Prostate health - natural ways to support it from the age of 40

Introduction: Why the prostate becomes important after 40

The prostate is a gland about the size of a walnut underneath the bladder. It produces part of the seminal fluid and plays a central role in fertility. With increasing age, the prostate can grow - benign prostate enlargement (prostatic hyperplasia, BPH for short) affects many men. This growth is benign, but can lead to symptoms such as frequent urination, a weak urinary stream or the urge to urinate at night. For men over 40, it makes sense to address men's health at an early stage and focus on your own prostate health. This article explains which natural measures can support your prostate without violating the EU Health Claims Regulation.

Understanding the prostate: Structure, function and common problems

The prostate surrounds the upper part of the urethra. Its growth is mainly influenced by hormones such as testosterone and its breakdown product dihydrotestosterone. With increasing age, the proportion of free testosterone decreases, while the conversion to dihydrotestosterone increases. This ratio contributes to enlargement, so a balance of hormone levels is important for prostate health. The following problems are common:

• Prostate enlargement (BPH): benign growth of the gland that encourages prostate symptom relief through supportive measures. The constant narrowing of the urethra explains symptoms such as weak urinary stream, frequent urination or dribbling.
• Prostatitis: Inflammation of the prostate, often caused by bacteria. The symptoms are similar to BPH and range from pain when urinating to fever.
• Prostate cancer: Malignant changes in the prostate. This article is about well-being and does not endorse any curative treatment for cancer.

Many men over 40 notice the first changes. It is important to have the prostate examined at an early stage. The PSA value (prostate-specific antigen) is a laboratory marker that can indicate enlargement, inflammation or even cancer. However, the value alone is of limited significance. Always discuss elevated PSA with your doctor.

Factors that influence the prostate

Numerous factors influence the prostate. These include age, hormones, diet, inflammatory processes and lifestyle. The following points play a role:

• Age: The risk of BPH increases with each decade of life.
• Hormones: The ratio of testosterone to oestrogen influences growth. Decreasing testosterone production can increase the conversion to dihydrotestosterone.
• Diet: A high-fiber, plant-based diet is associated with a lower incidence of BPH. Excessive consumption of red meat and saturated fats may increase the risk.
• Physical activity: Regular exercise contributes to a healthy metabolism and can reduce symptoms such as nocturnal urination.
• Stress and lack of sleep: These have an effect on the hormonal environment and can promote inflammation.

Other influencing factors: In many cases, several factors work together. Genetic predispositions can determine whether and to what extent BPH is present. Men whose fathers or brothers are affected are more likely to develop enlargement. An unhealthy lifestyle can increase this predisposition. Metabolic syndrome, consisting of obesity, high blood pressure, increased blood lipids and insulin resistance, is also discussed as a risk factor. Studies show that BPH patients often have higher insulin levels and lower insulin sensitivity. A diet high in refined carbohydrates and saturated fats promotes inflammatory processes and hormonal imbalances. Chronic inflammation, for example due to recurring urinary tract infections or prostatitis, can irritate the prostate tissue and also stimulate growth.

Medication such as certain antidepressants or diuretics can affect the bladder muscle and increase symptoms. It is therefore advisable to talk to your doctor about possible effects on the prostate if you have been taking medication for many years.

Lifestyle measures for the prostate

Many men want to strengthen their prostate without taking medication directly. Here are evidence-based prostate health tips:

1. exercise as a prostate workout

Regular physical activity has a positive effect on general health and can reduce urinary symptoms. A large cohort study of 28,404 men showed that participants who exercised at least one hour per week were 13% less likely to urinate at night and 34% less likely to urinate heavily at night than inactive men[0]{index=0}. These results support the recommendation to integrate moderate exercise into everyday life - for example walking, swimming or cycling.

Why does prostate training work? Regular exercise improves the metabolism, lowers body weight and balances the hormone system. At the same time, it promotes blood circulation in the pelvis. There are no specific prostate exercises, but an overall active lifestyle is helpful. People with physical limitations should discuss suitable activities with their doctor.

2. prostate diet: focus on plant-based foods

A plant-based diet provides fiber, antioxidants and phytochemicals that can reduce inflammation in the body. A case-control study from Iran compared 112 men with BPH and 112 healthy controls. Participants with the highest Dietary Phytochemical Index (DPI) had a 70% lower risk of BPH than those with a low DPI[1]. The researchers attribute this to the higher consumption of whole grains, nuts, legumes, fruits, vegetables and olive products, while red meat and refined grains were more common in the low DPI group[2].

From this it can be deduced: Those aiming for prostate protection should favor foods with high nutrient density. Important components of such a prostate diet are:

• Fruit and vegetables: tomatoes, broccoli, berries and green leafy vegetables provide antioxidants such as lycopene or indoles.
• Legumes and nuts: Beans, lentils, peas as well as walnuts and almonds provide fiber and beneficial fatty acids.
• Omega-3-rich fats: Fatty fish such as salmon, walnuts and linseed oil contribute to an anti-inflammatory diet.
• Wholegrain products: Oats, wholegrain rice and rye bread are high in fiber and can help keep blood sugar stable.

Important: A healthy diet can support the prostate, but cannot cure diseases. The links between individual foods and the prostate are complex. Without EFSA-approved health claims, it must be pointed out that many suspected connections have not yet been conclusively confirmed scientifically.

3 Body weight and fat distribution

Excess weight and especially abdominal fat increase the risk of hormonal disorders and inflammation. The so-called waist circumference is an indicator of visceral fat tissue. Men should ensure that their BMI is within the normal range and aim for a waist circumference of less than 102 cm. Weight reduction is best achieved through a combination of a balanced diet and regular exercise.

4. stress reduction and sleep

Stress increases the production of stress hormones such as cortisol, which affect the immune system and promote inflammation. Make sure you get enough sleep and integrate relaxation methods such as meditation, yoga or breathing exercises into your daily routine. A balanced hormone balance indirectly supports the prostate.

5. fluid intake

Drink enough water throughout the day. Many men avoid drinking for fear of frequent urination. However, too little fluid leads to concentrated urine, which irritates the bladder and promotes urinary tract infections. Make sure you drink less before going to bed to reduce night-time visits to the toilet.

Early signs and diagnosis

Many men find it uncomfortable to talk about urinary problems. As a result, the diagnosis is often only made when the enlargement is already well advanced. However, BPH can usually be controlled well if it is detected early. Typical early signs are

• Frequent urge to urinate, especially at night (nocturia),
• delayed start of micturition and weak urine stream,
• feeling of incomplete emptying of the bladder,
• sudden, strong urge to urinate (imperative urge to urinate),
• incontinence or dribbling.

Several methods are used for diagnosis. The International Prostate Symptom Score (IPSS) is a questionnaire that measures the severity of the symptoms. Doctors also carry out a digital rectal examination (DRU) to check the size and consistency of the prostate. The PSA blood test provides indications of changes, but is non-specific - BPH as well as inflammation or cancer can increase the value. Ultrasound examinations can measure the size of the prostate, residual urine volume and urine flow. In special cases, urodynamics or biopsies are required.

Timely diagnosis is crucial to avoid complications such as urinary retention or repeated urinary tract infections. Talk to your doctor early if you notice any changes, even if the symptoms appear mild at first.

Testosterone and the prostate

Many men associate the term testosterone with muscle strength and sexuality. What is less well known is that a balanced testosterone-dihydrotestosterone ratio is important for the prostate. Testosterone is converted in the body by the enzyme 5-alpha-reductase to dihydrotestosterone (DHT), which binds more strongly to the prostate receptors. An excess of DHT is associated with BPH. Drugs such as finasteride inhibit this enzyme to slow down growth. However, these drugs require a prescription and have potential side effects such as decreased libido or erectile dysfunction.

Some men consider testosterone supplements to increase performance. However, uncontrolled use can lead to unwanted effects such as acne, sleep apnea, high blood pressure and potentially prostate enlargement. There is also no reliable evidence that testosterone boosters from the internet protect the prostate - they may even contain dangerous ingredients. If a low testosterone level is medically confirmed, substitution should always be supervised by an endocrinologist. Make sure that you only use hormonal products as prescribed by a doctor. Such products may be contraindicated for men with BPH or prostate cancer.

Research is also investigating whether natural ingredients such as β-sitosterol or isoflavones can modulate the activity of 5-alpha-reductase. Some plant extracts show inhibitory effects in laboratory tests, but these results cannot simply be transferred to humans. Without EFSA approval, such associations should be considered hypothetical.

Treating prostatitis naturally?

Prostatitis refers to inflammation of the prostate, which can be acute or chronic. Acute bacterial prostatitis absolutely requires antibiotic treatment; if left untreated, it can lead to serious complications. Chronic or abacterial prostatitis is characterized by diffuse pain in the pelvis, frequent urge to urinate and sexual dysfunction. As the cause is often unclear, some men resort to herbal mixtures or prostate alternative methods. However, there is no reliable evidence that herbs alone will cure prostatitis. A balanced diet, sufficient fluid intake, stress reduction and physical measures such as heat applications can improve well-being, but are no substitute for medical treatment. Talk to a urologist about the best treatment options. If you want to use herbal supplements, make sure that they do not interact with antibiotics or other medications.

Prostate biohacking: trend or future?

The term "biohacking" has become fashionable in the health and fitness scene. It describes methods that aim to "optimize" the body with the help of technology, nutrition, lifestyle adjustments or food supplements. Some men opt for prostate biohacking by changing their diet, monitoring blood values such as PSA levels or trying herbal supplements. While a conscious lifestyle certainly makes sense, the following applies: there are no true hacks for the prostate in the sense of quick miracles. Prostate health is the result of complex physiological processes and long-term, evidence-based approaches are more sustainable.

Interesting areas of biohacking include, for example, intermittent fasting, a dietary concept that involves deliberately restricting eating times. Animal studies suggest that calorie restriction can reduce inflammation and improve hormone balance. However, clinical studies on humans are still rare. The use of wearables to monitor sleep can also be helpful in reducing stress and keeping hormones in balance. This allows you to optimize specific lifestyle habits instead of relying on individual supplements. Remember: Biohacking should not lead you to neglect necessary medical examinations or therapies.

Plant extracts and dietary supplements: what does the research say?

Many men seek natural prostate remedies such as saw palmetto, nettle root or prostate capsules. Before you reach for a dietary supplement, you should know the scientific situation. Below are studies that examine efficacy and safety. Please note that there are no EU-wide approved health claims for many extracts. Any unapproved effect must be accompanied by a statement that the relationships have not yet been confirmed by the EFSA and that further studies are required.

Saw Palmetto (Serenoa repens)

Saw palmetto is a dwarf palm shrub native to North America. Its extract contains fatty acids and sterols and is often used in prostate supplements. Numerous studies have been dedicated to the question of whether saw palmetto extract can alleviate symptoms of BPH.

Research findings: A comprehensive Cochrane review from 2023 analyzed 21 randomized, placebo-controlled trials. The authors found that Serenoa repens made little difference to the Urinary Symptom Scale Score (IPSS) or quality of life compared to placebo[3]. There were also no relevant differences in terms of urinary flow rate or PSA levels. The study quality was predominantly high, which means that the result is considered robust. Side effects occurred with a similar frequency to placebo[4].

A more recent randomized study compared a β-sitosterol-enriched saw palmetto oil (3 % β-sitosterol), conventional saw palmetto oil and a placebo. In the group with the enriched saw palmetto oil, the symptom scale (IPSS), residual urine volume and PSA level improved significantly compared to placebo, while the conventional saw palmetto showed weaker effects[5]. This study suggests that the addition of the plant sterol β-sitosterol could enhance the effect, but again EFSA confirmation is lacking.

In a multi-center trial, saw palmetto, Palmex® (a pumpkin seed extract), finasteride and tamsulosin were compared. After six months, all four groups showed an improvement in maximum urinary flow rate and IPSS symptoms, but there were no significant differences between the treatments; all were well tolerated. This suggests that phytotherapy is not necessarily inferior to current medications, but is not clearly superior either.

Conclusion and reference: According to current research, saw palmetto may have a slightly soothing effect, but large meta-analyses show no significant advantage over placebo. An EFSA-approved health claim does not currently exist, which is why caution is advised when purchasing saw pal metto dosage and efficacy claims. As a potential ingredient in prostate capsules, saw palmetto may only be used in conjunction with the statement that the effect has not been scientifically confirmed.

Stinging nettle root (Urtica dioica)

Nettle root is traditionally used for urinary problems. A randomized, double-blind study with 100 patients investigated the efficacy of nettle root in BPH. After eight weeks, the AUA symptom scale had decreased from 26.5 to 2.1 points in the stinging nettle arm, while the placebo group showed virtually no change[7]. The authors reported no side effects and concluded that stinging nettle can effectively relieve symptoms[8].

Although the results are impressive, it is important to note that this study is relatively small and there is no EFSA-approved health claim for nettle root in relation to prostate. Nevertheless, the research suggests that nettle root could be a promising natural prostate remedy. The dosage in the study was 600 mg dry extract per day; talk to your doctor before taking it.

Pumpkin seed and palm extracts (Cucurbita pepo)

Pumpkin seeds are rich in phytosterols and essential fatty acids. In 2022, a meta-analysis of two randomized, placebo-controlled studies was conducted that examined a special pumpkin seed extract (Palmex®). The difference in the symptom scale (IPSS) compared to placebo was 0.7 points (95% CI 0.1-1.2)[9]. Responder rates were 3-5% higher than placebo and safety was good[10]. Another study comparing Palmex® with saw palmetto, finasteride and tamsulosin showed no significant differences between the treatments after six months.

Again, there is no EFSA health claim for the relief of prostate symptoms by pumpkin seed extract. However, the studies indicate that Palmex® can provide symptomatic improvements. The relationship between pumpkin seeds and the prostate is still being researched and further studies are needed.

Pygeum africanum (African plum tree)

The bark of the African plum tree is traditionally used. A Cochrane analysis of 18 randomized trials involving a total of 1562 men found that Pygeum africanum moderately improved urological symptoms and urinary flow rate (effect size -0.8 standard deviations). Men taking Pygeum were twice as likely to report an improvement in symptoms as the placebo group. Nocturia decreased by 19%, residual urine volume decreased by 24%, and maximum urinary flow rate increased by 23%. The side effects were mild and on a par with the placebo[12].

These data suggest possible efficacy, but the included studies were often short and heterogeneous. Pygeum may contribute to prostate symptom relief, but no EFSA-approved efficacy claim exists. If you want to try Pygeum, choose standardized extracts and discuss taking it with your doctor.

Lycopene and tomato products

Lycopene is a red carotenoid found in tomatoes. Some studies are investigating its effect on the prostate. A randomized double-blind study with 52 men compared lycopene, the sugar-amino acid complex FruHis, their combination and a placebo. The combination of lycopene and FruHis lowered IGF-1, PSA and symptom score more than lycopene alone, but these differences (with the exception of IGF-1) were not significant compared to the placebo[13]. The scientists suspect that FruHis enhances the antioxidant properties of lycopene. As this was a small, eight-week study, further research is needed.

Tomatoes and other lycopene-rich foods can be part of a healthy prostate diet. However, there is currently no EFSA-approved health claim linking the consumption of lycopene to confirmed relief of prostate symptoms.

Zinc and other micronutrients

Zinc is important for the function of many enzymes and the immune system. Zinc concentrations are higher in the prostate than in many other tissues. Some older studies show that low zinc levels may be associated with BPH or prostate cancer. However, specific randomized trials on supplementation for BPH are scarce. The EFSA has approved the health claim "contributes to the normal function of the immune system" for zinc. Claims such as "zinc relieves prostate pain" cannot be made. Research is ongoing; discuss zinc supplements with your doctor, especially if you want to take high doses of zinc over a long period of time.

Polyherbal and alternative remedies

In addition to traditional extracts, polyherbal mixtures and alternative approaches exist. A randomized, controlled study from India tested a Unani polyherbal formulation "Habb-i-muqil" against tamsulosin. After 90 days, the AUA symptom index decreased by 59.4 % in the herbal group and by 49.4 % in the tamsulosin group; the difference was significant[14]. The authors reported that the herbal mixture was well tolerated. As this formulation is hardly available outside India and has no EFSA approval, it should only be used in Europe under medical supervision.

Another trial from Korea combined the drug tamsulosin with two traditional formulations (hachimijiogan and ryutanshakanto). The study showed that all groups - including the placebo group - improved in terms of IPSS and quality of life; only the pain sub-dimension was significantly better in the tamsulosin-ryutanshakanto group[15]. The overall effect was moderate, and there were no severe side effects. These results emphasize that many factors such as placebo effects and accompanying measures (diet, exercise) play a role.

Scientific evidence at a glance

The following table summarizes key studies. LUTS stands for "Lower Urinary Tract Symptoms". The table shows the type of study, the duration and the most important results.

Intervention/study	Study design	Study results
Saw palmetto (Cochrane Review 2023)	21 RCTs, 3-17 months	No significant difference to placebo in LUTS and quality of life[16]
β-Sitosterol-enriched saw palmetto oil (2020)	Randomized, double-blind study, 12 weeks	Improvement in IPSS scores, reduction in residual urine, reduction in PSA; better than placebo[17]
Palmex® vs. saw palmetto vs. finasteride vs. tamsulosin (2024)	Prospective, randomized study, 6 months	All groups improved similarly; no significant differences; good tolerability
Nettle root (2013)	Double-blind RCT, 8 weeks	IPSS from 26.5 to 2.1 points; placebo no change; no side effects[19]
Pumpkin seed extract (Palmex®, meta-analysis 2022)	2 RCTs, 12 months	IPSS improvement of 0.7 points; 3-5% more responders than placebo[20]
Pygeum africanum (Cochrane Review 1998)	18 RCTs, average 64 days	Moderately improved LUTS; 19% less nocturia; side effects mild[21]
Lycopene + FruHis (2022)	Double-blind RCT, 8 weeks	IGF-1, PSA and symptom score reduced; only IGF-1 significantly better than placebo[22]
Unani herbal mixture Habb-i-muqil (2021)	Randomized study, 90 days	59.4 % improvement in AUA symptoms vs. 49.4 % with tamsulosin[23]
Combination tamsulosin + ryutanshakanto (2022)	Placebo-controlled RCT, 12 weeks	All groups improved IPSS; the pain dimension was significantly better with the combination[24]
Exercise (cohort study, 2015)	28,404 men, prospective	13% less urination at night with ≥1 h of exercise/week[25]

Practical tips to support the prostate

The following recommendations can be derived on the basis of scientific findings and in accordance with legal requirements. They do not replace a medical diagnosis, but provide suggestions for a healthy lifestyle:

Regular check-ups

Have your prostate examined regularly from the age of 45. In particular, the PSA value and a rectal palpation can detect early changes. If you have a family history of prostate cancer, an earlier check-up may be advisable. If you experience symptoms such as frequent urination, nocturnal urination or pain, seek medical advice as soon as possible.

Healthy diet and weight

Incorporate plenty of fruit, vegetables, wholegrain products, nuts and omega-3-containing foods into your diet. Avoid strong alcohol, high-sugar foods and processed meat. Reduce your intake of saturated fats and fried foods. A plant-based prostate diet can reduce inflammation and support hormone balance.

Moderate exercise

Exercise regularly. Aim for at least 150 minutes of moderate activity per week - for example, five 30-minute walks or bike rides. Muscle building also has a positive effect as it influences testosterone levels. Do not underestimate everyday exercise (climbing stairs, gardening).

Stress management and sleep

Chronic stress can promote hormonal imbalances. Try out relaxation techniques such as yoga, meditation or autogenic training. Make sure you get enough sleep, ideally 7-8 hours per night. Try to keep to fixed bedtimes and avoid electronic devices before going to bed.

Fluid balance

Drink enough water during the day to flush the bladder. Cut down on caffeinated drinks in the evening to reduce night-time trips to the toilet.

Choose nutritional supplements carefully

If you are considering prostate nutritional supplements or prostate supplements, do your research. Choose products with a transparent declaration and check whether they have been scientifically tested. Refer to studies and avoid products with exaggerated claims. In the case of extracts such as saw palmetto, nettle or pygeum, it must be clearly stated that the links between the ingredient and the alleviation of prostate problems have not yet been confirmed by the EFSA; further studies are necessary.

Zinc, vitamin D and other micronutrients

Zinc contributes to the normal function of the immune system and is involved in many metabolic processes. A balanced zinc level makes sense. Foods such as meat, nuts, seeds and wholegrain products provide zinc. Food supplements should only be taken if there is a proven deficiency. Vitamin D also plays a role in the immune system; a deficiency should be compensated for after consulting a doctor. The following applies to both substances: Do not take high doses without consulting a doctor.

Reduce alcohol, smoking and environmental toxins

Excessive alcohol consumption and smoking have a negative effect on the hormone balance and increase oxidative stress. Environmental toxins such as pesticides can also affect the hormone system. Try to minimize these stresses by choosing organic foods and avoiding smoking.

Take urological symptoms seriously

Even if many prostate complaints are benign, you should not ignore changes. The earlier you get treatment, the better you can alleviate symptoms and avoid secondary problems. An enlarged prostate can damage the bladder in the long term; untreated inflammation leads to further complications.

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Conclusion: balance instead of a miracle pill

The prostate has to cope with many hormonal changes over the course of a lifetime. BPH and other prostate problems increase in men over 40. Natural measures such as exercise, a healthy diet, weight control and stress reduction form the basis for men's health from the age of 40.

Herbal extracts such as saw palmetto, nettle root, pygeum, pumpkin seed and lycopene have shown some positive effects in studies, but the results vary. Some studies report measurable improvements in symptoms, while others find hardly any differences compared to placebo. As long as there are no EFSA-approved health claims, these substances may not be advertised as remedies; however, they can be tried as a supplement to a healthy lifestyle - always with the caveat that further research is required.

The most important piece of advice is to stay aware of your body, have regular check-ups and maintain a healthy lifestyle. In this way, you can support your prostate in the long term and keep complaints to a minimum.

Bibliography

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