MALE ORDER: A GUIDE TO MEN'S HEALTH

By: 

ION Archives

Issue: 
Autumn
Year of publication: 
2001

Until recently women’s issues have dominated media articles and reports on health. Men’s health, in comparison, has tended to be very much ignored. This is a concern as men have a lower life expectancy (around six years) than women, and a higher mortality rate in all age groups. In this article, Hilda Glickman MA Bphil Dip.ION, examines four common complaints in men, and provides nutritional advice for their prevention and control

In terms of lifestyle, men appear to care less than women about their health, and particularly about what they eat. The Oxford Regional Health Authority Lifestyle Survey showed that men were less likely to associate diet with health, had poorer diets and smoked and drank more than women.(1) Interestingly, the study stated that many women eat healthily but prepare different meals for their husbands! Red meat is often portrayed as a “masculine food”, and promotion of British meat pushes the message that “real men eat meat”. Other out-dated theories imply that fish is a food for wimps, plain white fish being associated with the sick and frail.

Men have a tendency to deny illness. Men’s denial of illness is so strong that it is one reason that their average lifespan is considerably shorter than women’s.(2) Doctors know well the male patient who has “nothing wrong” and only attends the surgery because “my wife sent me”. In relation to health and nutritional surveys, men will often return an almost blank questionnaire, while deeper probing might uncover a wealth of ailments. In addition, men usually escape the regular medical checks that many women receive during pregnancy, or when visiting the doctor or health clinic for a mammogram or smear test. Unlike women, men are often not willing or unable to talk about their health problems with friends or relatives. This is especially true of potentially embarrassing conditions such as impotence, prostate problems and infertility.

This article looks at four complaints specific to men and provides dietary and nutritional recommendations for each one.

IMPOTENCE

Impotence or erectile dysfunction affects about three million (one in ten) men in Britain and the success with the drug Viagra shows just how frequent the problem is. Impotence refers to the inability to achieve an erection, and can be occasional or chronic in nature. Ageing itself is not a cause of impotence and men are capable of retaining their virility well into their eighties.

The condition can be caused by a variety of factors, including peripheral vascular disease, excessive alcohol intake, smoking, stress, depression, chronic high blood pressure, heavy metal toxicity, antidepressants and diabetes. Psychological counselling can be helpful if the problem is related to emotional factors.

 

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DIETARY CONSIDERATIONS

Since impaired circulation is the main physical cause of impotence, a diet that protects the arteries is vital. Meals should be based on whole grains, legumes, fresh fruit and vegetables, nuts and seeds and adequate protein in the form of organic chicken, fish or vegetarian alternatives. Foods that should be avoided are those high in saturated and hydrogenated fat and refined carbohydrate products. Alcohol should also be excluded from the diet as it reduces the body’s ability to testosterone.
Ageing itself is not a cause of impotence and men are capable of retaining their virility well into their eighties
SUPPLEMENTATION

 

Nutritional Therapy

L-arginine

Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide. In turn, the amino acid arginine is needed for nitric oxide formation. In a group of 15 men with erectile dysfunction given 2,800mg of arginine a day for two weeks, six were helped, though none improved while taking placebo.(3) Although little is known about how effective arginine will be for men with erectile dysfunction or which subset of these men would be helped, available research looks promising and suggests that at least
some men are likely to benefit.

 

Herbal recommendations

Various herbs have been found to relieve impotence either by improving male glandular function, increasing blood supply to tissues, or enhancing the transmission of nerve signals. For example, yohimbe (Pausinystalia yohimbe) dilates blood vessels produce the male hormone and appears to be effective regardless of the cause of the problem. However, supplementation is best taken under the supervision of a GP or health professional as the herb can elevate blood pressure.

Gingko biloba works by increasing arterial flow, particularly to the extremities. One study found that 80mg three times a day helped increase erectile function.(4) Rhodiola has been used traditionally as a male sexual
tonic, saw palmetto can help improve testosterone activity in the body, and ginseng has long been valued as a supportive herb for male potency. Combinations of some of these herbs are available in health food shops.

 

 

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BENIGN PROSTATIC HYPERPLASIA (BPH)

The prostate is a small round gland about the size of a walnut that surrounds the neck of the bladder and urethra in men. Its main function is to contribute to seminal fluid. If the prostate enlarges, pressure can be put on the urethra, acting like a partial clamp and causing a variety of urinary symptoms. This is known as benign prostatic hyperplasia (BPH).

More physically active men have a lower frequency of symptoms related to Benign Prostatic HyperplasiaAfter the age of about 50, a man’s testosterone level decreases, while other hormones such as prolactin and estradiol increase. These hormone changes cause an accumulation of dihydrotestosterone (DHT), a potent form of testosterone, which gives rise to a hyperplasia (overproduction) of prostate cells. It is this cell overproduction that causes the prostate to enlarge. Typical symptoms of BPH include urinary urgency, frequent urination, dribbling of urine and a burning sensation when passing water. If the prostate enlarges too much, urination is difficult or impossible and the risk of urinary tract infections and kidney damage increases. Around 60% of men aged 40 to 60 suffer from BPH. By the age of 80 this figure increases to about 85-90%.

More physically active men have a lower frequency of symptoms related to BPH. In a recent preliminary study, physical activity was associated with a decrease in occurrence of BPH. (5) Men who walked the most (two to three hours a week) had a 25% lower risk of BPH compared with those who walked the least.

DIETARY CONSIDERATIONS

A whole food diet that includes nuts and seeds (particularly pumpkin seeds), vegetables, fruit and whole grains, along with adequate water intake is recommended. Refined foods, tea, coffee and alcohol should be limited in the diet. A case control study in Greece found that added fats in the form of butter and margarine increased the risk of BPH while fruit decreased the incidence. (6)

SUPPLEMENTATION

 

Nutritional Therapy

Essential fatty acids

Many health professionals have been impressed with the effectiveness of essential fatty acids (EFAs) in cases of BPH. A typical recommendation is one tablespoon of flaxseed oil a day, perhaps reduced to one or two teaspoons a day, after several months.

Pumpkin seed oil has been used in combination with the herb saw palmetto in two double-blind human studies to effectively reduce symptoms of BPH. (7,8) Researchers have suggested the zinc, essential fatty acid, or plant sterol content of pumpkin seeds might account for their benefit in men with this condition, but this has not been confirmed. Animal studies have shown that pumpkin seed extracts can improve the function of the bladder and urethra; this might partially account for BPH symptom relief. (9)

 

Zinc

Prostatic secretions are known to contain a high concentration of zinc; this observation suggests that zinc plays a role in normal prostate function. In one study, men with BPH took 150 mg of zinc daily for two months, and then 50–100 mg daily. In 14 of the 19 men (74%), the prostate became smaller. (10) As this study did not include a control group, the possibility of a placebo effect cannot be ruled out.

Because supplementing with large amounts of zinc (such as 30mg or more a day) can potentially lead to copper deficiency, most nutritionists recommend taking 1mg of copper a day along with zinc.

Beta-sitosterol

Beta-sitosterol, a phytosterol present in fruit, vegetables, seeds and nuts, has been found to be helpful in the treatment of BPH. In one double-blind study, 200 men with BPH received 20mg of beta-sitosterol three times a day or a placebo for six months. Men receiving beta-sitosterol had a significant improvement in urinary flow and an improvement in symptoms, whereas no change was reported in men receiving the placebo. (11)

Rye Pollen

Rye pollen has been reported to improve symptoms of BPH, possibly through an anti-inflammatory effect.(12) One study demonstrated that two capsules of rye pollen extract taken twice a day led to a reduction in symptoms of BPH, compared with the effects of placebo.(13) A multi-centre trial in Germany produced comparable results.(14)

Herbal recommendations

Saw Palmetto The fat-soluble extract of saw palmetto berries has become a popular remedy for BPH. The herb appears to inhibit 5-alpha-reductase, the enzyme that converts testosterone to its more active form, DHT. It also enhances the breakdown and elimination of other hormones and reduces inflammation. A three year study in Germany found that 160mg of saw palmetto extract taken twice daily reduced night time urination in 73% of patients and improved urinary flow rates significantly. A review of all available double blind studies concluded that saw palmetto is as effective for BPH as the drug finasteride, with fewer side effects.(15)

Pygeum

This is an extract from the bark of an African tree and has been approved in Europe as a remedy for BPH. It contains the phytosterol beta-sitosterol which is anti-inflammatory, pentacyclic triterpenoids which has a diuretic action and ferulic esters, which help rid the prostate of any cholesterol deposits that accompany BPH. Studies suggest a dose of 50–100mg of pygeum extract (standardized to contain 14% triterpenes) twice a day.(16)

Nettle

Another herb for BPH is a concentrated extract made from the roots of the nettle plant. This extract may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH.(17)

 

 

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PROSTATE CANCER

The incidence of prostate cancer has doubled in the last 30 years, accounting for four times as many deaths as cervical cancer. Men with a family history of prostate cancer run a higher risk of developing the disease, as do men who experience recurring prostate infections and those who have taken testosterone. A MORI health poll revealed that only 1 in 10 men knew where the prostate gland was situated and half thought that women had a prostate too! (18)

 

DIETARY CONSIDERATIONS

It is generally accepted that a diet rich in fresh fruit and vegetables helps reduce the risk of most cancers. Fish eaters have been reported to have low risks of cancer, including prostate cancer. (19) The omega-3 fatty acids found in fish are thought by some researchers to be the components of fish responsible for cancer protection.

When combined with a low-fibre diet, men consuming a high-fat diet have been reported to have higher levels of testosterone, which could increase the possibility of prostate cancer. (20) In one study, prostate cancer patients consuming the most saturated fat from meat and dairy when followed for over a period of five years had over three times the risk of dying from the disease. (21) A study in 41 countries found that the non-fat portion of milk had the highest association with prostate cancer mortality, possibly due to the calcium content. (22) Another study found that frequent milk intake was a “significant independent indicator of prostatic cancer risk”. (23) It is recommended that men wishing to reduce their risk of prostate cancer should reduce their intake of high fat foods.

Overall, the effect of drinking alcohol on prostate cancer risk appears weak, although some association between beer drinking and increased incidence may exist, according to an analysis of most published reports. (24)

SUPPLEMENTATION

 

Nutritional Therapy

Lycopene

Lycopene, present in tomatoes and tomato based products, is the only carotenoid found to be protective of prostate cancer. One study found that men who ate ten or more servings of tomato-based products a week were up to 45% less likely to develop the disease. (25) When the same researchers looked at advanced prostate cancer they found that high lycopene eaters had an 86% decreased risk. (25) All tomato-based products with the exception of tomato juice, give high protection, cooked tomatoes being better than raw. This is because cooking breaks down the cell walls in tomatoes, releasing more lycopene. The addition of fats and oils aids absorption.

 

Vitamin E

New research suggests that the form of vitamin E known as gamma tocopherol may be more important than alpha tocopherol. The combined use of alpha and gamma tocopherols with selenium seems to have a protective effect. (26)

The incidence of prostate cancer has doubled in the last 30 years accounting for four times as many deaths as cervical cancer

Soya

An inverse association has been found with genistein and daidzein, (isoflavones present in soya produce) and prostate cancer. A prospective study of 12,395 men found that frequent consumption of soya milk was associated with a 70% reduction in the risk of developing the disease. (27)

 

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MALE INFERTILITY

Infertility is defined as the failure of a couple to achieve pregnancy after a year of unprotected intercourse. Males appear to be responsible or share responsibility in around two thirds of all cases. In men, infertility is usually associated with a decrease in sperm production. However, it is possible to have a high sperm count with many defective sperm e.g. abnormally shaped, low motility (power of spontaneous movement).
Sperm count and quality have decreased dramatically in the last twenty years, mainly due to pollution, heavy metal toxicity, organic solvents and pesticides
Sperm count and quality have decreased dramatically in the last twenty years, mainly due to pollution, heavy metal toxicity, organic solvents and pesticides such as DDT and PCBs. PCBs have been particularly implicated and one study found that total sperm counts were inversely proportional to semen concentration of PCBs, the highest being found in fish eating urban dwellers.(28)

 

DIETARY CONSIDERATIONS

The semen of infertile men often contains high levels of free radicals, so an antioxidant-rich diet supplemented with antioxidant nutrients is indicated. Sperm are particularly susceptible to free radical damage because their cell membranes contain large amounts of essential fatty acids, which are easily oxidised. Polyunsaturated fats found in nuts, seeds and oily fish are needed for all aspects of sexual function, including sperm formation. Alcohol reduces sperm count and cigarettes should be avoided.

SUPPLEMENTATION

Nutritional Therapy

Antioxidant nutrients

Vitamin C is required for protection and is more concentrated in seminal fluid than any other bodily fluid, including the blood. Supplementation can be effective as it can prevent sperm agglutination (clumping together). One study found a 140% increase in sperm count in just one week after supplementation with 1000mg of vitamin C daily.(29) After 60 days the entire vitamin C group had impregnated their wives compared to none in the control group.

Other antioxidants are equally important. Vitamin E deficiency in animals leads to infertility.(30) In a preliminary study, men with low fertilisation rates in previous attempts at in vitro fertilisation were given 200iu of
vitamin E a day for three months. After one month of supplementation, fertilisation rates increased significantly and the amount of oxidative stress on sperm cells decreased.(31) A trial at Glasgow Royal Infirmary found that selenium supplementation significantly improved sperm motility.(32)

Vitamin B12

Injections of vitamin B12 have been shown to increase sperm counts. It is involved in cellular replication and a deficiency can result in reduced sperm counts and motility. A dosage of 1000µg has proved effective.(33)

 

Zinc

A lack of zinc can reduce testosterone levels and supplementing zinc can help promote both sperm count and fertility. The optimum amount of this mineral in relation to male infertility has not been established, although 45-60mg a day is suggested.

 

L-arginine

The amino acid L-arginine is needed to produce sperm. Research shows that several months of supplementation can increase sperm count and quality,(34, 35) and also fertility.(36, 37) A dosage of 2-4g a day is recommended.

 

Coenzyme Q10

There is evidence that the compound coenzyme Q10 in amounts of as little as 10mg a day can increase sperm count and motility.(38) This is thought to be linked to sperm movement which depends on the availability of this nutrient.

Conclusion

Male specific conditions such as the ones covered can be helped or prevented by diet and lifestyle modifications. Perhaps targeting men’s health specifically, together with some positive discrimination in favour of men, might go some way to redressing the balance in which men’s and women’s health issues are dealt with. In turn, this may help avoid some of the illness and premature death experienced by the male sex.

 

REFERENCES

 

Roberts H. Oxford Regional Health Lifestyle Survey. Women’s Health Matters, Routledge, 1992.
Sidell, et al. Debates and Dilemmas in Promoting Health, MacMillan 1997.
Zorgniotti A, et al. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impotence Research 1994;6:33-36.
Aitkin, et al. Analysis of the relationship between defective sperm function and the generation of reactive oxygen species in cases of oligospermia. J Androl 1989;10:214-220.
Platz EA, Kawachi I, Rimm EB, et al. Physical activity and benign prostatic hyperplasia. Arch Intern Med 1998;158:2349–56.
Lagiou P, et al. Diet and benign prostatic hyperplasia: a study in Greece. Urology1999;54(2):284-90.
Carbin BE, Eliasson R. Treatment by Curbicin in benign prostatic hyperplasia (BPH). Swed J Biol Med 1989;2:7-9 [in Swedish].
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Zhang X, Ouyang JZ, Zhang YS, et al. Effect of the extracts of pumpkin seeds on the urodynamics of rabbits: an experimental study. J Tongji Med Univ 1994;14:235–8.
Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.
Berges RR, Windeler J, Trampisch HJ, et al. Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.12. Horii A, Iwai S, Maekawa M, Tsujita M. Clinical evaluation of Cernilton in the treatment of the benign prostatic hypertrophy. Hinyokika Kiyo 1985;31:739–45 [in Japanese].
Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, Cernilton. A double-blind, placebo-controlled study. BrJ Urol 1990;66:398–404.
Becker H, Ebeling L. Conservative therapy of benign prostatic hyperplasia (BPH) with Cernilton. Urology (B)1988;28:301–6 [in German].
Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA 1998;280:1604–9.
Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res 1995;56:796–817.
Koch E, Biber A. Pharmacological effects of sabaland urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urology 1994;334:90–5.
Daily Telegraph Magazine, 1995.
Kune GA. Eating fish protects against some cancers:epidemiological and experimental evidence for a hypothesis. J Nutr Med 1990;1:139-44.
Dorgon JF, Judd JT, Longcope C, et al. Effects of dietary fat and fibre on plasma and urine androgens and oestrogens in men: a controlled feeding study. Am J Clin Nutr 1996;64:850-5.
Meyer F, Bairati I, Shadmani R, et al. Dietary fat and prostate cancer survival. Cancer Causes Control 1999;10:245-51.
Grant W. An ecologic study of dietary links to prostate cancer. Altern Med Rev 1999;4(3):162-9.
Chan. Dairy Products, calcium, phosphorus, vitamin D and risk of Prostate cancer. Cancer Causes Control 1998;9(6):559-66.
Dennis Lk. Meta-analysis for combining relative risks of alcohol consumption and prostate cancer. Prostate 2000;42:56-66.
Giovanucci E, et al. Intake of carotenoids and retinal in relation to risk of prostrate cancer. J Natl Inst 1995;87:1767-76.
Helzlsouer KJ, et al. Association between alpha-tocopherol, gamma-tocopherol, selenium and subsequent prostate cancer. J Natl Cancer Inst 2000 Dec 20; 92 (24):2018-2023.
Jacobsen, B. Does high soy milk intake reduce prostate cancer incidence? The Adventist Health Study (United States), Cancer causes Control 1998;9(6):553-7.
Rozati R, et al. Xenoestrogens and male infertility: myth or reality? Asian J Anrol 2000;2(4):263-9.
Dawson E.B, et al. Effect of ascorbic acid on male infertility. Ann NY Acad Sci 1987;489:312-23.
Thiessen DD, et al. Vitamin E and sex behaviour in mice. Nutr Metab 1975;18:116-9.
Geva, Bartoov B, Zabludovsky N, et al. The effect of antioxidant treatment on human spermatozoa and fertilisation rate in an in vitro fertilisation programme. Fertil Steril 1996;66:430-4.
Scott R, et al. The Effects of Oral Selenium supplementation on human sperm motility. British Journal of Urology 1998;82(1):76-80.
Sandler B, et al. Treatment of oligospermia with vitamin B12. Infertility 1984;7 133-8.
Lewin A, et al. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med 1997;18 Suppl:S213-9.
De Aloysio D, Mantuano R, Mauloni M, Nicoletti G. The clinical use of arginine aspartate in male infertility. Acta Eur Fertil 1982;13:133–67.
Tanimura J. Studies on arginine in human semen. Part II. The effects of medication with L-arginine-HCl on male infertility. Bull Osaka Med School 1967;13:84–9.
Schacter A, Goldman JA, Zukerman Z. Treatment of oligospermia with the amino acid arginine. J Urol 1973;110:311–3.
Schacter A, Friedman S, Goldman JA, Eckerling B. Treatment of oligospermia with the amino acid arginine. Int J Gynaecol Obstet 1973;11:206–9.

Hilda Glickman is a Dip.ION nutritionist practising in Hatch End and Northwood.

 

 

Keywords: 
MEN'S HEALTH
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