Article at a Glance
- The condition known as prostatitis, or inflammation of the prostate, is actually a number of different diseases, many of which are not well understood by urologists.
- Antibiotics can make fungal prostatitis worse. Young men with low PSA numbers and chronic prostatitis that hasn’t responded to antibiotics are likely suffering from Candida colonization of the prostate.
- E. Coli, a common culprit for prostatitis, causes urinary tract infections more often in acidic urine, meaning some men will benefit from a plant based diet that has an alkalizing effect on the urinary tract.
- In some men, prostatitis is an autoimmune condition, and antihistamines may do more good than antibiotics.
- When antibiotics are called for, studies show antibiotic treatments are more effective when combined with certain natural supplements.
This post is part of multi-part series shedding light on the latest treatments for common chronic conditions faced by an increasing number of Americans.
Just mentioning the word will get some snickers, but this little forgotten gland is crucial to every man’s health. In fact, if you are a man who would like to avoid getting cancer, the prostate is an excellent place to begin.
Approximately one in seven men will be diagnosed with prostate cancer at some point in their lifetime, and prostate cancer currently ranks as the third leading cause of cancer death for men behind only lung and colorectal cancer. Although this is a post about prostate inflammation and not prostate cancer, the principal is the same: men need to take care of their prostates from a relatively early age.
And while the vast majority of the research dollars go to prostate cancer, prostatitis, or chronic inflammation of the prostate, is often lost in the shuffle.
Yet, virtually all men will develop prostatitis at some point in their adult lifetime, and with symptoms ranging from frequent urination, to pelvic pain, and even erectile dysfunction, this disease should be on every man’s radar. (R) When you take a deep dive into the literature, it becomes clear that the umbrella term “prostatitis” actually represents multiple different infections and sources of inflammation.
As such, this post will offer a series of easy experiments men can perform at home to either better protect, or heal the prostate.
- Top supplements for prostatitis
- Is prostatitis contracted through sex?
- Antibiotics and prostate problems
- Fungal study
- The prostate is prone to infection and inflammation
- Known prostatitis cures
- Quercetin study
- Berberine study
- H1 anti-histamines study
- Plant based study
- Exercise study
- Honorable mention
- Additional studies
- Closing thoughts
Top supplements for prostatitis
|Quercetin||Quercetin in men with category III chronic prostatitis (R)||1 month||67% of quercetin takers had improvement of at least 25%||Quercetin and bromelain found to be effective at treating prostatitis|
|Berberine||Berberine Ameliorates Nonbacterial Prostatitis via Multi-Target Metabolic Network Regulation (R)||One week||Reduced gut inflammation and reset metabolic pathways in rats||Berberine may be protective against CNBP|
|Antihistamines||Role of mast cells in male chronic pelvic pain (R)||Unknown||Taking H1 antagonists, like Zyrtec or Claritin, helped alleviate prostatitis||Mast cells "may be potential targets for therapeutic intervention in men with chronic prostatitis/chronic pelvic pain syndrome"|
|NAC||N-acetylcysteine Ameliorates Prostatitis via miR-141 Regulating Keap1/Nrf2 Signaling (R)||Unknown||NAC relieved the carrageenan-induced CNP in rats||miR-141 inhibitor could reduce the effect of NAC on prostatitis|
|Saw palmetto, lactobacillus sporogens, and Arbutin with fluoroquinolones antibiotics||Chronic bacterial prostatitis: efficacy of short-lasting antibiotic therapy with prulifloxacin in association with saw palmetto extract, lactobacillus sporogens and arbutin (R)||2 months||Antibiotic group combined with natural supplements saw most reduction in symptoms||Serenoa repens, lactobacillus sporogens and arbutin show better control and recurrence rate than antibiotics alone|
|Nettles, saw palmetto, curcumin and quercetin blend with antibiotic prulifloxacin||Serenoa repens associated with Urtica dioica and curcumin and quercitin extracts are able to improve the efficacy of prulifloxacin in bacterial prostatitis patients (R)||14 days||Nearly 90% of patients who took prulifloxacin with natural treatments had reduced symptoms; after 6 months, all patients in this group had no recurrence of the disease||The association of S. repens, U. dioica, quercitin and curcumin extracts is able to improve the clinical efficacy of prulifloxacin in patients affected by CBP|
Is prostatitis contracted through sex?
Interestingly, Trichomonas vaginalis, a parasite and STD, has been found in prostate biopsies of men with prostatitis, and although it seems that E. Coli is a much more regular culprit, the prostate’s susceptibility to Trichomonas vaginalis colonization has been linked to zinc levels. The prostate is the number one home for zinc in a man’s body, and when levels get low, studies have shown these types of pathogens can take a greater foothold. (R)
Experiment: mineral deficiencies are common in the U.S. Try supplementing with small amounts of zinc (you don’t want to overdo it with zinc as large doses can cause side effects) to see whether conditions improve. If you don’t want to add a nutritional supplement, pumpkin seeds and oysters are both high in zinc. As an added benefit, zinc supplementation has also shown some promise in maintaining the cell lining of the gut, which can prevent or help to heal leaky gut, a condition that often accompanies prostatitis, and that is marked by a breakdown of the “epithelial” wall of the gut lining, which allows pathogens and undigested food particles to enter the blood stream. (R) (R) I will touch more on leaky gut later in this post.
While we are putting a focus on Trichomonas vaginalis in this discussion about zinc, ultimately, identifying the exact pathogenic bacteria causing issues in the prostate can be difficult since samples are often contaminated by the bacteria that grow in the urethra. (R)
Antibiotics and prostate problems
Prostatitis can be contracted from sexual activity, but the very antibiotics used to treat prostatitis can, in some cases, be the culprit behind chronic inflammation of the prostate.
Ruling out fungal infection
Consider this study which appeared in the Central European Journal of Urology. The authors found that most young men presenting with prostatitis, who also had low prostate specific antigen (PSA) numbers (higher PSA means greater likelihood of prostate cancer), were suffering from a yeast infection, not bacterial prostatitis, although E. Coli was thought to be the “bridge” that brought yeast to the prostate region in the first place.
|Treatment||Fluconazole, potassium citrate|
|Diet changes||Low carb|
|Results||80% saw improvement in symptoms|
This tiny study had the same finding, but in this case, biopsies showed dual contamination with Candida Albicans and Trichomonas vaginalis.
So, as a preliminary matter, if you’re a young man suffering from what you think could be prostatitis, have your PSA labs done. Bacterial prostatitis can raise PSA numbers, so if you have low PSA numbers, you may be looking at an anti-fungal regimen rather than a course of antibiotics.
Broad-spectrum antibiotics, which is the solution offered by most urologists, will only serve to further destroy the microbial balance in the gut and urinary tract, making it that much easier for the yeast to spread. In these cases, loading up on antibiotics will only make matters worse.
Experiment: An easy experiment to run if you suspect a fungal issue is to go on a type of Candida protocol for a few days and see how your body responds. In essence, this will involve eating zero sugar or glucose (meaning very low carb or no carbs at all). If these dietary changes provide relief, you have a decent idea that the problem is fungal in origin, especially if you have low PSA numbers. It is also a good idea to have a mycotoxin panel done to identify potential issues with toxic mold.
The Central European Journal of Urology study used fluconazole, but some men may better tolerate nystatin.
I would also note that the mechanistic justification for the low carbohydrate and anti-fungal diet in the Central European Journal of Urology could actually justify two experiments. The one I list above is the anti-fungal-diet option (very low carb), which is proven in a well designed study, however, what seems to have been lost in that approach is the suggestion that E. coli was the bridge that allowed for the invasion of Candida in the first place. The low carbohydrate diet cuts off the fuel source for Candida growth, but doesn’t address the possible source of the E. coli.
Based on the studies I cite below in the plant based protocol section of this post, it could just as easily be argued that a diet, like many plant based protocols, that work to make the urine more alkaline could be just as effective, if not more so, at healing cases of prostatitis, since the rise in urine PH would remove the fuel source for E. coli (which thrives in acidic urine) and therefore remove the “fungal bridge” to the urogenital region.
The prostate is prone to infection and inflammation
The prostate sits in an anatomical position, wrapped around the urethra, and close to the rectum, that is ripe for infection.
Infection causes inflammation. (R) When the prostate is inflamed, it can become enlarged, putting pressure on the urethra and, in some cases, making it more difficult to fully empty the bladder. Urine then gets trapped and backs up, which can contribute to lingering low grade infection, even where tests come back negative.
The role of leaky gut
In addition to the retention of urine, the prostate can become infected due to a break down in the intestinal lining, sometimes called “leaky gut.”
Leaky gut is characterized by bacteria, toxins, and even undigested food, which are all meant to stay within the digestive system, leaking out into the blood stream where these invaders have the potential to cause autoimmune like reactions in some people. (R)
For example, men who give up gluten sometimes find that their prostate issues abate. Presumably, this happens because gluten increases the production of zonulin, a protein that is responsible for breaking down the “intracellular tight junctions” that form the gut wall. (R) Removing gluten reduces levels of zonulin, which allows the gut to heal, stopping the release of irritants that had previously reached the blood stream where they can cause autoimmune reactions. (R)
Experiment: as a practical matter, this will overlap with the anti-fungal protocol above, but stop eating gluten for a month and see if the condition improves. There are multiple anecdotal stories online about men healing prostate issues by cutting out gluten.
And while the Paleo community has done an excellent job tagging grains as the cause of leaky gut, the reality is more complex for most men. Yes, grains, especially refined grains, can feed yeast and are contraindicated on an anti-fungal protocol, but some men will also do well to avoid saturated fat, as saturated fat has been linked to intestinal permeability as well. (R) While the saturated fat study I cite here was a study performed in mice, it’s worth mentioning because many with mast cell issues don’t respond well to high fat diets and foods, and one of the theories I will advance later in this post discusses the possibility that prostatitis is an autoimmune condition for a good number of men. Additionally, it’s worth noting that some studies show that a diet higher in saturated fat is linked to aggressive prostate cancers. (R)
The point here is that a low-grade infection of the prostate can come from places you may not expect, including the gut.
Most people have cancerous cells in their bodies, but they do not have “cancer.” (R) The principal is the same with infection. A urologist may tell a man with prostate issues that he has no infection, but as I alluded to above, that doesn’t mean there aren’t bad bacteria present in the region that are causing problems.
However, it is important to point out that many men have identifiable infection that can be detected through lab tests.
This quote from the Journal of Clinical Microbiology Reviews is instructive:
While it is difficult to definitively extrapolate from animal models, antibiotic pharmokinetic studies with a murine model have suggested that treatment failures in chronic prostatitis are probably a result of the local microenvironment surrounding the persistent focal and well-protected small bacterial biofilms buried within the prostate gland. These conclusions support the molecular and culture data implicating bacteria as a cause of chronic idiopathic prostatitis.
As a result, the first course of treatment for men who complain of prostatitis is antibiotics.
However, antibiotics cannot penetrate the prostate effectively. Forums are full of men who claim to have had some temporary relief from antibiotic use, only to have symptoms return when antibiotics stop. This can likely be explained by the fact hat the antibiotics temporarily lower the pathogenic load in the region, but don’t address the underlying cause of the disease in the first place. Ironically, and as the studies on yeast infections above demonstrate, antibiotic use may be one of the primary contributing factors to long battles with prostatitis.
To be fair, antibiotics may have efficacy for men suffering with an acute infection. However, for chronic repeat sufferers, antibiotics are not a cure, because, as the Journal of Clinical Microbiology states, bacteria can thrive in a prostate not receiving proper blood flow due to bacteria fortified in biofilm. (R)
It’s now time to bring nitric oxide into the equation.
Nitric oxide and blood flow
The blood vessels in the prostate are the smallest and most delicate in the body.
Nitric oxide (“NO”) causes blood vessels to relax so they can receive oxygenated blood. The popular erectile dysfunction drugs Cialis and Viagra work because they flood NO into the prostate region (also relieving symptoms of BPH). (R)
NO is anti-pathogenic, but unfortunately, infection reduces BH4, a chemical the body needs to make NO. (R) So, in essence, an infected prostate loses the ability to receive NO because the body uses BH4 to fight off the invaders, rather than to synthesize NO.
Therefore, lingering infection means lower NO bioavailability, reduced blood flow, and greater risk for infection, or greater risk for lingering infection to better protect itself with production of biofilm. (R) (R) Reduced BH4 also results in a process known as NOS uncoupling, which produces the free radical superoxide instead of NO.
For more on the genetics of NO production, see our NOS3 gene page.
Whether you want to call it acute bacterial, or chronic nonbacterial, prostatitis is a recurrent inflammation of the prostate caused in part by chronic decline in nitric oxide bioavailability.
The recent literature suggests that the condition referred to as chronic idiopathic (nonbacterial) prostatitis may actually have an infectious etiology.
During the past few years, molecular data and cultures performed with special media (discussed below) strongly suggested that chronic idiopathic prostatitis may actually be a cryptic bacterial infection of the prostate gland that is usually missed or undetected by routine conventional cultures in clinical microbiology laboratories.
Journal of Clinical Microbiology
Decline in the anti-pathogenic NO results in poor blood flow to the prostate, which adds an anaerobic environment to a region that sits next to multiple potential sources of infection. The stage is then set for infection to settle in, with E. Coli being one of the biggest culprits.
It is for this reason that studies have shown that use of the ED drug Cialis, actually helps heals the prostate and reduce inflammation markers in the prostate. Flooding the region with NO, reduces pathogenic load. (R)
Increase in mast cells irritate the prostate
Chronic infection causes inflammation.
In response to inflammation, the body produces a greater number of localized mast cells, which makes matters worse. (R) Mast cells are produced during times of stress, as well as in response to ingesting foods or substances that trigger an allergic response. (R)
Therefore, mast cell production in the bladder and prostate is basically an allergic response to inflammation that can increase the inflammatory cycle and locally suppress the immune system. (R) Remember that when provoked by a stimulus perceived as a threat to the immune system, mast cells release histamine, as well as a whole host of other inflammatory compounds. After a long period of inflammation, which has caused mast cells to pool in the prostate area, seasonal allergies can contribute to symptoms. The mast cells are there in larger numbers and will release their inflammatory cocktail in greater concentrations in areas of the body that are perceived as under attack.
I’ve written previously about pollen allergies causing anxiety, but presumably they can contribute to some types of prostatitis as well.
Experiment: I get into a study focusing on an autoimmune model of prostatitis in a couple paragraphs, but many people with mast cell issues don’t do well with red meat, pork, and high fat diets. If you have allergies, cutting out saturated fat and going on more of a plant based diet for awhile could be helpful, especially, as we will see when you pair with certain antihistamines.
Known prostatitis cures
Applying the prostate facts
Ok, so we’ve offered three overarching reasons for prostate problems:
- Anatomical position close to sources of infection (vulnerable to leaky gut)
- Small blood vessels sensitive to declines in NO
- Mast cell / autoimmune reaction to allergens, infection, stress
Let’s now take these three theories and apply them to the best prostatitis studies.
Quercetin is a mast cell stabilizer and biofilm disrupter.
Knowing this, it’s not a surprise that studies show quercetin significantly reduces symptoms of prostatitis, especially when it’s paired with bromelain, an enzyme found in pineapple juice that increases the bioavailability of quercetin. Both quercetin and bromelain act as natural antihistamines, which reduces mast cell count and eases symptoms. (R) Quercetin has also been shown to increase NO levels and improve endothelial function. (R)
This double blind, placebo controlled study found that quercetin and bromelain to be effective at treating prostatitis.
|Treatment||Quercetin 500mg twice daily, and then twice daily combined with bromelain|
|Results||67% of quercetin takers had improvement of at least 25%|
Quercetin fits under the three prostate rules listed above both as a mast cell stabilizer and a biofilm disrupter.
A note on prostatitis and genetics (technical)
At a genetic level there isn’t much data out there for potential markers related to prostatitis, although SOD2 SNPs and other endogenous may play a role. One interesting study from 2002 did highlight some potential markers and interestingly identified differential treatment responses based on genetics.
The risk allele ‘A’ of rs1800896 in the IL10 gene is associated with a reduction in levels of IL-10 protein. IL-10 is a major anti-inflammatory cytokine, a protein released by cells which helps damp down the inflammatory response, and so a lack of its expression is therefore associated with chronic inflammatory disorders.
The 2002 study in patients with chronic prostatitis found that men with prostatitis were more likely to have a low IL-10 producing genotype, “suggesting autoimmunity as a potential etiology.” So, check another box for our mast cell rule there.
Interestingly, the authors also noticed that those with the “normal” ‘G’ allele of rs1800896, who also carried the risk ‘A’ allele of rs1800629 in the TNFA gene responded poorly to quercetin treatment. Which may somewhat explain the differences seen in quercetin treatment studies.
|Size||N/A, study performed in rats|
|Treatment||Berberine (Note: Epithelial (gut) degeneration observed in rats with CNBP. Histidine metabolism observed as an issue contributing to CNBP. Berberine may be protective against CNBP because it resets disruptions in metabolic pathways associated with the condition.)|
|Results||Berberine reduced gut inflammation and reset metabolic pathways, which helped with CNBP|
There is a community of functional medicine doctors, the most vocal being Dr. Dach in South Florida, who believe that berberine heals leaky gut. Healing of leaky gut, presumably by wiping out pathogenic bacteria, closes the doorway for bad bacteria to enter the blood stream and infect the prostate.
Berberine is anti-fungal and antimicrobial. It fits nicely within our three rules for prostate health listed above.
As an added benefit, berberine has been proven as a prostate healthy supplement in the context of prostate cancer where it inhibited growth of prostate cancer cells. (R)
Antihistamines – prostate allergy?
To further advance this theory, this study in the Journal of Urology found that taking H1 antagonists, like Zyrtec or Claritin, helped alleviate prostatitis. Why? Just as the quercetin did, the antihistamine reduced mast cell count, thus dialing back inflammation.
H1 anti-histamines study
|Type||Autoimmune, mast cell|
|Treatment||H1 anti-histamines, testing for mast cell and nerve growth factor secretions in prostatic secretions|
|Results||Men with prostatitis showed increased mast cell tryptase and nerve growth factor in expressed prostatic secretions. Treatment of experimental autoimmune prostatitis with a mast cell stabilizer combined with a histamine 1 receptor antagonist resulted in a synergistic decrease in chronic pelvic pain|
Consider these two quotes:
Men with chronic pelvic pain syndrome showed increased mast cell tryptase and nerve growth factor in expressed prostatic secretions.
Treatment of experimental autoimmune prostatitis with a mast cell stabilizer combined with a histamine 1 receptor antagonist resulted in a synergistic decrease in chronic pelvic pain.
Antihistamines are mast cell stabilizers, again fitting nicely within our three rules.
Plant based diet
Try a plant based diet.
This study out of the University of Washington in St. Louis found that people with more acidic urine had greater likelihood of developing repeated urinary tract infections, especially those driven by E. Coli. Now think back to the yeast study I quoted above. The authors there believe that E. Coli was the bridge that allowed Candida and other pathogenic yeast to infect the prostate. As we don’t currently know exactly what causes prostatitis, it’s not a reach to assume that urinary tract infections could be present in symptomatic men. The UTI could then spread to the prostate or bladder, causing chronic problems. In fact, the urinary tract has its own microbiome, and certain strains of probiotics may play a role in staving off infection. (R)
Plant based study
|Type||Urinary Tract Infection (UTI)|
|Results||Those with more acidic urine at greater risk for recurrent UTI. Microbiome health also a factor. Acidic urine feeds E. Coli|
High animal protein diets cause greater acidity in the urine which allows for the invasion of bad bacteria, like E. Coli, that are linked to prostate inflammation.
If too much animal protein causes acidity that proliferates E. Coli, and eventually Candida, a plant based diet that makes the urine more alkaline could be a solution to prostate issues for some men. In fact, in addition to anti-fungal drugs, the yeast infection study gave subjects potassium citrate as a means for making the urine more alkaline, and the success rate there was over 80%. For more on how potassium citrate makes the urine more alkaline, see this University of Chicago article.
In this context, it is crucial to know your blood type. Although the blood type diet has largely been debunked, it contains one sound scientific principle, which is that blood type correlates to hydrochloric acid levels in the stomach. Type A, and A+ blood types have the lowest levels of hydrochloric acid with which to digest protein. A high protein diet in these individuals may leave undigested meat fermenting in the gut, which leads to pathogens, like E. Coli, that can cause problems for the urinary tract and prostate. (R) (R)
Last, red meat in particular has been shown to be a problem for those with mast cell issues. If chronic inflammation, or some type of under the radar autoimmune condition, has caused a localized increase in mast cells or E. Coli infection, red meat and pork are definitely to be avoided.
Bottom line is that degraded gut health caused by too much animal protein will undoubtedly be a cause of poor prostate health for many men.
Exercise has been shown to increase NO and as I have written about previously, increase levels of butyrate, a short chain fatty acid that helps protect the lining of the gut.
In an Italian study, 231 sedentary men were put on an exercise regimen. Those who performed aerobic exercise saw greater relief than those who lifted weights.
|Size||231 sedentary men|
|Treatment||Aerobic exercise and weights for 18 weeks total|
|Results||Both groups saw improvement, with the cardio group showing greatest results|
Well, this study also fits nicely within our paradigm. The increases in NO help with blood flow, and the cardio helps to repair the lining of the gut, degradation of which is a key factor contributing to the development of prostate infection.
Additional studies that show promise treating prostatitis:
|NAC (R)||Nrf2 / Biofilm||Rat study||Pain and inflammation reduced|
|Fluoroquinolones antibiotics, saw palmetto, lactobacillus sporogens, and Arbutin (R)||Reduction in Uropathogens||Human||Group using antibiotics plus natural supplements showed greatest reduction in symptoms|
|Nettles, saw palmetto, curcumin and quercetin blend plus antibiotic prulifloxacin (R)||Destroyed biofilms||Human||One month after treatment, 89.6% of patients who had received prulifloxacin and natural blend did not report any symptoms related to CBP, whilst only 27% of patients who received antibiotic therapy alone were recurrence-free|
Ejaculation “drains” the prostate of stored fluid. When the prostate is becoming inflamed, or has a low grade infection, ejaculation gets rid of the bad stuff that is lingering and gives a “clean slate.” This is why you see some men with prostate issues get a “massage” which is a more thorough draining of the gland performed by a urologist, but those procedures come with risk of injury, so better to just have sex.
In fact, studies have shown that men who ejaculate more have lower incidence of prostate cancer. (R)
Having said that, the issue of draining the prostate cuts two ways. In one sense, getting rid of stored fluid has shown promise for many men. However, let’s think back for a second to the discussion of zinc and Trichomonas vaginalis infection of the prostate, which seems to hinge on the zinc levels in that organ. You know what drains the prostate of zinc? You guessed it, ejaculating. So, it would seem, that at least for some men, excessive ejaculation, especially from masturbation since it offers very little in the way of, well, “benefits,” could be doing more harm than good. We do have studies that show that the prostate drained of zinc is more prone to infection.
Experiment: long term not ejaculating isn’t good for the prostate, but a short course, perhaps two weeks, of abstaining from what could be your favorite past time (while still engaging in sex) might do you some good, and give your prostate time to heal, if in fact it’s excessive masturbation that has been an irritant.
Note: some urologists would disagree that abstention from ejaculation improves zinc levels in the prostate. There are however, communities of men who swear by the practice, so I’ve offered the idea here as an experiment to consider if you’re facing a chronic case of inflammation you can’t seem to shake. See also this Reddit thread.
Lab testing is the first step if you suspect you have an issue with your prostate, or if you’re interested in taking a proactive role in keeping it healthy.
If you’re 40 or younger and have low PSA, it’s likely your prostate issue is fungal.
If PSA is elevated, more traditional paths are worth looking into, possibly even antibiotics, especially when they are paired with the nutrients listed above. But don’t rely on a pill of any kind. The goal is to change lifestyle factors that are contributing to a low grade infection. On this path, understanding blood type is important as it may determine the amount of animal protein you can handle.
Per the Washington University study, take a look at the acidity of your urine. If it’s highly acidic, you may have the perfect recipe for E. Coli colonization. Transitioning to a vegetarian diet could be what your body needs to alkalize your urinary tract which will have the effect of making it harder for pathogenic bacteria to thrive. You may also want to consider potassium citrate to accelerate this goal, especially if you find yourself taking biofilm disrupting supplements, such as NAC, that are highly acidic.
But don’t stop with antioxidants. Assuming you find high quality strains that work for you, using probiotics will help to crowd out the bad guys. Strains I would look at: B. Longum, L. Plantarum, soil based probiotics such as Prescript Assist, and even non-pathogenic yeast strains like S. Boulardii.
Last, gut health must be a focus for all men, especially in these circumstances. Embarking on a protocol to heal the gut could be just what the doctor ordered to shut down issues with leaky gut and the autoimmunity that goes with it.