In this video, you will learn about Prostate enlargement, also known as benign prostatic hyperplasia (BPH). It is a common ...

best-ways-to-prevent-prostate-enlargement-explained-by-a-urologist

Best Ways to Prevent Prostate Enlargement, Explained by a Urologist

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 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 a 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 in 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 keratin aite 
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 autoimmune condition they can be due to   urine reflexing 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 release of 
cyto kindes which are chemical Messengers from te-   cells which are from our immune system and these 
release cyto kindes like il6 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 sympath itic 
nervous system and this can include hypoglycemia   or hypoglycemia 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 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 now 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 so being overweight 
is actually a strong indicator of risk of getting   BPH so having a waste 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 a 
being obese 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 decided they categorize 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 and   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 kilo calories per 
day in the men's Massachusetts aging study saw   a reduction in 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 
large populationbased study using the Nan's   data they saw a reduction of of again nearly 
5050 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 and enlarge   prostate the second one is decongestion like 
pseudophed or pseudophedrine 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 Su of fedrin actually do the opposite 
they tighten up these smooth muscles so it makes   it more difficult to urinate also things like 
anti-depressants anti-depressants specifically   tricyclic anti-depressants 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 recruit 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 so 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 quti 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 we 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 the   ones who ate 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 keratinoid it's the most powerful 
keratinoid in terms of reducing inflammation   and it's the primary component in tomatoes 
tomatoes are basically the source of about   80 5% 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 it 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 malard 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 histadine molecule and 
this in addition addtion 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 Mig all the 
way to 21 milligrams per day and just for set for   context a four a cup of tomato paste which you 
probably use in your food very often has about   19 milligram eating a slice of watermelon gives 
you 13 Mig and eating one cup of cherry tomatoes   gives you about 3.8 Mig so getting that amount is 
not really too difficult and in terms of what's   necessary would say anything above 6 Mig 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 lopine containing products and there's quite   a bit so just Google it you'll see a whole list 
of different foods that have lopine in them but   Tomatoes is 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 gird 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 a orangish Hue if you're eating 
too much so eat within reason there's no 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 kind of shown   overall to 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 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 add 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 
condition 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 spent 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

Dr.

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