A Guide to Men's Health

James Brown might bellow that this is a "man's man's man's world," but the dietary supplement industry knows that its clientele consists mostly of women. Still, the opportunity for increased sales to men (or to women for men) is quite abundant, especially as research continues to deem certain nutrients and herbs as beneficial to specific male health problems or concerns.

At the forefront of men's health issues is prostate health, but there are other issues that figure quite prominently in the male experience. Cardiovascular disease affects all of humankind, but more men than women contract the disease. Also, while certainly incorporated by both genders, sports nutrition is one major segment of the dietary supplement market that enjoys a high number of male consumers. Likewise, the most popular single product category within the industry could well be male sexual aids, often dubbed as male vitality.

Prostate Problems

There are two major health issues suffered by the male prostate, a walnut-shaped gland that controls urine and semen flow through the urethra--prostate cancer and benign prostatic hyperplasia. Prostate cancer grows slowly and, as a result, is often considered a disease striking mostly elderly men. The American Cancer Society estimates that about 165,000 men will be diagnosed with prostate cancer this year, though only a percentage of those cases are invasive prostate cancer, the deadly form. This fatal cancer quickly overwhelms the prostate gland and infiltrates the rest of the body. There are many possible causes of prostate cancer, among which are environmental pollution and nutritional deficiencies. Nutritionally, prevention is the key word for prostate cancer candidates, who are mostly over the age of 40 but who can be younger.

Antioxidants play a key role in helping prevent prostate cancer. A genetic defect was found in prostate cancer cell samples from 88 men (Nelson, W. et al. Proc Nat Acad Sci USA 91:11733-7). According to researchers in the study, the defect prevents the production of glutathione S-tranferse (GST), a substance used by the body to dismantle toxic chemicals. GST production relies on glutathione, an antioxidant found both in food and made in the body from glutamic acid, cysteine and glycine. Vitamin C and lysine are key factors in the production of glutathione and GST. Isothiocyanates and sulforaphanes found in broccoli, cauliflower and brussels sprouts also support GST production.

Lycopene is another antioxidant praised for its ability to help prevent prostate cancer. Lycopene was reported as the only carotenoid to affect prostate cancer risk by Harvard researchers (Giovannucci, Et al. J Nat Cancer Inst 87:1767-76, 1995). Lycopene gives red fruits their color and is abundant in tomatoes, watermelon and guava. Most of the research has centered on tomato-based foods, however. Researchers have placed the highest protective lycopene dosage at 6.5 mg per day.

The antioxidant selenium is a vital factor of glutathione peroxidase, an enzyme and antioxidant that hampers cancer formation and growth. A University of Arizona study showed that patients taking 200 micrograms of selenium had 63 percent fewer cases of prostate cancer (JAMA 276:1957-1963, 1996). Selenium intake in excess of about 750 micrograms daily can cause balding, tooth loss and fatigue, but researchers in the study limited dosage to between 86 and 159 micrograms daily.

In addition to antioxidants, soy brings its heavy disease-fighting hammer down on prostate cancer. The high-soy diet of Asian men has been linked to low risk and incidence of prostate cancer, which is one-third that of American men. International researchers credit the soy isoflavone genistein for its prostate health benefit (Aldercreutz, H. et al. Lancet 342:1209-10, 1993).

Prostate maintenance, specifically prostate cancer prevention and management, can further be improved by beta glucan, such as is found in maitake mushrooms. Beta glucans in Maitake Pro Grifron D-Fraction® extract demonstrated a cytotoxic effect on prostatic cancer cells, which led to apoptosis or cell death (Tazaki, H et al. Amer Acad Anti-Aging Med Confer, Dec. 1999). Researchers noted that this effect was even more pronounced when the extract was combined with vitamin C. The maitake extract was further shown to have a synergistic effect with a chemotherapeutic agent (carmustine) and was proven more effective than other mushroom extracts and seaweed extracts.

Often confused with prostate cancer is the enlargement of the prostate gland. Benign prostatic hyperplasia (BPH) involves the swelling of the prostate gland, which causes a man to lose control of his urinary function. This creates symptoms such as urinary urgency and build-up of urine in the urethra. The cause of BPH has not been 100-percent determined, but scientists have widely speculated that dihydrotestosterone (DHT) is the hormone responsible for stimulating excess prostate cell multiplication leading to BPH.

One of the most popular natural remedies for BPH is the fruit of serenoa repens, or saw palmetto. Scientists believe that the medicinal components of this berry inhibit the conversion of testosterone to DHT, precluding BPH. Most commonly grown in the palm fields of Florida, this herbal medicinal remedy is used widely around the world for prostate health support and is the remedy of choice for men in Germany, where such herbal medicines are covered under medical insurance.

There is controversy in the medical community about phytotherapeutics and BPH, but saw palmetto does enjoy promising results from many trials, both published and unpublished. A study conducted in France found that a group of 50 men suffering early stages of BPH experienced a significant improvement of symptoms when given 160 mg of saw palmetto daily (Brit J of Clin Pharma, 1984). Studies conducted since that trial have found similar results, including an Italian study published in Urologia in 1998. More recently, an American study showed a modest reduction of BPH symptoms in 44 men taking 320 mg of saw palmetto daily (Marks, L. et al. Urology, 163(5):1451-6, 1999). The research concluded that the herbal treatment significantly improved prostate swelling, with the most impressive results focused on the epithelial tissue, especially in the inner prostate.

Other herbal preparations have been used in this area of prostate health, including stinging nettle, pygeum and medicinal pumpkin. However, there is not yet a significant body of research to support these herbs, leaving their proof of efficacy to a large body of anecdotal evidence.

However, plant-derived isoflavones will benefit from soon to be released research results that show the benefits of these substances on BPH symptoms. Research results to be reported at ENDO 2000: The Endocrine Society 82nd Annual Meeting will demonstrate that red clover isoflavones improved BPH symptoms in men with clinical BPH, according to Mark Warring, director of clinical and technical affairs for Stamford, Conn.-based Novogen, which manufactures a red clover-derived isoflavone product called Trinovin. He noted that the benefits from the herbal remedy used in the trial were experienced in a shorter time than comparable from many of the other BPH treatments. Scientists believe that isoflavones inhibit enzymes that contribute to prostate enlargement. Specifically, isoflavones reduce the conversion of testosterone to DHT and also have an anti-estrogenic effect on the stroma or connective tissue.

Sexual Healing

Sexual vitality is one of the greatest signals of male health, at least in the eyes of men worldwide. Sales of the pharmaceutical impotence aid Viagra topped $1 billion in its first year. This blew open the doors behind which sexual dysfunction hid for so many years.

When sexual function falters, many facets of male life can be affected. Sexual dysfunction affects more than 30 million American men, who can suffer such sexual setbacks as inability to establish or maintain erection and decreased sexual desire. Many factors can contribute to these conditions including decreased blood flow to the penis, hormone imbalance, anxiety and stress.

A success as big as Viagra garners major attention and leads to multiple copycat attempts. In this case, it has led to a flurry of natural alternatives, which have been especially reliant on the anonymity afforded by the Internet. Though many ingredients found in the seemingly endless array of "aphrodisiac" products have little or no scientific support, a handle full of natural products, primarily herbs, have been found by researchers to have significant effects on specific physical functions related to sexual performance.

The common "herbal Viagra" ingredients that enjoy the most scientific backing are maca and yohimbe. The rising star of herbal sexual aids is maca, a cruciferous plant found in Peru. Maca has been historically used in the jungles and Amazon Basin of Peru for hundreds of medicinal concerns including treatment of wounds, improvement of mental clarity and enhancement of fertility and libido in animals and humans. The herb acts on the endocrine glands, specifically the pituitary-hypothalamus axis of the brain. It stimulates the increase in production of endocrine gland hormones, which leads to more energy and vitality.

Research on maca is in infant stages but is ongoing. One recent trial showed that a maca extract enhanced sexual performance (Urology 55:598-602, 2000). According to researchers, mice and rats treated with maca showed significant improvement of erectile dysfunction in addition to a marked increase in libido.

Also exalted as a sexual stimulant for more than 100 years, yohimbe is a traditional African herb derived from the bark of a large evergreen tree that is indigenous to the tropical forests of Cameroon, Gabon and Zaire. Natives of these countries have used yohimbe for centuries as a tea for fertility celebrations and sexual relations. It was praised for increasing libido and improving and enhancing the size and stamina of erections.

This historical use is sufficient enough for many men to dive right in, but science has taken a further and deeper look into yohimbe and has verified the sexual enhancement abilities of an alkaloid isolated from yohimbe. Called yohimbine, this alkaloid has been widely accepted in the medical community as efficacious in treating certain forms of male impotence and is the basis for many pharmaceutical treatments targeting sexual dysfunction. Yohimbine has the approval of the Food and Drug Administration (FDA), is even gaining acceptance for use in veterinarian capacities and has enjoyed a promising results from more than 20 trials.

Recently, researchers from Valparaiso University in Indiana discovered that yohimbine exhibited beneficial effects on many aspects of sexual response in men, including increased frequency of sexual activity and heightened sexual arousal and erectile response during masturbation. These effects were more prominent in men suffering from erectile problems than in men without such problems. A 1994 study questioned the ability of yohimbine to improve sexual function any more than a placebo could (Riley, AJ et al. Brit J Clin Pract 1994).

While the beneficial abilities of yohimbe are thought to reside in yohimbine, resperinoid alkaloids and other chemicals in the herb may contribute to its overall effects. It is hypothesized that yohimbe blocks certain neurotransmitter receptors in nerve cells as a part of the adrogenic nervous system that helps control sexuality. It has little effect on adrenaline, but it has a more substantial effect on noradrenaline levels, which itself affects sex drive. Yohimbe is also credited with increasing blood flow through dilation of arteries.

Substances that dilate blood vessels, allowing more blood to reach and fill up the penis during erection, are in a category of agents known as vasodilators. Such agents comprise the greater part of the sexual aids market.

Leading the pack of vasodilators is ginkgo biloba, the fan-leafed plant native to Asia and popular for its role in improving memory. Ginkgo and its active constituents, flavoglycosides and ginkgoheterosides, dilate the blood vessels of the penis, strengthen the vessels and regulate blood platelet stickiness. A recent study exhibited ginkgo's ability to improve sexual function in 23 of 30 men (J Clin Psych, 1997). Almost a decade earlier, a study found that about half of a group of 60 men suffering from circulatory-based erectile dysfunction that had not been improved by medications were able to regain normal erectile function after 12 to 18 months of taking 60 mg of ginkgo extract daily (Urology, 1989). Even erectile dysfunction sufferers who have had some success with drug treatment benefited from ginkgo supplementation (J Sex Ed Ther, 1991).

At the Heart

Heart disease may no longer be thought of as just a man's disease, as it is the number one killer of both men and women. Still, more men suffer cardiovascular disease (CVD) than do women. As men pass their 20s, 30s and 40s, concerns about prostate, while more than warranted, should grow side-by-side with risk of CVD. Many factors contribute to CVD, which is characterized by the hardening of artery walls leading to the build-up of plaque and, subsequently, blocked vessels and decreased blood flow to the heart. At the top of the risk factors list are high cholesterol, high blood pressure and inactivity. Exercise can take care of the latter, but men may need a little help with the former two factors.

Cholesterol may well be a crucial component for steroids and most body tissue, but the body's required levels should ideally come from natural production in the liver. Too much dietary cholesterol, a high rate of oxidative damage and inadequate nutrient levels can cause cholesterol to build up on artery walls, leading to atherosclerosis or hardening of the vessel.

Antioxidants can help address the increased risk due to oxidation in arteries. Vitamins E and C, as well as selenium and bioflavonoids are potent antioxidants often incorporated into heart health plans. These nutrients not only disable the free radicals that commonly cause oxidation, but they also support other heart-related functions.

One of the most researched nutrients for reducing CVD risk, vitamin E was found to inhibit the growth of smooth muscle cells that can block the openings of blood vessels. Overall, 100 IU daily of vitamin E can decrease the risk of heart disease in men and women by as much as 41 percent, according to two studies in the New England Journal of Medicine.

Vitamin C helps clear low-density lipoprotein (LDL) through the liver via bile. Furthermore, low levels of this vitamin C have been linked to an increased risk of CVD (Amer J Epidemiol, 1996). More recently, a 500-mg per day dose of vitamin C lowered patients' blood pressure by as much as 9 percent (Lancet, 1999), due to its ability to improve the synthesis of nitric oxide.

Minerals can also contribute to a reduced risk of CVD. Selenium is a potent antioxidant that is often combined with vitamin E for relief from angina. Zinc is more generally effective in heart health, as it is crucial for wound healing, and atherosclerosis starts with a vessel wall injury. Additionally, zinc assists the activity of superoxide dismutase, the body's most potent antioxidant.

Antioxidant support for the heart can also be achieved with grape seed extract and Pycnogenol™ a French pine bark extract. Available in various forms, grape seed extract and its bevy of bioactive flavonoids has proven to be two or three times more effective at inhibiting oxidation of cholesterol than vitamins E and C. Pycnogenol™ reduces blood platelet aggregation (blood clumping) without the bleeding associated with aspirin, which also thins the blood (Thrombosis Research, 95:155-161, 1999). The pine bark extract has also been shown to enhance the effects of other antioxidants (Cardio Rev & Reports, 20:326-329, 1999) and relax blood vessels.

Beyond antioxidants, essential fatty acids (EFAs) and soy protein offer many protective effects against CVD. Likewise, specialty nutrients, including coenzyme Q10 (CoQ10) and carnitine, and herbs such as garlic can complete a well-rounded heart health regimen.

Unlike the saturated fats that increase the risk of CVD, mono- and polyunsaturated fats are more easily digested and can be even be called good fats. Of these good fats, EFAs such as omega-6 (found in vegetables) and omega-3 (found in flaxseed and cold water fish) are very protective in an optimum ratio. Unlike many other populations, the Western population has a lopsided ratio that leaves those people undernourished in omega-3 EFAs. This can lead to high triglycerides, high blood pressure, platelet stickiness and body tissue inflammation.

Soy protein has enjoyed much recent praise from the media, the government and many natural health proponents. The FDA was so convinced of soy's cardio-protective effects that it approved a health claim for soy and lowered CVD risk last year. Soy protein has been shown to decrease serum concentrations of total cholesterol, LDLs and triglycerides (NEJM, 333:276-282, 1995). The role of soy isoflavones is less determined, but studies have demonstrated that isoflavones can prevent arteriosclerosis by affecting plasma lipid concentration and disarming free radicals (Amer J Clin Nutr, 68:1390S-1393S, 1998).

CoQ10 is a vitamin-like substance concentrated in cell mitochondria and helps convert oxygen to energy via ATP production. Clinically, CoQ10 has exhibited the ability to improve heart functioning. Optimum natural levels of the nutrient may be depleted by pharmaceuticals including the statin class of drugs (Lipitor and Mevacor).

Carnitine is a another vitamin-like nutrient that has cardio-protective effects. Naturally occurring in the body and found in many foods of animal origin, carnitine helps move long chain fatty acids into the mitochondria to produce energy. High concentrations of carnitine are found in the heart, due to the energy demands of the organ. It can reduce the incidence of arrhythmia (irregular heartbeat) and angina following a heart attack. It also stimulates the body's efficient use of fat and fuel, making it a good sports nutrition product.

Despite the heart health benefits that can be attained via the aforementioned herbal vasodilators, garlic is perhaps the most important herb in lowering CVD risk. It has been used for centuries partly for its ability to lower both cholesterol and blood pressure as well as promote artery elasticity. A two-year study on German patients showed that 70-year olds supplementing with garlic had aortas that were as elastic as 50-year olds who did not use garlic.

Hawthorn is also helpful to the heart. The herb's berries can prevent arrhythmia and strengthen heart contractions. Patients with chronic CVD experienced improved heart function, fewer overall symptoms and reduced shortness of breath when using hawthorn (Phytomedicine, 1:17-24, 1994).

Game Time

Sports and active lifestyles are not just for men. But many men are involved in rigorous training and competitive activities, whether weekend warriors or everyday athletes. Sports combine men's age-old quest for strength, power and speed, though some men are active for the sole purpose of staying as a healthy as possible. Good physical condition starts with a good heart (see above) but also requires good lean muscle, adequate energy and strong bones.

Creatine wears the crown in the sports nutrition industry. Creatine monohydrate can be found naturally in many foods, especially red meat. In the body, creatine helps form phosphocreatine, the limiting factor in energy production in muscle tissue. Phosphocreatine, along with stored adenosine triphosphate (ATP), is used for energy during the start of intense workout. It is also used in production of ATP. Therefore, creatine monohydrate helps athletes maximize ATP, which allows for more repetitions, a few more miles or that general extra effort. This has led to increased lean body mass gains of five to 10 pounds, with dramatic results experienced within as little as seven weeks. Increasingly popular is creatine loading, which saturates the muscles, which then fill up with more water and appear larger. Loading typically involves taking 5 grams four times daily for five days. Incidentally, the positive benefits of creatine max-out at around 20 g daily. Questions on the safety of pure and uncontaminated creatine has been addressed and verified by scientific studies and was even cleared from investigation by the FDA.

A key to building muscle is testosterone, the male hormone. While anabolic steroids that increase testosterone are dangerous and illegal, people looking for natural testosterone boosts have turned to supplements such as androstenedione (known as "andro"). Backed by the usage by home run slugger Mark McGwire, andro exploded in sales but then suffered a backlash and downturn less than a year later. Andro is controversial at best and lacks a significant body of research backing. A recent study published in the Journal of the American Medical Association (JAMA) deemed andro useless and potentially harmful as a natural testosterone producer and sports supplement. There are debates over accused discrepancies between the data provided by researchers in the study and their published conclusions. Nonetheless, andro has suffered in the marketplace because of the study and bans on the supplement in many professional sports leagues and schools. Many consumers who have gotten results from andro are loyal buyers, but the industry awaits more research on the testosterone precursor before sales could be expected to regain growth rates.

In the shadow of muscle-building supplements are sports supplements that support overall performance and health. Glucosamine and chondroitin are prized in the natural health industry and abroad for positive effects on bone and joint health, as are shark cartilage (glucosamine source) and the anti-inflammatory MSM. Although not necessarily in the shadow of creatine, energy boosting supplements and vitamins are frequently used to support an active lifestyle. Products used most in this area of sports and fitness are led by ginseng, an adaptogen that has been used for centuries for its invigorating effects.

Millennial Man

The future of natural health for men is as potent as ever. Men's risk for disease, including prostate cancer and CVD, are ever increasing, as lifestyles become more stressful, food becomes more processed and nutrient-deficient and more men are living longer. These factors also contribute to a growing legion of men suffering a decreased sexual function and facing an uphill battle for peak physical conditioning.

The key to capturing men's health sales is to target the main concerns men have, which are the problems that trouble men enough to prompt them to seek help, whether advice or products. When addressing these concerns, the ingredients and end products with the most scientific support are likely to garner the most response--men are often drawn by high-tech and scientific products and marketing. They will also be attracted to products that can help them address more than one problem.

Many of the ingredients or products that target one men's health concern can be useful in other areas as well. Soy protein has cardioprotective effects that combine with a great amino acid profile to make it a good supplement for active and athletic people. Similarly, because sexual function is so dependent on getting blood to the penis, vasodilators and other artery helpers benefit not only lower CVD risk but also help fight erectile problems. And BPH aids, such as saw palmetto, can also be a boost to sexual desire and vitality. With such crossover ability coupled with growing bodies of research and target marketing, men's natural health may well get the attention and sales it deserves.

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