The
Aging Man - Men's Health
by Kim Schoenhals
While men's health issues have not necessarily
been at the forefront of research, there are numerous reasons this category is
an important realm to study. For example, men are more likely to develop heart
disease than women, and they have the unique concerns of maintaining prostate
and sperm health. In addition, the difference between life expectancy for a man
and a woman is becoming more significant, according to statistics from the Centers
for Disease and Prevention (CDC) and the National Center for Health. In 1929,
the average life expectancy for a man was only 2.9 years less than a woman, and
by 1997, that difference doubled to 5.8 years.
Men have a higher death
rate than women for each of the top 10 causes of death in America, the top two
being heart disease and cancer. And yet, research on male-specific diseases generally
receives less funding than women's health. The National Cancer Institute spent
more than $400 million on breast cancer research in 2000 and only $200 million
on prostate cancer research. According to Men's Health magazine, nearly $5 billion
went to women's health initiatives in 2000 while less than $1 billion went to
men's.
The No. 1 killer among men is heart disease, which causes more
than 350,000 male deaths each year--almost twice the number of female victims.
[More can be read about Cardiovascular Health in the 1/14 issue of INSIDER online
at www.naturalproductsinsider.com.] The second most significant cause of death
among men is cancer, including prostate cancer.
10
Leading Causes of Death for Men (in order)
· Cardiovascular
disease
· Cancer
· Unintentional injuries
·
Cerebrovascular diseases (stroke)
· Chronic obstructive pulmonary
diseases
· Pneumonia and influenza
· Diabetes mellitus
· Suicide
· Chronic liver disease and cirrhosis
·
Homicide and legal intervention
(Source: Centers for
Disease Control & Prevention)
The Prostate
Prostate cancer affects approximately 156,000 men each year, leading to more than
30,000 deaths. Additional issues affecting prostate health are benign prostatic
hyperplasia (BPH)--an enlargement of the prostate gland--and prostatitis--an inflammation
of the prostate that is sometimes caused by a bacterial infection. Modern medicine
is an obvious course of action for men needing treatment for prostate conditions,
although there are preventive and therapeutic measures available from the natural
products industry as well.
According to the National Institutes of Health
(NIH), more than one-half of the men 50 years of age and older have lower urinary
tract symptoms associated with BPH, and the condition accounts for at least 1.7
million office visits per year. Over the next seven years, three divisions of
NIH--the National Institute of Diabetes & Digestive & Kidney Diseases,
the National Center for Complementary and Alternative Medicine (NCCAM) and the
Office of Dietary Supplements--have earmarked a combined $29 million to study
the efficacy of saw palmetto (Serenoa repens) and pygeum (Pygeum africanum) for
relieving symptoms associated with BPH. "[T]he use of alternative therapeutic
agents to relieve the symptoms of BPH is increasing rapidly," NIH stated
in its objectives. "Despite the widespread use of phytotherapy for BPH in
the United States, most physicians are reluctant to either discuss or recommend
their use since only a modest number of published reports have appeared in the
peer-reviewed medical literature about their efficacy. Nonetheless, the available
literature supports the hypotheses that these compounds may have some beneficial
effects on BPH symptoms."
Saw palmetto is one of the most recognizable
supplements in the men's health arena. According to the Natural Marketing Institute's
(NMI) Health & Wellness Trends Database, 6.7 percent of male consumers purchase
saw palmetto. Berries from the fern are used in natural medicine to treat symptoms
of BPH and prostatitis. Currently, researchers at the University of California,
San Francisco, are conducting a large clinical trial to determine the effects
of saw palmetto on urinary symptoms in patients with moderate to severe BPH. The
products being used in this trial (including Indena's Sabalselect®) were chosen
by a panel of experts from NCCAM.
Published research on saw palmetto
indicates the herb is helpful in treating symptoms of BPH. A research review of
saw palmetto involving a total of 18 trials and 2,939 men indicated that the extract
is more effective than placebo in improving urinary tract symptoms, flow measures
and peak urine flow. In addition, saw palmetto was found to be effective for treating
BPH in comparison to other phytotherapies (Public Health Nutr, 3, 4A:459-72, 2000)
(www.cabi-publishing.org)
Although saw palmetto may benefit BPH, it
may not be a preventive treatment for prostate cancer. In a study conducted at
the University of California, Los Angeles, researchers randomized 44 men to compare
a saw palmetto herbal blend with placebo for improving symptoms of BPH. At the
end of the trial, the saw palmetto herbal blend group demonstrated a slight improvement
in clinical parameters, although neither prostate specific antigen (PSA), an indicator
for prostate cancer, nor prostate volume changed from baseline in either group.
However, when the study was concluded, 41 men elected to continue therapy. Researchers
concluded the saw palmetto herbal blend is a safe, highly desirable option for
men with moderately symptomatic BPH (J Urol, 163, 5:1451-6, 2000) (www.jurology.com).
Pygeum may also have application in easing the symptoms of BPH and prostatitis.
The plant's active constituents include beta-sitosterol, pentacyclic terpenes
and ferulic esters, which play a part in controlling testosterone activity in
the prostate. Pygeum africanum (as Tadenan® by Laboratoires Fournier SCA)
reduces the "obstructive" effects of dihydrotestosterone (DHT, a testosterone
metabolite) and counteracts the hormone-induced enlargement of the prostate (Urology,
55, 2:292-8, 2000) (www.meddevel.com). Pygeum is also known to reduce inflammation
(Fitoterapia, 71, Suppl 1:S21-8, 2000).
An unpublished study conducted
at the Urology Clinic of the University of Cagliari demonstrated that patients
with BPH who were treated for two months with a Pygeum africanum extract (as Pigenil®,
a bulk extract belonging to Indena S.p.A.), exhibited an 11-percent decrease in
prostate size as compared to no decrease in the group taking a comparison pharmaceutical
(mepartricin). In addition, researchers noted the supplement was well tolerated
and brought about a marked improvement in subjective and objective symptoms. While
the mechanism of action of this extract is not known precisely, it has many phytotherapeutic
effects, according to researchers at the Universidad de Alcala in Spain (Prostate,
45, 3:245-52, 2000) (www3.interscience.wiley.com).
10 Leading Causes
of Death for Men· Cardiovascular disease · Cancer · Unintentional
injuries · Cerebrovascular diseases (stroke) · Chronic obstructive
pulmonary diseases · Pneumonia and influenza · Diabetes mellitus
· Suicide · Chronic liver disease and cirrhosis · Homicide
and legal intervention Source: Centers for Disease Control & Prevention.
Beta-sitosterol, a phytosterol found in nearly all plants, including pygeum,
is independently effective in reducing the symptoms of BPH, as well as inhibiting
cancer growth. According to researchers from the State University of New York
at Buffalo, phytosterols, including beta-sitosterol, may offer specific protection
against prostate cancer (J Nutr, 130, 9:2127-30, 2000) (www.nutrition.org).
Medicinal pumpkin is another herb thought to have application in treating
conditions of the prostate because of its active constituents: phytosterols (including
beta-sitosterol), essential fatty acids, amino acids, vitamins and minerals. The
Commission E, a German committee charged by the federal health agency with reviewing
the safety and efficacy of phytomedicines, published a monograph for the use of
pumpkin seed for treating symptoms of BPH. Because of the phytosterols in pumpkin
seeds, it is thought to act by inhibiting DHT or by anti-inflammatory action (Alt
Med Rep, 1, 3:25-36, 2001). "Although drugs that inhibit the conversion of
testosterone to DHT (such as finasteride) have not proven to be of great benefit
against prostate cancer when used alone, trials have shown considerable positive
effects when a DHT inhibitor is added to hormone treatments to reduce testosterone
levels and, as a result, increase estrogen levels in the body," wrote Jesse
A. Stoff, M.D., and Dallas Clouatre, Ph.D., in The Prostate Miracle: New Natural
Therapies That Can Save Your Life (Kensington Publishing Corp., 2000).
Stinging nettle (Urtica dioica) is another herb thought to reduce the symptoms
of BPH. Researchers from the Philipps-Universitat Marburg in Germany discovered
that the activity of a 20 percent methanolic extract of stinging nettle roots
reduced the proliferation of human prostatic epithelial and stromal cells (the
spongy protoplasmic framework of some cells) in vitro. Researchers concluded that
stinging nettle extract has clear biological relevance for prostate health (Planta
Med, 66, 1:44-7, 2000).
Flower pollen extract can be collected from various
plants and has been found to have anti-inflammatory properties, to relax the muscles
surrounding the urethra and to inhibit growth of prostate cells. "Flower
pollen extracts ... can boost the immune system, reduce inflammation and fight
BPH," Stoff and Clouatre wrote. One animal study indicated that the anti-inflammatory
action of flower pollen extract (as Cernitin™, manufactured by Saginaw,
Mich.-based Graminex) can inhibit stromal cell proliferation by enhancing cell
death in rats with nonbacterial prostatitis (Prostate, 49:122-31, 2001).
Quercetin, a flavonoid found in apples, onions and tea, may also have application
in treating men with prostatitis. Researchers from the Harbor-UCLA Medical Center
in Torrance, Calif., hypothesized that the condition may be caused by oxidative
damage. They tested bacterial specimens from 100 men with chronic pelvic pain
syndrome, classified as prostatitis. Oxidative injury was greatly reduced with
antibiotics and with a quercetin-containing antioxidant supplement (as Prosta-Q™,
manufactured by Farr Laboratories). Earlier research with the same supplement
indicated that quercetin is well tolerated and provides significant improvements
in most men with chronic pelvic pain syndrome (Urology, 54, 6:960-3, 1999).
Quercetin may also have application in preventing and even treating prostate
cancer. "[The] bioflavonoid quercetin has several important anti-cancer effects,
one of which is to help induce apoptosis [cell death]," Stoff and Clouatre
wrote. Researchers from Harvard Medical School in Boston discovered that the flavonoid
can dose-dependently suppress tumor growth in vivo and in vitro (Int J Hyperthermia,
17, 4:347-56, 2001). According to additional cancer research conducted at the
Mayo Clinic in Rochester, Minn., quercetin has the ability to inhibit PSA and
the secretion of androgen-regulated tumor markers (Carcinogenesis, 22, 3:409-14,
2001) (http://carcin.oupjournals.org).
Conversely, researchers from
the Yamagata University School of Medicine in Yamagata, Japan, noted that quercetin
was unable to regulate the cell cycle progression that leads to cancer (Cancer
Lett, 176, 1:17-23, 2002) (www.elsevier.com).
However, the same researchers
found that genistein, a flavonoid found in soy, inhibits this cell cycle progression,
making genistein a potential anticarcinogenic agent. Research conducted at Virginia
Commonwealth University in Richmond, Va., demonstrated that genistein enhances
resistance to tumor formation by increasing the activities of cytotoxic T cells
and natural killer cells (J Nutr, 131, 12:3251-8, 2001). In addition, an animal
study conducted at the University of Birmingham in Alabama demonstrated dietary
genistein dose-dependently reduced tumor development (Cancer Res, 61, 18:6777-82,
2001). And, according to researchers at the Wayne State University Department
of Cancer Biology in Detroit, genistein inhibits cell proliferation independent
of PSA, leading researchers to conclude that genistein may be a chemopreventive
and therapeutic agent for prostate cancer (Int J Oncol, 16, 6:1091-7, 2000).
Another potential prostate cancer preventive agent is an extract from the Maitake
mushroom. Beta-glucan, a polysaccharide of the Maitake mushroom (as Grifron-D®,
by Maitake Products), has potential as an alternative therapeutic regimen for
prostate cancer because of its ability to induce more than 95 percent apoptosis
in human prostate cancer cells, according to research conducted at the New York
Medical College in Valhalla (Mol Urol, 4, 1:7-13, 2000) (www.liebertpub.com).
Antioxidants, in general, may be able to stave off cancer by inhibiting
the free radical damage that is thought to be carcinogenic. Epidemiological evidence
shows that environmental toxins induce oxidative damage, which in turn can lead
to prostate cancer. Antioxidants may also slow the progression of prostate cancer,
according to researchers at the University of Toronto (Urology, 57, 4 Suppl 1:90-4,
2001). Specifically, selenium and vitamin E are thought to suppress the formation
of prostate cancer.
According to NMI data, antioxidants are the third most
popular supplement among men, with 16.4 percent of male respondents purchasing
antioxidants. Vitamin E is the most popular dietary supplement among men, with
45.7 percent of males purchasing the supplement, according to NMI.
The
National Cancer Institute (NCI) is currently conducting a 10-year trial to determine
the efficacy of vitamin E and selenium supplementation for preventing cancer of
the prostate. Independently, low plasma selenium has been associated with a four-
to five-fold increase in the risk of prostate cancer, according to researchers
from the Stanford University Medical Center in Stanford, Calif. (J Urol, 166:2034-38,
2001). Selenium is being studied in several other NCI-funded clinical trials at
the University of Arizona Cancer Center to determine the mineral's role in reducing
the risk of prostate cancer. (These trials involve Cypress Systems' ingredient,
SelenoExcell®). The trials are based on results found by Larry Clark, M.P.H.,
Ph.D., in 1996, linking selenium to a decreased risk of prostate cancer (Nutr
Cancer, 40, 1:74-7, 2001).
In terms of vitamin E and selenium, researchers
from the Johns Hopkins School of Hygiene and Public Health in Baltimore published
a retrospective study involving more than 10,000 men in the Dec. 20 Journal of
the National Cancer Institute (92, 24:2018-23, 2000).
(http.//jncicancerspectrum.oupjournals.org)
regarding alpha-tocopherol, gamma-tocopherol and selenium in cancer prevention.
The study indicated that high levels of selenium and alpha-tocopherol were protective
only when gamma-tocopherol, a form of vitamin E not usually found in vitamin supplements,
was present in high concentrations as well. In support of this finding, researchers
from the University of California, Berkeley, found plasma concentrations of gamma-tocopherol
are inversely related to prostate cancer (Am J Clin Nutr, 74, 6:714-22, 2001)
(www.ajcn.org).
Another antioxidant with potential for men's health
application, specifically for prostate cancer, is coenzyme Q10 (CoQ10), which
is used by 6.0 percent of men, according to NMI. CoQ10 is produced by the body,
but levels decrease with age or chronic disease such as prostate cancer. "Therefore,
supplementary sources are quite important in helping to maintain a normal energy
environment within us," Stoff and Clouatre wrote. "... For all its wonderful
effects, its activity in prodifferentiation is perhaps most important. Recent
medical studies have shown that CoQ10 can, in some cases, induce 'spontaneous
remission' even in the face of an advanced cancer with metastasis to the liver."
Lycopene, a carotenoid found in high concentrations in tomatoes, is popular
among 1.2 percent of male consumers, according to NMI. This nutrient may also
be responsible for reducing the incidence of prostate cancer. Researchers from
the University of Illinois, Chicago, studied men who consumed tomato sauce-based
dishes (30 mg/d of lycopene) for three weeks preceding a radical prostatectomy.
They discovered that after the dietary intervention, serum and prostate lycopene
concentrations were significantly increased. In addition, compared with pre-intervention
levels, leukocyte oxidative DNA damage was significantly reduced and prostate
tissue oxidative damage was also lower in the lycopene group than the control
group (J Int Cancer Inst, 93, 24:1872-79, 2001).
Additional research
conducted at the Barbara Ann Karmanos Cancer Institute at Wayne State University
indicated that lycopene supplementation may reduce the growth of prostate cancer
in vivo, although researchers stated that no firm conclusions could be drawn because
of their small sample size of 26 men (Cancer Epidemiol Biomarkers Prev, 10, 8:861-8,
2001) (http://cebp.aacrjournals.org). The same researchers noted in a different
study that lycopene combined with radiation therapy can inhibit DNA synthesis
and inhibit cell division in patients with prostate cancer (Clin Cancer Res, 7,
2:382-90, 2001) (http://clincancerres.aacrjournals.org). Both of these studies
involved Lyc-O-Mato®, a natural lycopene product manufactured by LycoRed/Biodar.
Sperm Health
Male fertility is a function of numerous
components, particularly sperm health and motility. While many men opt for pharmaceutical
answers to their fertility health questions, the natural products industry has
a few answers of its own. Lycopene, selenium, zinc, maca and carnitine are just
a few ingredients thought to have application in the realm of male fertility.
One detriment to fertility is low levels of folic acid. Researchers
at the University of California, Berkeley, discovered that low folic acid intake
could lead to low sperm count, as well as poor development and repair of sperm
DNA (Fertil Steril, 75, 2:252-9, 2001) (www.asrm.org).
Selenium deficiency
may also lead to fertility difficulties. Rats with a deficiency of dietary selenium
experienced immotile, deformed sperm and infertility, according to researchers
for the U.S. Department of Agriculture. These researchers also studied the effects
of dietary selenium on semen quality in 11 healthy men. Seminal plasma selenium
concentration increased 50 percent with high selenium intake (297 mcg/d for 99
days), but decreased 40 percent with low selenium (13 mcg/d for 99 days). However,
the fraction of motile sperm in the high selenium group decreased by 32 percent
by week 13 and ended 18 percent lower than baseline. Researchers concluded that
while decreased sperm motility does not necessarily lead to infertility, these
results suggest a need for further trials to fully assess this side effect (J
Androl, 22, 5:764-72, 2001).
Another mineral that is thought to improve
male fertility is zinc. Researchers at the Sichuan University in the People's
Republic of China discovered that a zinc gene family is directly involved in maintaining
normal human male fertility (Biochem J, 359, Pt 3:721-7, 2001). However, a clinical
trial conducted by researchers from the University of Heidelberg in Germany did
not find a direct correlation between zinc levels and sperm health. The researchers
monitored 256 men and found that while zinc levels in seminal fluid and serum
were not associated with infection, they were not associated with other semen
quality parameters either (Fertil Steril, 77, 2:260-69, 2002).
Antioxidant
CoQ10 may also be able to treat male infertility, according to a research review
printed in Alternative Medicine Review (5, 1:28-38, 2000) (www.thorne.com/altmedrev)
.
Lycopene, known for its application in prostate health, is also thought
to improve male fertility. According to Israeli researchers, lycopene (8 mg/d
for one year) enhances sperm count and functional sperm concentrations. Authors
noted that there was a 36 percent increase in pregnancy rate among the 50 participants'
partners by the end of the study (Ind J Urol, 56:102, 2001). (This study was sponsored
by Jagsonpal Pharmaceuticals in New Delhi and Israel-based LycoRed/Biodar.)
L-carnitine, a naturally occurring vitamin-like substance, is one that many
people are lacking, leading to obesity, fatigue, elevated triglycerides and heart
problems. An L-carnitine deficiency is also a marker for evaluating male infertility,
according to researchers at the University Hospital in Crete, Greece (Int J Fertil
Womens Med, 45, 3:236-40, 2000). Researchers from the University Hospital Carite
in Berlin also noted that concentrations of free and total carnitine are significantly
lower in infertile men than fertile control subjects (Hum Reprod, 15, 4:840-5,
2000). Dietary carnitine may be able to reverse the symptoms of carnitine deficiency
and improve sperm count and motility, according to a research review printed in
Alternative Medicine Review (5, 1:28-38, 2000).
Maca (Lepidium meyenii
or Lepidium peruvianum) is an herb studied for its application in sexuality and
male fertility. Peruvian researchers found that the herb (L. meyenii) increases
seminal volume, sperm count per ejaculation, motile sperm count and sperm motility
(Asian J Androl, 3, 4:301-3, 2001).
Although women's health seems to take
precedence in the eyes of the world, men's health is an increasingly important
realm of the natural products industry. There are dozens of natural products available
on the market to improve prostate and sperm health. In the next few years, a number
of clinical trials will further elucidate the role vitamins, minerals and herbs
play in the men's health arena.