symptoms should talk with their doctor to make sure the cause is BPH and not some other condition.  If it is BPH, a man and his doctor can discuss the pros and cons of prescription medications and herbal supplements. 

The best advice is to avoid using herbal products since the science is lacking in their effectiveness, lack of standardization, and the unreliability of what is really in the bottle.  Until more and better clinical trials are conducted, it’s best to be leery of using herbal supplements or combining them with BPH drugs.   

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.