Why Aging Mandates More Protein

After the age of 50, the body starts to lose muscle mass at approximately 0.5 – 2% per year (1). In order to fight this inevitable process, it’s important to increase protein intake and physical activity. Research shows that regular resistance exercises, such as weight lifting or yoga twice a week, in conjunction with adequate protein consumption, can help to preserve muscle mass in the aging population (1).

Part of the reason older adults need more protein is due to the fact that they lose the ability to synthesize leucine, an essential amino acid for building muscle. This phenomenon is known as “leucine resistance.” Leucine “turns on” muscle building at the cellular level. Without adequate intake of this crucial amino acid, the body doesn’t optimize muscle building even when there is adequate protein consumption. Because the body becomes resistant to leucine, more protein is required to achieve the same maximal muscle-building and recovery benefits derived from a serving of protein; thus, you need to eat more protein to elicit the same benefits. In order to help combat this loss, it is helpful to increase the intake of protein sources that are high in leucine such as: chicken, beef, pork, tuna, firm tofu, navy beans, dairy products (milk, yogurt, cheese), and pumpkin seeds

For an average-sized person between the ages of 18 – 40 years of age, 20 – 25 grams of protein has been proven to be adequate to elicit maximal benefit from a serving of protein. For individuals over the age of 50, protein requirements almost double to 40 grams of protein in order to stimulate a similar response (or 1.0 gram per kilogram of body weight) (2). Some research indicates that a dietary protein intake of at least 1.2 grams per kilogram of body weight is even more protective against sarcopenia, a progressive and generalized loss of skeletal muscle mass and strength strictly correlated with physical disability, poor quality of life and death, and overall strength decline (3).

It is notable that protein is not just used for muscle synthesis, but has several other roles in the body. As we age, decreased protein stores contribute to increased skin fragility, lower immunity, poorer healing and longer recuperation time when one gets sick (2).

Because appetite may also decrease with age, it is important to ensure that a high-quality protein source is consumed with each meal. While animal-based proteins are the most bioavailable, combined plant-based sources of protein can also be used to ingest a complete amino acid profile. For example, eggs are a complete protein, whereas combining rice and beans makes up a complete protein.

In conclusion, it is crucial to increase protein consumption as we age in order to protect against skin health, immunity and muscle, bone and strength loss. The good news is that it is never too late to make dietary and lifestyle changes in order to protect our health. So, get moving and fuel up (with some protein) afterwards!

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References:

  1. Webb D. & nbsp; protein for fitness: Age demands greater protein needs.https://www.todaysdietitian.com/newarchives/040715p16.shtml. Updated 2015. Accessed 10/24/, 2019.
  2. Chernoff R. Protein and older adults.Journal of the American College of Nutrition. 2004;23(Supplement 6):627S-630S.http://www.jacn.org/cgi/content/abstract/23/suppl_6/627S. doi: 10.1080/07315724.2004.10719434.

Anxiety and Gut Health, What’s the Link?

Remember that uneasiness you felt in your stomach when you had to give a sales presentation before the boss or the butterflies in your stomach before a big road race? Do your symptoms of irritable bowel syndrome flare up when you’re nervous? These are just a few indicators of the link between anxiety and gut health.

What is anxiety?

Before we explore the two-way street between anxiety and gut health, let’s better understand this most common mental illness in the United States.

Anxiety affects about 40 million adults, or 18.1 percent of the population. The majority of people with anxiety have generalized anxiety disorder, with women being twice as likely to be affected as men.

About 6 million people suffer with panic attacks, and again women are affected more. Social anxiety disorder is an equal opportunity mental condition that affects about 15 million adults.

Even though anxiety is common and highly treatable, less than 40 percent of people who have any type of anxiety disorder get treated. Since men tend to be less likely to seek any type of medical treatment, it would seem many men are going untreated.

Understanding gut health

The gut hosts about 70 percent of the body’s immune system. The gut is populated by trillions of bacteria, also known as the gut microbiome. These bacteria help the immune system’s T cells discern between invading substances and the body’s own tissues. Obviously this is an extremely important task, because cells that don’t make this distinction can end up destroying healthy tissue, resulting in autoimmune disorders.

In addition to immune cells, your gut also harbors more than 100 million brain cells. This phenomenon has earned the gut the title of the “second brain,” also known as the enteric nervous system (ENS). The ENS consists of two layers of these 100 million-plus cells that line the gut from the esophagus to the rectum.

The gut also houses 95 percent of the 95 percent of the serotonin in your body. Serotonin is a neurotransmitter and hormone that plays a critical role in mood, and well-being, but also has a role in eating and digestion. This makes serotonin one of the major players in the link between anxiety and gut health..

Research on anxiety and gut health

Numerous studies support the intimate connection between anxiety and a healthy bacterial environment in your gut. Research indicates that the connection works both ways; that is, anxiety can cause gut problems and gut/digestive problems can cause anxiety and depression.

For example, the ENS can trigger emotional responses in individuals who are living with IBS or issues such as constipation, bloating, stomach upset, or diarrhea. According to Jay Pasricha, MD, director of the Johns Hopkins Center for Neurogastroenterology, experts long believed that anxiety contributed to IBS and other digestive problems. “But our studies and others show that it may also be the other way around,” he explains. Researchers are discovering that gut problems may send signals to the central nervous system, which in turn sparks mood changes.

In other research, experts conducted an analysis of 21 studies (more than 1,500 participants) and found that in 52 percent of the studies, when people regulated the bacteria in their gut, it helped reduce anxiety. Use of probiotics was one way individuals regulated their gut health.

However, study participants who made dietary changes (i.e., followed a low FODMAP eating program) actually fared better than those who took probiotics. FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) are short-chain carbohydrates (e.g., wheat [gluten], beans, dairy products) that are not adequately absorbed by the small intestine. The result can be a variety of gut problems such as diarrhea, constipation, stomach pain, gas, and bloating.

In a report by Randi Fredricks, PhD, he notes that “it is probably no surprise that stomach issues can cause stress, but they can also lead to significant mental health problems.” Gut problems most likely to be associated with anxiety are those such as irritable bowel syndrome (IBS). Studies show that individuals who have irritable bowel syndrome experience worsening of symptoms when they are anxious.

Among the 20 percent of Americans who experience recurring or persistent gut pain, including IBS, it’s been shown that these individuals are significantly more likely to also have anxiety or depression.

Bottom line

The connection between anxiety and gut health is a topic that warrants much research. Experts are learning more and more every day about how the two brains—the one in our head and the one in our gut—communicate with each other and have a significant impact on our overall health. Some research even suggests gut health has an effect on memory and cognition as well. Clearly the anxiety and gut health connection is one to keep your eye on.

References

Anxiety and Depression Association of America. Facts and statistics.

Blum S MD. What healing your gut can do for your immune system. MindBodyGreen

Fredricks R, PhD. Can gastric disorders contribute to anxiety and depression. Mental Health Net

Johns Hopkins Medicine. The brain-gut connection.

Yang B et al. Effects of regulation intestinal microbiota on anxiety symptoms: a systematic review. General Psychiatry 2019 May 17; 32(2): e100056

What Do We Know about Men’s Sexual Problems?

Do we pretend to know or think we know more about men’s sexual problems than we really do? The results of a recent survey among people attending an International Health Care Exhibition in Italy suggest individuals are out of touch with what’s happening in the sexual lives of men.

Men’s sexual problems: survey

The survey was conducted at Exposanita 2018 and addressed medical and non-medical professionals (most were not physicians). Two surveys were developed, one for each sex, and the questions centered on the subject’s knowledge of the causes of erectile dysfunction (ED), its prevalence, ED as an early sign of coronary heart disease, and/or myocardial infarction, which treatments are available for ED, attitudes toward penile prostheses, and reimbursement of treatments for ED.

A total of 1,094 people who attended the convention participated in the survey. The breakdown was as follows:

  • 495 men, 599 women
  • Mean age, 40.5 years in men and 39.9 years in women
  • 43% worked in health-related professions, and 5.9% were physicians

Overall, the respondents were not very knowledgeable about erectile dysfunction in men. For example:

  • Most respondents thought ED was much more prevalent than it actually is
  • Both men and women believed lifestyle and psychologic factors are the most common causes of ED
  • Most respondents did not believe ED was a possible predictor of cardiovascular problems
  • Oral ED medications were the most recognized treatment for erectile dysfunction (about 78% of respondents)
  • Psychotherapy was the second most known treatment modality
  • About half of male and female respondents said they were willing to choose or support the use of a penile prosthesis to treat severe ED
  • More than three-quarters of respondents said ED treatments should be covered by the National Health Service

Interesting survey findings

Two findings of the survey were of special interest. One was the ready acceptance of a radical treatment approach (penile prosthesis) for men with severe ED who have not responded to conservative treatment.

It also appears the public may not understand the prevalence and consequences of having erectile dysfunction, especially the relationship between ED and the cardiovascular system. Although ED does not always indicate a man has an underlying heart condition, research indicates that men with ED with no obvious cause and who have no symptoms of heart problems should be screened for cardiovascular disease before they begin treatment for ED.

Experts are currently of the opinion that the appearance of ED before heart problems is often caused by the dysfunction of the endothelium (inner lining of the blood vessels) and smooth muscle. This results in poor blood flow to the penis and to the heart.

Bottom line

Erectile dysfunction is a common health challenge, yet the general population does not appear to understand it, especially when it comes to its impact on cardiovascular health. It’s important for all men who are faced with this situation to seek out all the information they can, to consult with a medical and/or counseling expert, and to talk with their partners about the challenge and how it can be resolved together.

References

Mayo Clinic Staff. Erectile dysfunction: A sign of heart disease? Mayo Clinic

Pescatori ES et al. How much do people know about male sexual problems? A survey in a selected population sample. Archivio italiono di urologia andrologia. 2019 Oct 2

UroToday. How much do people know about male sexual problems? A survey in a selected population sample. 2019 Oct 2; 91(3)

Effects of Marijuana on Men’s Sexual Health

As more and more states legalize cannabis for medicinal and/or recreational use, there’s a rising interest in how marijuana affects men’s sexual health. The truth may lie somewhere between the lofty claims made by some men who use weed and the more cautious reports from a few research studies.

In addition to the impact of marijuana on erectile function, there are also questions about how occasional or chronic use may affect fertility. Let’s begin with erectile function.

Marijuana and erectile function

A few small studies have suggested cannabis use can put a damper on erectile function. However, one of the most recent studies of the impact of cannabis on erectile function conducted in Australia did not come to that conclusion.

The 92-study meta-analysis looked at the impact of six lifestyle choices (cigarette smoking, cannabis use, alcohol use, diet, caffeine, and physical activity) on erectile dysfunction, premature ejaculation, and female sexual dysfunction.

Although there was compelling evidence that alcohol, physical activity, and cigarettes were related to sexual dysfunction, the experts could not find sufficient evidence for cannabis use.

It is possible, however, that use of both marijuana and tobacco may increase a man’s risk of experiencing erectile dysfunction. Tobacco restricts blood flow to arteries and veins, while the cannabinoid receptors in the smooth muscle tissue of the penis may respond to the THC and cause penile dysfunction. This is theoretical, however, and has not been proven.

Despite interest in the topic of marijuana and erectile dysfunction, there is very little research in humans. It is believed this will change as the availability and acceptance of cannabis for both medicinal and recreational use increases.

Marijuana and male fertility

For young men who may want to start a family, use of marijuana can take on a different meaning. In a 2019 review, investigators looked at data from studies that examined the impact of cannabis on male fertility.

Research supports the idea that use of marijuana can have a significant impact on male fertility. In short, cannabis use can reduce sperm count and concentration, lower sperm motility and viability, inhibit the ability of the sperm to fertilize eggs, and induce abnormalities in sperm shape and size. All of these factors can have a negative impact on fertility.

In addition, cannabis in animal models has been shown to reduce libido and sexual function and cause testicular atrophy, although these results have not been replicated in human studies. Thus far there is inconclusive evidence that marijuana use affects testosterone levels or lowers levels of luteinizing hormone, which is needed to produce testosterone and sperm.

These findings suggest cannabis has a negative impact on male fertility. However, further research is needed in humans to validate animal findings and further explore the range of impact of marijuana on male sexual health.

Other effects of marijuana on sexual health

According to the National Institute of Drug Abuse, marijuana use can cause drowsiness and slowed reaction times, which may manifest as lower libido. An Australian study in the Journal of Sexual Medicine noted that daily use of cannabis was associated with men’s difficulty in reaching orgasm.

Bottom line

How marijuana affects men’s sexual health is still a study in progress. While it appears to have a detrimental effect on sperm and male fertility, the impact on erectile function remains debatable. Limited research indicates marijuana use may reduce libido and also the ability to reach orgasm.

References

Allen MS, Walter EE. Health-related lifestyle factors and sexual dysfunction: a meta-analysis of population-based research Journal of Sexual Medicine 2018; 15:458-75

Payne KS et al. Cannabis and male fertility: a systematic review. Journal of Urology 2019 Mar 27

Smith AMA et al. Cannabis use and sexual health. Journal of Sexual Medicine 2010; 7:787-93

Wu B. Does marijuana cause erectile dysfunction? MedicalNewsDaily 2018 Aug 9

How to Keep your Prostate Healthy

Out of sight, out of mind; you know how that goes! It’s human nature, yet it’s not in our best interest when it comes to health, including a healthy prostate. So when we begin to experience signs and symptoms of problems with the walnut-sized gland, that’s when we wish we had laid some preventive groundwork.

Now’s the time to take those steps and protect your prostate against infection, enlargement, irritation, and cancer, regardless of your age or whether you are already encountering problems with your prostate or not. If you are showing signs or symptoms, these tips can provide some relief and may even treat it.

The steps aren’t difficult; in fact, you can integrate them into your daily routine with little to no fanfare. Taken individually, these suggestions are helpful; collectively, they have the most power.

Go clean. Most conventional health care items, such as shampoo, body lotions, deodorant, toothpaste, and similar items, as well as common household cleaning products, harbor chemicals that are harmful to your health overall and your prostate in particular. Among the more common culprits are parabens, phthalates, formaldehyde, petroleum, triclosn, sodium lauryl sulfate, toluene, synthetic colors, fragrances, and more. Choose all-natural or organic products instead.

Go green. Green tea is a rich source of catechins, potent antioxidants with anticancer and anti-inflammatory properties as well as an ability to boost immunity. Research has indicated that the catechins in green tea may reduce the risk of an enlarged prostate, improve urinary function, and aid in the fight against prostate cancer.

Skip the caffeine. If you drink coffee, tea, or soda, caffeine-free is the way to go, as this compound can irritate the prostate and the bladder. If you are already experiencing urinary tract symptoms, caffeine can make them worse. (Sodas of all types also should be avoided, as research shows drinking just 11 ounces per day can increase a man’s risk of developing serious prostate cancer.)

Be a man on the move. Exercise is essential not only for overall health; it also can help you lose weight, which in turn can reduce symptoms of enlarged prostate (benign prostatic hyperplasia, BPH), prostatitis, and prostate cancer. Physical exercise has been shown to reduce the risk of developing BPH and urinary tract symptoms associated with it. If you are overweight, exercise and weight loss are important ways to improve prostate health.

Lack of exercise can result in obstructed blood flow, which in turn can increase the risk of prostate cancer and erectile dysfunction. As little as 30 minutes of brisk walking five to six days a week is recommended.

Be a plant man. Eating a mainly plant-based diet is highly recommended for a healthy prostate. Fruits, vegetables (especially green leafy ones), whole grains, legumes, nuts, and seeds should make up the majority—if not all—of your diet. Processed foods should be avoided, as well as added sugars and saturated fats. The Mediterranean diet, DASH diet, and entirely plant-based diets are recommended.

Try supplements. Even if you follow a healthy diet much of the time, sometimes it’s easy to fall short on the nutrients your body needs, and your prostate in particular. A variety of supplements are on the market for the prostate, and some of those with scientific evidence for their use include saw palmetto, vitamin D3, zinc, pygeum, green tea extract, and beta-sitosterol. Your best bet: one supplement that includes all or nearly all of them.

Practice (safe) sex. Use it AND lose it—as having sex or ejaculating may actually reduce your risk of developing prostate cancer. The findings of a Harvard study found that men who had more frequent ejaculations had a 33 percent lower risk of developing prostate cancer than their peers who reported fewer such occasions during their lifetime.

Get D. Not too much and not too little—that’s generally the rule when it comes to exposure to the sun so your body can create vitamin D. Research has indicated that vitamin D can reduce your risk of prostate cancer while also being good for heart health and optimal function of your pancreas and kidneys. If you don’t get about 20 minutes of sun exposure three to four days a week, you may want to take a vitamin D supplement. Before you do, however, have your levels checked—a simple blood test will do the trick.

Be screened. The recommendations for prostate cancer screening vary depending on whether you are considered to be normal or high risk. Men who are high risk (e.g., African-Americans, men of Scandinavian descent, men who have family members diagnosed with prostate cancer) should consider getting screened at age 40. Men who are at average risk should consider screenings starting around age 55. Overall, the decision to begin prostate cancer screenings is individual and personal and should be made after consulting with a knowledgeable healthcare provider.

Put out the butt. The carbon monoxide in tobacco works to lower levels of red blood cells, which reduces the amount of oxygen that travels throughout the body, including the prostate. Smoking also raises the levels of cell-damaging free radicals, which can lead to gene mutations and the development of cancer cells.

Bottom line

Keeping your prostate healthy involves some commonsense habits that will benefit your gland as well as your overall health. It’s never too late to start caring for your future!

References

Bettuzzi S et al. Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from a one-year proof-of-principle study. Cancer Research 2006 Jan; 66(2)

Hsu C. A soda a day raises a man’s aggressive prostate cancer risk by 40 percent. Medical Daily 2012 Nov 27

Leitzmann MF et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA 2004 Apr 7; 291(13): 1578-86

The 7 Types of Prostate Cancer

Normally when you hear about the different types of prostate cancer, you likely think of local and metastatic or advanced cancer; that is, cancer that is limited to the prostate and cancer that has spread beyond the organ. Yet the types of prostate cancer actually refer to the type of cell in which the cancer starts to develop.

Why is the type of prostate cancer important? Because knowing the cancer type, as well as the grade of cancer, can help your doctor decide which treatment approach to take.

Different types of prostate cancer
One type of prostate cancer makes up about 95 percent or more of the cases. That leaves about six other types that make up the remaining 5 percent. Here are the different types of prostate cancer.

Acinar adenocarcinoma
If you are diagnosed with prostate cancer, chances are it’s acinar adenocarcinoma, which is the most common type of prostate cancer. An adenocarcinoma is a type of malignant tumor that is formed from glandular structure in epithelial tissue, or the outer surface of an organ or gland.

This type of prostate cancer develops in the gland cells (aka, acini cells) that line the prostate and are responsible for producing the fluid that eventually becomes semen. Acinar adenocarcinomas form clusters and increase levels of prostate-specific antigen (PSA).

Ductal adenocarcinoma
This cancer begins in the cells that line the tubes or ducts of the prostate gland. Unlike acinar adenocarcinoma, this type of prostate cancer doesn’t always have an impact on PSA levels. This makes it potentially more difficult to detect. Men who have ductal adenocarcinoma usually experience a rapid growth and spread of the disease, as it is more aggressive than acinar adenocarcinoma.

Urothelial cancer
Also known as transitional cell cancer, this type usually begins in the cells surround the prostate, such as those that line the urethra, which is the tube that transports urine to the outside of the body. This type of cancer can act in two ways: it usually starts in the bladder and spreads to the prostate, but it also less often can originate in the prostate and travel to the entrance of the bladder and nearby tissues.

Urothelial prostate cancer is very rare. It often presents with bloody urine or difficulty urinating.

Squamous cell cancer
This type of prostate cancer develops from flat cells that cover the gland. Squamous cell cancer tends to grow and spread more rapidly than does adenocarcinoma. It makes up 0.5 to 1 percent of all prostate cancers and has a very poor prognosis.

Small cell prostate cancer
This type of prostate cancer consists of small round cells. It is a type of neuroendocrine cancer, which means it originates in cells that produce hormones. Small cell prostate cancer is very aggressive and does not cause changes in PSA levels. Once it is detected, it has already spread extensively and has a very poor prognosis.

Sarcomas
Sarcomas develop in soft tissue, including nerves and muscles. They can develop in the blood vessels, lymphatic vessels, and smooth muscles of the prostate, and they typically spread to the lungs. The two most common prostate sarcomas are leiomyosarcomas and rhabdomyosarcomas, which affect men between ages 35 and 60. Like other rare prostate cancers, they are challenging to detect and don’t alter PSA levels.

Neuroendocrine tumors (NETS)
Also known as carcinoids, neuroendocrine tumors are found in nerve and gland cells that make and release hormones into the bloodstream. This type of prostate cancer is extremely rare and usually grow slowly. Not much is known about NETs, but they don’t have an impact on PSA levels and they appear to be hereditary. When these tumors begin to secrete hormones, they can cause symptoms such as diarrhea, rapid heartbeat, dizziness, facial flushing, and wheezing. This collection of symptoms associated with an NET is called carcinoid syndrome.

References
Baig FA, Hamid A, Mirza T, Syed S. Ductal and acinar adenocarcinoma of prostate: Morphological and immunohistochemical characterization. Oman Medical Journal. May 2015; 30(3):162-66.
Hribar C. Types of prostate cancer. 2017 Oct ProstateCancer.net
Malik RD et al. Squamous cell carcinoma of the prostate. Reviews in Urology 2011; 13(1): 56-60

7 Ways to Help Prevent Prostate Cancer

Based on the findings of more than 200 studies conducted over nearly 20 years, these 7 steps are completely doable actions you can take to not only help prevent prostate cancer, the disease that will strike every 1 in 9 men, but also improve your overall health.

1. Prevent prostate cancer: diet

Your food choices play a significant role in the development of cancer, including prostate cancer. Many dietary recommendations are involved in this one suggestion. For example:

  • Maximize your intake of fresh (organic when possible) fruits and vegetables, which typically contain high levels of anti-inflammatory and anticancer substances.
  • Focus on healthy fats, such as monounsaturated and omega-3 fatty acids rather than saturated and trans fats. Monounsaturated fats are in olives and olive oil while omega-3 fatty acids are found in cold water fatty fish (e.g., salmon, tuna, herring, oysters, sardines), flaxseeds, chia seeds, walnuts, and soybeans.
  • Choose whole foods, which don’t contain preservatives, artificial colors or flavorings, or other chemicals.
  • Choose plant protein rather than animal protein. Plant protein provides all of the nutrition you need to support and maintain your prostate health. Protein is found in vegetables, soybeans, legumes, some grains (e.g., amaranth, quinoa), nuts, and seeds. Ease these foods into your menu.

2. Prevent prostate cancer: beware of supplements

Some nutritional and herbal supplements can be helpful for the prostate, such as saw palmetto and stinging nettle. Yet men need to be aware of the dangers associated with a few common supplements. Calcium supplements, for example, have been associated with an increased risk of advanced prostate cancer. Vitamin E supplements also are not recommended, as they’ve been shown to increase the risk of the disease among healthy men. Use of selenium supplements also have been associated with an increased risk of dying of prostate cancer among men with nonmetastatic disease.

3. Prevent prostate cancer: manage stress

Although stress may not have a direct impact on cancer development, chronic stress can weaken the immune system, cause fluctuations in hormonal balance, and make you more susceptible to disease. Stress reduction can include a wide range of activities, such as regular exercise (which has been shown to slow the spread of prostate cancer), tai chi, deep breathing, meditation, yoga, massage, reflexology, and progressive relaxation, among others.

4. Prevent prostate cancer: drink green tea

Green tea contains catechins, substances shown to help prevent the growth of cancer cells and encourage them to self-destruct (apoptosis). Catechins also can interrupt the actions of enzymes that promote the spread of cancer.

In 2017, a systematic review and meta-analysis found that higher (more than 7 cups daily) consumption of green tea was associated with a reduced risk of prostate cancer. This study was significant because it was the first meta-analysis of green tea catechins and the incidence of prostate cancer.

5. Prevent prostate cancer: stay hydrated

Drink enough water. Sounds simple, right? Yet it’s so easy to become dehydrated and not even realize it. Do it often and the effects can be cumulative. Staying properly hydrated can support prostate health and thus be a player in the prevention of prostate cancer.

6. Prevent prostate cancer: watch your weight

Research has shown that being overweight is associated with a greater risk of prostate cancer as well as a lower survival rate. One example comes from the International Journal of Cancer in 2017 in which the authors found strong associations between weight gain and metabolic changes and prostate cancer progression.

In fact, many studies have pointed to the relationship between weight (especially abdominal weight) and progression of prostate cancer. Scientists have been trying to understand the reason for this relationship, including an increase in the estrogen-to-androgen ratio and enhancement of inflammation, which in turn contributes to conditions favorable to prostate cancer. This is an area that requires much more research.

7. Prevent prostate cancer: avoid toxins

Preservatives, pesticides, and other toxins have become a part of everyday life. They have infiltrated our food, water, air, clothing, furniture, cleaning products, personal care items, and more. These substances are taking a toll on your health, including your prostate. The best preventive measure is to choose all-natural products, including organic foods, untreated furniture, chemical-free health and cleaning products, and pesticide-free garden and pest control.

Bottom line

Men need to be aware of the daily steps they can take to help prevent the development of prostate cancer. The suggestions provided here are also relevant for men who may already have been diagnosed with the disease to help ward off spread of the disease and improve quality of life.

References

Dickerman BA et al. Weight change, obesity, and risk of prostate cancer progression among men with clinically localized prostate cancer. International Journal of Cancer 2017 Sep 1; 141(5): 933-44

Esser KA et al. Physical activity reduces prostate carcinogenesis in a transgenic model. Prostate 2009 Sep 15; 69(3): 1372-77

Guo Y et al. Green tea and the risk of prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore) 2017 Mar; 96(13): e6426

Jian L et al. Protective effect of green tea against prostate cancer: a case-control study in southeast China. International Journal of Cancer 2004 Jan 1; 108(1): 130-35

Kenfield SA et al. Selenium supplementation and prostate cancer mortality. Journal of the National Cancer Institute 2014 Dec 12; 107(1): 360

Klein EA et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011 Oct 12; 306(14): 1549-56

World Health Organization. Q&A on the carcinogenicity of consumption of red meat and processed meat. 2015 October

What Does It Mean to Have Prostate Cancer?

If you have heard the words “You have prostate cancer” from your doctor, many thoughts and questions probably ran through your mind.

  • Why me?
  • What exactly is prostate cancer?
  • How bad is it?
  • Do I need treatment and if so, what are the options?
  • Will I be able to work? Have sex?
  • Am I going to die?

It would take volumes to answer these questions. However, here are some thoughts on each of them that can serve as launching points for further discussion between you and your physician and family.

Why me?

This is a common question regardless of what disease someone develops. Check out these statistics and see where you fit into the picture.

  • Prostate cancer affects 1 out of every nine men during their lifetime.
  • In 2019, an estimated 174,650 new cases of the disease will be diagnosed in American men, and about 31,620 men will die of the disease, according to the American Cancer Society.
  • Prostate cancer is rare among men younger than 40, as the average age at the time of diagnosis is about 66
  • Sixty percent of cases occur in men aged 65 or older.
  • Older age is a main factor in the development of the disease.

Why did you get prostate cancer? That’s difficult to say. Genetics and ethnicity play a role, as the disease is at least 60 percent more common among black men than non-Hispanic white men. Other risk factors include age, location (more frequent in North America, northwestern Europe, Australia, and the Caribbean islands), and family history.

For example, if your father or brother has had prostate cancer, you have twice the risk of developing the disease than do other men without this family history. The risk is slightly higher if your brother rather than your father has had the disease.

A few other risk factors for prostate cancer include:

  • Diet: Research indicates that eating a diet that contains high-fat dairy or red meat may increase a man’s chances of developing prostate cancer.
  • Obesity: The obesity risk seems to operate at two levels. One is that obesity itself is linked to the development of the disease, and another is that it increases a man’s risk of dying of advanced prostate cancer.
  • Agent Orange: Men who were exposed to Agent Orange during the Vietnam War appear to be more prone to develop aggressive prostate cancer. This relationship is still being explored by researchers.

What exactly is prostate cancer?

Prostate cancer is the uncontrolled growth of cells in the prostate gland. When mutations of DNA occur, they can cause the cells in the prostate gland to grow abnormally and out of control. Eventually those cells can develop into a tumor.

How bad is it?

The stage at which prostate cancer is discovered is important because it determines if and how treatment should occur, which treatments are most appropriate for you, and what you can expect along this journey with prostate cancer.

Prostate cancer is generally a slow-growing disease. Currently, nearly 3 million men in the United States alone are living with prostate cancer.

That’s not to say prostate cancer isn’t a very serious disease and doesn’t demand immediate attention. However, the type of attention depends on the stage of cancer, age of the patient, overall health, life expectancy, and the quality of life the patient desires.

Prostate cancer is staged based on the extent of the disease, the PSA level, and Gleason score at the time of diagnosis. The stages are:

  • T0: No evidence of a tumor in the prostate
  • T1: Although a doctor cannot feel changes in the prostate during examination, a tumor may be discovered during surgery or needle biopsy for another prostate problem, such as an enlarged prostate.
  • T2: The tumor is confined to the prostate and is large enough to be felt during a digital rectal exam.
  • T3: The tumor has grown through the prostate on one or both sides of the prostate. It also may have expanded into the seminal vesicles, which are the tubes that transport semen.
  • T4: The tumor has not grown or it has grown into the rectum, pelvic wall, of other nearby structures except the seminal vesicles, external sphincter, or several other areas.

The bottom line is, your doctor should explain to you the extent of the disease. To make that determination, clinicians use a range of diagnostic tools, including the PSA, digital rectal exam, prostate biopsy, biomarker tests, PCA3, and transrectal ultrasound test.

Do I need treatment and if so, what are the options?

You and your doctor will work together to determine whether your prostate cancer requires treatment. The choice of treatment, if any, depends on the severity of the disease.

For many men, and especially the majority who show an early, slow-growing cancer, a treatment approach called Active Surveillance is sometimes recommended. This involves regular monitoring of the disease using various tests but no active treatment unless there is progression. Other main options may include:

  • Surgery in the form of prostatectomy (removal of the prostate) for cancer that has not spread beyond the prostate
  • Chemotherapy, the use of drugs for prostate cancer that has spread beyond the gland. It is sometimes used along with hormone therapy
  • Hormone therapy, also known as androgen deprivation therapy, for cancer that has spread too far to be cured using surgery or radiation, before radiation to help make treatment more effective, or along with radiation for men at greater risk of cancer returning after treatment
  • Radiation, which may be used as the first treatment for low-grade cancer limited to the prostate, along with hormone therapy for cancer that has spread beyond the prostate, or in advanced cancer to help keep it under control
  • Cryotherapy, or the use of extremely cold temperatures to freeze and kill prostate cancer cells, may be used for early-stage disease. It is sometimes used if cancer has returned after radiation therapy.

Will I be able to work or have sex with prostate cancer?

For the vast majority of men, having prostate cancer does not end their ability to continue working or engaging in sex, although depending on the severity of the disease, they may need to make adjustments in both of these areas. For example, men who undergo chemotherapy may experience side effects from treatment that cause them to lose time at work because of nausea, fatigue, or weakness.

The ability to have sexual intercourse while living with prostate cancer can depend on the treatment. Prostatectomy and radiation, for example, are associated with a significant risk of experiencing erectile dysfunction and urinary incontinence.

However, men who become stressed over their diagnosis, even if they have low-risk disease and are on active surveillance, may experience performance anxiety. Therefore, men with prostate cancer who are concerned about their ability to continue sexual activity should discuss their concerns not only with their partners but with mental health professionals if necessary so they can find ways to continue their sex lives.

Am I going to die?

According to the American Cancer Society, about 1 man in 41 will die of prostate cancer. Once a man has been diagnosed with prostate cancer, the five-year relative survival rate for different types and stages of the disease are as follows. If the five-year relative survival rate for a specific stage of the disease is 90 percent, it means that men with prostate cancer are, on average, about 90 percent as likely as men without the disease to live for at least five years after diagnosis.

  • Localized (no sign of disease outside of the prostate), nearly 100%
  • Regional (cancer has spread to nearby structure or lymph nodes), nearly 100%
  • Distant (cancer has spread to bones, lung, liver, or other distant parts), 30 percent

Even though prostate cancer is the second leading cause of cancer death among American men, most men who have been diagnosed with the disease don’t die from it.

Bottom line

Men who have been diagnosed with prostate cancer need to educate themselves and their families about the disease. Consultation with one or more trusted physicians is recommended, and men should continue to stay abreast of the latest findings and research in the area of prostate cancer and treatment.

Reference

American Cancer Society. Key statistics for prostate cancer

Omega-3 Fatty Acids – Should Men Take Them?

Articles about omega-3 fatty acids is all over the internet. It seems there’s a new story about this important nutrient just about every week. If you’re among the nearly 19 million Americans who takes an omega-3 supplement in the form of fish oil (the typical way), then you may find yourself checking out the latest research on the topic. We’re going to talk about that here.

If you don’t take an omega-3 supplement, then it may be time for you to see why this supplement gains so much attention. Chances are unless you are a regular consumer of fatty cold water oily fish, you should be taking an omega-3 supplement since the body can’t make these fatty acids, so food and fish oil supplements are the only sources.

What are omega-3 fatty acids?

The two most prevalent omega-3s are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A third omega-3, called alpha-linolenic acid (ALA), is found in foods other than fish, such as walnuts, flax seed, soybeans, pumpkin seeds, canola oil, and tofu. However, the body must convert ALA into EPA and DHA, and the conversion rate is very low.

According to the National Institutes of Health, there’s insufficient data available to give recommended intake for EPA and DHA. However, many organizations recommend a range of 250 mg to 500 mg daily of EPA and DHA for healthy individuals. Higher amounts are usually recommended for people who have specific health conditions, such as heart disease. For ALA, the recommended intake is 1.1 to 1.6 grams. 

Why men should take omega-3 supplements

Heart health. Since heart disease is the number one killer of men in the United States and many other places around the world, research pointing to the heart-healthy properties of omega-3s is especially relevant. A 2017 Harvard University study reported that omega-3s are associated with a lower risk of cardiovascular disease and urged individuals to substitute saturated fatty acids with unsaturated fats, such as omega-3s. In a 2018 review, the authors noted that the American Heart Association recently expanded their Class II recommendations, stating that treatment with omega-3 fatty acids for cardiovascular disease is reasonable.

Prostate cancer. Numerous studies have shown that DHA has an ability to shrink prostate tumors, reduce the risk of prostate cancer, and enhance the impact of the chemotherapy drug, cisplatin. Now a recent study has discovered the processes by which this omega-3 fatty acid can help in the prostate cancer fight.

Without getting too technical, it appears that DHA induces the inhibition of cancer cell growth and cell suicide of prostate cancer cells that are dependent on something called the Hippo pathway. This knowledge may open the door to new therapies for prostate cancer. Until then, omega-3 fatty acids seem to be a wise supplement choice.

Memory support. Use of omega-3 supplements have been found to be helpful in individuals who have mild Alzheimer’s disease. In younger individuals (ages 18 to 25) without dementia, taking fish oil supplements daily for six months resulted in a 23 percent increase in working memory.

Depression. In a recent (December 2018) study from Spain, investigators found that moderate intake (500 to 1,000 mg daily) of omega-3 fatty acids was significantly associated with a lower prevalence of depression. This is half of the dose suggested by many organizations. In an Italian meta-analysis and review that involved 31 studies and more than 255,000 individuals, the authors reported that dietary intake of omega-3 fatty acids was associated with lower risk of depression.

Eye health. Approximately 11 million people in the United States alone have macular degeneration, and omega-3 fatty acids may be able to help. In a study of more than 114,000 adults, those with a higher intake of omega-3s were more likely to delay or prevent development of this devastating eye condition.

Australian researchers conducted what is believed to be the first study ever to show that daily use of omega-3s can reduce intraocular pressure, which is a risk factor for the potentially blinding eye disease, glaucoma. The dose used was 1,000 mg EPA plus 500 mg DHA and 900 mg ALA.

Weight loss and metabolism. Weight gain is a concern as men age, especially among those with heart disease, diabetes, or respiratory conditions. Use of fish oil supplements may help boost metabolism and result in less accumulation of fat and weight loss, based on the findings of an animal study. In a human study, adults who switched to fish oil from other fats showed a reduction in body fat mass index, which indicated that omega-3s have an ability to reduce body fat and prompt the fatty acids to produce energy (i.e., burn calories).

Immune system. Maintaining strong immune function is critical as men age, and omega-3s may play a part. A study appearing in the Journal of Leukocyte Biology indicated that DHA can enhance the activity B cells, which are critical for optimal immune system health.

Diabetes. Approximately 13 million men in the United States alone have diabetes, with up to 95 percent of them having type 2 disease. A number of studies have indicated that omega-3s can help reduce the risk of type 2 diabetes as well as prevent complications that are associated with it. One study, for example, found that adults with diabetes who took 500 mg omega-3s daily or ate two servings of fatty fish every week were nearly 50 percent less likely to develop diabetic retinopathy when compared with those who consumed less.

Another way fish oil may help with diabetes is to improve insulin sensitivity. A study in the Journal of Clinical Endocrinology and Metabolism reported that adults who took fish oil showed an increase in the levels of the hormone adiponectin, which is a strong marker for insulin sensitivity.

Bottom line

Omega-3 fatty acid supplements in the form of fish oil are beneficial for men’s health in a variety of ways. However, you want to be sure to take products from reputable suppliers. Look for supplements that have been PBC tested, sustainably sourced, and contain no preservatives, artificial colors, or allergens.

While the Food and Drug Administration states that 3,000 mg daily of omega-3s is the upper limit for safety, the European Food Safety Authority says 5,000 mg is safe. Keep these figures in mind when taking omega-3 supplements, as these fatty acids can cause excessive bleeding and blood thinning in some people.

References

Aucoin M. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrated Cancer Therapy 2017 Mar; 16(1): 32-62–YES

Bright Focus Foundation. Age-related macular degeneration: facts and figures

Canhada S et al. Omega-3 fatty acids’ supplementation in Alzheimer’s disease: a systematic review. Nutritional Neuroscience 2017 May 3:1-10–YES

Couet C et al. Effects of dietary fish oil on body fat mass and basal fat oxidation in healthy adults. International Journal of Obesity and Related Metabolic Disorders 1997 Aug; 21(8): 637-43—YES 

Downie LE, Vingrys AJ. Oral omega-3 supplementation lowers intraocular pressure in normotensive adults. Translational Vision Science & Technology 2018 May 1; 7(3): 1

EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on the tolerable upper intake level of eicosapentaenoic acid (EPA) docosahexaenoic acid (DHA), and docosapentaenoic acid (DPA). EFSA Journal 2012 Jul 27; 10(7)

Elagizi A et al. Omega-3 polyunsaturated fatty acids and cardiovascular health: a comprehensive review. Progress in Cardiovascular Diseases 2018 May-June; 61(1): 76-85

Gurzell EA et al. DHA-enriched fish oil targets B cell lipid microdomains and enhances ex vivo and in vivo B cell function. Journal of Leukocyte Biology 2013 Apr; 93(4): 463-70–YES

Hu Z et al. Docosahexaenoic acid inhibit the growth of hormone-dependent prostate cancer cells by promoting the degradation of the androgen receptor. Molecular Medicine Reports 2015 Sep; 12(3): 3769-74

Kyoto University. Fish oil helps burn fat by transforming fat-storage cells into fat-burning cells. 2015 Dec 18

Narendran R et al. Improved working memory but no effect on striatal vesicular monoamine transporter type 2 after omega-3 polyunsaturated fatty acid supplementation. PLoS One 2012 Oct 3—YES

National Institutes of Health. Omega-3 fatty acids. Accessed June 21, 2019.

Sala-Vila A et al. Dietary marine w-3 fatty acids and incident sight-threatening retinopathy in middle-aged and older individuals with type 2 diabetes. Prospective investigation from the PREDIMED trial. JAMA Ophthalmology 2016; 134(10): 1142-49—YES

Sanchez-Villegas A et al. Seafood consumption, omega-3 fatty acids intake, and life-time prevalence of depression in the PREDIMED-Plus Trial. Nutrients 2018 Dec 18; 10(12): pii:E2000

Wang DD, Hu FB. Dietary fat and risk of cardiovascular disease: recent controversies and advances. Annual Review of Nutrition 2017 Jun 23—YES

Wang J et al. FFAR1- and FFAR4-dependent activation of Hippo pathway mediates DHA-induced apoptosis of androgen-independent prostate cancer cells. Biochemical and Biophysical Research Communications 2018 Nov 30; 506(3): 590-96

Wu J et al. Dietary intakes of eicosapentaenoic acid and docosahexaenoic acid and risk of age-related macular degeneration. Ophthalology 2017 May; 124(5): 634-43—YES

Wu MHY et al. Effect of fish oil on circulating adiponectin: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Endocrinology and Metabolism 2013 Jun; 98(6): 2451-59

8 Prostate Supplement FAQs & What You Should Know

You may have been thinking about taking a prostate supplement but you’re not sure what to take. Perhaps you’ve been diagnosed with an enlarged prostate, prostate cancer, or prostatitis, or you may be interested in keeping that walnut-sized gland as healthy as possible. So your interest may be preventive.

In any case, you may have some questions about prostate supplements. After all, there are numerous products from which to choose, and the information may be confusing or lacking in specificity. Maybe your healthcare provider is not familiar with prostate supplements, in which case you should find a professional who can help you make your final purchasing decision to ensure you are getting a product that is right for you.

At the same time, you can do some research on your own, and that’s where this article comes in. Here are 8 FAQs on prostate supplements to help you get started on your search for the optimal prostate product for you.

1. Why should I take a prostate supplement?

You should consider taking a prostate supplement if you:

  • Have already tried conventional treatments for a prostate condition and you want to complement your efforts
  • Do not want to take any conventional medications. This is, of course, a personal decision. However, you should take this approach only if you are under the guidance of a medical professional, especially if you have a prostate condition or disease
  • Want to enhance or maintain your current prostate health. Taking a prostate supplement may be an effective way to help prevent future prostate problems.

2. How do I know if a prostate supplement is reputable?

You should consider several factors when looking for a reputable prostate supplement. One is transparency. Is there a way to contact the company and speak with a representative about their products? If the product is online, can you clearly see the product label and ingredients?

Another important factor is, are the claims made by the manufacturer backed up with scientific evidence? The producer should provide references to support the ingredients used in their product, and you should be able to search for and read the evidence for yourself. 

Yet another factor is certification. Look for products made in manufacturing facilities that are 100 percent FDA and GMP (Good Manufacturing Practices) certified. It is also recommended that the producer be NSF (National Sanitation Foundation) certified. NSF certification guarantees that the supplement’s contents match those printed on the label, that all the ingredients in the supplement have been listed on the label, and that there are no unacceptable levels of contaminants in the supplement.

Finally, choose a supplement that does not contain synthetic or artificial ingredients or fillers.

3. How long does it take for prostate supplements to work?

That depends on the supplement and the issue you are addressing. Remember that prostate supplements are not medications, and that natural substances can take longer to initiate noticeable results. You may experience results in a few days or a few weeks. If you don’t notice any improvement after 30 days, you may need to find a different prostate supplement.

4. What prostate supplement ingredients may help with an enlarged prostate?

If you have been diagnosed with an enlarged prostate (aka, benign prostatic hyperplasia), there are several natural ingredients that can complement your management strategy. The following ingredients are among those most studied for an enlarged prostate. Although these herbal remedies can be purchased individually, it is often best to use a supplement that combines several herbs to take advantage of the synergy of the product.

Beta-sitosterol: This substance is found in many plants, including corn oils, soybeans, peanuts, rice bran, and wheat germ. Although beta-sitosterol will not have an impact on the size of your prostate, it may help improve urinary flow and allow you to better empty your bladder. In a review of four studies involving more than 500 participants, researchers reported that beta-sitosterol improves urinary flow and urological symptoms.

Pygeum africanum: The bark of the African plum tree (Prunus africana) is the source of this herbal remedy. Some studies have indicated that it may help men with nocturnal urinary urgency (nocturia), improve urine stream, better empty the bladder, and go to the bathroom fewer times during the day. Prunus africana bark may contain atranorin, atraric acid, beta-sitosterol, ferulic acid, and N-butylbenzene sulfonamide, substances that have been shown to improve the symptoms of an enlarged prostate.

Rye grass pollen extract: Evidence that rye grass pollen extract is helpful in managing an enlarged prostate is limited. In one review that involved 163 men, rye grass pollen was compared with placebo. Use of the pollen extract was associated with a significant increase in self-rated improvement and reduced need to get up at night to urinate when compared with placebo. In a subsequent study that enrolled 444 men, the pollen extract resulted in an improvement in overall urinary symptoms, including nocturia.

5. What prostate supplement ingredients may help with prostatitis?

Many of the symptoms of prostatitis are similar to those of an enlarged prostate, so some of the natural remedies are the same. However, there are a few different ingredients you should look for in a prostate supplement that may help manage this condition.

Beta-sitosterol: See question on enlarged prostate

Green tea extract: So far, the research on green tea and prostatitis has focused on animal models. The findings have indicated that the catechins in green tea have anti-inflammatory and antimicrobial effects on prostatitis. This effect was better when the catechins were altered using nanotechnology. Other work has shown that catechins combined with the antibiotic ciprofloxacin (Cipro) resulted in significant improvements in prostatitis symptoms when compared with placebo.

Quercetin: Animal study results point to the value of using quercetin against prostatitis. According to a recent study published in Prostate, quercetin helps protect against CP/CPPS, which is mediated by anti-oxidation, anti-inflammation, and specific signaling functions in the body.

Rye pollen extract: See question on enlarged prostate

Saw palmetto: Numerous studies have explained the benefits of taking saw palmetto for management of prostatitis symptoms, especially those associated with the most common form of the condition, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In a 2017 report, for example, use of 320 mg saw palmetto daily for 12 weeks resulted in dramatic improvement in lower urinary tract symptoms and in quality of life.

Zinc: The prostate has a very high concentration of zinc, which indicates that this mineral is important for the integrity of this gland. Research shows that taking zinc supplements can help individuals with chronic prostatitis because of its anti-bacterial and immune-modulatory actions in the body.

6. What prostate supplement ingredients may help with prostate cancer?

Prostate supplements should not be used as a replacement for conventional prostate cancer treatment. However, they can be a significant complementary addition to your current treatment strategy. Be sure to discuss your plans to use prostate supplements with your physician.

Green tea: Numerous studies have shown that high consumption of green tea is associated with a lower risk of prostate cancer. One such study includes a systematic review and meta-analysis published in 2017. That study was the first meta-analysis that looked at the consumption of the active ingredients in green tea (catechins) and the incidence of prostate cancer. The authors found that “higher green tea consumption was linearly reduced PCa [prostate cancer] risk with more than 7 cups/day and green tea catechins were effective for preventing PCa.”

Resveratrol: This antioxidant and phytonutrient has been demonstrating much promise in the fight against prostate cancer. In 2019 alone, there have been numerous animal studies showing how resveratrol can not only inhibit the growth of prostate cancer cells but also suppress spread of the disease and promote cell death (apoptosis). Effective doses of resveratrol have not yet been determined.

Vitamin D: The body transforms vitamin D into several factors that help prevent the spread of prostate cancer cells as well as their reproduction. A number of studies also indicate that low levels of vitamin D are more likely to be seen in men with prostate cancer than in those without the disease, and that vitamin may help lower PSA levels. However, several studies have noted that high doses of vitamin D are not recommended.

Zinc: Taking zinc supplements may reduce the risk of developing advanced prostate cancer. In animal studies, human prostate cancer cells were exposed to zinc, and the cells were prone to undergo cell suicide. Zinc also has been shown to be a player in the regulation of prostate cancer cell growth.

7. What prostate supplement ingredients are recommended for overall prostate health?

Look for a prostate supplement that offers a variety of support. The main ingredients for a prostate supplement include beta-sitosterol, green tea extract, Pygeum africanum, vitamin D, and zinc (see details about each above). Saw palmetto and pumpkin seed oil are also sometimes suggested.

8. How do I know if my prostate supplement will interact with medications or other supplements?

If you plan to take a prostate supplement (or any supplement for that matter), you should talk to a knowledgeable healthcare professional about any possible drug and/or supplement interactions. This is especially important if you have any medical issues that may be impacted by your use of the supplement. Naturally, you can do your own research online to uncover possible interactions or contraindications, but it’s always best to check with a professional; if not your doctor, then talk with a pharmacist.

References

Costello LC, Franklin RB. A comprehensive review of the role of zinc in normal prostate function and metabolism; and its implications in prostate cancer. Archives of Biochemistry and Biophysics 2016 Dec 1; 611:100-12

Goodarzi D et al. The efficacy of zinc for treatment of chronic prostatitis. Acta Med Indones 2013 Oct; 45(4): 259-64

Guo Y et al. Green tea and the risk of prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore) 2017 Mar; 96(13): e6426

Jang YG et al. Resveratrol inhibits DHT-induced progression of prostate cancer cell line through interfering with the AR and CXCR4 pathway. Journal of Steroid Biochemistry and Molecular Biology 2019 Jun 8; 192:105406

Lee YS et al. Synergistic effect between catechin and ciprofloxacin on chronic bacterial prostatitis rat model. International Journal of Urology 2005 Apr; 12(4): 383-89

MacDonald R et al. A systematic review of cernilton for the treatment of benign prostatic hyperplasia. BJU International 2000 May; 85(7): 836-41

McNicholas T, Kirby R. Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMI Clinical Evidence 2011 Aug 26; 2011.

Petrou S et al. Effect of vitamin D supplementation in prostate cancer: a systematic review of randomized control trials. International Journal for Vitamin and Nutrition Research 2018 Feb; 88(1-2): 100-12

Ramakrishnan S et al. Association among plasma 1,25(OH)2D, ratio of 1,25(OH)2 D to 25(OH)D, and prostate cancer aggressiveness. Prostate 2019 Jul; 79(10): 1117-24

Shahvazi S et al. The effect of vitamin D supplementation on prostate cancer: a systematic review and meta-analysis of clinical trials. Hormone and Metabolic Research 2019 Jan; 51(1): 11-21

Thompson RQ et al. Chemical comparison of Prunus africana bark and pygeum products marketed for prostate health. Journal of Pharmaceutical and Biomedical Analysis 2019 Jan 30; 163:162-69

Wilt TJ et al. Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU International 1999 Jun; 83(9): 976-83

Yoon BI et al. Anti-inflammatory and antimicrobial effects of nanocatechin in a chronic bacterial prostatitis rat model. Journal of Infection and Chemotherapy 2010 Aug 7