Obesity, diabetes, and cholesterol: Managing metabolic factors can reduce BPH symptoms

This review outlined the effects of metabolic factors (such as obesity, diabetes, and cholesterol levels) on benign prostatic hyperplasia (BPH).

The authors concluded that weight loss, physical activity, and proper treatment of metabolic disorders can help reduce BPH symptoms. 

The occurrence and symptoms of BPH generally advance with age. However, there is increasing evidence to suggest that metabolic factors are also important in the development and progression of BPH. Some of these include obesity, diabetes, high blood pressure, and cholesterol levels. Appropriate treatment, as well as lifestyle changes, may allow for better management of symptoms associated with BPH.

A number of studies have reported a relationship between obesity and urinary symptoms. Men with a higher body mass index (excess weight according to height), greater waist circumference, or waist-to-hip ratio, were consistently more likely to report BPH related urinary symptoms. One recent study noted a waist circumference of more than 102 cm (about 40 inch) to be the most important predictor of persistent urinary storage symptoms (increased urinary frequency or urgency) after surgical treatment for BPH. Weight loss may, therefore, help reduce urinary symptoms. Multiple high-quality studies have suggested that men reporting high levels of activity to be significantly less likely to develop BPH symptoms, compared to men with a more sedentary lifestyle. Even light exercise (such as walking for 3 hours per week) was shown in one study to reduce the likelihood of BPH progression.

There is also some evidence suggesting that a balanced diet could be protective against BPH-related urinary symptoms. A high-energy high-fat diet, in turn, has been shown in some studies to significantly increase the frequency of BPH-related symptoms.

Disorders related to blood sugar levels have been shown to be an important risk factor for the development of BPH and urinary symptoms. Conditions such as diabetes, hyperinsulinemia (high levels of insulin) and glucose intolerance, have all been shown to stimulate prostate inflammation and overgrowth. One recent study demonstrated a direct link between increased insulin levels and prostate size. Proper screening and management of these conditions can, therefore, help reduce BPH progression.

Similarly, high cholesterol levels have been shown to contribute to prostate inflammation and enlargement. After accounting for various other factors (like age, smoking, and additional medical conditions), one large study noted that men taking statins (cholesterol-lowering medications) were about 60% less likely to have urinary symptoms or prostate enlargement, compared to men not receiving statins. However, the effectivity of using statins for treating pre-existing urinary symptoms is still unclear.

High cholesterol, blood sugar disorders and obesity, are known to be associated with hormonal changes (specifically low testosterone levels) among men. Testosterone replacement therapy has been found to significantly improve urinary symptoms (including increased urinary flow and bladder emptying) in men with BPH and low testosterone levels. All trials reviewed in this study indicated that testosterone replacement therapy is a safe and effective treatment option for men with low testosterone levels and moderate urinary symptoms. Proper investigation of testosterone levels may, therefore, help manage BPH-related urinary symptoms.

High blood pressure (hypertension) has previously been associated with urinary symptoms and overactive bladders in some small studies, but evidence regarding the effects of blood pressure on BPH symptoms and progression remains inconclusive at this time.

The authors concluded that proper screening and treatment of metabolic disorders, including recommended lifestyle changes, can slow BPH progression and reduce urinary symptoms.