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Men's prostate health: a variety of key nutrients may play a role in prevention; Chain PharmacyMale patients who are having some symptoms of benign prostatic hypertrophy may be trying to self-diagnose and medicate with saw palmetto or another agent. It is important for us as pharmacists to stress to patients that they should not self-diagnose, and should see their physician if any of the following symptoms are present or persist: increased urinary frequency or urgency, bladder obstruction, nocturia, dribbling, feeling of incomplete voiding or reduced force of urinary stream. If an enlarged prostate is in fact the culprit, and their physician has made a diagnosis of BPH, there are a variety of natural counseling options for a pharmacist to recommend as supportive therapy.Enlarged prostate is a relatively common condition affecting approximately 50 percent of the male population over 40 years old. BPH is thought to be caused by an increase in testosterone and its subsequent conversion to dihydrotestosterone in the prostate. This is believed to be compounded by the presence of estrogen, which inhibits the elimination of DHT. Prescribing 5-alpha-reductase blocking drugs and alpha - 1 blockers has been the standard treatment for BPH in the United States. However, undesirable side effects and less than anticipated results have sparked a search for more reasonable alternatives. Healthcare professionals in Europe have successfully implemented phytomedicines and other nutrients for this condition. Saw palmetto, an herb that was once part of the National Formulary, may be the most important of these phytomedicines. Saw palmetto (Serenoa repens), a standardized extract, whose principal constituents consist of 80 percent to 90 percent free fatty acids and sterols, has recently gained recognition in studies, performing superiorly to the drug Proscar[R] in doubleblind studies. Saw palmetto is thought to have multiple mechanisms of action. It inhibits the production of DHT and the binding of DHT to receptors, thus promoting its breakdown. Preliminary studies also indicate that saw palmetto may exhibit an antiestrogenic effect, as well as blocking progesterone and androgenic receptors. The dosage for saw palmetto is 160mg b.i.d. of an 80 percent to 90 percent standardized extract. No side effects or toxicity has been seen, even PAGE 41 Drug Store News July 14, 1997 in large doses. Nettles (Urtica dioica), standardized to 1 percent to 2 percent plant silica, has been used to treat BPH with good results in studies in Europe. Its actions are centered around inhibiting sex hormone, binding globulin, which affects the androgenic receptors of the prostatic cytosol, and inhibiting estrogenic effects. Nettles also influence the binding of 5-alpha-dihydrotestosterone with related proteins. The dosage for nettles is 250mg, 2 to 3 times a day. There is no known toxicity. Nutritional agents may provide support There are several nutritional agents which may provide the prostate with key nutrient support. Zinc has shown the ability to reduce the size of the prostate anecdotally, probably through the inhibition of 5-alpha-reductase. The typical dose is 20mg to 50mg daily. Antioxidants, including vitamin E and selenium, have shown a positive correlation with reducing cancer risks. Additionally, it is felt that selenium may reduce the potential for cadmium toxicity in prostatic tissues. Nutraceuticals may also play a role in prostate health. One of the recent, exciting finds has been the correlation between an increased tomato intake and a decrease in prostate cancer risk. Lycopene is the nutraceutical compound which is believed to be responsible for this action. Lycopene is also found in straw berries. There is still a great deal of research to be done in this area, but look for more information to emerge in the next one to two years. Genistein and daidzein, which are isoflavones found in soy, have also shown some preliminary success in reducing prostate cancer rates. Another agent which may be beneficial for treating BPH is grape seed extract or proanthocyanidins. Because of its favorable effect on inflammation and its powerful antioxidant activity, grape seed extract may provide addition support to the prostate. A combination of the amino acids glutamic acid, glycine and alanine has also shown some potential benefits for BPH, although there is no clear-cut mechanism for how these work. There are a number of lifestyle suggestions which also should prove to be beneficial for a healthy prostate. * Eliminate or reduce the intake of beer, caffeine, coffee and refined sugars. * Increase the intake of zinc-rich foods such as pumpkin seeds, garlic and onions. * Reduce exposure to pesticides and wash produce whenever possible. * Reduce the intake of saturated fats and red meat. * If applicable, drink fluids before the evening hours. PAGE 42 Drug Store News July 14, 1997 * Lower cholesterol to acceptable levels and try to attain proper body weight. A combination product consisting of several herbal and nutritional agents can be found. This shotgun approach is acceptable, and often favorable, but be aware of the minimum dose for each ingredient needed to gain the desired response. Levine said the program underscored the crucial role pharmacists play in any well-rounded healthcare system. "What we had was the launch of a breakthrough therapy to a patient population in need, and the pharmacist proactively monitoring compliance and ensuring and educating the patient about the importance of new therapy," he said. On another front, the chain recently put 750 of its pharmacist owners through a training program which will enable them to better manage their patients with osteoporosis. We had 16 meetings in the last 16 weeks around the country," Levine said. "We had a physician talk about the disease process, the therapeutic regimen and the role of the pharmacist in managing patients. We also had a Pharm.D. come in and talk about some case studies--what would you do, how you would document that encounter. "It gave the pharmacists a start on how to get involved, and it will be followed up with a two- to three-month home-study course." Medicine Shoppe is also developing new computer software to help pharmacists document and manage their patients' medical needs, as well as special instruction on how to build a niche practice in disease states such as osteoporosis, and how to work more effectively within their local healthcare networks. Drug manufacturers including Merck and Wyeth-Ayerst have also linked up with the effort by providing educational resources for pharmacists and patients.IAC-ACC-NO: 19597697 LENGTH: 1095 words |
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