The topic of this interview—prostate health—is crucially important to all men, so I hope all female readers will share this information with the men in their lives. Thankfully, there are simple, effective strategies men can employ that may significantly reduce their chances of having to face prostate problems such as enlarged prostate or prostate cancer, and here I discuss those strategies with Dr. Rudi Moerck; a drug industry insider who is an expert in the chemistry of food supplements.
The Importance of Maintaining a Healthy Prostate
While prostate health becomes more important with age, particularly for men over the age of 60, it's worthwhile considering this issue far in advance. Although you may be able to reverse the damage, ideally you'll want to prevent these problems from ever occurring in the first place. Additionally, you need to be informed of the serious potential side effects of the drugs typically prescribed for an enlarged prostate.
"Generally, statistics are overwhelming. Men over 70 have almost a 50 percent chance of developing some sort of enlarged prostate," Dr. Moerck says. "The medical doctors call that benign prostate hyperplasia (BPH). The word 'benign' is very important because it doesn't mean prostate cancer. It just means an enlargement of the prostate.
There are many drugs on the market that are used to treat that; some of which have recently had to issue warning labels that if you have a benign prostate hyperplasia or BPH, it may turn into prostate cancer… Some of these drugs can actually increase the cancer [risk] or make it a much more aggressive cancer."
Clearly, this is a disturbing prospect. But according to Dr. Moerck, you also need to be careful with dietary supplements, as both supplements and drugs can feed prostate cancer, so it's important to seek professional advice.
"There are things you can do with your diet, and there are things you should do, generally, as a male that can help mitigate this problem," Dr. Moerck says. "… [T]he use of saw palmetto by the American Indians, especially in the Southern States where the saw palmetto plant grows, has been around for thousands of years, and has been used for prostate health for thousands of years."
Before we get into the use of saw palmetto, let's quickly review the drugs typically prescribed for enlarged prostate, which will further help you understand what makes saw palmetto such an attractive alternative.
Conventional Drugs for Enlarged Prostate
The two primary types of drugs prescribed for benign prostate hyperplasia (BPH, or enlarged prostate) fall into two classes:
- 5-alpha-reductase inhibitors
Alpha-blockers relax smooth muscles, such as your bladder and prostate. Drugs in this class include Flomax, Hytrin, Cardura, and Rapaflo. While alpha-blockers can help improve urine flow, they do NOT reduce the size of your prostate.
The other class, 5-alpha-reductase inhibitors, includes drugs like Avodart and Proscar. Your prostate gland contains an enzyme called 5 alpha-reductase, which converts the male hormone testosterone to another androgen called dihydrotestosterone (DHT). It's the DHT that stimulates your prostate. This class of drugs inhibit 5 alpha-reductase, thereby blocking the conversion of testosterone DHT. As a result, they may help to actually shrink your prostate, but as mentioned earlier, these drugs come with significant risks, as they may also increase your risk of developing prostate cancer.
Conventional Recommendations are Flawed when it Comes to Testosterone
Many conventional experts do not recommend the use of testosterone because they believe it causes cancer, but it is actually the testosterone breakdown product DHT (dihydrotestosterone) that increases the risk of prostate cancer. The 5-alpha-reductase is the enzyme that is responsible for the conversion of testosterone to dihydrotestosterone (DHTTestosterone levels in healthy men typically decline with age, which actually is one of the reasons that prostate enlargement and cancer is caused, as the prostate gland requires testosterone to remain healthy.
One doctor who's trying to re-educate people on this point is Harvard-based Abraham Morgentaler, MD, FACS, author of Testosterone for Life. He has meticulously demonstrated that restoring testosterone levels in aging men does not increase their risk of prostate cancer. On the contrary, those with low testosterone are the ones at greater risk.
For an interesting article that contains a lot more information about this, read Abraham Morgentaler's report Destroying the Myth About Testosterone Replacement and Prostate Cancer. It explains how unfortunate assumptions have led to a dogmatic belief that testosterone replacement increases your risk of prostate cancer—a belief that might now be preventing many men from being optimally healthy. He writes:
"In 2004, when my article in the New England Journal of Medicine was published, there were 15 of these longitudinal studies examining the relationship of hormones and prostate cancer. Since 2004, there have been approximately a half-dozen more. Not one has shown any direct relationship between the level of total testosterone in a man's blood and the subsequent likelihood that he will develop prostate cancer.
Specifically, average total testosterone (T) levels were not higher in the cancer group compared to men without cancer, and men with the highest T values were at no greater risk for later developing prostate cancer than men with the lowest T values.
… At the end of immersing ourselves into this literature for a full year, Rhoden and I were stunned by the fact that there was not a single study in human patients to suggest that raising testosterone increased the risk of prostate cancer."
Saw Palmetto for Prostate Health
So, to recap, enlarged prostate and prostate cancer is caused, not by testosterone, but by excessive DHT. This is where saw palmetto works and can make a big difference.
According to Dr. Moerck, the medical literature contains as many as 100 clinical studies on saw palmetto. One of the first prostate drugs on the US market was actually saw palmetto, released by Eli Lilly Company back in the early 1870's.
"The mechanism of action of saw palmetto is not fully clear," Dr. Moerck says. "We are certainly not making any drug claims, but the anecdotal evidence suggests that there is a reduction in the conversion of testosterone into the dihydrotestosterone, and therefore, men that take saw palmetto will have slightly higher levels of testosterone in their body…That's a good thing...
It turns out that if you don't have enough testosterone in your body it can cause all kinds of problems like gaining weight, breast enlargement in men, and problem with urinating. So saw palmetto alone, or with pumpkin seed or lycopene is an interesting proposition … It's something that you should definitely try."
I agree with Dr. Moerck.
Trying a high quality supplement like saw palmetto before you resort to a drug is well worth it, considering the stern warnings that accompany some of these drugs. Granted, not all of the drugs have cancer warnings, but those also do not work on actually shrinking your prostate; they're just ameliorating your symptoms. And all drugs come with a list of potential side effects.
(Keep in mind that the average number of side effects per drug today is 70! So make sure you read the fine print and review the list of side effects for any and all drugs before taking them.)
As for saw palmetto, it does not increase your risk of prostate cancer. It decreases it. And if your body doesn't need it, it will do no harm. If you do choose to use a supplement, please understand that you need to be careful of the brand. As I explain below, most brands on the market are close to worthless because they use the inactive form of the plant.
Dosing and How to Identify High Quality Saw Palmetto
Dr. Moerck recommends a daily dose of 320 mg of saw palmetto oil (supercritical CO2 extract). Quality is extremely important, however. Saw palmetto is an effective supplement, but only if it's from a high quality source! Unfortunately, more than half of all the saw palmetto products on the market are ineffective for this very reason…
"Most will not work for you because of one very simple reason," Dr. Moerck explains. "Somebody had the bright idea a few years ago to take dried saw palmetto berries, picked in Florida, and grind them up and put them in a capsule. The berries themselves, those so-called green berries, do not have a lot of oil in them—maybe 8-9 percent oil. So if you put 300 or 500 mg of green berry powder in a capsule, you're only going to get 35 mg of oil. Whereas the right dose, the clinically trial dose, is 320 mg."
According to Dr. Moerck, these ineffective products include most of the mass-marketed saw palmetto supplements found in drug- and grocery stores.
"… [T]hey'll say 'Serenoa repens 320 mg as berry.' That's not 320 mg of oil. That's berry powder. It does not work… It is incredibly bad stuff… It gives people false hope."
What you want is the supercritical extract of saw palmetto oil. This oil can be made three different ways:
- Ethanol/alcohol extraction (darker oil that still contain some of the micronutrients, such as chlorophyll)
- Hexane extraction (yellow oil resembling corn oil that does not contain any micronutrients. May contain residue of hexane, which is toxic)
- Supercritical CO2 extraction
The highest quality oil comes from the third extraction method, using liquid carbon dioxide and ultra-high pressure to extract the oil from the berries. According to Dr. Moerck, supercritical CO2 extraction is the cleanest extraction method known today, aside from eating the food whole. And, the higher the pressure used, the more micronutrients are left in the oil, such as lutein, lycopene, zeaxanthin, and chlorophyll.
The highest quality products are the organic supercritical-extracted saw palmetto oils, which are very dark green in color. Only one or two out of every 20 brands will be of this high quality. Next in line are:
- Ultra-high or High pressure-extracted oils (rose colored)
- Super critical oils
- Low pressure-extracted oils (yellow colored)
Synergistic Benefits Between Saw Palmetto and Other Nutrients
Evidence also suggests that certain nutrients may synergistically heighten the benefits of the saw palmetto.
"There are a number of nutrients that have been used traditionally," Dr. Moerck explains. "One of them is organic pumpkin seed oil, which is a good nutrient… It's slightly less effective than saw palmetto [alone]… because it is a different mechanism of action…"
However, when buying a combination product, beware that saw palmetto oil is far more expensive than pumpkin seed oil. Some supplements will therefore contain mostly pumpkin seed oil and very little saw palmetto oil, resulting in a less effective product. Remember the threshold of what you want, as far as a daily dose, is a minimum of 320 mg of the saw palmetto oil.
"I would not go more than twice that [amount]," Dr. Moerck says. "I have to also mention that the fatty acids in saw palmetto are free fatty acids. They're very acidic. If you take a lot of it, it could cause some stomach upset. I recommend taking it with food…"
You don't want to take saw palmetto on an empty stomach because it's a fat soluble supplement, so it will not absorb well without a little bit of fat. I recommend taking it with eggs, which contain phospholipids that enhance absorption of fat soluble nutrients.
The other nutrient that works well with saw palmetto is lycopene, and there's a growing body of evidence indicating that lycopene is beneficial for prostate health. One excellent food source is tomatoes, including organic, non-sweetened tomato sauce. Animal studies have shown that of all the carotenoids, lycopene is the one that accumulates in the prostate of male animals, and this holds true for humans as well.
"[T]he prostate is a very important organ. It just so happens to have the urinary tract that goes right through the middle of it. So that when your prostate starts growing or swelling, it will cut off urinary flow… There has been some good reports of lycopene helping that," Dr. Moerck says.
"It is also one [nutrient] that is being investigated to prevent prostate cancer. I'm not making any claims about that. I'm just saying it's being investigated for that, and it's something that I'm going to keep an eye on. It's very interesting."
A third nutrient that has been found to offer significant protection against prostate cancer is vitamin K2. For more information about that, please refer to this previous article. Although I don't typically recommend a whole lot of supplements, vitamin K is one of the few supplements you may want to seriously consider because many people don't get nearly enough of it on a daily basis through the foods they eat.
The Importance of Vitamin D for Prostate Health
To protect against prostate cancer, you also want to optimize your vitamin D levels, ideally by exposing your bare skin to natural sun light on a regular basis. Evidence suggests that vitamin D may be one of the most potent variables associated with a lower risk of prostate cancer.
Thankfully, vitamin D's impact on your cancer risk is becoming increasingly well-documented, and there are now well over 800 scientific studies confirming the link between vitamin D deficiency and multiple types of cancers, including prostate cancer. For example, according to a 2005 study, men with higher levels of vitamin D in their blood were half as likely to develop aggressive forms of prostate cancer as those with lower amounts. Another study published two years ago found that men with higher levels of vitamin D in their blood were seven times LESS likely to die from prostate cancer than those with lower amounts.
Testing your vitamin D levels is done by a simple blood test. Anything below 20 ng/ml is considered a serious deficiency state, which will increase your risk of breast and prostate cancers, and autoimmune diseases like multiple sclerosis and rheumatoid arthritis. The OPTIMAL value that you're looking for is between 50-70 ng/ml. However, previous research has suggested that maintaining a slightly higher level of 70 ng/ml may be optimal for cancer prevention.
If you can't get regular sun exposure, you may want to consider using a safe tanning bed or an oral vitamin D3 supplement. However, be aware that when using a supplement, regular testing becomes even more important to make sure you're staying within therapeutic range.
Exercise Your Body… and Your Prostate
Exercise is another important factor for prostate health. You need to exercise, especially as you get older.
"Also… have sex on a regular basis, which involves exercising your prostate," Dr. Moerck advises. "It's a difficult thing to talk about… [and] in older people [it can] become an issue because of lack of a partner and those things. But it's something that every man should think about… I recommend sex on a regular basis… No matter what your age. My recommendation is a minimum of once a week. Probably two times a week for older people."
One of the reasons for why regular sex promotes male health is that not only does it exercise the prostate, but when a man does not have regular sexual activity, the sperm and other fluids must be reabsorbed into his body. Eventually, that can cause certain immunological issues.
Dietary Recommendations for Prostate Health
Diet is another factor that can greatly impact prostate health. You'll want to eat as much organic (preferably raw) food as possible. Foods that support prostate health include vegetables and fruits rich in vitamins, cartenoids, and lycopene. One 2009 study identified the following foods as being particularly beneficial against prostate cancer:
- Green tea
Limit carbohydrates like sugar, fructose, and grains as much as possible to maintain optimal insulin levels, which will help reduce your cancer risk in general. Highly processed or charcoaled meats, pasteurized dairy products, and trans fats correlate with an increased risk for prostate cancer and should also be avoided.
Safer Prostate Cancer Screening Methods
Prostate cancer is the most common type of cancer found in American men, other than skin cancer. Conventional testing for prostate cancer includes a biopsy. However, this practice has recently come under increased scrutiny due to the increased risk of hard-to-treat bloodstream infections, according to a recent article by NPR. Dr. Moerck advises using the classical test for enlarged prostate, which is a simple physical exam. He also recommends using instrumentation that does not involve radiation, such as ultrasound or magnetic imaging.
Once you've been diagnosed with prostate cancer, the conventional treatments include surgery to remove the prostate gland, or radiotherapy. Alas, more recent research has begun to question these invasive treatments as well. They might actually be unnecessary for most men diagnosed with a low grade of the disease.
Prostate cancer is typically slow growing, and the five-year survival rate for all stages of prostate cancer combined is 99 percent, the 10-year survival rate is 91 percent, and the 15-year survival rate is a healthy 76 percent.
So it is very much a disease that can be managed … if you make the appropriate lifestyle modifications. Ideally, you'll want to pay close attention to your prostate health early on—avoid waiting until you're in your 60's. Dr. Moerck recommends taking saw palmetto at least by the time you hit 50, even if you have no signs of problems. Perusing a high quality saw palmetto, along with the other healthy lifestyle recommendations discussed above, can help you prevent prostate problems from developing in the first place.