Open Randomized Clinical Trial to Evaluate the Effects of Intermittent Caloric Restriction in Patients With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

Lower urinary tract symptoms (LUTS) include filling, emptying or post-voiding state alterations; producing symptomatology depending of the underline mechanism. Benign prostatic hyperplasia (BPH) is the most common underlying disease, which increases with age and significantly affects men over 50 years. There are currently no prevention or curative treatment guidelines, as their pathophysiological mechanism is not exactly known. Several factors have been implicated, such as hormones, aging, lifestyle or diet.

BPH is associated with metabolic disorders, the basis of which is insulin resistance and its associated pathologies: diabetes, hypertension, obesity, dyslipidemia and metabolic syndrome. Patients without these metabolic signs have a lower incidence of BPH and / or LUTS. Insulin resistance (IR) is associated with greater proliferation and a reduction of cellular apoptosis at the prostate level; leading to an increase in prostate volume or symptoms. Likewise, the autonomic nervous system (ANS) imbalance, both in favor of sympathetic (emptying symptoms) or parasympathetic (filling symptoms), influences LUTS. SNA activity can be measured non-invasively, repetitively and effectively by measuring the heart rate variability (HRV).

Caloric restriction with optimal nutrition (CRON, hereinafter only CR) is the most physiologically adapted nutritional alternative to our ancestral needs and has been shown in humans to reduce insulin resistance and associated pathologies. It has also been observed that CR improves the balance of the SNA and allows to improve LUTS.

Proliferation inhibition and prostatic apoptosis induction, mediated through CR, by insulin-IGF-1 axis reduction and mTOR metabolic pathways inhibition, are the central axis of this project. CR will be used to reduce insulin resistance, IGF expression and inhibition of the PI3K / AKT / mTOR pathway, to reduce prostate cell proliferation and promote prostatic tissue apoptosis; in this way it will be possible to reduce its volume and improve the symptomatology.

Additionally, CR will allow us to evaluate the potential benefits it has on certain metabolic diseases (diabetes, dyslipidemia, obesity, hypertension, etc.), anthropometric values (BMI, abdominal perimeter and skin folds) and autonomic nervous system functionality (HRV) .


Eligibility Criteria:
Inclusion Criteria:

* Signature of specific informed consent for this study.
* Metabolic syndrome according to WHO criteria
* Current intake food pattern \> 14 hours of duration.
* Total PSA below 2,5 ng/mL or total PSA 4 - 10 ng/mL and free/total PSA \> 25%
* IPSS score \> 9 points
* Maximal flow rate \< 15 cc/secs
* Prostatic volume \> 40 cc.

Exclusion Criteria:

* Active oncological disease; includes patients already treated without complete remission or in current active treatment.
* PSA 4 - 10 ng/mL and free/total PSA \< 25% or PSA \> 10 ng/mL
* Previous prostatic biopsy in the last 5 years.
* Treatment with prostatic phytotherapy in the last 4 weeks.
* BPH alphablocking treatment in the last 6 weeks.
* 5-alpha-reductase treatment in the last 6 months.
* Anticholinergic or betamimetics treatment in the last 4 weeks
* Eating, weight management disorder or previous bariatric surgery.
* Concurrent treatment with the following drugs in the fasting period: AAS and NSAIDs (except paracetamol).
* Concurrent treatment with any of the following steroids: prednisolone, budesonide, dexamethasone, fluidcortisone, hydrocortisone or prednisone.
* Major mental illness, which does not allow informed consent.
* Previous cardiovascular event in the last 12 months.
* Liver, gastrointestinal, renal or severe previous endocrine or decompensated disease in the last 12 months.
* Presence of significant vesical lithiasis.
* Type I diabetic patients
* Type II diabetic patients in treatment with sulfonylureas and sodium-glucose cotransport inhibitors, as well as in patients with insulin therapy.
* Loss of patient follow-up
* Non-compliance with protocol procedures.