Role of diet in the development and progression of benign prostatic hyperplasia

Overview of BPH: Symptom Relief with Dietary Polyphenols, Vitamins and Phytochemicals by Nutraceutical Supplements with Implications to the Prostate Microbiome

“…This narrative overview updates the factors that influence BPH in reference to diet, physical exercise, the prostate microbiome, and nutraceutical supplements such as vitamin A, C, D, and E (alone or in combination with) polyphenols and phytochemicals derived from plants that hold promise or are likely to alleviate LUTS/BPH symptoms (using reports and reviews published mainly in the last 5 years from January 2018 through January 2023). The risk factors for BPH include (a) age [ 60 , 65 , 66 , 69 ], (b) smoking (vaping) [ 69 ], (c) obesity/overweight [ 69 , 72 ], (d) ↑ insulin [ 53 , 57 , 61 , 69 ], (e) ↑ lipids [ 61 , 69 , 72 ], (f) diabetes [ 69 ], (g) hypertension [ 53 , 69 ], (h) depression [ 69 ], and (i) a “Western diet.” Conversely, vitamins A, C, D and E along with a “Mediterranean diet” or “Eastern diet” and polyphenols/phytochemicals nutraceutical supplementation with equol, β-sitosterol, pumpkin seed extract, saw palmetto, lycopene, stinging nettle, and green tea are associated with decreased BPH symptoms. Notably, urologists and medical associations are rethinking the role of plant-derived phytochemicals, because now they are considered as treatment options for men with mild-to-moderate LUTS/BPH symptoms as an alternative to watchful waiting [ 158 ].…”

“…While diet has become a focus to enhance human health, the attention on what types of diets yield the best outcomes is paramount from the perspective of consumers. The “Mediterranean or Eastern” diets versus a “Western diet” have gained popularity and promise not only for the management of LUTS/BPH, but to increase the general health status and well-being to address many other diseases and disorders [ 60 , 61 , 62 , 63 , 64 ]. For example, the Mediterranean diet is one of the most widely described and evaluated dietary patterns in scientific literature [ 61 ].…”

“…[ 64 ]. Conversely, the Western diet contains refined carbohydrates, red meat, processed meats, fats/lipids/cholesterol, prevalent in high-income countries, which increase sympathetic nervous system, oxidative stress, and inflammation and low intake of fruits and vegetables [ 60 , 61 , 62 , 63 , 64 , 65 ] ( Figure 4 ). Additionally, shown in Figure 4 are the relative levels of physical activity associated among the three diets.…”

“…Notably, the relationship between dietary patterns and risk factors for LUTS/BPH, (but also for erectile dysfunction and prostate cancer) have been reported and reviewed elsewhere [ 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. From these various reviews, the risk factors for BPH include (a) age [ 60 , 65 , 66 , 69 ], (b) smoking (vaping) [ 69 ], (c) obesity/overweight [ 69 , 72 ], (d) ↑ insulin [ 34 , 52 , 53 , 57 , 61 , 69 ], (e) ↑ lipids [ 61 , 69 , 72 ], (f) diabetes [ 33 , 35 , 69 ], (g) hypertension [ 53 , 69 ], and (h) depression [ 69 ]. Conversely, vitamins A, C, D and E are associated with decreased BPH symptoms [ 59 , 64 , 67 , 69 , 70 , 71 , 72 ].…”

“…Additionally, a more recent report in 2022 by Hu et al reviewed the properties of polyphenol/flavonoids that can interfere with androgen synthesis and metabolism to regulate androgen hormone actions, thus providing a nutritional intervention to improve androgen disorders such as BPH [ 78 ]. In connection with this perspective, soy isoflavones have been studied and reviewed for their protective effects on BPH and prostate cancer [ 60 , 61 , 69 , 72 , 79 ] which include all the positive multiple mechanisms of actions outlined by Eleazu et al above [ 77 ]. Likewise, other reviews on dietary polyphenols/flavonoids for their anti-inflammatory and anti-allergic studies have been reported recently [ 79 , 80 ].…”