I stopped taking medications for my enlarged prostate because of the unbearable side effects: Can herbal remedies help me? DR MARTIN SCURR answers

I have been diagnosed with an enlarged prostate. However, I have stopped taking the medications prescribed by my GP because the side effects were unbearable. Are there any effective herbal remedies or should I consider surgical options? I am 69.

David Meech, St Asaph, North Wales.

Dr. Martin Scurr responds: Benign prostatic hyperplasia (BPH) – an enlarged prostate – is common, affecting 60 percent of men aged 60 and 80 percent of men aged 80.

Benign prostatic hyperplasia, an enlarged prostate, is initially treated with alpha-adrenergic receptor blockers, medications that can provide relief within a few days

In most cases, it disrupts the flow of urine, causing frequent urination, nocturia (needing to urinate at night) and poor urine stream. Usually, the symptoms worsen gradually, but it is worth emphasizing that BPH is not a risk factor for prostate cancer, although they can coexist.

Initial treatment consists of alpha-adrenergic receptor blockers, medications that can provide relief within a few days.

In your longer letter you write that you were treated with such a drug – tamsulosin – but that it caused dizziness and muscle spasms in the neck.

A second drug, finasteride, can also cause unpleasant side effects (including depressed mood and sexual dysfunction).

There is a third drug choice that you apparently haven’t been offered yet: phosphodiesterase type 5 inhibitors. These are commonly prescribed for erectile dysfunction.

One of these, tadalafil, is the treatment of choice for BPH and several studies show that it improves symptoms. Although it can also have side effects, such as headache, flushing and indigestion, it is worth discussing with your doctor.

You indicate that you have been using the herbal supplement saw palmetto on and off for a number of years, but you are not sure how effective it is.

Saw palmetto is a popular herbal remedy for BPH, but there is no clear research evidence that it works.

Your other option is surgery. The appropriate type depends on the size and shape of the prostate and the potential risk of bleeding. The most common is transurethral resection of the prostate (TURP), but there are also laser techniques or vaporizing the excess prostate tissue using steam or water jets, among other methods. Medications have largely replaced routine surgery, but if you choose this route, the importance of finding a skilled and experienced surgeon cannot be overstated.

My granddaughter has been a vegetarian since she was a little girl and although she now eats chicken, she stews it in salt. I am concerned about her diet and don’t think she realizes the health risks.

Name and address will be provided.

Dr. Scurr responds: I understand your concerns, but rest assured, there is ample evidence that children’s nutritional needs can be met with a well-balanced vegetarian or vegan diet supplemented with supplements.

A study of vegetarian adolescents found that they had lower BMIs, waist circumferences and cholesterol levels than their classmates. Given the high percentage of children who are worryingly overweight, this is not insignificant.

In your longer letter you express concern about her heavy periods and suggest she see a doctor.

I think this is wise, perhaps to check with a blood test that she has not become anemic as a result of low iron intake.

I am concerned about her calcium intake, especially if she does not eat dairy or fish. This is essential for a growing woman for bone strength – bone mass peaks at age 16 and after that she will not be able to improve bone strength regardless of her dietary intake. And protection against osteoporosis in middle age and beyond is set in during the adolescent years of growth.

Vegetarians’ intake of other key nutrients – including B vitamins, vitamin D and selenium – is also likely to be lower. One way to compensate for this is to eat fortified breakfast cereals.

It’s a delicate matter and if you express your disapproval of her dietary preferences, there’s a good chance it will fail.

My advice is not to judge, but to find a good vegetarian cookbook and get her interested. Also try to find a cooking class that you can take together.

• Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk — include your contact details. Responses should be taken in the general context and always consult your own GP with any health concerns.