I’ve been diagnosed with an enlarged prostate. But I’ve stopped taking the drugs prescribed by my GP as the side-effects were intolerable. Are there any effective herbal remedies or should I explore surgical options? I am 69.
David Meech, St Asaph, North Wales.
Dr Martin Scurr replies: Benign prostatic hyperplasia (BPH) – an enlarged prostate – is very common, affecting 60 per cent of men aged 60 and 80 per cent of those aged 80.
Benign prostatic hyperplasia, an enlarged prostate, is initially treated with alpha-adrenergic receptor blockers, medication that can bring relief within days
In most cases, it disrupts urine flow, causing frequent urination, nocturia (needing to go at night) and poor urinary stream. Typically, symptoms worsen gradually, but it’s worth stressing that BPH is not a risk factor for prostate cancer, though they can co-exist.
The initial treatment is with alpha-adrenergic receptor blockers, medication that can bring relief within days.
In your longer letter you say you were treated with one such drug – tamsulosin – but it caused dizzy spells and neck muscle spasms.
A second drug, finasteride, also caused you unpleasant side-effects (these can include low mood and sexual dysfunction).
There is a third choice of drug, which it appears you have not yet been offered – phosphodiesterase type 5 inhibitors, usually prescribed for erectile dysfunction.
One of these, tadalafil, is the preferred treatment for BPH and several trials show it improves symptoms. While it can also have side-effects – e.g. headache, flushing and indigestion – it’s worth discussing with your doctor.
You mention you’ve been taking the herbal supplement saw palmetto on and off for several years but are unsure how effective it is.
Saw palmetto is a popular herbal remedy for BPH, but there’s no clear evidence from studies that it works.
Your other option is surgery. The suitable type here will depend on the size and shape of the prostate and the potential bleeding risk. Best known is transurethral resection of the prostate (TURP), but there are also laser techniques, or vaporising the excess prostate tissue using steam or water jet, among other methods. Drugs have largely replaced routine surgery but if you do go down this route, the importance of finding a skilled and experienced surgeon cannot be overemphasised.
My granddaughter has been vegetarian from a young age and although she now eats chicken, she smothers it in salt. I’m worried about her diet and don’t think she realises the health dangers.
Name and address supplied.
Dr Scurr replies: I understand your concern but rest assured there is enough evidence that the nutritional needs of children can be fulfilled by vegetarian and vegan diets that are well-balanced and supplemented.
Indeed one study of vegetarian adolescents revealed they had a lower BMI, waist circumference and cholesterol levels than their classmates – with a high proportion of children worryingly overweight, this is not insignificant.
In your longer letter, you mention your concern that she has heavy periods and you’ve suggested seeing a doctor.
I think this is sensible, perhaps for a blood test to check she hasn’t become anaemic as a result of low levels of iron intake.
My concern is with her calcium intake, particularly if she is not eating dairy or fish. This is essential for a growing woman for bone strength – bone mass peaks at the age of 16, and after that she won’t be able to improve bone strength, whatever her nutritional intake. And protection against osteoporosis in middle age and older is set during the adolescent years of growth.
Vegetarians’ intake of other key nutrients – including B vitamins, vitamin D and selenium – is also likely to be lower. One way to make up for this is by eating fortified breakfast cereals.
It’s a delicate matter and voicing your opposition to her dietary preferences is almost certainly doomed to failure.
My advice is to avoid being judgmental, to seek a good vegetarian cookbook and gain her interest in this and try to find a cookery class that you could perhaps 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. Replies should be taken in a general context and always consult your own GP with any health worries.
