Critical Information on Prostate Complications, Impotence and Infertility!

Dear Friends,

Let's start this sensitive topic with a little anatomy 101. The prostate is a small, walnut sized organ in the male reproductive system. It lies just a few inches inside the body from the base of the male penis and can only be palpated rectally. The urethra, the tubular structure through which urine and semen exit the body, passes directly through the prostate, just past the bladder. The function of the prostate is to secrete liquids that prepare the urethra for the passing of semen, and then to aid the sperm on their way to impregnate the female ovum. The female vagina is acidic, so the prostate secretes a slightly acidic substance which prepares the route of the sperm on their way to their new environment.

Prostate Problems: How to Avoid
Impotence: Physiological Reasons
Drugs & Side Effects
Specific Supplements for Conditions

Benign Prostatic Hypertrophy is the condition in which nodules develop on the gland and the prostate enlarges in size and volume. This is an age-related condition affecting 50-60% of men between 40 and 50 years of age. This number increases to 70% by the time men reach 60, and 90% of those men who live to be 80 suffer from this condition.

Clinically, benign prostatic hypertrophy (BPH) manifests itself with any of several symptoms:

1. Urinary retention, or the inability to fully empty the bladder.
2. Urgency to urinate, with little actual urine production.
3. Nocturia, or frequent need to urinate during sleeping hours.
4. Difficult initiation of urine flow and decreased flow pressure or stream rate.
5. Sudden inability to urinate.
6. Recurring bladder infections.

These symptoms are not exclusive for BPH. Cancer of the prostate can have very similar symptoms and the only person qualified to tell the difference is your personal physician. If you have these symptoms, schedule an appointment to have it checked immediately.

These changes in the prostate represent changes in the metabolism of normal male hormones that takes place over decades. As men age, levels of testosterone, the major male hormone, begin to decrease. With this change, other hormones, often considered female hormones increase. (The outward effects of this change are evident in the change of the male chest. In youth, the male chest is muscular and defined. As men age, the definition is lost and there is an obvious feminization of breast tissue.)

In the production and metabolism of testosterone, several other hormones are produced including precursors for the female hormone estrogen. These hormones are derived from the precursor of all sex hormones, cholesterol. The final product is a hormone called dihydrotestosterone (DHT). It is DHT that is responsible for the enlargement of the prostate, and the difficulties associated with the condition. Interestingly, when levels of DHT increase, there is a negative feedback to the level of pregnenolone, which shifts the formation of hormones towards the estrogen side. The increase in levels of DHT is not due to increases in testosterone production, but rather a decrease in the ability of the body to excrete the DHT in the system.2 The enzyme, 5-alpha-reductase, is responsible for the metabolism and excretion of DHT. High protein diets have been shown to greatly diminish this enzyme, while diets high in carbohydrate and low in dietary proteins and fats stimulates the production and activity of 5-alpha-reductase.3

Prostatic enlargement and cancer of the prostate have been associated with a lack of zinc in the system. Studies have consistently demonstrated that men suffering from prostatic enlargement and prostate cancer have significantly lower levels of zinc in their system and in the prostate tissue.4 Supplementation with zinc should then be paramount in the treatment of prostatic disorders. Research has consistently shown that zinc supplementation reduces the enlargement of benign prostatic hypertrophy, and provides relief of symptoms in many patients.5 Studies giving patients 150 mg zinc daily for two months, followed by 50-100 mg daily demonstrated significant shrinkage of the enlarged gland.6 The body’s utilization of zinc is related to levels of hormones in the system. As was pointed out earlier, estrogen levels are generally elevated in men with BPH. Estrogen is known to inhibit zinc absorption in the intestine, which could only compound the situation for affected men. This would lead to an increased need for zinc supplementation, as compared to younger men.7

Supplementation with essential fatty acids (EFA’s), coming from sources such as evening primrose oil and flaxseed oil, have provided significant improvement for many men who suffer from BPH. EFA’s are converted in the body to many substances, one of which is prostaglandin, which modulate inflammation through the body. Experimental data suggests that when testosterone enters the prostate, both DHT and prostaglandins are synthesized. It is theorized that the prostaglandins may inhibit further entrance of testosterone into the prostate, providing a ‘gate keeper’ function. As men age, prostaglandin synthesis becomes much less efficient, resulting in a decreased protective effect on the gland.8 Research has demonstrated the beneficial effects of EFA’s on men with BPH. In one study, men who could not completely empty their bladder were given EFA’s as the only change in their diet for seven weeks. Following the study, 63% were able to completely empty their bladder with no residual urine.9,10,11

Cadmium, a metal known to be poisonous in excessive amounts, has clearly been shown to cause hyperplasia and cancer of the prostatic tissue.12,13 It is found in old fashioned ice trays, galvanized metals such as water pipes (which is one more reason why we recommend drinking only reverse osmosis or distilled water) and some sources of zinc. Cadmium exerts its toxic effects primarily by displacing bodily sources of zinc, making supplementation all the more necessary. In laboratory studies, selenium has been shown to provide a protection to the prostate when animals were injected with toxic levels of cadmium.14 Selenium also provides protection from free radicals, as is outlined in the Eat, Drink and Be Healthy newsletter on Cancer.

Impotence, whether it is an isolated event or occurs frequently (chronic), is the inability for a man to achieve and maintain an erection sufficient for sexual activities. In the United States, more than ten million men chronically suffer from impotence. Statistically speaking, by the age of fifty-five, 18% of all American males report that they are frequently unable to maintain an erection. By the age of sixty-five, 30% report the problem, and by seventy-five, 55% of the males in this age group report problems with impotence, either sporadic or frequent.15

In the past, most cases of impotence were attributed to psychological factors, a diagnosis stigmatizing the American male’s self esteem, further compounding his problem. However, today it is known that impotence is more often a physiologic problem rather than mental, though the psychological stresses still play a role and can easily compound the physiological problem.

Impotence is perhaps one of the most sensitive of all health problems for the American male. In our culture, one’s manliness is often equated with sexual performance. Therefore, when one is unable to perform, it follows that one is not manly. Even the term, impotence, which literally means “lack of power”, generates thoughts of inferiority and weakness. The problem with this cultural philosophy is that most men experience problems with sexual arousal at some time in their lives, however, because of the taboos associated with discussing the issue, a man is left with no avenue for help. It is hard to imagine a medical condition which is so stigmatizing that a person would actually avoid seeking medical attention, however, this problem often carries this consequence. Because many men suffer from this condition without complaint, little research has been done on the subject. The problem is so severe that in the area of research, even when male subjects do come forward and volunteer for studies, many drop out before the end of the program.

Male sexual arousal is physiologically simple. In the male penis, there are three parts to the shaft, the two corpus cavernosum that form the sides of the shaft and the corpus spongiosum where the urethra passes through. When sexually aroused, blood rushes into the corpus cavernosum and corpus spongiosum and it is prevented from leaving by a constriction of the blood veins leaving the penis. There are two main physiologic processes, vascular and nervous, which must work in harmony for a satisfactory erection to take place. There are other obvious factors which effect the vascular and nervous systems, most important of which is hormonal. Testosterone, the male hormone, is responsible for the sex drive, the inward desire for sexual relations, which causes arousal. Generally speaking, arousal without erection would be considered physiologic impotence, while lack of arousal may be considered hormonal or psychological.

In our world of “Have you got a pill that will fix my problem, Doc?” it is important to be aware that several prescription and non-prescription medications can cause impotence. It is important for you to know this because when physicians prescribe them, you will rarely hear them give impotence as a possible side effect. Of these medications, anti-hypertensives, or prescriptions for the treatment of high blood pressure, are notorious for causing impotence, however, few patients ever hear of the possible side effect until after a problem with impotence is experienced. High blood pressure can be equated to water flowing through a normal water hose. If the water pressure is too high, there is “pressure” on the hose which can make it rigid, can make it bulge or even break. Medications for high blood pressure, or hypertension, work to reduce the pressure of the blood flowing through the blood vessels of the body. Many of these drugs are quite effective and can reduce dangerously high blood pressures to “near normal” values in a short period of time. The problem sexually is that when blood pressure is artificially lowered by a medication, there may not be sufficient pressure for blood to flow into the penis for an erection sufficient for sexual activity. This is like turning the volume of water in the hose down; there is just no pressure. What astounds me is that physicians treat literally millions of people for hypertension daily in this country with prescription medications, while never addressing the key factors that cause high blood pressure. In many cases, high blood pressure can be reduced naturally, without medications or side effects. If you or someone you love suffers from hypertension and would like to do something other than take prescriptions, please read my article on hypertension. In this report, we will outline medical research that may help you gain control over your blood pressure without taking drugs, and without the embarrassing side effects of anti-hypertensive medications.

Men who suffer from diabetes can also suffer from impotence as a complication of the disease. One of the complications of diabetes is termed diabetic neuropathy, which is a disruption of the sensory and motor nervous system. The effects of diabetic neuropathy can have many manifestations, however, none carry the embarrassment that impotence does. During sexual excitation, the nerves of the blood vessels are signaled to dilate, causing blood to rush into the penis. When these nerves are compromised, the message does not make it to the penis intact, which can prevent or limit an erection. The communication between the spinal nerves and the penis are generally not totally cut off. Instead, it becomes like static on your phone line. The message gets garbled and the body cannot respond properly. Further complicating the diabetic’s condition, diabetes greatly accelerates the accumulation of artery clogging fats, called atherosclerosis, throughout the blood system. This will block the blood flow to the penis, and other organs, which will simply not permit sufficient blood to flow to the penis for a satisfactory erection.16 Compounding this problem, diabetics can have a total loss of sex drive and experience other general sexual dysfunction, including low sperm count and loss of libido. Research on laboratory animals which were made to be diabetic demonstrate considerable shrinkage in testicular weight, significant reduction in sperm count and sperm mobility as well as lower levels of testosterone in their blood. In fact, in one experiment, the diabetic animals showed a drastic decrease in mating behavior and NONE were able to ejaculate.17 The important fact to note here is that impotence from diabetes is preventable in many cases and is a complication no one should have to suffer. We have prepared an excellent report on diabetes, which is more than just informative. This paper can put the diabetic, and the person who is setting himself up to develop the disease, back in charge of their health and hopefully reverse the effects of diabetes.

Other types of medication which can cause impotence are those used to treat depression. Consider this scenario: a person seeks medical attention because they are having difficulty coping with the stresses of life and they are given a medication. The medication may help the person elevate their mood, thus helping them to “enter in” to society again. But when mood elevates to the point where the person can become interested sexually, the medication prevents the person from being able to experience an erection. Imagine the horror and humiliation? Talk about compounding the problem! The person now is faced with questions of manliness and self worth sexually while still dealing with the issues which brought him in for medical assistance in the first place. (It must be noted that depression itself can cause impotence in some men, however, if impotence is not a problem prior to pharmacological intervention and becomes a problem subsequent to antidepressant therapy, the situation speaks for itself). Fortunately, nutritionally speaking, there is much that can be done for the person suffering from depression which can elevate their mood without the embarrassing side effects associated with many antidepressants. Once again, we have produced an EDBH newsletter on depression. In this work, we examine causes of depression, treatment options and their side effects, and nutritional support programs that can help the body to generate those brain chemicals that relieve symptoms of depression.

Patients with epilepsy who are treated with the drug Dilantin, often report difficulty in sexual arousal and impotence. Although few studies have been conducted on this population, one study demonstrated that these patients typically have lower levels of ejaculate and total sperm count than people not taking the drug.18 We do not recommend discontinuing this medication without the advice of a qualified physician. However, if you do take this medication and experience difficulties with erection, you and your physician can discuss different treatment options.

If current literature has not persuaded you to quit drinking alcohol and smoking, perhaps the threat of losing your sex life will. For year, it has been known that alcohol consumption reduces sexual performance. Current literature examined cigarette smoking as an independent risk factor for impotence. The results found that smokers had more than twice the incidence of impotence than did non-smokers.19 People who consume large quantities of alcohol demonstrate shrunken testicles and decreased levels of hormones and low sperm counts. In fact, men who develop alcoholic cirrhosis often develop signs of feminization, including breast development. The good news is that cessation of alcohol consumption leads to a spontaneous recovery of sexual functions, provided that the patient survives the cirrhosis and lives a healthier lifestyle.20

Impotence can often be associated with low sperm counts, which can cause infertility. Numerous environmental factors can lower sperm count. Pesticides can drastically reduce sperm count in exposed individuals.21 Another culprit shown to diminish sperm count is the fluoride in your toothpaste and possibly, your drinking water. Sodium fluoride (NaF), the active ingredient in toothpaste, was administered to lab animals for a period of time with a significant reduction and alteration of sperm activity. Unfortunately, elimination of the NaF alone brought about an incomplete recovery, however, when vitamin C and calcium were added to the diet, there was a significant recovery.22 In fact, vitamin C and vitamin A have been shown to provide protective benefits to sperm when faced with toxic exposure.23,24

Folic acid has been used effectively to treat male infertility. In one study, infertile males were given 15 mg folic acid once a day for 3 months. During this time, there was a consistent improvement in sperm number and motility and several of the subjects were able to impregnate following the study.25

Vitamin E has been shown to improve fertility in males with low sperm counts. In fact, many remember that in the 1970’s, vitamin E was often touted as the male sex vitamin. Ironically, until recently, it has not been known if vitamin E supplementation actually reached the seminal fluid. However, current research has demonstrated that vitamin E supplementation reaches the fluid of the semen where the active sperm wait prior to ejaculation, providing its beneficial effects.26

At this point, you have been provided a lot of information, but no recommendations or directions. Before we spell this out it must be understood that our recommendations are in no way meant to be diagnostic, specifically therapeutic for specific individuals, nor are we attempting to replace your personal physician. Our recommendations are for general health and nutrition, concentrating on what research has shown to be safe and effective for the situations presented. It is also important to understand that impotence is not the same thing as infertility, which is the inability of the male sperm to reach the female egg (ovum) and impregnate. Because of this, there are some simple differences in our recommendations for the two issues.

Everyone should consume a well balanced diet, plentiful with fresh (preferably organic) fruits and vegetables. Excess weight should be shed and one should exercise moderately on a regular basis, at least three times weekly. If fertility is desired, hot tubs, vigorous exercise, saunas and tight fitting clothing must be avoided. The testicles are very temperature sensitive. (This is evident when men enter cold bodies of water and the scrotum contracts to conserve body temperature or when the body is very warm, and the scrotum relaxes to allow the testicles to cool. The body seeks to maintain the temperature of the testicles about 4-6 degrees below body temperature.) Sperm production is regulated under very strict temperature control, and the heat from these activities will reduce sperm production. In fact, hot water baths have been used for generations by many third world people as male birth control. Smoking must cease. Actually, anyone who is interested in health and nutrition and continues to smoke is only deceiving themselves. Alcohol consumption should preferably be eliminated or at least be strictly limited to no more than one serving per month.

I also strongly recommend the following supplementation:

NOTES:

1. Hinman, F: Benign Prostatic Hyperplasia. Springer-Verlag, New York, 1983.
2. Horton, R. Benign Prostatic Hyperplasia. A disorder of androgen metabolism in the male. J Am Gen Soc, 32:380-5, 1984.
3. Kappas, A., Anderson, K.E., Conney, A.H., et al. Nutritional-endocrine interactions. Induction of reciprocal changes in the delta-5-alpha-reductase of testosterone and the cytochrome P-450 –dependant oxidation of estradiol by dietary macronutrients in man. Proc Natl Acad Sci USA. 80:7646-9. 1983
4. Habib, F.K., et al. Metal-androgen iterrelationships in carcinoma and hyperplasia of the human prostate. J Endocrinol, 71(1): 133-41, 1976
5. Fahim, M., et al. Zinc treatment for the reduction of hyperplasia of the prostate. Fed Proc, 35:361, 1976
6. Bush, I.M., et al. Zinc and the prostate. Presented at the annual meeting of the Am Med Assn, Chicago, 1974
7. Leake, A., Chrisholm, G.D., Busuttil, A., and Habib, F.K. Subcellular distribution of zinc in the benign and malignant human prostate: Evidence for a direct zinc androgen interaction. Acta Endocrino. 150: 281-8. 1984
8. Klein, L.A., Stoff, J.S., Prostaglandins and the prostate: An hypothesis on the etiology of benign prostatic hyperplasia. Prostate 4(3): 247-51. 1983
9. Scott, W.W., The lipids of the prostatic fluid, seminal plasma and enlarged prostate gland of man. J Urol 53:712-8, 1945
10. Boyd, E.M. and Berry, N.E. Prostatic hypertrophy as part of a generalized metabolic disease. Evidence of the presence of a lipopenia. J Urol 41:406-11, 1939
11. Hart, J.P., Cooper, W.L. Vitamin F in the treatment of prostatic hyperplasia. Report Number 1, Lee Foundation for Nutritional Research, Milwaukee, WI, 1941
12. Hoffman, L., et al. Carcinogenic effects of cadmium on the prostate of the rat. J Cancer Res Clin Oncol 109(3): 193-99, 1985
13. Habib, F.K., et al. Metal-androgen interrelationships in carcinoma and hyperplasia of the human prostate. J Endocrinol 71(1): 133-41, 1976
14. Webber, M.M., Selenium prevents the growth stimulatory effects of cadmium on human prostatic epithelium. Biochem Biophy Res commun 127(3): 871-77, 1985
15. Pentimone, F., Del-Corso, L. Male impotence in old age. Minerva-Med, 85(5):261-4, May, 1994
16. Kadioglu, A., et al. The effects of diabetes on penile-somato-afferent system. Arch Esp Urol, 47(1):100-3, 1994
17. Hassen, A., et al, The effect of diabetes on sexual behavior and reproductive tract function in male rats. J Urol 149(1):148-54, 1993
18. Teneja, N., Kucheria, K., Jain, S., Maheshwan, M., Effect of phenytoin on semen. Epilepsia, 35(1):136-40, 1994
19. Mannimo, D.M., et al. Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol 140(1):1003-8, 1994
20. Van-Steenbergen, W. Alcohol, liver cirrhosis and disorders in sex hormone metabolism. Acta Clin Belg 48(4):269-83, 1993
21. Abell, A., Ernst, E., Bonde, J.P. High sperm density among members of organic farmers’ association (letter). Lancet, 343(8911):1498, Jun 11, 1994
22. Narayana, M.V., Chinoy, N.J. Reversible effects of sodium fluoride ingestion of spermatozoa of the rat. Int J Fertil Menopausal Stud 39(6):337-46, Nov-Dec, 1994
23. Bose, S., Sinha, S.P. Modulation of ochratoxin-produced genotoxicity in mice by vitamin C. Food Chem Toxicol, 32(6):553-7, 1994
24. Sinha, S.P., et al. Vitamin A ameliorates the genotoxicity in mice of aflatoxin B-1 containing Aspergillus flavus infested food. Cytobios, 79(317):85-95, 1994
25. Bentivogolio, G., et al. Folinic acid in the treatment of human male infertility. Fertil Steril, 60(4):698-701, 1993
26. Moilanen, J., et al. Vitamin E levels in seminal plasma can be elevated by oral administration of vitamin E in infertile men. Int J Androl, 16(2):165-6, 1993