Latest / Intellectual Medicine / BPH Explained: Best Treatments for Enlarged Prostate and Frequent Urination in Men

Transcript

BPH Explained: Best Treatments for Enlarged Prostate and Frequent Urination in Men · Intellectual Medicine

• 0:00
  I expect to live past 100, and my expectation is that if I
• 0:05
  don't take some proactive steps, my prostate gland will likely
• 0:09
  continue to enlarge. Or, as the joke goes, the first
• 0:14
  third of a man's life they spend trying to make money, the second
• 0:18
  third they spend trying to Make Love, and the last third they
• 0:21
  spend trying to make water. Be that not our fate.
• 0:25
  We want to live vitally throughout.
• 0:27
  We want to mitigate the consequences of aging but are
• 0:30
  nuisance to us. So what can you do?
• 0:38
  There are things in our life that are almost inevitable.
• 0:43
  Normal phenomenon of getting chronologically a bit older.
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  Sometimes in medicine we like to create a disease statement
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  around normal changes. I think this is done in part to
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  satisfy the need to label things.
• 1:00
  You know, Doc, I'm having trouble urinating.
• 1:02
  I'm going to the bathroom a lot. You have benign prostatic
• 1:05
  hypertrophy, or BPH. Now you got a label, you've got
• 1:10
  a diagnosable code. Becomes a reimbursable event.
• 1:15
  But what really is it? What can you do about it?
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  Do you need to do anything about it?
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  Is it a sign of cancer? Is it a sign of pathology,
• 1:24
  something that will alter the quality or length of your life?
• 1:28
  In most circumstances, it is not correlated with the likelihood
• 1:33
  of cancer being present. As we age, guys, the prostate
• 1:37
  will get a bit larger. It is inevitable.
• 1:41
  So if you're lucky, right, you've lived long enough to have
• 1:44
  this become a relevant issue. But what can be done about it?
• 1:48
  How do you prevent it? Or if you're experiencing it,
• 1:51
  how do you safely manage it? So a few caveats right out of
• 1:55
  the gate, you must be patient. This process moves slowly and
• 2:01
  changing it takes time. So most of the things I'm going
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  to discuss, you have to apply for six months, maybe a year.
• 2:09
  Now there's a difference if things go fall apart quickly.
• 2:13
  That is pretty uncommon. In most cases, you start to have
• 2:17
  initial symptoms. Some of these are quite common
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  past 50. Waking up in the middle of the
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  night to go to the bathroom. Many men do that.
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  In fact, many women do that. It's considered a normal
• 2:30
  variant. It doesn't mean that something
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  needs to be done unless by virtue of waking up in the
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  middle of the night, you're feeling exhausted all the time.
• 2:38
  Yeah, maybe. How about if you wake up two
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  times in the night? Still depends on how you feel
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  during the day. You get up twice during the
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  night. Daytime's not much of A nuisance
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  for you. It's OK.
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  Now we're talking about a functional judgement.
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  How does it affect your quality of life?
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  Is it interrupting you, or should you take an action now so
• 3:00
  that it doesn't progress? I kind of like that approach
• 3:04
  because I expect to live past 100 and my expectation is that
• 3:10
  if I don't take some proactive steps, my prostate gland will
• 3:14
  likely continue to enlarge. Or as the joke goes, the first
• 3:19
  third of a man's life they spend trying to make money, the second
• 3:23
  third they spend trying to Make Love, and the last third they
• 3:26
  spend trying to make water. Be that not our fate.
• 3:30
  We want to live vitally throughout.
• 3:32
  We want to mitigate the consequences of aging that are
• 3:35
  nuisance to us. So what can you do?
• 3:38
  Here are some things. First, what does not 'cause this
• 3:44
  enlarging process, it is not caused by testosterone.
• 3:47
  Can we put that to bed? That misconception has
• 3:51
  interfered with men's acceptance of testosterone therapy for
• 3:57
  decades. Think about it guys.
• 3:59
  It makes no sense. Young men have super high
• 4:01
  testosterone levels. They APE fine.
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  Well, Doc, what about that drug that lowers your levels of some
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  testosterone and helps shrink the gland?
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  We'll talk about that in a moment.
• 4:15
  Well, we'll talk about it now. There's a difference.
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  We're talking about prostatic hypertrophy, which can be
• 4:22
  promoted in fact, by DHT. Dihydrotestosterone is a
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  metabolite of the big T testosterone.
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  So you have testosterone in the blood, some of it converts into
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  dihydrotestosterone, some of it converts into estrogen.
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  It turns out we need all these hormones to feel our best.
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  But here's a part that many doctors and most people don't
• 4:48
  understand. The prostate gland makes its own
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  DHT inside the gland. Can't measure it in the
• 4:58
  bloodstream. It's in the gland.
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  Here's another detail you need to know, guys.
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  Your testosterone saturates the prostate with DHT at most normal
• 5:11
  levels. Typically, even if your level is
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  low but above, say 300, you've maxed out the amount of DHT the
• 5:21
  prostate gland can hold. What that means is if your
• 5:25
  testosterone level is 400 and it goes to 1200, because now you're
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  on testosterone therapy, it has no impact on the gland, no
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  impact on the PSA level, no impact on hypertrophy or growth,
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  right? So you can have it all.
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  You could be on testosterone without worry.
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  It's separate and cutting down testosterone is no way to manage
• 5:50
  prostate hypertrophy. Now you're O for two, you're
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  going to have low testosterone and you're going to have an
• 5:55
  issue with your prostate gland. So testosterone levels don't
• 5:59
  make grow really. We're not sure exactly what
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  does, but we know some of the aggravators.
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  Free radical overload. Inflammatory dynamics can
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  contribute to this process. What makes inflammation?
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  Start with mid abdominal fat accumulation?
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  Percent body fat amplifies hypertrophy, amplifies
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  inflammation. So get the down in your weight.
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  If that means thoughtful use of prescription medicine to support
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  the effort, that's reasonable to consider.
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  This is a hard task. I'm not going to kid and say
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  hey, just cut out, you know, a couple snacks and you'll be good
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  to go. My book has an entire chapter on
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  weight loss. It's worth it just to get to
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  that chapter. Even if you don't have any
• 6:46
  concern about prostate cancer. It's an area of specialty format
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  of practice for 30 years and the behavioral elements, some of the
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  nutritional details are in that book.
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  Although came from my book on, I actually wrote a book on weight
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  loss. It's a great book.
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  Nobody ever read it because they didn't get it published, almost
• 7:06
  got it published. We had an agent.
• 7:08
  Publishers liked it. They said, Doc, you got to put a
• 7:12
  hook in it. I said, what do you mean?
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  You know, it's got to have something catchy like like a
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  carnivore, like, you know, grapefruit.
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  Like I said, that's the point of the book.
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  There is no hook. It is a permanent modification
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  of behave, nutritional behavior or behavior.
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  No hook, no publisher. That's OK, We got it.
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  We got some material out there and it's there for you guys to
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  look at. So percent body fat is relevant.
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  How about other inflammatory factors?
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  Anything that enhances free radical overload of poor dental
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  hygiene? That's a correlate of
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  inflammation. Certain foods can be
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  inflammatory. Sometimes you can tell just by
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  how they make you feel. You eat something, you feel
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  rotten, bloaty, maybe there's a connection.
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  You get kind of a headache, maybe there's a connection.
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  So avoiding inflammatory events. Stress is clearly an
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  inflammatory dynamic, as is travel.
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  So what do you do? There are some antioxidants I
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  love. I always like to start out with
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  the natural stuff. If you can control BPH without
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  pharmacologic intervention, that's the king of the hill.
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  The next step is using thoughtful pharmacology to
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  achieve the goal. And of course, there's always a
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  surgical intervention should behold held for last trial this
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  other first. So what about supplement?
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  Here's some things that don't work great but have a reputation
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  they don't deserve. One of them is saw Palmetto.
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  Saw Palmetto is a supplement that behaves like the
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  prescription drug finasteride. These are 5A reductase
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  inhibitors which is the enzyme that stimulates the conversion
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  of DHT. So they help to lower dihyde for
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  testosterone. Salt Palmetto doesn't do a good
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  job of that. So does it help prostatic
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  hypertrophy? Not by itself.
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  If it's a stand alone supplement it's it's going to just burn
• 9:18
  money with no value. There may be synergistic effect
• 9:21
  when you put stuff together, and it may be that it's worth
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  combining in that setting. How about lycopene?
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  Lycopene is a nice substance we found.
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  We find this polyphenol antioxidant in tomatoes, red
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  cherries, red Peppers. If it's red, it probably has
• 9:39
  lycopene. I like it as a supplement, but I
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  complement it with an actual tomato.
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  Plum tomatoes have the largest amount of it because it seems
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  when you take a supplement from a food substance and isolate it,
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  it may not work as good as a substance itself.
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  Paradoxically, some things work better than the food because you
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  can't get enough of it from the food alone.
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  So I like lycopene. I like combined with salt.
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  Palmetto may have some synergy, combined effect.
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  I like to have a plum tomato every day.
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  It's got the mixture of micronutrients that have
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  correlated with benefit. The goal is to be proactive.
• 10:23
  The goal is to anticipate living to 100 and taking steps to
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  mitigate some of the things that may happen, like prostate
• 10:32
  hypertrophy, like prostate cancer, even, although today's
• 10:36
  topic is parallel but separate. As your prostate gets bigger,
• 10:41
  does that increase the risk of cancer happening?
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  Not necessarily. But the mere fact that we're
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  getting older, men, increases that risk.
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  You know these atypical cancer cells that I talk about, dormant
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  cells in the gland, Those are inevitable.
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  The trick is to not let them get triggered and become metastatic.
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  So keep them buried in the gland.
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  These supplements may have value in that regard as well.
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  Stinging nettle or nettle root been shown to correlate with
• 11:13
  decreased prostate hypertrophy, better urinary flow dynamics.
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  Very nice supplement, but you got to make sure they're dose
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  appropriate. We'll talk about those
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  specificity a little bit as well.
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  Beta cytosterol, another nice agent that is correlated with
• 11:31
  reduction of urinary frequency. Also element and pidgeon bark.
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  How about zinc? Zinc's fantastic for immune
• 11:40
  support. The prostate does concentrate a
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  lot of it, but as a stand alone supplement not correlate with a
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  lot of reduction in size. We talked about antioxidants,
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  vitamin C is foundational, alpha lipoic acid foundational.
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  These are things that help globally regarding our health,
• 12:01
  our Wellness and to the extent that it can neutralize free
• 12:05
  radicals may have value within the prostate gland itself.
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  So you can look for some of these things individually.
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  I actually have researched and developed a blend that is unique
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  and has all the components in it.
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  The supplements and nutriceuticals that I could
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  discover, not uncover. I should say didn't discover
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  them, identify them. Then I had to analyze the
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  potency. There was not a supplement on
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  the market that I could find that I liked, so I made my own.
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  This is the Prostate Vitality Supplement and it has in it all
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  the micronutrients and supplements that have a high
• 12:47
  degree of evidence of benefit regarding prostate cancer and
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  hypertrophy. So it may have value in a
• 12:54
  preventative setting and it can have value with the prostate
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  hypertrophy. It's if you're interested in it,
• 13:01
  you can find it in the notes associated with this podcast.
• 13:06
  I don't promote products as a consequence of any consideration
• 13:12
  given to me. This show comes to you, my
• 13:15
  podcast comes to you straight from Shannon, from me, by virtue
• 13:20
  of our own investment in promoting it.
• 13:23
  I think that's how I like to roll because the minute you
• 13:27
  start taking money from any entity, it affects thought and
• 13:32
  judgement. So do we make some profit from
• 13:36
  the supplement? I think we do.
• 13:38
  I hope we do. So to the extent that you're
• 13:41
  purchasing it, great help support our work, delivering
• 13:44
  information to you. So take a look at that if you're
• 13:48
  feeling great. My message to you is be careful
• 13:51
  about some of the supplements. They have a tendency to have a a
• 13:55
  list of all the ingredients that sound good because you've heard
• 13:59
  them before. The dose is the difference for
• 14:03
  this to work. It's six capsules every day.
• 14:07
  That's what it took to get the right dose of everything in
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  there. So if you see something and it
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  has all the ingredients, it's one capsule a day, maybe
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  subtherapeutic. So I mentioned what you do with
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  this, with anything, you got to wait six months and watch what
• 14:23
  happens. It can help even chart it.
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  You know how many times you getting up at night?
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  How's it during the day? What else can you do?
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  Suppose you're on supplements or you're saying, yeah, that's not
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  playing for me. Prescription drug therapy works.
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  These A1 reductase inhibitors, finasteride and dutasteride,
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  Avodart and Proscar are the are the trade names.
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  Generic name for Proscar is finasteride.
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  Generic name for Avodart is ditusteride.
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  These drugs lower the the DHT level, the dihydrotestosterone
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  level in the gland. They lower it by like 90%.
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  This is why they work at shrinking the prostate, not by
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  blocking testosterone. That has nothing to do with it.
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  The stuff in your blood doesn't affect what's in the gland when
• 15:19
  it's already at saturation. But this is the cool part you
• 15:23
  can take these drugs lower the DHT in the gland, it'll lower
• 15:28
  the blood level as well. That's not so welcomed.
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  We need testosterone in our blood to fuel us.
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  Libido, erections, energy, sex drive, brain function.
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  Oh, and you need estrogen too. Guys, don't just block estrogen
• 15:47
  because you think it's bad. If it goes too low, you will
• 15:50
  lose value with regard to sexual function and bone health.
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  So here's a combo I love when you're struggling with an
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  enlarged prostate, Finasteride or dutasteride.
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  But I kind of like finasteride. I'm not sure why it's been out
• 16:05
  longer. Finasteride plus testosterone.
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  Now that makes perfect sense because you need the higher
• 16:13
  levels in your blood to feel your vest while you're blunting
• 16:16
  the level in the gland. So I believe this combination
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  can be a great asset to many men who are struggling and are
• 16:25
  nervous about finasteride because what are one of the
• 16:28
  potential side effects? It can interfere with sexual
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  function and erections and libido in some men.
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  And I believe it does that because the blood levels aren't
• 16:38
  high enough to compensate for the drug.
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  So when you go, if you go on finasteride, dutasteride,
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  consider high dosing testosterone, not low dose.
• 16:50
  Folks with misconception, you don't go on a low dose because
• 16:53
  you're afraid of negative side effects.
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  You go on a higher dose because you want the beneficial effect.
• 16:58
  So it's safe to do that. Then you got to wait six months,
• 17:03
  significant reduction of prostate size after six months,
• 17:07
  alleviation of urinary flow issues.
• 17:09
  So I like this approach and you can combine your supplements I
• 17:12
  mentioned with the prescription agent.
• 17:15
  Well, here's what I don't like. I don't like tamsulosin.
• 17:20
  I don't like the the alpha adenergic drugs.
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  They relax the sphincter muscle. They therefore are intended to
• 17:31
  help the bladder empty more easily.
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  But they have no impact on the actual process itself.
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  They have no impact on prostate cancer.
• 17:40
  They have no impact on prostate enlargement.
• 17:43
  They can cause dizziness and Lightheadedness when you stand
• 17:45
  up quickly. They can cause retrograde
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  ejaculation. That's not fun.
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  Very uncomfortable. Instead of ejaculating outward,
• 17:54
  it goes inward. Yeah, towards the bladder.
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  Not cool. So I don't like those drugs.
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  They can be helpful short term when you're on the brink of
• 18:03
  complete obstruction. In that case, they may have
• 18:06
  value, but then you want to endeavor to get off of them.
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  Well, what else can you do? What else matters?
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  What doesn't matter? Ejaculating.
• 18:15
  Having sex does not 'cause hypertrophy.
• 18:19
  How about the absence of ejaculation?
• 18:21
  Does that cause a backup? I mean, it might.
• 18:24
  It's hard to research this stuff.
• 18:26
  Why? Because everybody lies about
• 18:28
  sex, for one thing, but the other thing is just hard to
• 18:30
  quantify. But when I think about it
• 18:32
  mechanistically and I think about it physiologically, it
• 18:38
  makes sense. So my advocacy is to ejaculate
• 18:42
  at least once a week. Guys, you know how to do it.
• 18:45
  The skill is out there. You discovered it back when you
• 18:48
  were 14 and it never left you. So you could do that once a week
• 18:52
  and you're good to go. If that's your outlet, no harm
• 18:55
  in it. But don't think you're going to
• 18:57
  ejaculate your way to a shrinking prostate.
• 18:59
  That will not happen. How about these drugs,
• 19:03
  finasteride to tasteride? What's their role with regard to
• 19:06
  prostate cancer? It turns out that the studies do
• 19:10
  support a reduction in cancer onset when the drugs are in
• 19:17
  place. There was a paradox in that when
• 19:20
  cancer occurred, it seemed to be more advanced, and that may be
• 19:24
  because it lowers the PSA level and there's less investigation
• 19:29
  done at the outset. That's the speculation nobody's
• 19:32
  sure about. But the drugs are safe.
• 19:34
  They don't cause cancer. They may be protective against
• 19:38
  it if you've never had it. So an overview on some of the
• 19:42
  things about how to manage a large prostate.
• 19:44
  Here's another trick that has helped some of my men in the
• 19:47
  practice. Taking an anti-inflammatory
• 19:51
  medicine, a non steroidal anti-inflammatory drug like
• 19:54
  Motrin or ibuprofen, 400 milligrams with dinner has
• 19:59
  helped some men to alter nighttime frequency.
• 20:03
  And this can be done sporadically.
• 20:05
  There'll be times where you were doing OK and then all of a
• 20:10
  sudden you're peeing every 5 minutes.
• 20:12
  What's going on? It's an inflammatory storm.
• 20:16
  Get yourself out of it, bump up your vitamin C, maybe go on some
• 20:21
  some ibuprofen for short term to kind of settle things down.
• 20:26
  So here's wishing you guys an enlarge prostate.
• 20:30
  It means you're making it. It means you're living long.
• 20:35
  It means you now are entering the phase of life where we can
• 20:39
  be proactive. Don't do the things that are
• 20:42
  fruitless. Don't do the things that are
• 20:44
  harmful. Start with supplement, go to
• 20:47
  drugs if needed, and don't be afraid of testosterone.
• 20:51
  And when you get your PSA and it comes back elevated like it's
• 20:56
  likely going to do, remember, no biopsy.
• 21:01
  All right, team, it's all I got for today.
• 21:03
  Thanks for spending time with me.
• 21:05
  Talk to you soon. Bye now.