By Dr. Kyle Maynard, ND
BC, a 67-year-old male, was first seen in September 2020 with the chief concern of a very low-pressure urinary flow which made it difficult for him to completely void in a timely manner. Bearing down hindered his urination to the point where urine flow would stop. He denied urgency, and with time would fully void. Morning urination was more frequent than the rest of the day. He had a history of lower testosterone and erectile dysfunction, no issues with bowel movements or discomfort when sitting and no family history of prostate concerns. His most recent appointment with his medical doctor revealed a swollen prostate and slightly elevated prostate specific antigen (PSA). Despite his ongoing symptoms, the elevated PSA levels had resolved back in July 2020.
BC was both retired and a semi-professional musician who spent his time tending a large garden and brewing his own craft beer. His diet was primarily vegetarian with a high intake of carbohydrates from fruits, maple syrup, granola, pasta, homemade pizza, and sourdough breads. He enjoyed the home-grown food that he produced and preserved for year-round consumption. He smoked cigarettes occasionally and was a habitual marijuana user. While BC disclosed that he was no longer smoking marijuana, he consumed about one ounce per day as a cookie for recreational purposes.
Lab work was ordered to evaluate his prostate and assess a suspicion of diabetes and metabolic syndrome. In October 2020, the results showed normal cholesterol values, liver enzymes, electrolytes, kidney function, testosterone, and PSA. An insulin tolerance test showed elevated fasting glucose and insulin with a HOMA-IR score at 3.3 demonstrating significant insulin resistance.
Initial recommendation of dietary modifications included reduction of sugars and grains along with education around the appropriate timing, amounts, and types of carbohydrate to improve his metabolism. In addition, a flash glucose monitor was used to track glucose levels for two weeks as an accountability tool and to help determine the foods that increased glucose levels.
In February 2021, he reported significant changes to his diet with noticeable improvements but requested something to take specifically for his urinary symptoms. He had started a retail formula two months before but had no benefit. The main ingredients were Saw Palmetto and vegetable extracts. Voiding was manageable, but he wanted to have an adequate flow. After discussing all the options, he opted for a herbal-based, professional-line, prostate formula with saw palmetto, stinging nettle, pygeum and rosemary at the recommended dosing on the bottle.
BC returned one month later with worsened symptoms. He described urination as “the worst it has ever been”. Since starting the product, he didn’t notice any significant difference other than the occasional day where he had enough pressure to void, but “definitely was not consistent”.
He was instructed to book an appointment with his GP for a digital rectal exam (DRE) and was given a requisition to expedite testing. He was able to get his labs done within the hour and had an appointment with his GP booked for 3 weeks out. His PSA levels were 10.4 ug/L. He was still able to void, and he had no urgent symptoms, no pain, and no signs of infection. While he waited for his appointment, BC was instructed to follow a specific prostate diet for the 3 weeks and to discontinue the prostate formula. He had his PSA checked two days before seeing his GP to help provide the doctor with more context to how things were changing.
The diet prescribed included the elimination of all dairy, bread, grains, eggs, and beer. He was also instructed to stop smoking, decrease his marijuana intake and consume fresh vegetables especially those representing deep, dark colors from the garden. He was given recipes to incorporate chia and flax for soluble fibers and to increase seafood and legumes as the main sources of protein. Furthermore, he was also prescribed another flash glucose system for monitoring his blood sugars.
BC followed the recommended dietary plan over the next three week period. He had symptom improvement and the follow up blood work reflected this with a PSA at 3.4 ug/L. Most notably, BC mentioned that his doctor of 40 years had rarely seen a PSA of 10 ug/L decline like that and to “keep doing whatever he’s doing”.
A year later, BC has continued the lifestyle changes as suggested, continues to monitor his carbohydrate intake, and reduce his substance use. He admitted to enjoying his homemade pizza once a month. His most recent HOMA-IR was 1.1, which put him at the normal range for insulin sensitivity. He also reports an improved management of his urination.
According to the Canadian Task Force on Preventive Health Care, only one man out of 1000 will escape death from prostate cancer because of PSA screening. About 40 of the 1000 men will be over investigated or experience short and/or long-term complications from the biopsy or treatment that would typically be required after positive prostate cancer screening. While the cause of BC’s acutely elevated PSA in February 2021 is still unknown, the 3 weeks before his doctor’s appointment may have been a blessing in disguise. The lifestyle changes BC made in that short period was enough to see noticeable and significant benefits to his overall and prostate health. The intervention inspired him to continue these changes long-term without the need of further referrals or interventions related to his prostate.
Dr. Kyle Maynard BIO
Dr. Kyle Maynard is a naturopathic doctor practicing in Victoria, BC. After completing his BSc in Chemical Biology at Thompson Rivers University, he relocated to Vancouver to attend the University of British Columbia where he obtained a MSc in Neuroscience. His interest and exposure to how the brain works, encouraged him to pursue naturopathic medicine at Boucher Institute of Naturopathic Medicine. Dr. Maynard has a a special interest in mental health, neurological conditions and physical medicine.
