Drop the Finasteride (Proscar): The Benefits and Risks of Natural Prostate Treatments
By Jonathan V. Wright, M.D.
Prostate enlargement (benign prostatic hypertrophy or BPH) sometimes seems an inevitable hazard of male aging. A small minority of men notice symptoms of hesitancy (taking longer than usual to urinate), one or more trips to the bathroom at night, and diminished force of the urine stream as early as in their 40s. Many more develop these symptoms in their 50s, and the numbers only increase with age. Its unusual to encounter a man in his 70s or 80s who’s had no symptoms of prostate enlargement at all.
Zinc, essential fatty acids (including alpha linolenic acid), and saw palmetto are all helpful in reducing or eliminating symptoms of BPH. There’s just no need at all to take a patent medication such as finasteride (Proscar) or its patent medication competitors!
But even natural substances can be overdone and possibly increase your risk of prostate cancer so its important to understand the benefits and risks.
From ALA to zinc: natural treatments that work
In 1941, the Lee Foundation for Nutritional Research published a small study of 19 men who had all the symptoms of BPH. Each participant in the study had a prostate examination confirming an enlarged but not cancerous prostate gland. Each man then took six capsules of an essential fatty acid complex (10 milligrams linoleic acid, 10 milligrams alpha-linolenic acid or ALA, and 10 milligrams arachadonic acid per capsule) daily.
After three days at six capsules daily, the quantity was reduced to four capsules daily for several weeks, then maintenance quantities of two capsules daily. All 19 men had reduction in prostate size as determined by physical examination, and the majority had all other symptoms of BPH reduced or eliminated as well.1
In 1974, Dr. Bush, head of the division of urology at Cook County Hospital in Chicago, presented another study of BPH treatment in a poster session at the annual meeting of the American Medical Association. Curiously enough, he also worked with 19 men with BPH, this time confirmed not only with a physical examination, but also with X-rays and other means that were high-tech in 1974.
These 19 men took 50 milligrams of zinc (from zinc sulfate) three times daily for two months, then 50 to 100 milligrams daily for another two to three months. Fourteen of 19 had shrinkage of the prostate gland as shown by the same examination techniques.2
In his presentation, Dr. Bush also observed that 105 of 150 men with chronic prostatitis not caused by bacterial infection were cured with this same zinc treatment. In 1976, another group also reported that zinc treatment reduced the size of enlarged prostate glands.3
Since 1974, whenever I work with a man with BPH, I advise him to take one tablespoonful of flaxseed oil daily (along with 400 IU vitamin E), and 50 milligrams zinc (from sulfate) twice daily (later modified to 30 milligrams zinc from picolinate two to three times daily). After three to four months, symp-toms are almost always improved and the prostate is usually smaller. I then recommend reducing the zinc (from zinc picolinate) to 60 milligrams every other day or 30 milligrams of zinc (from picolinate) daily, along with one to two teaspoons of flaxseed oil daily (and vitamin E). Men who eat enough unroasted sunflower seeds or pumpkin seeds (for essential fatty acids and zinc) and oysters (mostly for the zinc) can sometimes cut the supplements back further or even eliminate them for weeks to months at a time.
Saw palmetto is not my first choice
As natural medicine became ever more popular in the last quarter of the 20th century, more and more herbal products were introduced among them a breakthrough herbal treatment for BPH: saw palmetto. Saw palmetto quickly became available in nearly all natural food stores, and almost immediately became a bestseller, as it is quite effective for reducing sometimes dramatically the symptoms of BPH.
But even though saw palmetto was usually effective for the symptoms of BPH, I continued to recommend using zinc and essential fatty acids first for at least three to four months, followed by saw palmetto only if zinc and essential fatty acids together weren’t effective in that time.
My reasoning, admittedly theoretical (no money for controlled studies was or is available), is that zinc and essential fatty acids are essential to life and health, and saw palmetto isn’t. Most Americans live entire lifetimes without even one microgram of saw palmetto, but no one can live long without zinc or essential fatty acids! So even though saw palmetto isn’t thought to be harmful (more about this below), its best to use zinc and essential fatty acids for BPH first.
If a mans prostate function improves with more zinc, then his retina and hearing apparatus (both of which normally contain more zinc than the prostate) will very likely benefit from some of that supplemental zinc, too even if those areas aren’t yet symptomatic. Similarly, if a mans prostate function is improved with additional essential fatty acids, then likely his cardiovascular health will be improved as well as Nutrition & Healing readers know, in just the last few years many research studies have shown that essential fatty acids significantly reduce risk of atherosclerotic vascular disease.
Again, if after three to four months zinc and essential fatty acids aren’t effective, saw palmetto can always be tried next.
Everything in moderation
But in the last few years, evidence has been accumulating that like many other individual nutrients both zinc and essential fatty acids can be overdone and that excessive quantities may increase a mans risk of prostate cancer. The same risk hasn’t been reported for excess quantities of saw palmetto yet. However, my observations of the effects of saw palmetto in laboratory tests of steroid metabolism appear to also make increased cancer risk a possible effect of excessive saw palmetto use.
That’s because zinc, essential fatty acids, and saw palmetto all share a common mechanism of action with finasteride, a patented space alien molecule frequently prescribed for symptoms of BPH. This mechanism of action is inhibition of a testosterone-metabolizing enzyme called 5-alpha-reductase. As might be expected, the patent medication is a much more potent inhibitor of this enzyme than the natural substances.
The 5-alpha reductase enzyme metabolizes testosterone into di-hydrotestosterone (DHT), which is a much more potent testosterone, but also has been termed a bad testosterone since it causes more cellular disorganization. Cellular disorganization increases the risk of cancer.
For many men, finasteride reduces the symptoms of BPH. The well-known (to many physicians, at least) Prostate Cancer Prevention Trial4 demonstrated that finasteride also lowers prostate cancer riskbut at the price of spurring more aggressive cancer when it does occur. In this trial, 18,882 men with normal prostate exams and PSA below 3.0 (normal) took either finasteride or placebo for seven years.
At the end of that time, 18.4 percent of the men in the finasteride group and 24.4 percent in the placebo group had developed prostate cancer; the reduction of cancer occurrence (24.8 percent) was statistically significant. But 37 percent of the cancers occurring in the finasteride group were more aggressive types (translation: more likely to kill you) versus 22.3 percent more aggressive cancers in the placebo group.
This shows us that inhibiting 5-alpha reductase may not be entirely a good idea. Since alpha linolenic acid, zinc, and saw palmetto all inhibit 5-alpha reductase, could they also have this downside? This appears to be the case if the quantities used are too high.
Evidence for increased cancer risk
Evidence has been accumulating for over a decade that higher levels of a major essential fatty acid found in flaxseed oil, alpha linolenic acidmuch smaller quantities of ALA are found in canola and soy oils may be associated with higher prostate cancer risk.
A large case-control study from Uruguay found that men in the highest quartile of ALA intake had almost four times the risk of prostate cancer compared with those in the bottom quartile of intake.5 In a recent dietary case-control study,6 217 Spanish men with prostate cancer were matched with 217 hospitalized men (with non-cancer diagnoses) and 217 healthy controls.
The prostate cancer patients were three times more likely to be in the upper quartile of ALA intake. (Other findings from this study: Animal fat intake was positively correlated with increased prostate cancer risk, while vitamin C intake was correlated with decreased prostate cancer risk).
Although the preponderance of the evidence (so far) indicates caution about higher quantities of ALA-containing oils being associated with higher prostate cancer risk, a smaller amount of evidence is contradictory. One review article noted that five research studies were positive (including the two noted above), but one was negative. It also pointed out that one study using actual prostate cancer cells showed that ALA promoted their growth,7 while another showed growth suppression.8
Zinc also reduces 5-alpha reductase activity, and excess zinc may also be associated with increased cancer risk. A research group at the National Institutes of Health9 reported data from a study of 46,974 U.S. men participating in the Health Professionals Follow-Up Study. They wrote: Supplemental zinc intake at doses of up to 100 mg/day was not associated with prostate cancer risk. By contrast, men who took more than 100 mg/day of supplemental zinc had an increased risk of prostate cancer.
So far, there aren’t any research reports that implicate excessively high doses of saw palmetto as possibly increasing risk of prostate cancer. But in doing very careful laboratory follow-up of men taking both bio-identical hormones and saw palmetto, I and other Tahoma Clinic physicians have observed too many instances of definite over-inhibition of the 5-alpha reductase enzyme by saw palmetto supplementation. In these cases, the men involved have reduced their saw palmetto intake and the laboratory signs of 5-alpha reductase over-inhibition have gone away.
So what do I do?
If you’re a man starting to have symptoms of BPH or already taking zinc, and/or alpha linolenic acid-containing flaxseed oil, and/or saw palmetto to control BPH, the infor-mation above does not mean you should stop taking these substances.
Correct quantities are good for you, but correct quantities can vary from person to person. For example: Ive seen just one man whose metabolism was so sensitive to saw palmetto (as shown on his lab test by severe 5-alpha reductase inhibition) that he had to quit it entirely before the test result normalized. But zinc supplementation didnt have the same effect on his lab test, and helped his BPH symptoms, so he used that instead.
Very few men are that sensitive to the effects of saw palmetto, but laboratory testing has led me to recommend reduction, although not elimination, of saw palmetto supplementation for a significant minority of the men I work with.
But over-inhibition of 5-alpha reductase doesn’t have symptoms, and waiting to see whether youve possibly increased your risk of a more aggressive type of prostate cancer isn’t a good idea, either. Check with a physician who knows how to monitor testosterone metabolism with appropriate laboratory testing! Whether 5-alpha reductase is over-inhibited isnt the only question that needs to be answered; you also need to know whether the enzyme aromatase is turning too much of your testosterone (or DHEA) into excessive (for a man) estrogen, which may be equally if not more hazardous to your prostate.
Find a physician who uses the 24-hour urinary steroid analysis to monitor steroid hormone metabolism. At present, neither saliva testing nor blood testing has the breadth (total number of steroid metabolites) to follow these and other aspects of testosterone metabolism. The test follows estrogen metabolism much more completely, too, and allows your physician to keep both testosterone and estrogens as safe for you as is presently possible. JVW
Why does 5-alpha reductase over-inhibition possibly increase cancer risk?
In 2004, a report in the New England Journal of Medicine gave us a possible explanation.10 These researchers pointed out that while di-hydrotestosterone (DHT) is indeed potentially hazardous, the very next step in this metabolic pathway of testosterone metabolism transforms DHT into 3-beta androstanediol, a molecule that causes cellular re-organization, an anti-cancer action.
They point out that inhibiting 5-alpha reductase inevitably reduces the amount of 3-beta androstanediol. They wrote that the balance between DHT and 3-beta androstanediol may be a more important factor in increasing a mans risk of prostate cancer, and whether any cancer that does occur is more or less aggressive.
At this point, this explanation is not proven by actual experiment. But I think these researchers are likely to be proven right, as their observations could also explain why excess alpha-linolenic acid and excess zinc appear to increase prostate cancer risk and why excess saw palmetto might also do soas all of these natural substances inhibit 5-alpha reductase, and high doses can over-inhibit 5-alpha reductase.
