June/July 2025 Issue
Clinical Nutrition: Benign Prostatic Hyperplasia
By Alexandria Hardy, RDN, LDN
Today’s Dietitian
Vol. 27 No. 6 P. 10
Nutrition Support for Men’s Health
Benign prostatic hyperplasia (BPH) is a condition that affects up to 50% of men as they age and over 94 million men worldwide.1,2 BPH is defined by a noncancerous growth (also known as hyperplasia) on the prostate tissue.3 This can cause an increase in negative lower urinary tract symptoms and is typically seen in 50% to 60% of men in their 60s and 80% to 90% of men who are 70 years of age or older.3 This is significant as the prostate gland helps to control hormones in the male reproductive system.2 There’s a growing interest in exploring dietary approaches, supplementation, and lifestyle changes concurrent with medical care to improve symptoms of BPH. Dietitians can develop a working understanding of the common triggers that may exacerbate symptoms and learn how to make appropriate recommendations to aid their aging male patients.
What RDs Should Know About BPH
BPH occurs when new prostate cells grow more quickly than the old cells are dying, which can cause an enlarged prostate.3 This growth typically centers around the urethra, which is why it’s often associated with urinary tract problems.3 Testosterone can contribute to BPH, so men who don’t produce testosterone won’t experience BPH.3 Those who are most at risk for developing BPH include individuals with obesity, those with diabetes (especially if they use insulin), localized inflammation, metabolic syndrome, and who may be genetically predisposed.3 National Health and Nutrition Examination Survey data has also shown a correlation between elevated levels of Systemic Immunoinflammatory Index and platelet-to-lymphocyte ratio and BPH.4
Dietary patterns may be protective or indicative of BPH. Men with moderate to high dietary (but not supplemental) consumption of carotenoids and vitamin A are less likely to develop BPH, while those who drink alcohol and caffeine excessively and take excess supplemental vitamin C are more likely to develop BPH.3
Diagnosis typically comes through a physical examination of the abdomen and external genitalia, as well as digital rectal examination; patients may also be given a questionnaire (usually the American Urological Association Symptom Score or the International Prostate Symptom Score) to assess symptoms.3 BPH is typically characterized by an enlarged, smooth prostate and a score of ≥ 10, which indicates moderate to severe BPH.3 Symptoms include urinary frequency and urgency, difficulty initiating urination, and an increased risk of urinary tract infections.3
Common treatment options for BPH include alpha blockers, 5-alpha-reductase inhibitors, antimuscarinics, or surgery, depending on the specific symptoms.3 Alpha blockers relax the muscles of the bladder and prostate for easier urine passage and are used for quick relief.3 5-alpha-reductase inhibitors work more slowly by shrinking the prostate; these two medications can be used together.3 Antimuscarinics (like solifenacin or oxybutynin) can be used to help calm the bladder, and surgery is the best option for a prostate that doesn’t respond to medication or lifestyle change.3
Evidence-Based Nutrition Strategies
There is a positive association between certain lifestyle habits, like exercise, and relief from BPH symptoms.2 Moderate exercise, defined as 150 minutes per week, was shown to improve symptoms.2 Focusing on certain types of proteins, like soy and legumes may also help, as well as increasing dietary sources of phytochemicals and polyphenols. Finally, supplementation with saw palmetto and beta-sitosterol has also been attributed to symptom relief.2
A case-controlled study published in the Journal of Health, Population, and Nutrition found an inverse association between phytochemical intake and the development of BPH in a Middle Eastern population.5 The Dietary Phytochemical Index was used to determine intake; eligible foods in this study were whole grains, vibrantly hued produce, legumes, olives, olive oil, nuts, carrot/orange/lemon juice, and products made from soybeans.5 Men with the highest intake of these phytochemical-rich foods were 70% less likely to develop BPH than those in the lowest tertile.5
The inclusion of polyphenols is another dietary strategy to decrease BPH symptoms. A review published in Frontiers in Pharmacology studied each group of polyphenols (phenolic acids, stilbene, lignans, flavonoids, and curcuminoids) and determined that their antioxidant activity and ability to repair damaged proteins may help inhibit BPH.6 More research is needed to determine a therapeutic dose, but dietitians can recommend the inclusion of phytochemical-rich foods like seeds, soy, and produce into the diet.6
RDs can help provide practical, actionable dietary steps to clients by explaining how to include food high in phytochemicals and polyphenols in their diets. Adopting a Mediterranean or Eastern style eating pattern to reduce inflammation has a natural emphasis on fruits, vegetables, whole grains, and healthy fats that complements research on diet and BPH.1 Limiting caffeine and alcohol, as they are potential sources of bladder irritation, may be helpful, as well as prioritizing plant-based proteins like legumes and soy over processed and red meat.1
Supplements and Alternative Therapies
There are currently no gold standard recommendations for supplements for BPH, so the use of clinical judgement is key. Common supplements that have been associated with symptom relief include saw palmetto and beta-sitosterol.7 Beta-sitosterol acts in a similar manner to finasteride and may prevent 5-alphareductase activity by increasing urine flow.7 This effect may last for months after initial treatment.7
Saw palmetto may work by helping to decrease the inner epithelium of the prostate; more clinical research is needed before establishing a baseline for treatment.8 Several other plant ingredients that have shown promise in improving symptoms include pumpkin seed extract, stinging nettle root, and pygeum tree bark.1,8 Clinical trial dosages vary as do supplemental dosages, but a good starting place is to recommend 30 mg to 91 mg of beta-sitosterol daily and 320 mg of saw palmetto daily with an extract standardized to 85% to 95% fatty acids in the form of sterols broken into two doses.8 Consumer Lab has a list of approved and recommended products for interested patients and clinicians.
Counseling Considerations for RDs
BPH is common, but may be a source of embarrassment for men. It’s important that RDs and other members of the care team use empathy and discretion when providing medical nutrition therapy and discussing interventions. There may also be food considerations specific to this older population pertaining to dentition and other dietary restrictions that might arise from comorbidities, like hypertension or diabetes.
Final Thoughts
While it may be unfamiliar to some dietitians, BPH is a common and manageable health condition. RDs can help support symptom management through food-first strategies, ensuring that their patients are not over- or underconsuming key nutrients and prioritizing produce and plant-based proteins. Through coordination of care, moderate physical activity, and an anti-inflammatory diet, many men should experience relief from BPH symptoms.
— Alexandria Hardy, RDN, LDN, is a writer and the owner of Pennsylvania Nutrition Services, an insurance-based private practice located in Lancaster, Pennsylvania.
References
1. Stewart KL, Lephart ED. Overview of BPH: symptom relief with dietary polyphenols, vitamins and phytochemicals by nutraceutical supplements with implications to the prostate microbiome. Int J Mol Sci. 2023;24(8):5486.
2. Das K, Buchholz N. Benign prostate hyperplasia and nutrition. Clin Nutr ESPEN. 2019;33:5-11.
3. Ng M, Leslie SW, Baradhi KM. Benign prostatic hyperplasia. In: Stat Pearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024.
4. Shi C, Cao H, Zeng G, Yang L, Wang Y. The relationship between complete blood cell count-derived inflammatory biomarkers and benign prostatic hyperplasia in middle-aged and elderly individuals in the United States: evidence from NHANES 2001-2008. PLoS One. 2024;19(8):e0306860.
5. Mousavi SN, Nouri M, Rad EY, et al. Association between dietary phytochemical index and risk of benign prostatic hyperplasia: a case-control study. J Health Popul Nutr. 2024;43(1):35.
6. Eleazu C, Eleazu K, Kalu W. Management of benign prostatic hyperplasia: could dietary polyphenols be an alternative to existing therapies? Front Pharmacol. 2017;8:234.
7. Are there supplements that can reduce prostate size? Consumer Lab website. https://www.consumerlab.com/answers/are-there-supplements-that-can-reduce-prostate-size/prostate-supplements/?search=Benign Prostatic Hyperplasia. Updated August 2, 2017. Accessed April 30, 2025.
8. Prostate supplements review (saw palmetto and beta-sitosterol). Consumer Lab website. https://www.consumerlab.com/reviews/prostate-supplements-beta-sitosterol-phytosterols-saw-palmetto/sawpalmetto/#toppicks. Updated February 10, 2025. Accessed April 30, 2025.