In this video, Dr. Reena Malik, a urologist and pelvic surgeon, discusses ways to prevent prostate enlargement. She explains that the growth of the prostate is typically caused by an increase in certain growth factors, genetic factors, inflammation, and lifestyle factors like diet and physical activity. Dr. Malik suggests avoiding developing metabolic syndrome by maintaining a healthy diet and weight, engaging in regular physical activity, and avoiding certain medications that can worsen BPH symptoms. She also mentions that a diet rich in lycopene, found in tomatoes, may help reduce the risk of developing BPH. Overall, she emphasizes the importance of a healthy lifestyle in preventing prostate issues.
Key Insights:
- Prostate enlargement is caused by the growth of cells in the prostate, not declining testosterone levels.
- BPH (benign prostatic hyperplasia) can be inherited genetically.
- Inflammation, caused by factors such as infections or changes in the prostate microbiome, contributes to the growth of prostate cells.
- Increased prostate smooth muscle tone, influenced by factors like blood sugar levels, dietary factors, and obesity, can lead to BPH symptoms.
- Metabolic syndrome, including conditions like diabetes, high cholesterol, and high blood pressure, increases the risk of BPH.
- Certain medications, such as antihistamines, decongestants, and antidepressants, can worsen BPH symptoms.
- A diet high in fat, red meat, and low in vegetables increases the risk of BPH.
- Lycopene, found in tomatoes, may help reduce the risk of BPH, but the amount and type of tomato product consumed matter for its effectiveness.
- Eating a Mediterranean-like diet, rich in vegetables and small amounts of meat and fish, can have overall health benefits, including reducing the risk of BPH.
- Premium membership provides access to early and ad-free podcast episodes and the opportunity to ask the doctor questions in a monthly AMA episode.
- Dr. Reena Malik’s practice offers treatments for bladder conditions, sexual dysfunction, hormone problems, and pelvic pain, including Shockwave therapy.
Transcript
Whether you’re a man or you have a man in your life, I’m certain that you’ve heard of men having issues with heting when they’re older all because of an organ called the prostate. Well, have you ever wondered if you can actually prevent yourself or someone you love from getting prostate issues? I’m Dr. Reena Malik, urologist and pelvic surgeon, and today we’re going to talk about preventing prostate enlargement. What can you do?
The prostate is a walnut-shaped organ that sits underneath the bladder around the urethra, which is where you urinate from. And as it grows, typically it goes from having normal prostate tissue to having growth of the cells in the prostate called hyperplasia, and in a lot of men, it goes on to develop abnormal cells and sometimes even prostate cancer. But can you stop it?
So, when you think of prostate growth, in order for the prostate to grow, at least through adolescence and to early adulthood, you need to have androgens. It is very androgen dependent. Now, what’s an androgen? That’s things like testosterone, and in the prostate specifically, when testosterone reaches the prostate, it’s converted by an enzyme called 5 Alpha reductase to something called DHT or dihydrotestosterone. Now, this is found in the prostate in very high concentrations and it binds to proteins in the blood at a much higher concentration than that of testosterone because it has a stronger affinity. So, dihydrotestosterone is found in the prostate in much higher concentrations than testosterone, and this dihydrotestosterone then binds to receptors or androgen receptors, which then causes changes to occur in the prostate causing growth.
But as you may already know, as men age, their testosterone tends to decline. So, while men have declining testosterones as they age, their prostate continues to grow. So, androgens by themselves are not the cause of the growth that causes BPH, or benign Prostatic hyperplasia.
Now, if you’re wondering more about that, check out my video where I talk about everything you need to know about BPH so you can learn more about that condition, as well as treatments and options that you have if you are struggling with those symptoms.
So, to understand how to prevent prostate enlargement, it’s important to understand what happens. So, BPH, or benign prosthetic hyperplasia, is due to the increase in number of prostate cells, particularly epithelial cells and stromal cells, which are different types of cells located in the prostate. Basically, in the body, when any cells are growing or multiplying, you’re also going to see some death of old cells. And so, when there’s an imbalance, particularly in the prostate, we’re seeing that there’s more growth than there is death of prostate cells. And so, that is typically caused, in this case, by an increase in certain growth factors like epidermal growth factor, insulin-like growth factor, keratinocyte growth factor, and transforming growth factor beta or TGF Beta.
And so, what causes this? Well, one is genetic. We know that BPH can be inherited in somewhat of an autosomal dominant fashion. What that means is that if your father has BPH, it’s very likely that you’re also going to get it. That doesn’t mean that everyone’s form is inherited, but typically, when we see people who have enlarged prostates before the age of 60, so bothersome that they need to get surgery for prostate removal, this is the kind of person that’s more likely to have a genetic component.
The second cause is inflammation. Now, inflammation is sort of a term that’s thrown around all the time, right? But what causes inflammation? Well, it can be from bacterial or viral infections. It can be through hormone changes, which are not necessarily specific to having high levels of testosterone. They can be due to an autoimmune condition. They can be due to urine refluxing back into the prostate duct, creating inflammation, or even changes in the prostate microbiome. Now, in terms of the prostate microbiome, we’re still learning a lot about this area, but certainly disruptions in the normal prostate microbiome can lead to inflammation.
So, inflammation typically occurs from the release of cytokines, which are chemical messengers from T-cells, which are from our immune system. And these release cytokines like IL-6, which then stimulates certain growth factors like fibroblast growth factor 2, which causes the cells to proliferate.
Now, here’s where it gets into sort of a vicious cycle. After the proliferation, this then creates what’s called a local hypoxic environment, meaning that now this new tissue needs oxygen. It’s not getting the oxygen it needs, and so it releases these inflammatory markers like reactive oxygen species. So, this then creates more inflammation and subsequently creates more growth, and then more inflammation, and then you’re in this vicious cycle.
And, lastly, symptoms of BPH can be due to increased prostate smooth muscle tone, which is regulated by our sympathetic nervous system. And certain things can cause upregulation of the sympathetic nervous system, and this can include hypoglycemia or hyperglycemia, meaning changes in your blood sugar levels, dietary factors, and obesity.
So, what are things now that you can do to prevent or stop this cycle? Well, number one is you can avoid developing what we call metabolic syndrome. Metabolic syndrome is essentially a constellation of conditions that’s all due to certain metabolic abnormalities, including things like diabetes, high cholesterol, high blood pressure, and they often occur together. These are particularly due to our Western diet, which is high in fat, high in red meat, high in simple carbohydrates and sugar, and physical inactivity. And they’ve actually looked at some of these factors to see what percentage increase of risk are you to getting BPH if you have some of these factors.
First off, diabetes. Diabetes increases your risk of having benign prostatic enlargement by 125.5%. That is really remarkable. Now, having a large prostate doesn’t always mean you have symptoms. So, when they looked at the correlation with lower urinary tract symptoms or symptoms that are usually caused due to an enlarged prostate, like weak stream, stopping and starting your urine, having to wait a long time before your urine starts, and sometimes having to go often at night or during the day or having a lot of urge to go to the bathroom, they found that having diabetes increased the risk of lots by 95%. So, diabetes certainly is a very problematic condition.
What about BMI or body mass index? Now, I know it’s not a perfect indicator of health because some people can have a high BMI and have a lot of muscle mass, and they’re actually not unhealthy. But, generally speaking, a BMI of greater than 35, compared to people who had a BMI of less than 25, had an increase in benign prosthetic enlargement by over 200%. So, being overweight is actually a strong indicator of risk of getting BPH. Having a waist circumference of 109 cm or 42 in increases your risk of getting BPH by 138%. Now, 42 in is quite large. Now, with about 102 cm or about 40 in, that increases your risk by about 48%. So, regardless of how you look at it, having obesity, having a large waist circumference, and having diabetes is going to put you at risk for BPH.
Number two, now moving on to the second way you can reduce your risk of BPH, is by increasing your physical activity. So, in a literature review, they compiled eight studies with over 355,000 men, and with all the data on the different types of activity, they categorized the activity as light, moderate, or heavy exercise. And they found that even light exercise decreased the risk of BPH by 30%, and if you increased that, it went up to 36% reduction. And specifically, in terms of what types of exercises, there was one study that looked at walking for greater than 2 hours a week versus walking less than that, and they found that that reduced the risk of BPH by about 27%. Now, 2 hours a week is really not that much. There’s 7 days in a week, and you can do the math, right? That’s less than 20 minutes a day if you do it every day. So, it’s really not a huge amount of activity that you need to see an improvement. So, doing physical activity to the tune of 862 kilocalories per day in the men’s Massachusetts aging study saw a reduction of about 50% in terms of risk of BPH. Now, what about doing physical activity regularly? If you do it about six times a day based on a large population-based study using the Nurses‘ Health Study data, they saw a reduction of, again, nearly 50%, 51%.
Number three, avoid certain medications. So, over-the-counter medications can worsen your BPH symptoms, and potentially, if you’re starting to have some symptoms, it’s important to realize that certain things can make it worse. Now, this is not preventative, but I think it’s important to discuss because if you’re having any symptoms at all, this can make it significantly worse, and sometimes, it can make it difficult to urinate. So, one is antihistamines. A side effect of antihistamines is that they can relax the bladder, so that the bladder can’t squeeze as hard as it normally does to help pass urine past an enlarged prostate. The second one is decongestion like pseudoephed or pseudoephedrine. We, as urologists, use alpha blockers to help improve the symptoms of BPH. These are things like Flomax or tamsulosin, and these work by relaxing the bladder neck and relaxing the prostate to allow urine to flow. And things like pseudoephedrine actually do the opposite. They tighten up these smooth muscles, so it makes it more difficult to urinate. Also, things like antidepressants. Antidepressants specifically tricyclic antidepressants can also worsen symptoms because of their negative effect on the bladder.
Number four is diet. Now, the best data we have on diet, and as you if you’ve been here before, you know that learning about diet and how it affects our bodies is actually very challenging in research settings because you have to control everything that goes into someone’s mouth in order to ensure that they’re going to follow the exact plan that you’re prescribing for them compared to a general control, and that can be very difficult and costly. So, they’re very difficult to do. But the best data we have is from something called the prostate cancer prevention trial, which was done to look at the effects of a medication called dutasteride on prevention for BPH. But within that study, one, they recruited a ton of patients, over 18,000 patients. They also included data with food frequency questionnaires. This was a pretty rigorous questionnaire that looked at 99 different food groups, six different beverage groups, as well as different preparations of food to see what types of foods people are eating regularly and how much of it. And they followed these men for seven years, so we have long-term data. So, these people, when they started the study, couldn’t have BPH, but they could have developed it during that 7-year period.
So, in terms of fat intake, they looked at quartiles. So, they looked at how much of their total diet was coming from fat. Now, the highest quartile took in about 38% of their total consumption or total energy from fat, and the lowest quartile was less than 26%. Those people who had a more high-fat diet had about a 31% increase in risk of developing BPH. And then, was it a specific type of fat? So, they looked at polysaturated unsaturated saturated fat, and they really didn’t find a difference in terms of the type of fat you’re consuming compared to the risk of developing BPH. Now, they also looked at red meat intake, and they found that men who ate red meat less than once per week, versus eating it daily, had a 30% increased risk of developing BPH. And similarly, they looked at vegetables. So, people taking vegetables less than one serving per day, compared to four servings per day, they saw a 38% increase in risk of BPH. So, from this, we can take away that high-fat diet, high red meat intake, and low vegetable intake puts you at higher risk of developing BPH.
Now, lastly, in terms of diet, everybody wants to know, is there a certain food I should eat to reduce my risk? That brings me to something that’s actually been studied quite a lot, which is called lycopene. Lycopene is a carotenoid. It’s the most powerful carotenoid in terms of reducing inflammation, and it’s the primary component in tomatoes. Tomatoes are basically the source of about 85% of our dietary lycopene intake. Now, you can take lycopene as a supplement, but we’re going to talk about food right now, and in my next video, I’m going to talk about the data on supplements for improving symptoms related to BPH. And now, how these are anti-inflammatories, essentially, they’re like an antioxidant.
Now, in that same PCPT trial, or the prostate cancer prevention trial, they did see an 18% reduction in risk of developing BPH in those who had lycopene in their diet. And there’s been a lot of studies that have sort of shown mixed results. Some show a benefit, whereas some do not, in terms of improving symptoms related to BPH. Again, in terms of prevention, there’s not a ton of data, and the best one we have is that prostate cancer prevention trial. But there are some questions in what makes lycopene more effective. So, one is there’s definitely genetic variability in how our bodies process lycopene and make it bioavailable. So, some people may do better, and some not. At this point, we don’t know who’s the do better with lycopene intake. The other thing is that actually cooking the tomato may, in some ways, be better. So, cooking the tomatoes actually creates a reaction called the Maillard reaction. And what happens is when you cook an amino acid attaches to a sugar, and that’s why certain things will brown or their flavors will change when cooked. And so, particularly when you cook tomatoes, you get what’s called a fru his reaction. The fructose attaches to the histidine molecule, and this, in addition to the lycopene, also has antioxidant properties and has been shown, at least in one study, to improve the effect of lycopene by itself.
Now, how much tomato product do you need to eat? Well, there’s no really perfect amount, but the studies have looked at anywhere from 6 mg all the way to 21 milligrams per day. And just for context, a four a cup of tomato paste, which you probably use in your food very often, has about 19 milligrams. Eating a slice of watermelon gives you 13 mg, and eating one cup of cherry tomatoes gives you about 3.8 mg. So, getting that amount is not really too difficult. And in terms of what’s necessary, I would say anything above 6 mg is probably sufficient based on the studies that we’ve seen. However, again, I would not say this is a mandatory must-do, but if you like tomatoes, by all means, eat them because they may be helpful or other lycopene-containing products, and there’s quite a bit, so just Google it. You’ll see a whole list of different foods that have lycopene in them, but tomatoes are usually the easiest one for people to eat. You do have to be thoughtful about eating too many tomatoes. It can cause other side effects. So, some people can develop irritable bowel syndrome, some people can get bladder overactivity because tomato-based products can be a bladder irritant. You can also get GERD or reflux, and that can be quite uncomfortable. In rare cases, it can cause kidney problems, body aches or arthritis, or even, in some cases, cause discoloration of the skin. It can turn sort of an orangish hue if you’re eating too much. So, eat within reason. There’s no strong evidence at this point that that will prevent BPH. The strongest evidence we have is through exercise and eating mostly a Mediterranean-like diet, which is high in vegetables and small amounts of meat, small amounts of fish, some small amounts of healthy fats, and that has been shown overall to show the most benefit in terms of reducing your risk, avoiding the development of other conditions like diabetes, high blood pressure, high cholesterol, which, as we know, are sort of a direct reflection of our diet and exercise.
I hope you guys found this helpful. If you are enjoying my content, please check out our premium membership where you will get early access and ad-free access to all of our podcasts, which are released on Fridays, as well as the ability to ask me anything and a monthly AMA episode that is just for you. Only premium members will have access.
Also, if you’re having issues with bladder conditions, sexual dysfunction, hormone problems with testosterone for men, or going through menopause for women, or if you’re having pelvic pain, we’d be happy to see you at our practice at Reena Malik MD. We’re currently running a special. We’re offering $1,000 off of Shockwave therapy treatments in our office if you book an appointment before January 26, 2024. In my practice, I spend an entire hour with all of our new patients, making sure that we address all of your issues and concerns, and I’m easily accessible between visits. So, I’d love to see you there.
And, as always, remember to take care of yourself because you’re worth it.
