Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Tuesday, July 19, 2011

Baldness/Prostatitis Treatment, Impotence, Inflammation

Male pattern baldness appears to result from the interaction between enzyme-modified male sex hormones (DHT) and receptors in some hair follicles of the scalp.  Inhibition of the enzyme by topical (Rogaine) or oral administration (Propecia) of an inhibitor, e.g Finasteride, can stop hair loss.  One of the significant side effects of oral use of Finasteride is loss of all sexual functions, which can be temporary and reversible after the drug is stopped, or permanent.  I think that inflammation may play a critical role in both hair loss (and prostatitis) and loss of sexual functions in response to Finasteride and an anti-inflammatory approach my be helpful.
Testosterone is Converted to  Dihydrotestosterone (DHT) by 5-Alpha Reductase
The male hormone, testosterone, is produced in the testes and travels to hair follicle or to other parts of the body via the blood in either a free state, or bound to a carrier protein.  Only the free form interacts with the 5-alpha reductase enzyme in the scalp to produce the DHT that diminishes hair follicles.  Application of the Reductase inhibitor, Finasteride, directly to the scalp stops the production of DHT in the scalp.  Taking oral Finasteride blocks DHT production throughout the body, and unlike topical application, can also result in apparent changes in the brain, which can explain loss of sexual behavior.
DHT Role in Hair Loss and Brain-Based Sexual Behavior is Poorly Understood
Surprisingly, the molecular biology of male pattern baldness (MPB) is not known, even though this is one of the classic examples of a dominant, sex-associated phenotype, i.e. a single copy of the baldness allele in males produces baldness.  Of course, this is not a sex linked gene, since baldness is not inherited from mothers with their X chromosome, and in some cases as many as 80% of the males in a single family exhibit male pattern baldness.  It appears to me that baldness is also likely to have an environmental, e.g. gut flora, heritability similar to obesity.  In fact, metabolic syndrome and type 2 diabetes are substantial risk factors for male pattern baldness.
There is also an association between MPB and polycystic ovary syndrome (PCOS) in females of the same family.  I would also expect that MPB is related to prostatitis, since the prostate is a major processor of testosterone to DHT via 5-alpha reductase and prostatitis can be treated with Finasteride.  PCOS is also treated with Finasteride.  PCOS is also associated with obesity and metabolic syndrome.  Prostatitis, PCOS, obesity and metabolic syndrome can all be treated as inflammatory diseases with significant contribution of dysfunction of gut flora.
PMB, Testosterone, 5-Alpha Reductase and Aromatase
In PMB, testosterone levels are lower and 5-alpha reductase is higher.  This suggests that testosterone has been converted into DHT in scalp hair follicles.  In order for DHT levels to make a difference, the hair follicles have to have specific receptors for DHT.  Testosterone/DHT receptors, like all steroid hormone receptors, are proteins in the cytoplasm of cells, which bind the hormone and become activated as transcription factors that migrate to the nucleus and control the expression of particular genes.
Testosterone can also be converted by another enzyme, aromatase, into estrogen.  DHT cannot be converted enzymatically into estrogen.  Estrogen has a separate receptor and controls a different set of genes.  Thus, enhanced conversion of testosterone into DHT in MPB follicles, may shift the balance away from estrogenic in favor of androgenic effects.  Women exposed to aromatase inhibitors, stop converting their limited testosterone into estrogen and more is converted into DHT, resulting in rapid signs of baldness.   All brain estrogen is produced from testosterone via aromatase in the brain and aromatase inhibitors can reduce libido in women.
DHT Activates Inflammatory NFkB (and Block Nerve Apoptosis?)
Prolonged exposure of cerebral blood vessels to DHT has been shown to activate the inflammatory transcription factor NFkB.  Conversion of testosterone to DHT by 5-alpha reductase may amplify the inflammatory impact of testosterone by virtue of the stronger activation of the androgen receptor by DHT.  Activation of NFkB also suppresses apoptosis and may be necessary to maintain some neural cells.  Reducing DHT production by 5-alpha reductase inhibitors, may reduce NFkB activation in the brain and expose androgen-sensitive parts of the brain to apoptosis.  This loss of brain cells may result in loss of sexual behavior.
Vitamin D is also Steroid Hormone/Co-Transcription Factor
It should be remembered that vitamin D also has a cytoplasmic receptor that acts as a transcription factor and that vitamin D deficiency can result in hair loss.  If fact, vitamin D is required for the normal hair growth cycle, as well as intestinal villi development (defensin production).   The vitamin D receptor can also inhibit the inflammatory transcription factor NFkB.
Thus, multiple steroid hormone receptors are involved in hair development, prostate function and brain sexual behavior.  Modification of the conversion of testosterone into DHT or estrogen can have diverse consequences directly or indirectly by modification of inflammation/development signaling.  This is also true of fertility/menstrual cycles, mammary tissue and perhaps intestinal epithelial villi or skin/follicle development in the case of rosacea.  All of these processes are affected by enzymatic interconversion of steroid hormones and interaction of hormone/receptor and NFkB transcription factors.
The questions that I have about hair loss (or prostatitis), treatment with 5-alpha reductase inhibitors, and subsequent loss of sexual function are:
  1. Why are the genetics of MPB so unusual/non-Mendelian?  There are too many males with MPB in the same family.  This points to some hereditary predisposition, but with a major environmental component, e.g. “inherited gut flora.”
  2. Why are only a few of the people treated with 5-alpha reductase inhibitors rendered permanently impotent?
  3. There is anecdotal evidence that dexamethasone (or prostate message and antibiotics) can reverse some impotence.  Does this indicate that inflammation is involved in hair loss and/or impotence?  Where do the antibiotics act and is their action to kill bacteria?
Treatment for Finasteride-Induced Impotence
Impotence is a severe side effect of a few men using Finasteride to treat baldness or prostatitis.  I doubt that those with induced impotence are genetically predisposed, but rather these individuals probably had an altered immune system.  I suspect two types of alterations:  a compromised blood/brain barrier and a compromised suppressive immune system.  Diet-based chronic inflammation is a typical path to a leaky blood/brain barrier that facilitates the penetration of Finasteride into the brain to alter 5-alpha reductase in the DHT-responsive regions responsible for sexual function.  I presume that the subsequent reduction of DHT also results in inflammation that contributes to loss of function.  Dexamethasone and some antibiotics could attenuate the inflammation and return normal function.
Suppression of attack of normal tissues by the immune system is mediated by development of the suppressive immune system in the gut in response to specific bacteria of the gut flora.  A history of antibiotic treatment can yield a dysfunctional gut flora and a compromised immune system that results in allergies and autoimmunity.  Prostatitis may have an autoimmune component and may result from compromised gut flora.
All of the symptoms discussed from hair loss to prostatitis to impotence should be improved by normal function of the gut and immune system by my anti-inflammatory diet and normal gut flora.  Use of antibiotics will always lead to further side effects by perturbing and limiting the function of gut flora and the immune system that is dependent on the gut flora.
I particularly suspect that vitamin D deficiency is a significant contributor.  Most “anti-inflammatory diets” will lead to chronic inflammation, because they are just high carb diets with a few vegetables.  All of the complex phytochemicals produced by plants will be “antioxidants”.  Adding these antioxidants to an inflammatory diet has no impact.  Look at my anti-inflammatory diet and note that it requires attention to serum vitamin D levels, gets most calories from saturated fat and not carbs (low carb/high saturated fat), no vegetable oils and high omega-3 (EPA, DHA) to 6 ratio.  That means meat/fish/eggs/dairy and lots of fresh vegetables for new gut bacteria.


Fred Hahn said...

Nice blog post.

I have male pattern baldness yet I have been eating a very low carbohydrate, high sat fat, fish and fish oil diet for almost a decade.

I take probiotics, digestive enzymes, NEVER eat junk food or grains, save for a little rice now and again, am lean and muscular.

So why am I so bald? Any ideas?

Dr. Art Ayers said...

Fred Hahn,
This was a difficult article for me to write, because there is no genetic foundation for MPB and I could only address the draconian drug treatments.

You seem to have a good handle on your diet, but don't mention vit.D, antibiotic history or fresh vegetables to enhance gut flora. Is there a particular reason why you take probiotics, digestive enzymes and fish oil? What about constipation or any food allergies? Dental health is also essential.

It would be very interesting to know if fecal transplants can cure or transmit MPB.

I look forward to more info. Thanks for the questions and person insights.

Fred Hahn said...

Thanks doc for the speedy reply!
You said:

"You seem to have a good handle on your diet, but don't mention vit.D,"

My D levels are quite high usually well over 80 and has been as high as 140! I take a D supplement and never use sunscreen.

"...antibiotic history"

I never, ever take them.

"...or fresh vegetables to enhance gut flora."

I don't eat a lot of plants but I do eat some and fruit almost every day along with a potent probiotic.

"Is there a particular reason why you take probiotics, digestive enzymes and fish oil?"

I thought these were good for me. The fish oil is for inflammation. I don't take a lot of it as I eat a lot of fish. I eat my meats fairly raw as well.

"What about constipation..."

I have never been constipated save for recently after taking vicodin for knee pain. I've since had knee surgery and I no longer take the stuff. But I've been balding for years before this.

"...or any food allergies?"

None that I'm aware of save for gluten and I don't touch the stuff. Perhaps when I did this is what killed my hair?

"Dental health is also essential."

Excellent dental health.

I do drink wine every night and have for years. Could this be damaging my gut flora?

It would be very interesting to know if fecal transplants can cure or transmit MPB.

I look forward to more info. Thanks for the questions and person insights.

Anonymous said...

Hello Art,

Thank you so much for addressing this issue. In the interest of keeping this concise, I will try to bullet point my outstanding observations and questions on this matter:

* My physician has had me on a high protein / high probiotic / high fat / low carb / grain-free / high Vit D diet for nearly a year. Effects on sexual function are minimal. Others report the same.
* What are options for patients who don't respond to the anti-inflammatory/Vit D diet? Are fecal transplants, helminth therapy or any other out-of-the-box treatments called for?
* Many propecia-suffering men have generally lowered levels of androgens and do not respond to replacement therapy - can inflammation cause reduced androgen levels and/or prevent a clinical response to therapy?
* Could localized inflammation in the prostate due to bacteria (the gateway being lowered immune response via finasteride-suppressed DHT) result in a novel kind of chronic prostatitis that could incite HPA disregulation?
o I mention this possibility because we have at least 1 anecdotal case of a patient who tried every hormonal therapy possible for a decade, and only now has experienced relief in sexual function after antibiotic cocktails administered in conjunction with deep prostatic massages to break up calcficied bacteria
o And because it is not uncommon for patients to suffer permanent sexual side effects evn after 1 or 2 doses of finasteride!
* One additional worry is that you mention brain cell apoptosis in androgen mediated parts of the brain - is this in any way treatable?
* You mention that "Use of antibiotics will always lead to further side effects by perturbing and limiting the function of gut flora and the immune system that is dependent on the gut flora." But also mention that "some antibiotics could attenuate the inflammation and return normal function." Is there a specific strategy in anti-biotic usage?

I know this is a lot of information. I truly appreciate your time and consideration. There are a lot of us out there with these debilitating, seemingly-permanent side effects from finasteride, and so far, the doctors are very confused on the matter, most treatments do not seem to work.

Anonymous said...

Thank You for this article on hormones. I think hormones are a big part of what is going on in the body. Even people eating perfect diets can have terrible health if their hormones are out of balance.

Do you have any advice on men who have low Testosterone levels? What is the best way to increase it without causing ill effect?

Any more insights on hormones in the body will be greatly appreciated.

Thank You

Asim said...

As a general comment and is NOT directed at Fred above:

One of the trends I am seeing on this site is that posters usually argue that they are getting a diverse gut flora by the following two methods:

a. Taking a probiotic, even one that is 'diverse or eating yoghurt
b. Eating fruits and vegetables,

I would like to comment, because I am quite sure that the good Doctor may sometimes get frustrated that people come on board and consistently make the claims that they are following his 'anti-inflammatory' advice and not seeing results:

As Dr. AYers continually emphasizes, and it seems to be constantly missed by many people, is that probiotics do not provide the diversity needed for the multiple different bacteria that inhabit the gut. This is precisely why, as Dr. AYers points out and he can correct me if I'm wrong, a particular probitioic may actualy excacerbate an already existing inflammatory symptom.

It is nature alone that can provide this diversity, so there are two possibilities:

a. Eating the bacteria directly from nature
b. Stop being overly-hygenic and constantly cleaning yourself and indulge in playing in nature, through things like gardening

The two are essentially related.
As far as fruits and vegetables, they ALSO DO NOT provide the bacteria, they provide the FOOD FOR THE BACTERIA because of the soluble fiber, meaning if your eating fruits and vegetables, but not adding new bacteria, than your just providing food for the pre-existing bacteria already in your gut.

This leads me to a common theme of this site:

Fruits and vegetables, per our kind host, need to carry the diverse bacteria of nature, meaning they should be eating directly from a garden with minimal cleaning, such as simple dusting.

And thnaks AR. AYers once again, for the great post.

Asim said...

To summarize quite simply:

If your not eating and playing 'dirty', your not getting the necessary bacteria.

Anonymous said...

I wonder if the influence of insulin on SHBG and IGFBG (leading to increased DHT) could be a missing link for you? My understanding is that there may be an insulin resistance at the level of skin/hair follicles (but not necessarily throughout the body) that influences testosterone metabolism at least partly through decreased binding globulins. A similar mechanism may promote acne and PCOS. We know that women with PCOS are often insulin resistant and have higher DHT (causing acne, body hair growth, infertility and sometimes pattern baldness). Treating them with metformin will often restore fertility, but not sure if it helps the other symptoms. SHBG is also produced locally by testes, ovaries & prostate.
New research is also questioning if vitamin K is important to SHBG because the structure is very homologous to vitamin K dependent protein S. It all seems to fit with your recommendations...

Nick said...

Hello Art,

I just finished listening to your Jimmy Moore podcast and I was reminded I that I have been wondering for awhile how you feel about recommendations to use antibiotics to treat arthritis (and other joint inflammation issues) and brain infections?

The Perfect Health Diet also differs from the your recommendations with regard to potatoes and rice. I'm curious if you have altered your thoughts about 'safe starches' recently?

I was a long term antibiotic user as a teen for cystic acne and ear infections as a child, so I am hesitant about trying AP.

Best regards,

Jim Thomas said...

Dr. Ayers,

My urologist has me on finasteride and cardura for an enlarged prostrate. I do not suffer from prostatitis or impotence. The only side effect I notice is a marked decrease in ejaculate. Should I be concerned? Thanks for a fascinating site.

Jim Thomas

Anonymous said...

Jim--and others currently taking finasteride/proscar/propecia or any 5ARI-type drug (like saw palmetto)--please visit to learn more about the devastation that these drugs potentially cause to men taking them. (Chemical castration, hormonal upheaval, depression, fatigue, etc.)

Ed said...


Looking forward to your comments on this. Researchers identify 3 enterotypes.

Makes me wonder if randomized studies performed over the last 50+ years have properly randomized cohort enterotypes.

Stephen Boulet said...

Is calcification involved in MPB? If so, I wonder if:

1) nightshade intolerance and its calcitriol content might play a role, and
2) whether vitamin K2 supplementation might help

My digestion has been markedly improved by eliminating nightshades.

Steve said...

Hi Dr. Ayers,

Under what conditions then does 5-AR increase in the body?
If metabolic syndrome and inflammation are the causes of increased 5-AR, then would you recomend reducing and eliminating 5-AR inhibitors after treament with anti-inflammatory diet, increased vit-d, and gut flora balance?

I ask this as i have a young client on 1mg finestride daily because his father has MPB, so he will potentially be taking a LOT of this drug in the long run. The young man currently shows no sign of MPB nor noticed any side effects on sexual activity (yet).



lightcan said...

Thank you dr. Ayers for writing about this.
I heard that male pattern baldness skips a generation, although it seems silly to me. My father was almost totally bald already in his 20s (no visible metabolic syndrome) and his grand-father from his mother's side was too. My husband's father was bald too especially as an old man. Does this means my son is going to suffer from this?
My father has also had recently some problems with his prostate, he didn't want to talk about it, but he was saying he needs to drain the liquid from it with a needle.
BTW, I am 'hormonally challenged' too, have adult acne, hirsutism, however, no PCOS diagnosis, unfortunately gum disease, as you know, and constipation.
Does it make any sense?

Anonymous said...

steve -

get him off of it, slowly taper. I was also a normal active 24 year old and took only 40 pills, and now am stuck with a plethora of health issues and no libido at age 26.

Rich said...

I started going bald when I was 15, which is pretty extreme, so I have been interested in its causes. After starting to read your blog it occurred to me that it might be inflammation related.

Baldness is an autoimmune disease in that your white blood cells attack your hair follicles under the influence of DHT. At first I could actually feel a burning sensation at the forehead hairline and at the tonsure where I was losing hair the fastest. I've read accounts of skin reddening being visible along with the burning sensation. All signs of an immune system out of balance.

Have you written about inflammation and sleep disturbances? I have also had a problem with waking up at 3 or 4 in the morning and being unable to get back to sleep. This has been greatly improved since I've started to take fish oil, which might be a clue to inflammation being a cause.

Gavin said...

Dr Ayers

I came across this article this morning which suggests (as far as I can see) that omega 3 PUFAs can cause just as much oxidative damage as Omega 6s

I read this as: supplementing with fish oil may alleviate inflammation short term but cause more serious health problems long term

What's your take on this?

Fred Hahn said...


If balding is due to systemic inflammation and not genetic, why are there so many junkies, bums, alcoholics, etc. with full heads of hair?

Fred Hahn said...

Q: If baldness is not genetic but instead caused by systemic inflammation, why are there so many drug addict, alcoholic, homeless people with full heads of hair?

Mary said...

Dr. Art Ayers: Great article! I hope you can write about FPB and women's hair thinning too, apologies if you already have, as I reaslise they have similarities with MPB but there must be some differences too. I've been reading that Finisteride might not work on women as it does on men.. Plus, I don't think women want anymore help at lowering their libido!

Rich: I had that same burning feeling on my head. It felt like it was literally on fire and loads of hair was falling out. My doctor didn't seem to take me seriously and said my scalp looked fine.. Eventually they prescribed Nizoral but I didn't like the way it made me feel so I stopped using it. Months later the burning stopped but I still have an irritating feeling on my head.

Anonymous said...

DR Ayers, you are about to get BOMBED with questions from Finasteride sufferers.

Thanks for the blog and hope you can answer some of the questions, It really is a desperate situation for us.

Anonymous said...

Hello Dr,

You talk about diet, supplements and dexamethasone. Do you have any views of exercise and alcohol consumption?

Dave, RN said...

I have developed trouble urinating and have eaten a low inflammatiry diet for about 5 years. The problem started in the pat year or so. Digital exam was normal. PSA was .4 (point four). All they could figure ws that there ws a tiny bit of inflammation at the wrong spot (the front that they can't feel).
Any suggestions on how to fix this without drugs? My doc gave me Avodart, which has helped, but I hate taking that stuff.
I do have an appt with a doc that speacializes in hormones next month to see whats what. My testosterone level was 485 recently. D level was 55 ng/ml... I'm 51 and eat exactly as you suggest. I get plenty of saturated fat. I do drink dairy, but it's raw goat milk from a local farm. I eat wild caught salmon and get beef that's grassfed from a local ranch...I eat no processed foods. Thanks in advance.

Dave, RN said...

I forgot to mention that I'm 6' tall and weight about 160. I workout 3X a week, typically with the TRX system. Changing my diet 5 years ago lead to a 30 lb weight loss and I got rid of my blood sugar problem that was developing.
I also have tendonitis in both elbows and knees. Shoulder spurs as well. All developed in the past 3 years.

Dr. Art Ayers said...

Dave, RN,
I think that your diet sounds basically good, but you still have classic symptoms of chronic inflammation: tendonititis, swollen prostate.

The obvious sources are low vit.D, dental infections, gluten intolerance or dysfunctional gut flora. You should be able to just gradually increase fish oil until the symptoms are gone. That will tell you if the problem is inflammation. Your blood vitD is on the low end, so I would probably supplement to raise it to >70.

How do you respond to pectin in apples and inulin in leeks? Are you constipated? Have you taken antibiotics?

I would not use a 5-alpha reductase inhibitor unless the alternative was surgery or death.

I think that your problem has a simple solution. Get back to me with more info.

Dr. Art Ayers said...

Hi Asim,
Thanks for your concise summary and comments. I completely agree.

Betsy said...

Hi Dr. Ayers, Like many people I found your blog while researching my own condition and have learned a lot from it. I was recently diagosed with rheumatoid arthritis based on symptoms (joint pain and stiffness in hands, wrists and knees that came on suddenly) and weak positve anti-CCP blood test(25). But my Sed rate is low (7mm/h), rheumatoid factor is negative, CRP is also low (<.01mg/dL). I am 47, have been eating a diet that is fairly anti-inflammatory for most of my adult life, mostly veggies, very little processed foods, oily fish and fish oil, only olive oil, some gluten but way less than average American diet, no anti-biotics and good dental health. I swim 3x week and am very fit. Currently taking 10mg of prednisone while deciding what to do about treatment. It has helped my sypmtoms significantly. Rheumatolgist is suggesting MTX, but I would like to avoid heavy drugs. Do you think inflammation is an underlying problem for me despite my blood results and diet? Thanks, Betsy

Fred Hahn said...

Besty I'd remove ALL gluten. Even a little is very inflammatory. Wheat is the worst offender.

Dr. Art Ayers said...

Your condition is obviously inflammatory (and autoimmune) with classic symptoms and response to a potent anti-inflammatory drug.

The cause of your condition was chronic inflammation (probably dietary), combined with modest injury to joints and damage to your gut flora (which reduced regulatory T cells and led to autoimmunity.) Normal and even intense exercise should result in joint damage that is fully repaired. Chronic use damage can accumulate, however, if chronic inflammation is present.

I can't tell from your brief description where you get most of your calories. If it is not saturated fat in meat/dairy, then it is usually plant starch. The carb-based diet would tend toward higher blood sugar/insulin and higher production of reactive oxygen species... inflammation. Your diet remains your main cause of problems. Constipation would be a symptom of extreme gut dysbiosis.

As Fred indicated, gluten would be another obvious source of inflammation and disruption of normal gut/gut flora function.

Vitamin D deficiency would be another likely candidate.

All of the local treatments. heat/cold, capsaicin/menthol/castor oil, vagal stimulation postures/exercises, should give temporary relief from pain, so that you can maintain a complete range of motion. Brief use of NSAIDS may also be worth their side effects, to provide a return to normal activity.

For a permanent cure, you need to repair your gut flora, fix vit.D, fix diet and maintain exercise.

You should have no symptoms at your relatively young age, unless you have poorly managed inflammation. I think that complete relief from your symptoms should be fairly simple.

Let me know how you do.

Fred Hahn said...

Dr. Ayers you said:

"The carb-based diet would tend toward higher blood sugar/insulin and higher production of reactive oxygen species... inflammation."

Can you cite any good papers that support this. I have many clients who would love to read up on this.

Also, how badly does alcohol damage gut flora? I drink a few glasses of wine each night.

And what would you say is the best way to "regrow" a healthy gut flora if it is damaged? Are any supplements useful?

Dr. Art Ayers said...

Fred Hahn,
Thanks for your thoughtful comments and questions.

I am puzzled by baldness. There are some hereditary components, but not just the result of one or two genes.

It seems to me that baldness is like type I diabetes, but with the DHT receptor, and stem cells in the hair follicles also involved. Attack on pancreatic cells is in turn similar to amyloid death in Alzheimer's. As you can see, all of these diseases lack knowledge of their causes, genetics and treatment/cures. In all cases, treatment is a better source of income to the medical industry than prevention or cures.

You make the point that chronic inflammation is not sufficient to cause baldness. A single gene does not control baldness, yet the prevalence of baldness in some families can be extreme. I tend to attribute this hereditary component to common diet and gut flora, which might lead to common deficiencies of the immune system.

When I project deficiencies of the immune system onto your case, all I come up with is a deficiency of your gut flora that is not offset with probiotics. This would necessitate that you have a high level of personal hygiene without the possibility for intrusions of new bacteria via new initmate relationships, soil clinging to raw vegetables, etc. This hypothesis would also require that your gut flora is in equilibrium and perhaps refractory to new bacterial recruits. This would suggest, as you indicate, that a fecal transplant from an unrelated donor with healthy hair, might be interesting.

Others who have shifted to the diet that I recommend have reported an improvement in hair health, with loss of grey and improved thickness, so at least some forms of hair health are related to inflammation.

Let me know if you get any other insights.

Fred Hahn said...

Interesting Dr. Ayers. What sort of diet other than what I am already eating would aid my gut flora? Eating unwashed veggies? ;)I would eat almost anything to get my hair back.

Dr. Art Ayers said...

Alcohol should have an impact only on gut flora at the top of the GI tract. For example, the treatment to eliminate H. pylori is augmented by drinking alcohol. I wouldn't think that the gut flora at the top of the colon (important for T regs) would be influenced, but I would also note that H. pylori infections increase T regs responsible for avoiding autoimmunity.

The dietary starch/blood sugar/insulin/ROS/inflammation scenario is based on the molecular basis for insulin resistance. I wrote an article on it for Suite 101. Basically, insulin resistance is a protective cellular mechanism to avoid transporting more glucose into a cell that has already maxed out its ATP production and saturated the electron transport chain in its mitochondria. The extra high energy electrons from glycolysis that are dumped into mitochondria leak out as superoxide and inactivate the insulin receptors. The superoxide contributes to ROS and then can signal inflammation via NFkB/IL-1,TNFa, etc. These inflammatory signals are associated with metabolic syndrome and can be readily reversed by fasting even in obese individuals.

By the way, how much vitamin C can you tolerate before diarrhea? Higher tolerance (>4g/d) is an indication of ROS/oxidative stress.

Dr. Art Ayers said...

I just remembered that you commented on knee surgery for knee pain. That would indicate chronic inflammation.

Fred Hahn said...

I never tried high dose C so I'm not sure. What would you suggest taking to see if I am suffering from oxidative stress?

My knee pain seems to be mainly due to being severely bow-legged and 25 years of martial arts. But again, how does one repair the gut if this is the issue?

Betsy said...

Dr. Ayers, Thanks so much for your insights. I have eaten little to no red meat or poultry meat for 20+ years. I eat seafood usually once/wk, eggs once/wk, a fair amount of cheese (almost daily), legumes, nuts, almond milk,and lots of vegetables, especially leafy greens, herbs, mushrooms, alliums. I do usually eat pasta once or twice a week, fresh bread several times per week and we make our own pizza dough at home. I have never had a problem with constipation. So I am hearing that I should reduce or eliminate gluten. I also started taking vitamin D3 supplements 1 month ago. Started at 1000 IU and increased to 2000 IU when I found your blog last week. I take a multi vitamin and 2 nordic natural omega 3s per day (for 2+ years)and it looks like I should increase that as well. My vit D was tested at 23ng/mL before supplementation. Should I increase these supplements? Add pro-biotics? I eat some fermented foods and could easily eat more. I am not obsessive about cleaning veggies. Also, you mentioned glucosamine is good for gut health. Should I supplement with plain glucosomine or one with chondrontin and MSM? Again, many thanks for your insight and advice. Betsy

Anonymous said...

Great blog Dr. Ayers.

I had a question about my condition which is unrelated to this post...
I have cerebellar ataxia and have seen it progress slowly over the past 2 years. I distinctly remember unexplicably having constipation like 3 years ago. Also my D and B12 levels were quite low. A gluten test (although I am skeptical) came out positive. I also have many inflamation related problems like dandruff, periodontal disease, etc.
I took supplements just started taking probiotics and am following some of your advice.
I think improving my digestion is a key.

Any ideas how to slow down the degeneration I am having?


golf said...

I would love to see the questions by Anonymous left on July 20, 2011 12:40 PM answered. No offense to the other people here (such as fred) questioning about hair loss - but the blog post has more to do about finasteride and its side effects. The side effects from finasteride are FAR worse then hair loss, and if one were to experience the full breadth of the side effects for even a day they wouldn't care about their hair at all.

Fred Hahn said...

Finasteride in Propecia gave me a burning sensation in my legs after using it for a week. I flushed the stuff right then and there.

Still, part of the title of the blog is "Baldness treatment..."

The weird thing is I have no baldness in my family. My Dad had more hair than me after chemo for his liver cancer. Grandparents all had full heads of hair. Mother too.

If it is inflammation, again, why do many drug addicted, cigarette smoking, junk food eating, obese 50+ year old men who are riddled with inflammation and have completely disturbed gut flora have full shocks of hair? They should all be bald. This is why I think it is genetic like blue or green eyes are. You're coded so to speak to be bald or to have a hairy back or no body hair at all like some men.

I do observe that men with a lot of body hair especially back hair, tend to be bald. In fact it is almost always the case. When you're at the beach next, observe this. You will almost never see a man with a hairy back with a full head of hair.

When I went full bore paleo nothing changed on my pate in the least and it continues to thin.

Ah well...

Fred Hahn said...

Besty - I firmly believe/know that gluten is absolutely terrible for everyone. Ditch it entirely. No bread, no grains, nuthin'!

I was in the UK last week, caved in and had a few pints. My nose exploded with 3 bloody pustules after 2 days. I had gas coming from everywhere. Terrible.

My opinion is if you are eating gluten in any amount you will never cool your inflammation.

Steve B said...

Dr. Ayers,

I am fascinated by your comment regarding the possible role of gut flora and baldness vis-a-vis the role of gut flora on the immune function. Given the interesting response that occurs when a fecal transplant is done between skinny and obese people, has a reversal/improvement in improvement ever been observed in such cases?

Thank you,


Steve B said...

Clarification: Has there been an improvement in baldness ever observed in someone who has had a fecal transplant for other health reasons?



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Could someone please tell me where or how to have fecal transplant in UK . I am interested in this but I can not find any information on the net !

nutritionbytradition said...

I've read of many centenarians who down bread daily, probably more than once daily in many cases.

I feel that gluten itself prodoesn't cause the same degree of inflammation in everyone. Other lifestyle/dietary practices, like intermittent fasting and calorie restriction, likely help centenarians who eat bread reach their 100th birthday.

nutritionbytradition said...

Also Fred, are you chronically stressed out? I have a hunch that stress itself is sufficient to cause baldness. Stress overworks the adrenal-pituitary cortex, negatively affecting hormone production.

I think it may be these hormonal imbalances that lead to balding.

Fred Hahn said...

Yes of course I have stress. But there are folks under way more stress than I am who are out of shape and eat poorly with full shocks of hair.

Dr. Art Ayers said...

Fred Hahn and Anonymous,

I have been thinking about blocking the inflammation assoicated with balding and will put up another article. I look forward to your comments.

Fred Hahn said...

Great Dr. Ayers. That would be fantastic. As I mentioned, my CRP is usually 1 or under. All my other health markers are excellent. It could be that the years of eating gluten and low fat and all that other nonsense caused my balding and once you do that is that. Some people don't go bald in the face of massive inflammation - lucky them.

Mark Leach said...

Dr. Ayers,

I am a 30 year old man who is 3 years into a battle with "Chronic Prostatitis." Prior to this I had no real health concerns other than "epididimytis" in 2003. I did the usual and took antibtiotics for too long (3 months), alpha blockers, 2400 mg of ibuprofen for months on end, etc. I eventually stopped everything and just relied on pelvic PT and hoping that time would allow the condition to moderate enough for me to live normally which I did for almost 2 years. All the doctors I've seen say there's nothing wrong except for one urologist who was much more thorough in his exam and said that the area around and above my prostate and seminal vesicles is inflamed and congested feeling. This was judged off of his touch alone.

We tried manually breaking up the inflammation through repeated prostate massage which greatly worsened my urinary irritation symptoms for several months afterwards.

Since then I've had several doctors tell me I have symptoms of a systemic inflammatory condition such as chills, swollen nodes, various other -itis's, yet none have offered suggestions on what to do about it other than try steriods. I've just started on an anti-inflammatory diet based on the Zone diet, and am awaiting a shipment of fish oil to try as I now realize the one pill a day I've been taking isn't sufficient. I've also been using a supplement called "Anatabloc" which I don't know if you're familiar with or not. Any other suggestions for me? I've really struggled to get a handle on how to approach this condition as one specialist after another says whatever body part they're looking at is fine and it must be something else in me causing the inflammation and pain. I've never been tested for vitamin D defiency or anything like that but my c-reactive protein tests were always "normal." My hope is if I lower my systemic inflammation maybe the specific area above my prostate will somehow be able to be healed eventually. Thanks in advance for any advice you can offer. I've been beyond frustrated and discouraged by this condition for years now.

Dr. Art Ayers said...

Mark Leach,
I think that chronic prostatitis is easier to treat than most MDs wish to think. In most cases the postage picks up a minor infection by being connected to the urinary tract. So it is kind of similar to an ear infection and is similarly prone to exploitation by the medical industry. In both cases, the plumbing is normally flushed out/drains, but inflammation can block fluid flow and result in spreading cycles of inflammation. The inflammation can also result in autoimmune responses.
Treatment should begin with simple adjustments to the immune system: vitamin D, gluten elimination, increase omega 3/6 ratio, remediate gut flora. In most cases, this will reduce symptoms in a week or two. It may take longer if your gut flora were permanently damaged by antibiotics and you are too hygienic.

Vitamin D: Have your serum vitamin D level measured, supplement until a new test gives a value over 70 ng/ml.

Gluten Elimination: Response to grain gluten in the gut can result in an autoimmune reaction to intestine proteins that are also found in the prostate. Stop exacerbating this cycle by eliminating grains -- just switch to the low carb diet that I recommend.

Increase Omega 3/6 Ratio: Vegetable oils contribute to your inflammation. Eliminate them from your diet and switch to saturated fats and fish oils. The Sears Zone diet should provide you with guidance.

Remediate Gut Flora: I think that your problems started by the first antibiotic treatment that made your gut flora inflammatory. Now you have to restructure it by eating new bacteria (probiotics PLUS OTHER BACTERIA ON RAW FOOD.) If you routinely try to avoid dangerous bacteria with frequent hand washing and cleaning vegetables, then that behavior is part of your problem. You are also eliminating the sources of bacteria that you need to recolonize your gut and repair your immune system. You also need to eat soluble fiber to feed the gut bacteria that provide you with vitamins and form your stools. constipation is the sign of a sick gut flora and defective immune system.

I cover these subjects in the 180+ articles on this blog. If you need more help, just ask. I try to monitor posts.

Mark Leach said...

Thanks for the advice Dr. Ayers. It's tough navigating through all the countless theories and anecdoctal tales of people curing their prostatitis by switching toothpastes and stuff like that. I've had 3 urologists say my inflammatory symptoms and conditions I developed concurrently can't be related to the prostatitis and I should go see another specialist for each one. I went from being a healthy 28 year old to chronic pain and a stable of 6 useless specialists in 3 months.

This actually started with "epididimytis" though I never tested positive for any bacteria. My scrotum was painful and swollen, and then over the several months of bactrim, cipro, doxy, and levaquin, it progressed into urinary symptoms and a "prostatitis" or "chronic pelvic pain" diagnosis.

I started approaching this more holistically last winter when I did the CLEAN Program 3 week detox that is intended to rebuild the gut flora. I went off gluten for those 3 weeks and didn't notice anything drastic but I also wasn't taking fish oil or anything else at the time. My symptoms were also really bad at the time, which probably means inflamed, which also means I was depressed and stressed out over it so it might not have been the best test. It was shortly after a urologist tried repeated prostate massages over a three day period trying to break up the inflammation manually. It seemed to greatly increase the inflammation and bladder/prostate irritation instead. He thought it was a mast cell response but taking both singulair and benedryl did nothing to help with that. I'm still not back to where I was prior to that attempted treatment pain wise.

I plan to follow your suggestions. I stopped gluten this week and plan to start supplementing with a high dose of fish oil once that comes in. I also will start supplementing with vitamin D. I unfortunately was given antibiotics again since I did the CLEAN program so I take probiotics and eat yogurt with pre and probiotics in it several times a week. I plan to read more of your posts as I have found them very interesting and relevant to my condition. Thanks again, I'll let you know how it goes.

Joe said...

Sorry to go of the topic, but would love your opinion on something. My mother has recently had some memory problems, we think she is pretty much post menopause, but her issues seem to be getting worse, she is really struggling it seems with short term memory, she says her thoughts are fuzzy, she has started carrying a little notebook with everything in it. We are concerned she might lose her job, she is a nurse. I am guessing this will be affecting her work, as she just cannot say what she wants to most of the time, most people must think she has Alzheimer's or similar. But she has had brain scans and there is no sign of stroke or anything. We suggested to the doctor it could be menopause, but they disagree. Even though they have put her on HRT treatment, but she stopped after 2 weeks complaining of pains near her heart. I have read that lowered estrogen can cause fuzzy thinking and memory problems. I do not like the idea of HRT treatment from what I have read, as excess estrogen leads to all sorts of health problems(strokes cancer etc). A bit of family history both her parents died of strokes in their early 60's. Both me and my sisters all seem to suffer from some autoimmune disorders. One sister has dysphraxia, the other has all sorts of allergies and myself have an early receding hairline, premature greying and I am pretty sure if I was at school now I would be diagnosed with ADHD, as I had most of the symptoms. I decided to go on a gluten free/low inflammatory diet just over 2 months ago and already can feel some benefits, for the first time in my life my stools seem to be normal, more energy, need less sleep, better concentration and my muscles do not seem to be as sore after training, this has never happened before, I am a competitive athlete by the way. So I am thinking there is less inflammation in my body. So back to the important matter of my mother. I have suggested a similar diet for her. Do you have any thoughts on any of this you would be kind enough to share?

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I recently read that finasteride can cause permanent loss of libido in certain men. With so many prescriptions being sold each year, that can amount to thousands of men having permanent damage to their libido. I think vitamin D (liquid) and Omega 3, 6 and 9 fish oils should have a positive effect on digestion, as well as saw palmetto and mastic gum.

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Anonymous said...

Hi guys, I'm a newbie to the forum and came across it while trying to find out ways to cure my Chronic Prostititis. Dr Ayers, your knowledge on thsi subject is very impressive! I hope to gain soem knowledge and hope my posts will help others as well.

Some backgound information on myself:

32 year old healthy male eat right and exercise regularly. I noticed problems over 5 years ago but can't pinpoint when they started.

Urologist, checked prostate, did cystoscopy and then put me on 6 weeks of sulfatrim.

After those antibiotics didn't work I decided to try Saw Palmetto 320mg for 3 weeks.... BIG MISTAKE!
Negatives: Lost Libido & Brain Fog
Benefits: CP symtoms got better and I grew a few new hairs on my hairline (I have a full set of hair so growing hair is not my concern)

I then tried one week of 0.5mg of finistrade a day and I had the same sides as SP, so I stopped.

Seems that the DHT inhibitors were good for my prosititus and hair but not my Libido and I do not want to lose that. I still have not fully recovered and it's been a week of no SP or Fin.

I currently take:
Fish Oils
Omega 3, 6, & 9 tabs
GNC Mega Man Sport
GNC Saw Palmetto formula: LOW DOSAGE (5Omg sp, 6mg Pygeum & 25mg Pumpkin Seed)
Eat pumpkin seeds, watermelon, pomoganede, green tea, yorurt, regularly. Cut out spices, caffeine and alochol (Except Red Wine, which reduces the symptoms of frequent urination at night)

I am going to start accpunture and regular therapudic massages this week. Has Accunpuncture worked for anyoen else?

I also will start taking hot baths and doing abdonimnal stretches to see if it helps.

Dr, is there anything else you can recommend?

One point I must make is that I've been masturbating heavily since I was 12 years old. It's really embarrasssing but I mean upto 10 times a day soemtimes. I've decided that starting this week I will cut out sex and masterbation totally to see if that helps, as I noticed I feel pain down in the whole area after sex or masterbation includign testicle pain. Cutting this out should not be hard since my libido is struggling right now anyways.

Any help or advice would be greatly appreciated but I jsut do not want to take any more drugs.


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Manuel said...

I hope there are more clear ways on how to prevent prostatitis. There are lots of men that suffer from it and isn't aware of where they got it.

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Will said...

Hi Dr Ayers,

I recently stopped taking propecia and less than a week later started developing symptoms including pain in the testicles particularly the left one and have got back ache as well. I have a urologist appointment tomorrow but I'm terrified something may be wrong. I've not suffered any noticeable sexual sides on fin since coming off, just this very painful ache in my testicles.

From you vast experience of this topic, is there anything I can take to calm these symptoms down?

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