The effect of diet on BPH, LUTS and ED

  • Mahmoud ElJalby
  • Dominique Thomas
  • Dean Elterman
  • Bilal ChughtaiEmail author
Topic Paper



Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are common conditions that increase in the aging population. Several environmental factors have been linked to the development and progression of BPH and ED. Several studies have shown potential direct and indirect influences of several micronutrients and macronutrients on the risk of developing these conditions. We reviewed the available published literature of the effect of diet on BPH and ED.


A comprehensive search was performed to identify studies that evaluated how diet affected males with BPH and ED. Searches were run on July 5th, 2018 in the following databases: Ovid MEDLINE®; Ovid EMBASE; and The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). There were no language restrictions, publication date restrictions, or article type restrictions on the search strategy.


We retrieved a total of 1670 results across all databases. After removing any duplicated results, 2 independent reviewers screened a total of 1325 citations. A total of 35 articles were selected for inclusion in this review. Diet is an important factor affecting the risk of development of BPH and ED. Several studies have shown the effect of dietary interventions for BPH and ED.


A better understanding diet and its relative effects on the development, treatment and prevention of these diseases are an important area of further research for the given aging male population.




Author contributions

ME: data collection/management, data analysis, drafting of manuscript, critical revisions. DT: data collection/management, data analysis, drafting of manuscript, critical revisions. DE: data analysis, protocol development, drafting of manuscript, critical revisions. BC: data analysis, protocol development, drafting of manuscript, critical revisions.

Compliance with ethical standards

Conflicts of interest

BC is a consultant for Allergan and Boston Scientific.

Research involving human participants and/or animals

There were no human participants or animals used in this manuscript. This was a review article.

Informed consent

Informed consent was not required in this manuscript. This was a review.


  1. 1.
    Roehrborn CG (2008) Pathology of benign prostatic hyperplasia. Int J Impot Res 20(Suppl 3):S11–S18. CrossRefPubMedGoogle Scholar
  2. 2.
    Rosen R, Altwein J, Boyle P et al (2003) Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 44:637–649CrossRefGoogle Scholar
  3. 3.
    Isaacs JT (1994) Etiology of benign prostatic hyperplasia. Eur Urol 25:6–9. CrossRefPubMedGoogle Scholar
  4. 4.
    Patel ND, Parsons JK (2014) Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol 30:170–176. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Roehrborn CG, McConnell JD, Lieber M et al (1999) Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 53:473–480CrossRefGoogle Scholar
  6. 6.
    Roehrborn CG, McConnell J, Bonilla J et al (2000) Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol 163:13–20CrossRefGoogle Scholar
  7. 7.
    Vuichoud C, Loughlin KR (2015) Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol 22(Suppl 1):1–6PubMedGoogle Scholar
  8. 8.
    Feldman HA, Goldstein I, Hatzichristou DG et al (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol 151:54–61CrossRefGoogle Scholar
  9. 9.
    Platz EA, Joshu CE, Mondul AM et al (2012) Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol 188:496–501. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chughtai B, Forde JC, Thomas DDM et al (2016) Benign prostatic hyperplasia. Nat Rev Dis Primers 2:16031. CrossRefPubMedGoogle Scholar
  11. 11.
    Yafi FA, Jenkins L, Albersen M et al (2016) Erectile dysfunction. Nat Rev Dis Primers 2:16003. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lue TF (2000) Erectile dysfunction. N Engl J Med 342:1802–1813. CrossRefPubMedGoogle Scholar
  13. 13.
    Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479CrossRefGoogle Scholar
  14. 14.
    Pashootan P, Ploussard G, Cocaul A et al (2015) Association between metabolic syndrome and severity of lower urinary tract symptoms (LUTS): an observational study in a 4666 European men cohort. BJU Int 116:124–130. CrossRefPubMedGoogle Scholar
  15. 15.
    Parsons JK (2007) Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol 178:395–401. CrossRefPubMedGoogle Scholar
  16. 16.
    Raheem OA, Parsons JK (2014) Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Curr Opin Urol 24:10. CrossRefPubMedGoogle Scholar
  17. 17.
    Corona G, Vignozzi L, Rastrelli G, et al (2014) Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions. Int J Endocrinol. Accessed 20 Jun 2018
  18. 18.
    Tewari R, Rajender S, Natu SM et al (2013) Diet, obesity, and prostate health: are we missing the link? J Androl 33:763–776. CrossRefGoogle Scholar
  19. 19.
    Yu H, Harris RE, Gao YT et al (1991) Comparative epidemiology of cancers of the colon, rectum, prostate and breast in Shanghai, China versus the United States. Int J Epidemiol 20:76–81CrossRefGoogle Scholar
  20. 20.
    Kristal AR, Arnold KB, Schenk JM et al (2008) Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol 167:925–934. CrossRefPubMedGoogle Scholar
  21. 21.
    Rohrmann S, Giovannucci E, Willett WC, Platz EA (2007) Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Am J Clin Nutr 85:523–529. CrossRefPubMedGoogle Scholar
  22. 22.
    Sökeland J (2000) Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int 86:439–442CrossRefGoogle Scholar
  23. 23.
    Bent S, Kane C, Shinohara K et al (2006) Saw palmetto for benign prostatic hyperplasia. N Engl J Med 354:557–566. CrossRefPubMedGoogle Scholar
  24. 24.
    Lagiou P, Wuu J, Trichopoulou A et al (1999) Diet and benign prostatic hyperplasia: a study in Greece. Urology 54:284–290. CrossRefPubMedGoogle Scholar
  25. 25.
    Vignozzi L, Morelli A, Sarchielli E et al (2012) Testosterone protects from metabolic syndrome-associated prostate inflammation: an experimental study in rabbit. J Endocrinol 212:71–84. CrossRefPubMedGoogle Scholar
  26. 26.
    de Ribeiro ICA, da Costa CAS, da Silva VAP et al (2017) Flaxseed reduces epithelial proliferation but does not affect basal cells in induced benign prostatic hyperplasia in rats. Eur J Nutr 56:1201–1210. CrossRefGoogle Scholar
  27. 27.
    Zhang W, Wang X, Liu Y et al (2008) Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food 11:207–214. CrossRefPubMedGoogle Scholar
  28. 28.
    Vahlensieck W, Theurer C, Pfitzer E et al (2015) Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. UIN 94:286–295. CrossRefGoogle Scholar
  29. 29.
    Mondul AM, Giovannucci E, Platz EA (2014) A prospective study of obesity, and the incidence and progression of lower urinary tract symptoms. J Urol 191:715–721. CrossRefPubMedGoogle Scholar
  30. 30.
    Adedeji TG, Fasanmade AA, Olapade-Olaopa EO (2016) An association between diet, metabolic syndrome and lower urinary tract symptoms. Afr J Urol 22:61–66. CrossRefGoogle Scholar
  31. 31.
    Maiorino MI, Bellastella G, Esposito K (2015) Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl 17:5–10. CrossRefPubMedGoogle Scholar
  32. 32.
    Corona G, Maggi M (2010) The role of testosterone in erectile dysfunction. Nat Rev Urol 7:46–56. CrossRefPubMedGoogle Scholar
  33. 33.
    Bivalacqua TJ, Usta MF, Champion HC et al (2003) Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl 24:S17–S37CrossRefGoogle Scholar
  34. 34.
    Stein RA (2003) Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage. Rev Urol 5:S21–S27PubMedPubMedCentralGoogle Scholar
  35. 35.
    Castela A, Vendeira P, Costa C (2011) Testosterone, endothelial health, and erectile function. ISRN Endocrinol. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Maiorino MI, Bellastella G, Volpe ED et al (2017) Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res 29:17–22. CrossRefPubMedGoogle Scholar
  37. 37.
    Khoo J, Piantadosi C, Duncan R et al (2011) Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. J Sex Med 8:2868–2875. CrossRefPubMedGoogle Scholar
  38. 38.
    Barbery CE, Celigoj FA, Turner SD et al (2015) Alterations in microRNA expression in a murine model of diet-induced vasculogenic erectile dysfunction. J Sex Med 12:621–630. CrossRefPubMedGoogle Scholar
  39. 39.
    Vignozzi L, Cellai I, Filippi S et al (2017) HP-01-006 The dual FXR/TGR5 agonist INT-767 counteracts nonalcoholic steatohepatitis and erectile dysfunction in a rabbit model of high fat diet-induced metabolic syndrome. J Sex Med 14:e143–e144. CrossRefGoogle Scholar
  40. 40.
    Giugliano F, Maiorino MI, Bellastella G et al (2010) Adherence to Mediterranean diet and erectile dysfunction in men with type 2 diabetes. J Sex Med 7:1911–1917. CrossRefPubMedGoogle Scholar
  41. 41.
    Maiorino MI, Bellastella G, Chiodini P et al (2016) Primary prevention of sexual dysfunction with mediterranean diet in type 2 diabetes: the MÈDITA randomized trial. Diabetes Care 39:e143–e144. CrossRefPubMedGoogle Scholar
  42. 42.
    Esposito K, Giugliano F, Maiorino MI, Giugliano D (2010) Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med 7:2338–2345. CrossRefPubMedGoogle Scholar
  43. 43.
    Fox CS, Golden SH, Anderson C et al (2015) Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 38:1777–1803. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Di Francesco S, Tenaglia RL (2017) Mediterranean diet and erectile dysfunction: a current perspective. Cent Eur J Urol 70:185–187. CrossRefGoogle Scholar
  45. 45.
    Musicki B, Hannan JL, Lagoda G et al (2016) Mechanistic link between erectile dysfunction and systemic endothelial dysfunction in type 2 diabetic rats. Andrology 4:977–983. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Rokkas K, Ioakeimidis N, Vlachopoulos C et al (2017) P-01-030 Low adherence to mediterranean type of diet is associated with testosterone deficiency in erectile dysfunction patients. J Sex Med 14:e170. CrossRefGoogle Scholar
  47. 47.
    Cassidy A, Franz M, Rimm EB (2016) Dietary flavonoid intake and incidence of erectile dysfunction. Am J Clin Nutr 103:534–541. CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Mykoniatis I, Grammatikopoulou MG, Bouras E et al (2018) Sexual dysfunction among young men: overview of dietary components associated with erectile dysfunction. J Sex Med 15:176–182. CrossRefPubMedGoogle Scholar
  49. 49.
    Ramírez R, Pedro-Botet J, García M et al (2016) Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort. Intern Med J 46:52–56. CrossRefPubMedGoogle Scholar
  50. 50.
    Lopez DS, Liu L, Rimm EB et al (2018) Coffee intake and incidence of erectile dysfunction. Am J Epidemiol 187:951–959. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyWeill Cornell Medical College New York-PresbyterianNew YorkUSA
  2. 2.Division of Urology, Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Department of Obstetrics and GynecologyWeill Cornell Medical College New York-PresbyterianNew YorkUSA

Personalised recommendations