What would a functional medicine approach, including testing, supplements, and protocols, to benign prostatic hyperplasia be? I have two patients, both male, mid-60s, retirees with weak urination. They wake up multiple times in the night to urinate. They both have belly fat, osteoarthritis, cravings for sweet, hungry every three hours, so I hear adrenal issues. I was thinking DUTCH Complete for hormones, organic acids to check detox, CSAP x3 due to annual international travel and history of bloating and belching. And a SIBO breath test. One patient has impaired detox markers on Genova Organix. For supplements, I have them on Vital Nutrients, saw palmetto, pygeum, and nettle. Both have improved, but seeking more improvement, but neither of them are very compliant with diet, although open to testing and supplements. One is vegetarian with 60 percent gluten-free, and the other is Paleo 70 percent of the time, but both of them like gluten, junk, and sweets outside the home.

Dr. Amy Nett: Oh, that’s so tricky. Okay. So, both of them are including gluten in their diet? Then both of them need the Cyrex Array 3. So I normally tell patients, look, I’m absolutely okay with you including gluten in your diet as long as we do the Cyrex Array 3 so that you’re making an informed decision. If you don’t have the Cyrex Array 3 to know whether or not your body is responding inappropriately to gluten, then I don’t think you can make it part of your, you know, 80-20 rule, 90-10 rule, or in this case a 60-40 rule. So I would say when we’re looking at benign prostatic hypertrophy or hyperplasia, you’re thinking about inflammation. I would say Cyrex Array 3 definitely, and then depending on what that comes back as, you may want to think about doing Cyrex Array 4. Diet is tricky, so I would discuss because they’re not that compliant, get the data so you that you can fine-tune the diet if it needs to be.

Otherwise, I think you’re absolutely on the right track. I would do the DUTCH Complete hormone profile looking for two things, three things in particular here. Number one, what is the 5-α reductase activity? Because BPH, I’m thinking that 5-α reductase activity might be high, so do they have high testosterone? Do they have these 5-α androgens, such as 5-α androstenediol? Are those very high? Because if those are high, saw palmetto can be good, but you may want to think about using DIM, which can decrease 5-α reductase and also aromatase. I’m kind of thinking DIM possibly because you mentioned the belly fat, so I’m also wondering what do their estrogen levels look like? Is there an aromatase issue as well? I know we’re not going into the complete hormones as much, but I think you’re on the right track there. You want to know, like, are their estrogens too high? Is the 5-α reductase activity too high?

Then you can certainly get supplements that are going to help bring down aromatase and probably bring a little bit more for decreasing 5-α reductase. I’d have to double check on this, but you could look. I think zinc supplementation might also help decrease 5-α reductase activity, but bringing down inflammation can also decrease 5-α reductase and aromatase sometimes. Definitely look at hormones, and yes, you also need to look at the cortisol here based on the cravings for sweet, hungry every three hours.

You didn’t mention a complete blood panel, but you might want to consider that, in part to look at glucose, hemoglobin A1c, like what’s going on with blood sugar issues, especially given their diet. So consider at least a comprehensive metabolic panel if not a full blood panel. Doctor’s Data test I like. Urine organic acids test, yes, I like that. I would prioritize the other ones you mentioned, including the Cyrex, so depending on how open they are to testing, that’s probably the first one I would get rid of because, again, it’s not the most precise test, meaning if you do that test seven days in a row, you might get about five different answers. That would be the one I would leave out. I see what you’re saying in terms of detox, but again, I’m not sure if that is going to be the most useful. So SIBO breath test, yes, because you mentioned bloating and belching. Again, the idea here is to bring down inflammation.

You said one patient has impaired detox markers. Again, what does he need to detox? You could do something general such as glutathione, vitamin C. It’s hard to know. It sounds like there were multiple detox markers that were impaired, so if it’s multiple ones, you might do a metals panel to see if that is one of the more obvious sources of things that are sort of burdening detox. Sometimes if I have patients, and we just have a suspicion that the liver doesn’t seem to be functioning too well, like maybe they’re not clearing their hormones too well, it seems like there is a detox issue. I like the formula from Vital Nutrients called Detox Formula, so I sometimes use that and maybe just go through a bottle and see how patients respond to doing some detox support, but something such as milk thistle, dandelion, taurine, glycine, and that sort of thing, a formula like that.

Okay, I think I answered that so, yes, the only test I would add would be Cyrex Array 3, maybe Cyrex Array 4. If they do have impaired detox, think about a Quicksilver blend metals panel, and the first test I would get rid of from that list if they’re not open to all of that testing would be the urine organic acids test just because it’s big picture overview, and you’re doing some more specific testing there. So that’s where I would go, but I think you’re right on track.