Welcome to another edition of the Doctor’s Note, where we talk about what’s on our minds when it comes to your health.
This week I really want to talk to men over 40, especially those who are concerned about their prostate.
Take it from me who is older, and have had prostate problems myself. I’ve also treated lots of patients over the many years.
If you’re involved in men’s health, you have to keep an eye on prostates.
You can screen for prostate cancer, and check PSA’s. You can order an MRI of the prostate. Hopefully, you do all of this before having to get it biopsied. If your PSA is rising quickly, or your prostate exam is abnormal, you need to be concerned.
I want to focus today on enlarged prostates. As you age, your prostate grows. You get more prostate cells, and they get bigger.
What’s the cause of this? In integrative medicine, we’re trying to find the root cause of these problems, instead of simply putting you on another medicine.
Millions of men are affected by this, including myself.
What happens is as you get older, almost invariably you have a difficult time urinating. It can be that you have trouble starting the stream, or you have to keep getting up at night to go to the bathroom. It can be extremely disruptive to your sleep. It’s one major reason for sleep problems as you age.
It can also cause sexual dysfunction. What can cause even more sexual dysfunction is some of the medicines we treat it with.
Medicines like finasteride, which takes up to six months to work half of the time. If you put a man on a full dose of finasteride, most won’t continue it because of the side effects.
Interestingly, I do use a small dose of this medication to help men regrow hair on their head. So, finasteride may shrink the prostate, and it definitely regrows hair on your head.
There are some other medications that can temporarily help symptoms.
Flomax helps with urinary spasms. It relaxes and soothes the muscles so you can urinate better at night. There can be some sexual side effects with this. Not a lot of men tolerate this well.
If you can’t pee you will do anything. There are other variations of Flomax like Rapaflo. This is a newer one. I haven’t found it to be much more effective than Flomax.
There’s also some procedures you can do, such as a TURP. This is the reaming of your prostate. This is not a fun one.
You can use steam, which isn’t fun either.
There’s all kinds of newer things.
Another one is called the Urolift. This is when they put brackets in there that can open up the prostate. I think this is better.
The urethra is surrounded by the prostate. As the prostate grows, it squeezes the urethra. The urethra is the outlet between your bladder and the outside of your body. The prostate sits in between them, and can cause problems in men besides cancer.
Prostates and Insulin
For years people thought it was testosterone. This is why people were so hesitant to give men testosterone.
News flash! It’s been proven that testosterone doesn’t cause swelling of the prostate, and it certainly doesn’t cause cancer.
Estrogen, however, can cause your prostate to swell. That’s why I always tell men to avoid soy products, and avoid getting fat.
As a man, you want to watch your testosterone to estrogen ratio. As you get older, your testosterone levels decline, but your estrogen levels don’t.
This can affect the prostate. We look at estrogen levels closely with prostates. It’s a factor.
The main hormone that affects the prostate, and makes it grow when you don’t want it to, is actually insulin.
Insulin is the age old hormone that we talk about with nutrition and diabetes.
If you have a lot of insulin in your body, what that basically means is that you eat too many carbohydrates.
Insulin is a growth factor. When you’re old, you don’t want to go through a growth phase. It makes certain things grow faster. When you’re young you want that. When you’re old, not so much.
You want to maintain, not grow.
IGF-1 correlates to how much growth hormones you have in your body. If it’s too high, then it can cause prostate growth and probably cancer. You don’t want it to be naturally too high.
IGF-1 stands for Insulin Like Growth Factor.
Insulin stimulates growth of the prostate.
It also makes you fat and hungry all the time. This fat is distributed around your abdomen.
What happens is insulin is secreted by your pancreas in response to carbs (sugar, glucose) in the bloodstream.
The job of insulin is to put sugar into your cells for energy. If you are eating too many carbs, then you get insulin resistance. You get high insulin levels because it doesn’t work well enough to keep sugar levels in the normal boundary.
If you have a high insulin level, fasting or non fasting, you need to take action.
You need to learn how to eat. The low carb diet is vital for everything, not just weight loss. A low carb diet also helps keep your prostate from growing too large.
When men get on a Ketogenic diet, the prostate shrinks. It doesn’t happen overnight, but they do become much less symptomatic.
The ketogenic diet is not sustainable for many people. A better way is intermittent fasting. This puts your body in ketosis for part of the day, which is much more doable.
I typically go for 17 hours a day without eating, and 7 hours where I can eat. And I definitely don’t eat sugars and high glycemic carbs.
Going low carb includes most fruits too. Fruits are just sugar. They are actually fructose, which is worse than sugar in some ways.
Certainly don’t eat wheat bread. It’s supposed to have fiber, but most of the time it doesn’t. Also avoid soy.
An enlarged prostate is very common. Don’t worry about testosterone. Be more concerned with estrogen. Even more so than estrogen, worry about insulin. That’s the growth hormone that causes an enlarged prostate.