Botanical Treatment of Benign

Prostatic Hyperplasia (BPH)

Debra L. Brammer, ND
This article discusses the use of botanicals normally classified as women’s botan-
icals in treatment for benign prostatic hyperplasia (BPH) as both an alternative and
as an adjunct to pharmaceutical treatment. Benign prostatic hyperplasia occurs in

a majority of American males by the age of 60. Biomedical treatment has some
limitations and drawbacks. Surgery has the potential to leave the patient with
urinary incontinence or impotence. Pharmaceutical treatment may not provide
complete relief of symptoms. Addition of alternative nutritional and botanical
treatment under the guidance of a trained naturopathic physician can provide
additional relief of symptoms and reduction of inflammation for patients.

Benign adenomatous hyperplasia, also known as benign prostatic hypertrophy (BPH),

is a condition commonly occurring in males in the United States. It includes histologic
changes to the peri-urethral tissue rather than the muscular tissue of the prostate.
Through epidemiological studies, the histologic changes have been found in 8% of
males in the United States age 31 to 40, 40% to 50% age 51 to 60 and >80% after age
80. Symptoms caused the
by changes can range from mild to severe in expression (Beers
& Berkow, 1999, p.1829).
The symptoms may be caused by the hormonal changes associated with aging. Signs
and symptoms may include increased urinary frequency, urgency and nocturia with
urinary hesitancy, adecrease in the force of the stream and decrease in the size of the
stream flow. The commonly used diagnostic survey as presented by the American
Urological Association includes charting the frequency of symptoms. Symptoms
commonly include incomplete emptying, incontinence, decrease in strength of stream,
difficulty in starting or stopping stream and frequency of nocturia (Barry et al., 1992).
Physical examination may find prostate enlargement with a rubbery or firm consistency
on palpation. The changes may occur either in the lateral lobe or the middle lobe and

may not be palpable on physical examination. If tenderness of the prostate is present on

palpation, there may be inflammation or infection of the prostate. If the prostate is hard
or nodular on examination, further diagnostic testing is indicated to rule out a diagnosis
of cancer. The bladder should be percussed to determine if residual urine is present. The
clinical criteria for diagnosis include &dquo;prostate volume of more than 30 ml, a maximal
urinary flow rate of less than 10 ml per second, and a post voiding residual volume of
more than 50 ml&dquo; (Beers & Barkow, 1999, p. 1829). Diagnosis is made by a combination
of physical examination, frequency of symptom occurrence as indicated in the Barry

© 2001 Springer Publishing Company 21

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survey mentioned above, and testing to ensure that Prostate Specific Antigen (PSA)
levels are within normal limits. Ultrasound may be included if the PSA is elevated.
Complications of BPH may include obstruction of flow that can promote or predispose
the patient to urinary or prostate infection or the formation of renal calculi.
Common mainstream treatment includes watchful waiting with annual examinations
and annual PSA testing. Alpha-adrenergic blockers may be prescribed to improve
voiding. Finasteride, a 5-alpha reductase inhibitor, may be prescribed to reduce
glandular size. The patient’s pharmaceutical use should be monitored, since use of anti-
cholinergic drugs and narcotics can promote obstruction (Beers & Barkow, 1999, p.
1830; Lepor, 1989; Physicians Desk Reference, 2000). The most common surgical
procedure, transurethral resection of the prostate, may leave the patient impotent and/
or incontinent in a minority of cases (Lepor, 1989).

Complementary and alternative treatment of BPH by naturopathic physicians is less

invasive. It can include nutritional therapy with diet and supplements, homeopathic
treatment, hydrotherapy and botanical medicine. Nutritional therapy includes use of the
mineral Zinc, which has been shown to inhibit the activity of 5-alpha reductase and slow
down conversion of testosterone to dihydrotestosterone, thus slowing down growth of the
prostate gland (Leake et al., 1984). The indicated dose is 30 mg, two to three times per day.
Supplementation with 2-4 mg copper is indicated to decrease incidence of a copper
deficiency (Marz, 1997, pp. 123,128). The Omega 3 and 6 essential fatty acids are indicated
to reduce overall levels of inflammation in the body and to contribute to the formation of
healthy cell membranes. The dose is 1-3 grams per day. Taking 400 IU of Vitamin E per day
will reduce oxidation of the essential fatty acids. The amino acids, glutamic acid, glycine
and alanine have been shown to reduce edema of the prostate gland at a dose of 100-200 mg
three times daily between meals (Gaby & Wright, 1999; Werbach, 1993, pp. 110-112).
The botanicals most commonly used in the treatment of BPH include Serenoa repens
(Saw Palmetto), Urtica dioica (Stinging Nettle) and Pygeum africanum, also known as
Prunus africana. Pygeum is now endangered and other sources of treatment should be
examined (Simons et al., 1998). There are several botanical medicines commonly
considered to be women’s botanicals that should be considered for use in treatment of
BPH. They include Alchemilla vulgaris (Lady’s Mantle) and Mitchella repens (Partridge
Berry). Agropyron repens (Couch Grass) is a botanical used most commonly to treat
urinary cystitis. These botanicals are pelvic decongestant herbs and have been shown to
elicit symptomatic relief in cases of mild to moderate BPH. All of them are non-toxic, are
available through health food stores and have no known drug interactions.
Alchemilla vulgaris has a profound anti-inflammatory effect in the pelvic region. It
contains salicylate compounds, tannins, and glycosides that act to reduce size and
restore tone to tissues. It has been used primarily in women and as a pelvic tonic to
reduce inflammation, especially when fibroids or prolapse of tissues is present. The
common dose is 6 ml a day of a 1 :fluid extract (Bove, 1989; Hoffman, 1988, p. 204;

Tilgner, 1999, p. 79).

Mitchella repens is a slow-acting botanical that produces long-lasting effects. It has
long been used to tonify uterine function in women. It has also been used to treat BPH,
prostatitis and urinary incontinence. Native Americans of the plains ate the berries
whole to address water retention and pelvic pain. The usual dose is 4-5 ml a day of a 1 :1
fluid extract (Bove, 1989; Ellingwood, 1983, pp. 478-479; Felter, 1938, pp. 480-481;
Hoffman, 1988, p. 228; Mitchell, 2000, p. 231; Tilgner, 1999, p. 93).
 23

Agropyron repens has been used as a urinary anti-inflammatory and mild anti-microbial
herb to reduce urinary incontinence that is secondary to an inflammatory condition. It
contains polysaccharides, nutrients, saponins and a volatile oil which provided its actions
as ananti-inflammatory, antiseptic and demulcent botanical medicine. A 1:5 tincture should
be dosed at 3 ml-5 ml a day in divided doses (Culbeth, 1983, pp. 91, 98; Ellingwood, 1983,
p. 430; Felter, 1983, p. 682; Hoffman, 1988, p. 187; Weiss, 1988, p. 255).
Anenome pulsatilla (Anenome) can be added by a physician to address the spasmodic
pain that may accompany BPH. Since patients can experience toxicity at higher doses of
Pulsatilla, recommended dose would be a maximum of 21 ml a week of a 1:5 tincture, at
no more than 1 ml three times daily. Pain relief may be achieved at doses as low as 1/2
ml a day. Signs of toxicity include burning in the mouth and throat, abdominal pain,
nausea and vomiting and/or bloody diarrhea. At much higher doses, the patient may

experience bradycardia, suppressed respiration and cardiac arrhythmia (Culbeth, 1983, p.

208; Ellingwood, 1983, pp. 149-152; Felter, 1983, pp. 583-587; Mitchell, 2000, pp. 119,
231; Tilgner, 1999, p. 98;Weiss, 1988, p. 319). Anenome is not available over the counter
°

and must be administered under professional care.

Inclusion of these botanicals, under the guidance of a physician, into the treatment
of mild to moderate BPH may allow reduction of the dose or elimination of prescription
medication. While these plants have given relief when used in clinical practice,
evidence-based studies to confirm the historical use is needed for confirmation. A
combination of botanicals into the treatment plan allows functional improvement for
the patient. Addition to the pharmaceutical regimen should be considered when the
patient is not experiencing complete relief.

REFERENCES

Barry, M., Fowler, F. J., & O’Leary, M. P. (1992). American Urological Association
symptom index for benign prostatic hyperplasia. Journal of Urology, 148,1549.
Beers, M. H., & Berkow, R. (Eds.). (1999). Merck manual (17th ed.). Whitehouse Station,
NJ: Merck Research Laboratories.
Bove, M. (1989-1992). Lecture notes. Unpublished manuscript, Bastyr University, Seattle,
Washington.
Culbeth, D. (1983). A manual of materia medica and pharmacology. Sandy, OR: Eclectic
Medical Publications.
Ellingwood, F. (1983). American materia medica, therapeutics and pharmacognosy.
Sandy, OR: Eclectic Medical Publications.
Felter, H. W. (1983). Materia medica, pharmacology, and therapeutics. Sandy, OR:
Eclectic Medical Publications.
Gaby, A., & Wright, J. (1999). Nutritional therapy in medical practice. Seattle, WA:
Nutrition Seminars.
Hoffman, D. (1988). The holistic herbal. Longmead, England: Element Books Ltd.
Leake, A. (1984). The effect of zinc on the 5-alpha reduction of testosterone by the
hyperplastic human prostate gland. Journal of Steroid Biochemistry, 20, 651-655.
Lepor, H. (1989). Nonoperative management of benign prostatic hyperplasia. Journal of
, 1283-1289.
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Urology,
Marz, R. (1997). Medical nutrition from Marz. Portland, OR: Omni Press.
Mitchell, B. (2000). Lecture notes and plant medicine: Application of the botanical
remedies in the practice of naturopathic medicine. Preparatory Manuscript, Seattle.
24

Physicians Desk Reference. (2000). Montvale, NJ: Medical Economics Company, Inc.
Simons, A. J., & Dawson, I. K. (1998). Passing problems: Prostate and prunes. HerbalGram,
43, 49-53.
Tilgner, S. (1999). Herbal medicine from the heart of the earth. Creswell, OR: Wise Acres
Press, Inc.
Weiss, R. F. (1988). Herbal medicine. Beaconsfield, England: Beaconsfield Publishers,
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Werbach, M. R. (1993). Nutritional influences on illness: A sourcebook of clinical research.
Tarzana, CA: Third Line Press.

Biographical Data. Debra L. Brammer, ND, is the Chair of the Department of Botanical
Medicine at Southwest College in Tempe, Arizona. She received her ND degree from Bastyr
University and is currently teaching and practicing medicine in Scottsdale, Arizona.

Offprints. Requests for offprints should be directed to Debra Brammer, ND, 2140 East
Broadway Road, Tempe, AZ 85282.