Benign Prostatic Hyperplasia (BPH) - Ad Hoc with a Doc

On this episode of Ad Hoc with a Doc, Dr.s Rubin and Waite discuss clinical and naturopathic treatments for BPH. Find out how simple lifestyle changes may actually lead to big impacts and help people reduce or eliminate symptoms without reliance on medications.

Check out the video, or read the transcript below to pick out some of the highlights fast!

Rubin: Hi, I'm Dr. Dan Rubin with “Ad Hoc with a Doc”. I'm here with my associate, Dr. Amy Waite, and today we're going to talk about benign prostatic hyperplasia, a condition that affects men.  Dr. Waite tell our audience a little bit about this condition because I know many people are familiar with the term, but they might not completely understand it.


What is BPH? (0:22 in Video)

Waite: BPH is an enlargement of the prostate gland, and like you said it only occurs in men, and usually the symptoms of it start with urinary symptoms.  So usually guys will start, you know, waking more often to use the bathroom at night.  Some of the other symptoms can be hesitancy to urinate, they'll have to stand there for a while before they can urinate, they can't fully empty their bladder, dribbling, all of these are signs of possibly an enlarged prostate.


Rubin: Does it come along with pain as well?


Waite: It can, it can. Especially if they're retaining urine, they can get urinary tract infections which are usually only found predominantly in women, but men can start to get urinary tract infections if they can't fully empty their bladder.

BPH can be very disruptive for men and their partner as well. Both are disturbed when one of them is getting up several times each night to use the restroom.


Rubin: And I can imagine that it's a frustrating condition as well.


Waite: Especially for their wives, that's usually who I hear the complaint from. 


Rubin: Is that because the men are getting up and down in bed and moving around?


Waite: Yes, it's extremely disruptive to their quality of life, both their quality of life, if they're waking that often.  Some men I've seen it wake 8 to 10 times the night to pee. 


Rubin: That is a lot, especially if sometimes as men age, they don't sleep as much too, so the proportion of wake to sleep and then having to get back to sleep could actually impact other parts of their life; cognition, their overall well-being, and you know other physiological


Waite: Mood...


Rubin: Mood, absolutely, and you can compound those. So, what are the conventional treatment approaches and their options?

What are the Conventional Treatment Approaches and Options for BPH?  (1:56 in Video)

Waite: Conventional treatments are drugs and surgery. So, the drugs usually are either an alpha blocker


Rubin: Okay


Waite: Which just allows the bladder to empty more freely or 5-alpha reductase inhibitors, which the FDA actually found in 2011 can increase your risk of high-grade prostate cancer.


Rubin: Okay, hang on, because that's a big statement.  So, there was two classes of drugs that you talked about alpha blockers, which help the bladder empty better, and then something called a 5-alpha reductase inhibitor, which is a type of a drug, commonly known as?


Waite: Finasteride.


BPH isn’t necessarily a risk factor for high-grade prostate cancer, but according to the FDA, one of the common drugs used to treat BPH is.

Rubin: Finasteride, okay, and so a lot of men are prescribed this in the United States, and that drug you said, there was an FDA warning that that could like, a complication, or side effect could become the development of high-grade prostate cancer?


Waite: Yes, they found that link. 


Rubin: Is BPH a risk factor for high-grade prostate cancer?


Waite: Not necessarily, but the drug to treat it is.


Rubin: Interesting, so it's not a disease-based connection, but the drug.  So besides drug treatment, are there any other conventional options that men have? 


Waite: If drugs don't work, then they usually turn to surgery.


Rubin: Okay. 


Surgery may leave men with similar side-effects to the symptoms they were experiencing before from BPH.

Waite: The surgeries can have similar side effects to the symptoms they were experiencing before, which is interesting. So, they can have urinary symptoms. The surgery, they usually have to go through the urethra to reach the prostate, which can cause damage to that area and cause urinary symptoms/side effects. 


Rubin: Is this what's called a TURP? 


Waite: Mm-hmm. That's one of many ways.


Rubin: Explain a TURP. 


Waite: A TURP is a tool that that, like I said passes through the urethra to remove prostate tissue that's pressing on the urethra, and hopefully alleviate symptoms without, without causing more side effects.


Rubin: So, the idea is that if you have a prostate: my fist, and the urethra: the tube that lets urine empty into, the toilet, right?  If it's going through the prostate, and the prostate is too big, and it's squeezing on that urethra, then the idea would be to just chop out some of the prostate?


Waite: Yes, just cut away some of that tissue. 


Rubin: Well that would be very inflammatory, I would assume. 


Waite: Yes, and they do have quite a bit of side effects.  Especially up to four to six weeks after, some men have to have a catheter.


Rubin: Well, that's uncomfortable too. 


Waite: Right, and can cause damage to the urethra.


Rubin: Interesting, and that damage could be permanent.


Waite: Yes, it can also cause erectile disfunction that can be permanent. 


Rubin: Well, it doesn't sounds like asolution, but it doesn't sound like a very good one.  It sounds like a painful one, and you're also saying that the treatment, the TURP, can also cause sort of like a rebound BPH type symptomatology and so it's like you're going for the treatment but you end up with the same symptoms.


Waite: Painful urination, frequent urination…it's the same symptoms...doesn't sound like a very good option.  


Rubin: Are there any other side effects from these drugs that they take? 


Waite: One side effect that I see clinically, is retrograde ejaculation, which, in some patients, can lead to prostatitis, which is more inflammation of the prostate, which can lead to even worse symptoms.


Rubin: Yeah, I would think that would be painful, and for some men terrifying, you know, when things are going backwards. 


Waite: Right.


Rubin: All right, well, that compendium of symptoms or side effects from treatment certainly make it a really good idea for naturopathic doctors, and naturopathic medicine.  What are some of the naturopathic treatments that you offer in your office?


What are Some of the Naturopathic Treatment Options that You Offer in Your Office? (5:45 in Video)

Waite: So, I believe that BPH is a multifactorial disease, there are a lot of things, you know, conventional medicine just says ‘it's getting older, you're just going to have a big prostate’, but there's a lot of you know, ”Why do some men experience symptoms and some don't?”  “Why do some why do some prostates get larger than others?”  I believe that obesity plays into it.  Endocrine disruption, or hormonal disruption, you need to balance the hormones properly. 


Rubin: Well, this is more than just your belief, I mean, this is good physiological data and there's science to show that this is true. 


Waite: Yes.


Rubin: Absolutely. So, okay, I'm sorry obesity, which is intertwined with the endocrine system too…


Waite: Yes, when men are obese, particularly in the abdominal region, there's an enzyme in the fat cells that converts testosterone into estrogen.  I tell men that that big belly is an estrogen-factory and estrogen can increase the size of the prostate.  So, can that testosterone converting to something called DHT or dihydrotestosterone, so all of these things I look at on labs and make sure that we're getting everything into balance. So decreasing the obesity, weight loss, you know diet, lifestyle, balancing hormones addressing nutritional deficiencies where sometimes I can put patients on a good supplemental program it'll increase their testosterone levels, which will therefore help them lose weight and you know things just kind of balance out.


Rubin: But and then, so there was a big thing that you said, it might be scary or not understood by some of our audience. You're saying that even though commonly thought of as like the female hormone, estrogen is in men and that some people have a greater preponderance of testosterone conversion into estrogen depending on say their body composition?  The more fat that they have compared to muscle, the more chance they have of converting testosterone to either an estrogen or into dihydrotestosterone?  And you can test that? 


Waite: Yes.


Rubin: That's an important thing to test.  Is that conventionally tested; is that part of protocol?


Waite: I've not seen it tested. 


Rubin: Okay, and so you use that as a driving force behind what you're gonna do for the person. 


Waite: I do.  I also measure the actual size of the prostate.


Rubin: How do you do that? 


Waite: I have men go in and get an ultrasound or get a picture of the prostate so I can see the actual size of it, and then I can monitor my treatments to make sure they're effective


Rubin: And this is a particular type of ultrasound you send for, correct?


Waite: Mm-hmm. Yes


Rubin: And then you also then you said maybe develop a supplemental program?  You said something about increasing their testosterone. Does that mean you increase it because you're decreasing the conversion away from testosterone? 


Waite: Yes.


Rubin: Okay, so instead of having the testosterone converting into something else you're keeping it as testosterone.  And that doesn't have the impact, you said, on the prostate that the metabolites do. 


Waite: Correct, and we can also use herbs as natural 5-alpha reductase inhibitors that don't have the same side effects - that don't have any side effects actually, - that can prevent that conversion of testosterone into DHT.


Rubin: What are some of the components of a dietary modification program that you might give to somebody with BPH?


What are Some of the Components of a Dietary Modification Program that you might Give to Somebody with BPH? (8:58 in Video)

Waite: There are some men out there, usually they're single men, that they don't know how to cook. So sometimes it's teaching them how to cook, keeping them off of the fast food, or TV dinners that they've been living on for 50-plus years.  Other things can just be you know, incorporating enough vegetables per day, decreasing the amount of simple carbohydrates, that's raising their blood sugar and turning into fat. 


Rubin: Which then gets stored where? 


Waite: In the belly. 


Rubin: In the belly, which helps convert testosterone to estrogen right?


Waite: It's all just this vicious cycle that once you can figure out, you know the cause or causes, you can address it and the prostate can go
back to a relatively normal size.


Rubin: I imagine that some of the men that you talk to might have some apprehension about cooking or the time that it would take to understand, you know come up with a recipe, or go buy the food, prepare the food, clean the food, when sometimes it's easy to just go drive through something.  So, do you meet with resistance to that?


Waite: Let me give you an example of a patient that I've seen within the last year, a man that gave me quite a bit of resistance about changing his diet.  He's been eating fast food and TV dinners his whole life, he's never cooked, and he was waking multiple times a night to pee and I asked him if he would just give me two weeks -two weeks- of eating a good diet to see if how much we could reduce his symptoms, because the drugs weren't working. 


Rubin: So, he went from zero to 80 immediately.


Waite: Yes.  He was on both an alpha blocker and a 5-alpha reductase inhibitor, having –


Rubin: Stacking medications?


Waite: Stacking medications, having a lot of side effects from the drugs, and now his urologist was ready to move to surgery and he was terrified. So, he agreed to give me two weeks.  I wrote him up a very simple diet plan and he was able to follow it 100%, didn't cheat one time, and he came in two weeks later and instead of waking nine times a night was waking two times a night. 


Rubin: That's immense!


Waite: It was, and he, he said okay, you proved it to me, I need to start cooking and so he agreed to start taking some cooking classes and it was just evident how much his diet was playing a part in, in the overall inflammation in his body…inflammation in the prostate, you know growth of the prostate, everything. 


Rubin: The prostate loves fat, and so many fats can turn into inflammatory molecules.  So, I imagine just by improving his diet how sensitive those cells are, and it shows, just by doing something that's actually simple, eating how somebody's supposed to eat, can affect a very specific tissue, and the body's smart.  And it knows what it's supposed to do when you tell it. 


Waite: Yep, and giving that anti-inflammatory diet, it you know, it's just incredible with BPH.


Rubin: So, I imagine that dietary modifications come at different levels for different patients depending on their needs and where they are.  What about exercise as part of a lifestyle program?  Does that have a role to play in the treatment of men with BPH? 


What about Exercise as Part of a Lifestyle Program?  Does That Have a Role to Play in the Treatment of Men With BPH? (12:00 in Video)

Waite: It does, the prostate is a gland that holds fluid and when any fluid is stagnant in the body, that's not a good thing.  So, you think about the pelvic area a lot of us sit all day at work.  A lot of people are just stagnant all day long.  Moving, especially moving that pelvic area, helps move that fluid, and can be very good for the prostate. 


Rubin: What types of exercises are good for sort of moving the pelvis? Is that like an elliptical?


Waite: Elliptical, running…not necessarily squats or heavy lifting for this particular issue, but yes, like you said elliptical, running, those types of movements help quite a bit. 


Rubin: And then you also mentioned a nutritional plan and not with diet I mean but with supplements or botanicals, so you have a compendium of agents that you choose from based on the case. 


Waite: I do, and it like you said, it's based on the case.  There's not a one-size-fits-all for anybody. So, my initial intake is looking at all of the bits and pieces that I need, the puzzle pieces I need to put together to figure out the cause of this person's enlarged prostate, and like I said, it's multifactorial and off of all of those different factors, I base my supplemental program up off of that.


Rubin: I have one last question that I think a lot of people are wondering about out there in the audience, is the role of the environment in this.  I'm assuming there's a role.  I know that some of the toxins in the environment so to speak, quote-unquote, are mimickers of either estrogen or testosterone or you know, xenoestrogens.  You know a lot more about this than I do. Can you explain that to the audience? 

What about Xenoestrogens?  (13:36 in Video)

Waite: So, you mentioned xenoestrogens, and I find that it's definitely more prevalent in our environment, much more now in this decade than it was years ago.  Xenoestrogens, or synthetic estrogens, are found in things like plastics, so having men switch even from using plastic water bottles into glass can make a big impact and I've actually measured, you know, estrogen levels decrease after they've removed plastics out of their, their body.


Rubin: That's amazing, because many people just go to the store and buy a little 16 fluid ounce or 500ml bottle and drink five, six, seven of those a day or buy a big case of them and that's the water they drink.


Waite: Or even worse, they leave it in their car, it heats up and that seeps even more xenoestrogens into the water.


Rubin: That's a problem. And those can affect the prostate? 

The prostate can’t distinguish between synthetic estrogens and natural it’s important not to ignore the impact of xenoestrogens when thinking about BPH.


Waite: Yes, definitely the prostate doesn't know if it's synthetic estrogens or you know, natural estrogens and it yeah.


Rubin: So even people watching at home before you give us a call to talk to Dr. Waite, switching from plastic water bottles to glass which means you have to fill that water bottle and be responsible for it and take it with you, that can actually help maybe even reduce symptoms quickly. 


Waite: Mm-hmm. 


Rubin: Wonderful. Well, I can't see a reason why somebody with BPH wouldn't give you a call and talk to you, and want to fall under treatment with you. Thanks for the information!  With “Ad Hoc with a Doc”, this is Dr. Dan Rubin, and Dr. Amy Waite.

Michael Nelson