Men with BPH and APOE4

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
Fc1345linville
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Men with BPH and APOE4

Postby Fc1345linville » Thu Jun 06, 2019 4:11 pm

Ladies, you may want to talk among yourselves on this one! :lol:

As many already know, Benign Prostatic Hyperplasia, or BPH, is the medical term for an enlarged prostate gland, which is said to affect 50% of all men older than 50. I am on the wrong side of that 50%, and just turned 77, but medications have limited me to a single and perhaps the most common symptom of the need to get up and pee at hours three and six of my eight hours of nightly sleep. Every night.

Since learning the importance of a good eight hours of sleep for "brain cleansing" from this forum, I have worried that my two-a-night interruptions are hindering that process, and until today I thought I simply had to accept the consequences.

Today I had a conversation with my Urologist about what has apparently become a fairly common surgical procedure that would almost certainly eliminate my 2x nightly interruptions. The surgical procedure is called Transurethral Resection of Prostate, (TURP), and here is a good site if you are interested in knowing more: https://www.urologyhealth.org/urologic- ... lasia-(bph)

If I have the surgery, I am told that I will have uninterrupted sleep. My question is whether uninterrupted sleep is likely to result in a healthier brain that is already dealing with my 4/4 status?

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Re: Men with BPH and APOE4

Postby mike » Thu Jun 06, 2019 8:48 pm

If you are getting more than an hour of deep sleep, then you are probably okay, and that can happen even with some interruptions. Might be worth getting something to determine time spent in different phases of sleep. I use an Oura ring.
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Re: Men with BPH and APOE4

Postby Julie G » Fri Jun 07, 2019 7:48 am

Ladies, you may want to talk among yourselves on this one! :lol:

FC, Pardon the female interruption and sideline commentary. BPH, as it relates to E4 men, has been on my mind lately. As you mention, this is extraordinarily common and may ultimately be associated with prostate cancer. In fact, if you live long enough, ALL men will be affected. I've been reading research finding a correlation with egg consumption, specifically choline (and riboflavin.) This may force E4 men into a difficult position; choosing between their prostate and their brains. Choline is an essential nutrient that exerts a powerful neuroprotective effect. It’s a major component of membrane phospholipids such as phosphatidylcholine and a precursor to the neurotransmitter acetylcholine, which is critical for memory. Choline is necessary for the creation and maintenance of neural synapses. Most people don't get enough in their diet: 550mg/per day is recommended for men & 425mg for women. For men who know they have BPH, it may be best to focus primarily on plant sources of choline: broccoli, almonds, walnuts, pinto beans, avocados, Brussels sprouts, swiss chard, and collard greens, and consider reducing egg consumption until we learn more. All men, 45-50 should get a baseline PSA testing done and annually each year thereafter to help you balance the risk/benefit of choline.

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Re: Men with BPH and APOE4

Postby PeterM » Fri Jun 07, 2019 8:29 am

This study does not address the egg consumption issue but appears to be good news regarding the relationship between a man’s apoe4 status and prostate cancer in general. I have not read beyond the abstract, however.

http://cebp.aacrjournals.org/content/24/10/1632

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Re: Men with BPH and APOE4

Postby Tincup » Fri Jun 07, 2019 11:37 am

From this paper there appears to be an insulin BPH relationship.

"8. Conclusions
Insulin-resistance syndrome is associated with the group of disorders which includes, obesity, glucose intolerance, endothelial dysfunction, dyslipidemia, diabetes and hypertension. Careful review of the experimental and clinical/epidemiological literature pertaining to the co-existence of insulin-resistance or insulin-resistance associated factors and BPH, clearly shows that insulin-resistance is an important risk factor for prostatic hyperplasia. Further, different components of the insulin-resistance syndrome are interlinked with each other and activate several prostatic growth-promoting mechanisms (please see Fig. 1) and thereby affect the subsequent susceptibility for developing symptomatic BPH. Future research to investigate the effect of insulin-resistance on
the insulin like growth factor and testosterone–dihydrotestosterone axis could facilitate the understanding of the mechanisms responsible for increased incidence of BPH in insulin-resistant individuals. Further, evaluation of herbal products with potential of (i) inhibiting insulin/IGF-1 signaling in the prostate gland or (ii) improving glucose disposal to normalize hyperinsulinemia secondary to the insulin resistance might be useful objectives for their potential use in the treatment of BPH."

In my early 50's, I started to have an issue. When I changed my diet to address (reduce) serum glucose/insulin the issue went away.

Years ago my dad had a TURP. He wasn't thrilled with the outcome. I'm sure the technique has changed. He called it a "ream job." I've also had some friends who got one more recently also not thrilled, so would advise looking at it in detail before getting one.

My bladder doesn't wake me up, but I will typically urinate if I do get up as I have a hard time getting back to sleep, so I don't want any distractions. I do pay attention to my PSA, it was measured a year ago at 0.5 and I'll be 64 in a few weeks.
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Re: Men with BPH and APOE4

Postby Julie G » Fri Jun 07, 2019 1:13 pm

From this paper there appears to be an insulin BPH relationship.

Tincup, good stuff! What do you make of the egg/prostate noise summarized nicely here. (The site loads slowly, but it works & is worth the wait.)

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Re: Men with BPH and APOE4

Postby Tincup » Fri Jun 07, 2019 1:56 pm

Julie G wrote: What do you make of the egg/prostate noise summarized nicely here. (The site loads slowly, but it works & is worth the wait.)


A number of the cited studies use food frequency questionnaires, which I usually discount. The Choline C-11 PET scan is interesting. Everything is association, with no really arrow of causation, so I really don't know. I can say I eat a lot more eggs than their cutoffs and have a low PSA (as stated above at 0.5) as of a year ago. I read one piece that suggested if your PSA was <2 at age 60, then your chances of getting fatal prostate cancer was near nil.
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Re: Men with BPH and APOE4

Postby Julie G » Fri Jun 07, 2019 3:54 pm

A number of the cited studies use food frequency questionnaires, which I usually discount. The Choline C-11 PET scan is interesting. Everything is association, with no really arrow of causation, so I really don't know. I can say I eat a lot more eggs than their cutoffs and have a low PSA (as stated above at 0.5) as of a year ago.

True, re. FFQ, but we have a lot of smoke. Also, true re. association, not causation. I couldn't help but wonder if the healthy user bias could also be at play. People who eat eggs tend to eat other bad things, i.e. pancakes, hash browns, CAFO bacon and sausage, etc. and perhaps live a less healthy overall lifestyle. There are relatively few people like you and I who eat eggs with tons of veggies.

All that aside, I read down to the comments on my link and came across this nugget from Ralph W. Moss, PhD:
Thank you for raising these important issues. I am still trying to wrap my head around this Harvard paper. One thing that jumped out at me was that the authors themselves state that these findings only held for North America! There was no such effect in the rest of the world. So if excess choline is the cause, then wouldn’t this biochemical fact hold for the entire male population, and not just those of us in the U.S. and Canada.

I also started to do some research to see if there was a correlation between egg consumption and prostate cancer mortality. It’s crude but could be provocative. Here is what I have found out:

The top country in the world for per capita egg consumption is China. In 2008, the average Chinese person consumed the 333 eggs per year. In the same year, by comparison, average consumption in the U.S. was 248 eggs….i.e., 85 fewer eggs consumed per person per year. One might therefore expect a concomitant increase in fatal PC in Americans.

But the annual mortality rate from prostate cancer in China was 2.5 per 100,000 men (in 2013), while the annual mortality rate from PC in the US in that same year was 19.9 per 100,000 men. In other words, American men on average eat far fewer eggs but have a PC mortality rate almost eight times greater than in China! And, as I said, there is no correlation between egg yolk or choline consumption outside the borders of the U.S. and Canada.

China has since been surpassed by Japan as the number one consumer of eggs with an even lower incidence of prostate cancer. I decided to take a look at men's average BMI as an indicator of insulin resistance. For China: 24.2, Japan: 23.6, US: 28.8, Canada: 27.6. Might be something there. I took a look at the incidence of prostate cancer across Asia and overall it's really low, even in Kuwait where they have one of the highest average male BMIs, 29.5. I noticed the prostate cancer rate in Isreal is by far the highest across all of Asia. The deeper I dive, the more confused I get.
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Re: Men with BPH and APOE4

Postby Tincup » Fri Jun 07, 2019 8:25 pm

Julie G wrote:I decided to take a look at men's average BMI as an indicator of insulin resistance. For China: 24.2, Japan: 23.6, US: 28.8, Canada: 27.6.


I know that Stavia told me that to use BMI as an indicator for insulin resistance for (at least South) Asians, you would use a much lower cutoff than for Caucasians.

Most, but not all of the men that I know with prostate cancer have bellies, many of them significant (of course, as does most of the population).

Healthy user bias certainly can be an issue, especially with FFQ data.

And this paper on IR, hypertension & BPH.
"The Tsimane, an indigenous population living in the lowland Amazonian region of Bolivia, rely on hunting, fishing, foraging, and small-scale horticulture for subsistence.107 The authors report that Tsimane men have significantly smaller prostate volumes and a reduced rate of prostate growth with age, compared to men in industrial populations. The Tsimane prevalence of BPH between the ages of 40-80 is less than half of what is seen in U.S. and British men [. . .], while more advanced cases of BPH (>40 cc) were almost non-existent (<1% of Tsimane men)."
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Re: Men with BPH and APOE4

Postby Stavia » Sat Jun 08, 2019 12:24 pm

The thing about prostate cancer is that most older men die with a small histological focus if you look closely enough at autopsy. Prostate cancer does not have a high mortality and usually goes undetected over a lifetime if not sceened for. So if you live in a country with prostate screening, the incidence will appear higher than countries where there is no screening. You need to compare prostate cancer mortality, not incidence, to get a more accurate idea.


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