Specialty Nutrition for Men's Health

“Brother, brother, brother/there’s far too many of you dying.”

The brothers, fathers, sons and boyfriends of the world face a challenge in getting and staying healthy. Males’ common fear of knowing about health problems plays into the lack of early diagnosis and treatment, in addition to indirectly limiting preventive intervention based on the connections found between diseases; but, the bulk of prevention is tied to health behaviors, namely dietary.

More males than females are born, but from birth, the male gender has a tougher time staying healthy and alive. Death rates are higher for males, from newborns to adults, and men still lag in life expectancy, although the gap has narrowed recently, according to the Centers for Disease Control and Prevention (CDC). To better understand the factors involved in men’s health, including life expectancy, mortality and diseases, it’s important to look at what the statistics reveal about what ails men and how they react to health challenges.

Men fall victim to the top causes of death more often than do women. According to the CDC, men’s top 10 causes of death, by percentage of men affected are heart disease, cancer, accidents, stroke, lung disease, diabetes, influenza, suicide, kidney disease and Alzheimer’s disease. While the top four have seen small percentage declines in death rates, these maladies befall a big percentage of men, despite the great potential for prevention.

Statistics reflect the trends in men’s health behavior. The CDC reports 23 percent of men smoke; 70 percent of men 20 years of age or older are overweight; and 26 percent of men 20 years of age or older have hypertension. These three factors greatly affect most of the leading causes of death among adult men. Smoking is indicated as a major causative factor in two-thirds of cancers and also contributes to non-cancerous lung disease. Overweight status is a primary risk factor in diabetes and heart disease, not to mention its effect on depression, immune health and end-stage renal failure. Hypertension is a risk factor in not only heart disease, but also diabetes and stroke.

If men don’t fear the reaper, they should fear the quality of whatever life they have left, as many of the diseases in the top ten affect male performance, from the field to the office to the bedroom. This should be a wake-up call to change male health behavior.

At the heart of male health behavior is lack of awareness. Many men are unaware of underlying diabetes, heart disease and hypertension. Stereotypical machismo assumptions aside, CDC officials report women are 100-percent more likely to visit a doctor for an annual examination or preventive service than are men. There is much speculation and theory as to why men don’t connect often enough with their doctors, but surveys on this behavior should be eye-opening for men and the women who care about them.

A 2005 national survey of U.S. men ages 35 and older revealed eight of every 10 men with high blood pressure were not aware of its connection to erectile dysfunction (ED), one of the biggest health concerns among adult men.¹ Additionally, the results showed many of these men were unaware of the connection between ED and other medical conditions that commonly affect men, such as high cholesterol and diabetes.

An earlier survey from Men’s Health Network, the American Foundation for Urologic Disease (AFUD) and Bayer Corp. found only 15 percent of American men have heard of prostatitis, a painful, non-cancerous inflammatory condition that will affect more than half of the male population at some point in their lives.² “Men suffering with prostatitis often don’t know what hit them, and may be reluctant to talk about it because of the fear factor,” said Tom Bruckman, AFUD.

Another aspect of lack of proper knowledge on health topics is evidenced by the MHN prostatitis survey results showing 83 percent of those respondents who considered themselves knowledgeable about this condition believe prostatitis is a warning symptom or leading indicator of prostate cancer. In fact, prostatitis is an inflammation of the prostate gland, usually from bacterial infection, but not connected to cancer. As a bacterial infection, the main course of treatment is antibiotics, but natural products may help.

In 2000, scientists from Institute for Male Urology in Encino, Calif., found 82 percent of patients who received a specially formulated blend of the bioflavonoid quercetin experienced a 25-percent improvement in the National Institutes of Health (NIH) pain and quality of life symptom score.³ A year later, some of these researchers found an oxidative stress causative component, which they concluded could potentially benefit from antioxidant therapy.⁴ Then in 2006, Chinese researchers discovered increased oxidative stress and damage induced by chronic bacterial prostatitis in patients, noting a connection to the pathology of the disease.⁵

Beyond chronic prostatitis, other degenerative diseases threaten male prostate health.

Benign prostatic hyperplasia (BPH) is enlargement of the prostate gland that causes urinary tract dysfunction and discomfort. BPH accounts for at least 1.7 million doctor’s office visits per year, according to NIH. Researchers have focused on dihydrotestosterone (DHT) and 5-alpha-reductase as primary causative factors.

Saw palmetto (Serenoa repens) is considered an inhibitor of 5-alpha-reductase.⁶ This herb is used for stage one and two BPH cases, including as a prescription preparation in Germany. Saw palmetto extract possesses anti-estrogenic activity and increases urinary flow rate while decreasing nocturia, residual urine and painful urination.

Early trials showed promise for saw palmetto in BPH,^7,8 but a 2006 NEJM trial publication reported no benefits to BPH symptoms in men taking saw palmetto.⁹ However, the American Botanical Council (ABC) and other herbal experts noted the trial focused on men with moderate to severe BPH symptoms, as opposed to men with mild to moderate symptoms, the focus of more than 21 previous trials showing positive benefits of saw palmetto.

Fellow herbal remedy pygeum is often taken in combination with saw palmetto for prostate health. It contains phytochemicals such as beta-sitosterol, pentacyclic terpenes and ferulic esters that help control harmful testosterone activity in the prostate gland. Research has shown pygeum extract can help control DHT and counteract gland enlargement indicated in BPH pathology.¹⁰ Another BPH supplement is pumpkin seed, which may inhibit DHT and inflammatory factors in BPH.¹¹

Despite the availability of herbal supplements, elements of basic nutrition are important to inhibiting development of BPH. A 2007 Johns Hopkins Bloomberg School of Public Health, Baltimore, study report inversely linked risk of BPH with consumption of fruits and vegetables, due mainly to nutrients such as beta-carotene, lutein and vitamin C—vitamin E did not show a connection.¹² More recently, 2008 research from the Fred Hutchinson Cancer Research Center, Seattle, found a slight effect of vitamin D, lycopene and zinc on BPH risk, though failing to connect antioxidants in general.¹³ Researchers also noted moderate alcohol consumption correlated to decreased risk of symptomatic BPH; however, a 2004 study found heavy drinkers are at higher risk of BPH. Alcohol is a risk factor in BPH development, possibly via lower hormone levels due to high consumption.¹⁴

The other major prostate concern among men is cancer, which kills around 30,000 men each year among the 230,000 men afflicted with the disease, including the 186,000 new cases expected in 2008, according to the National Cancer Institute (NCI). In prostate cancer research, lycopene again has taken center stage. Lycopene has been linked to decreased risk of developing prostate cancer, decreased PSA scores and reduced prostate tumor size.¹⁵ However, FDA rejected a health claim for lycopene’s role in prostate cancer, approving a series of qualified claims instead. This tomato carotenoid took its hardest hit in 2007, when scientists from Fred Hutchinson and NCI reported serum levels of lycopene and other carotenoids had no impact on prostate cancer development, while increased beta-carotene actually correlated to increased prostate cancer incidence.¹⁶

As with BPH, plants help inhibit and manage prostate cancer development and progression. Acetyl-11-keto-beta-boswellic acid (AKBA), a component of Boswellia serrata, has been shown to promote apoptosis induced by cytokines and chemotherapeutic agents, as well as inhibit invasion and suppress osteoclastogenesis through inhibition of NF-kappaB-regulated gene expression.¹⁷ Similarly, pomegranate extract inhibited cell growth and induced cancer cell apoptosis in an animal prostate cancer trial.¹⁸ Likewise, both garlic and soy have been found protective against prostate cancer.¹⁹ In fact, garlic was found to lower PSA scores,20 as was soy and its isoflavones genistein and daidzein, which can also limit prostate tumor growth and development.²¹ In 2008, a research report surfaced detailing how genistein could help prevent the spread of prostate cancer in patients.²²

Hormonal help may come from what are widely considered female hormones. A 2005 Swedish trial reported phytoestrogen intake is inversely associated with risk of prostate cancer.²³ And Finnish researchers reported plant lignans (as HMRlignan®, from Linnea) inhibited growth of LNCaP human prostate cell line, resulting in smaller tumor volume, lower tumor take rate, higher tumor cell apoptosis score and increased proportion of nongrowing tumors.²⁴

Micronutrients also weigh in, as selenium intake has been linked to reduced risk of prostate cancer,²⁵ in addition to promoting apoptosis in prostate cancer cells and decreasing cancer-causing DNA damage.²⁶ In fact, the NCI-sponsored Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest ever prostate cancer trial, is investigating the effects of L-selenomethionine (as Selenium SeLECT®, from Sabinsa Corp.) on cancer prevention in more than 35,000 men from a variety of ethnic backgrounds.

Men have many other health concerns below the belt, including ED and fertility problems. As previously mentioned, ED can be a consequence of hypertension and other areas of vascular health. A study reported in the Journal of the American Heart Association concluded men experiencing silent, or symptom-less, coronary artery disease (CAD) and type II diabetes were nine times as likely to have erectile dysfunction (ED) as were diabetic men with more noticeable CAD symptoms.²⁷ On the other hand, a JAMA trial found men diagnosed with incident ED have a 25-percent higher risk of CAD than do men with no ED, while risk in men with prevalent ED rose by 45 percent.²⁸

As an erection requires blood to fill the caverns of the penis, improving blood flow is a crucial aspect of counteracting ED. Nitric oxide-mediated vasodilation is one targeted method of improving blood flow in ED. In fact, an Italian study discovered a direct relationship between copulatory performance and NO synthase activity in the hypothalamus region of the male brain.²⁹Arginine is a well known mediator of NO-dependent vasodilation and has shown the ability to boost sexual activity, including ED.³⁰ Combined with yohimbine, arginine has effectively improved erections in males with mild to moderate ED.³¹ Arginine and yohimbine, as well as panax ginseng, maca and the vasodilator ginkgo, have displayed some degree of benefit in men with ED, possibly due to improvements in penile endothelial L-arginine-NO activity.³² South Korean scientists found 900 mg of panax ginseng given three times daily to patients with clinical ED significantly improved erectile function scores.³³

L-arginine aspirate combined with pine bark extract (as Pycnogenol) has proven an effective ED remedy. A 2008 study revealed intake of the Pycnogenol combination for one month in patients with mild to moderate ED restored erectile function to normal.³⁴ Researchers noted intercourse frequency doubled; e-NOS in spermatozoa and testosterone levels in blood increased significantly; and both cholesterol levels and blood pressure were lowered in those taking Pycnogenol and arginine. This echoed earlier research from Slovakia, which reported Pycnogenol reduced ED from severe to mild in 21 patients, while also increasing plasma antioxidant activity and reducing in total cholesterol.³⁵

One of the newest ingredients to the ED arsenal is pomegranate, which has turned in positive early results in improving erections in ED patients. A 2007 study from UCLA involved 53 males assigned either pomegranate juice (as POM Wonderful, from POM) or placebo for four weeks.³⁶ Measures of erectile performance were obtained using International Index of Erectile Function (IIEF) and Global Assessment Questionnaires (GAQ). At the trial end, 47 percent of men in the pomegranate group reported improved erections, compared to just 32 percent in the placebo group. Researchers suggested the positive effects may be due to pomegranate’s potent antioxidant properties.

Pomegranate, which has additional benefits to heart and prostate health, might also help areas of sexual health beyond ED. A Turkish animal study revealed a set of benefits to sperm antioxidant activities.³⁷ In animals consuming concentrated pomegranate juice, major oxidation end products decreased, while activities of various antioxidant compounds in sperm increased. Researchers reported epididymal sperm concentration and sperm motility were significantly higher in animals consuming pomegranate juice, although only a high dose of juice significantly decreased total abnormality of sperms, when compared to the control.

Impotence and infertility are joined at the hip. The natural ED aid L-carnitine has demonstrated prowess in improving male fertility, especially in the area of sperm health and function.³⁸ Both L-carnitine and acetyl carnitine are highly concentrated in the epididymis and figure prominently in sperm metabolism and maturation, as well as sperm motility and overall quality.^39,40,41 In fact, science shows infertile men have significantly lower seminal carnitine levels than do fertile men,⁴² and carnitine is more active than testosterone in boosting nocturnal penile tumescence (swelling) and International Index of Erectile Function scores.⁴³

Maca also offers sperm health benefits, as research shows the botanical remedy can increase testosterone, improve sperm production and motility, limit spermatogenic disruption and stimulate spermatogenesis.^44,45,46,47 In fact, between 48 g/d and 90 g/d of maca extract has boosted spermatogenesis in animal models.⁴⁸

Basic nutritional support can also help address sperm function. A Dutch trial found combined zinc sulfate and folic acid treatment in both subfertile and fertile men resulted in increased total normal sperm count.⁴⁹

Combining Forces

NHANES III showed men take dietary supplements less often and in lesser quantities than do women.⁵⁰ This correlates with surveys finding men visit the doctor’s office less often than do women. The key to improving men’s health, then, may well be in streamlining the supplements men need. Men’s multivitamin formulas go a long way to this end, delivering a power-packed punch in a small number of daily pills or potions.

Fortunately, there are a number of ingredients that address multiple areas of men’s health.

Sexual health aids arginine, carnitine, lycopene, soy and garlic all have researched benefits to vascular health, including lipid integrity, cholesterol management and blood pressure regulation.^{51,52,53,54,55} Similarly multifaceted in men, chromium can boost fat metabolism and muscle activity at the genetic level,⁵⁶ while it also has many positive benefits for diabetics. Study results for chromium in various forms include enhanced efficiency of insulin use, improved fasting and postprandial glucose levels, and controlled markers of glucose control.^57,58,59

Another common men’s formula nutrient, folic acid is not only useful in sperm health, but it also lowers risk and incidence of heart attack and stroke,⁶⁰ possibly reducing the risk of stroke by 20 percent in male smokers.⁶¹ Folate’s health benefits are tied to its ability, to lower homocysteine, a mechanism central to the nutrients ability to reduce risk of Alzheimer’s disease.⁶²Omega-3 fatty acids, including fish oil, also reduce the risk of Alzheimer’s disease, due to both lipid protective and antioxidative properties, which are also indicated in fish oil’s benefits to heart health and diabetes management. Studies show omega-3s inhibit lipid peroxidation, lower total and low-density lipoprotein (LDL) cholesterol levels and triglycerides, and decrease adiposity in diabetes.^63,64,65 Further, fish oil might help manage depression, a risk factor in suicide.

The other major category for men’s health is antioxidants. Vitamin C can help ameliorate diabetes by affecting lipids and glucose,⁶⁶ suppress melanoma,⁶⁷ predict stroke risk,⁶⁸ reduce cognitive impairment⁶⁹ and strengthen the immune system.⁷⁰ Similarly, vitamin E may protect against lipid peroxidation in the cardiovascular system and brain, a crucial mechanism in Alzheimer’s pathology.^71,72 In fact, vitamin E was found to reduce heart attack, stroke and death in heart disease patients, including those with diabetes.⁷³ The antioxidant vitamin also boosts the immune system and helps protect against oxidative damage to the kidneys, especially from metallic toxicity.^74,75

Flavonoids have many benefits to offer men, as evidenced by quercetin’s effect on prostate health. Catechins from tea can decrease risk of prostate cancer and even reduce the incidence and size of chemically-induced tumors;^76,77 inhibit cholesterol oxidation and lower blood pressure;^78,79 and play a protect role against prostatitis, diabetes and both kidney and Alzheimer’s diseases.^80,81,82,83 The aforementioned Pycnogenol is a flavonoid extract that not only addresses ED problems, but also reduces the risk and mechanisms of heart disease, cancer, diabetes, Alzheimer’s and male infertility.^{84,85,86,87,88} Flavonoids are especially rich in colorful fruits and berries, including pomegranate. Apart from its work on ED, pomegranate helps modify heart disease factors, including hyperlipidemia;⁸⁹ support weight management;⁹⁰ and inhibit prostate cancer.⁹¹

The plight of men’s health need not be one of ignorance and disease. A group of multi-talented natural compounds can help address men’s primary health concerns, from sexual function to degenerative diseases.

Editor's Note: The full list of references starts on the following page.

References

1. Harris Interactive, on behalf of Schering-Plough and GlaxoSmithKline.

2. Men's Health Network, http://www.menshealthnetwork.org

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