I have been diagnosed with an enlarged prostate but have stopped taking the medications my GP prescribed because the side effects were intolerable. Are there effective herbal remedies or should I explore surgical options? I am 69 years old.
David Meech, St Asaph, North Wales.
Dr Martin Scurr answers: Benign prostatic hyperplasia (BPH), an enlargement of the prostate, is very common, affecting 60 percent of men in their 60s and 80 percent of men in their 80s.
Benign prostatic hyperplasia, an enlargement of the prostate, is initially treated with alpha-adrenergic receptor blockers, medications that can provide relief within days.
In most cases, it disrupts urinary flow, leading to frequent urination, nocturia (the need to urinate at night), and poor urinary flow. Symptoms usually worsen gradually, but it is worth noting that BPH is not a risk factor for prostate cancer, although they can coexist.
Initial treatment is with alpha-adrenergic receptor blockers, medications that can provide relief in a matter of days.
In your longer letter you say that you were treated with one such drug, tamsulosin, but that it caused dizziness and muscle spasms in your neck.
A second drug, finasteride, also caused unpleasant side effects (which can include moodiness and sexual dysfunction).
There is a third medication option, which it seems you have not yet been offered: phosphodiesterase type 5 inhibitors, which are commonly prescribed for erectile dysfunction.
One of them, tadalafil, is the treatment of choice for BPH, and several trials show it improves symptoms. While it can also have side effects (such as headache, flushing, and indigestion), it’s worth discussing with your doctor.
You mention that you have been taking the herbal supplement saw palmetto on and off for several years, but are unsure of its effectiveness.
Saw palmetto is a popular herbal remedy for BPH, but there is no clear evidence from studies to show that it works.
The other option is surgery. The right type will depend on the size and shape of your prostate and the potential risk of bleeding. The most well-known is transurethral resection of the prostate (TURP), but there are also laser techniques or vaporization of excess prostate tissue using steam or a jet of water, among other methods. Medications have largely replaced routine surgery, but if you choose this route, the importance of finding a trained and experienced surgeon cannot be overemphasized.
My granddaughter has been a vegetarian since she was very young, and although she now eats chicken, she sprinkles it with salt. I am concerned about her diet and I don’t think she realizes the health dangers.
Name and address provided.
Dr. Scurr responds: I understand your concern, but rest assured that there is sufficient evidence that children’s nutritional needs can be met with well-balanced and supplemented vegetarian and vegan diets.
In fact, a study of vegetarian teenagers found that they had lower BMI, waist circumference and cholesterol levels than their classmates (considering there is a worryingly high proportion of overweight children, this is not insignificant).
In your longer letter, you mention your concern that she has heavy menstrual periods and suggest she consult a doctor.
I think it would be wise to do a blood test to check that he is not anaemic as a result of low iron intake.
I am concerned about your calcium intake, particularly if you do not eat dairy products or fish. This is essential for a growing woman’s bone strength – bone mass peaks at age 16 and after that age you will not be able to improve bone strength regardless of your nutritional intake. Furthermore, protection against osteoporosis in middle age and beyond is established during the growing years of adolescence.
Vegetarians are also likely to consume less of other key nutrients (such as B vitamins, vitamin D, and selenium). One way to compensate is to eat fortified breakfast cereals.
It’s a delicate subject and expressing your opposition to their dietary preferences is almost certainly doomed to failure.
My advice is to avoid judgment, find a good vegetarian cookbook and get her interested in it, and try to find a cooking class that you can maybe attend together.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk; include your contact details. Responses should be read in a general context and always consult your GP if you have any concerns about your health.