Men's health
Men's health encompasses a range of health concerns and conditions that are particularly relevant to men, including issues like prostate disorders, erectile dysfunction, and male infertility. An increasing number of men are exploring complementary and alternative medicine (CAM) as potential solutions for these health issues. Research indicates that a significant percentage of men diagnosed with prostate disease engage in discussions about CAM therapies with their healthcare providers, highlighting the growing acceptance of these approaches.
Diet plays a crucial role in men's health, with various foods and supplements showing promise in preventing conditions like prostate cancer. Nutritional elements such as soy, lycopene from tomatoes, and cruciferous vegetables are associated with lower prostate cancer risk. Additionally, herbal supplements, including saw palmetto and green tea extract, have shown effectiveness in managing conditions like benign prostatic hyperplasia and erectile dysfunction.
Erectile dysfunction, affecting a substantial portion of older men, can be addressed with both pharmaceutical and alternative approaches, with herbs like Panax ginseng and Ginkgo biloba providing some evidence of efficacy. Male infertility, often linked to oxidative stress, can be improved through antioxidants like vitamins C and E, zinc, and other dietary supplements, which help enhance sperm quality and motility. Overall, while CAM holds potential benefits for men's health, the debate continues regarding the evidence supporting their efficacy compared to conventional treatments.
Men's health
DEFINITION: The use of nutrients, dietary supplements, herbal extracts, and alternative therapies for preventing and treating health conditions specific to men, such as prostate disorders and erectile dysfunction.
Overview
The use of complementary and alternative medicine (CAM) for managing men’s health is increasing worldwide. A study published in 2016 in Evidence Based Complementary Medicine found that 44.3 percent of men use some form of complementary or alternative medicine. As many as 56 to 58 percent of American men diagnosed with prostate disease discussed personal use of CAM therapy with their doctor, according to the National Cancer Institute and a study published by The Journal of Urology.
Many dietary, phytotherapeutic, supplemental, and herbal agents have been used to prevent or treat prostate cancer, benign prostate hyperplasia, erectile dysfunction, and male infertility, but the role of CAM in managing men’s health conditions continues to be debated. If CAM is evaluated by criteria of evidence-based medicine, available data have not clearly established the efficacy of many alternative agents. Different extraction procedures, variations in the quality of raw products, and the lack of knowledge regarding mechanisms of action of active ingredients make comparisons between various products virtually impossible and lead to conflicting results in clinical trials. Nonetheless, many health care professionals believe that when used properly, CAM can be beneficial in improving men’s health.
Prostate Cancer
Prostate cancer is the most common cancer diagnosed in men and the second leading cause of cancer-related deaths in men in the United States. No complementary or alternative treatments will cure prostate cancer, but several CAM alternatives may be helpful in preventing the disease. CAM therapies present valuable opportunities for prostate cancer, particularly in the watchful waiting population. As mentioned, both the National Cancer Institute and a study published in 2019 by The Journal of Urology found that between 56 and 58 percent of men had used CAM therapy to support their prostate cancer diagnosis.
Foods that protect against prostate cancer. Several types of foods have shown potential for preventing prostate cancer. Of special interest are soy and soy products. Epidemiological data show a ten- to one-hundred-times lower incidence of prostate cancer in Asia, compared with Western countries. Soy products are a traditional staple in the diets of Eastern countries, suggesting that nutrition plays an important role in prostate cancer prevention. Legumes such as soybeans are rich in a variety of phytochemicals and are rich in isoflavones such as genistein and several other anticarcinogens that inhibit the growth of prostate cancer cells.
Lycopene, a carotenoid found mainly in tomatoes and tomato-derived products, has been shown in a number of clinical studies to have protective effects against the development of prostate cancer. Lycopene is an acyclic isomer of beta-carotene, and its most important anticancer property may be its strong antioxidant activity.
Cruciferous vegetables such as cabbage, Brussels sprouts, and broccoli have been shown to possess anticancer activities, possibly because of the substances they contain, such as indole-3-carbinol, glucaric acid, and sulforaphane, and because of their high concentration of the carotenoids lutein and zeaxantin.
The role of dietary supplements. The effectiveness of selenium in preventing prostate cancer has been the subject of numerous clinical trials, and different trials have yielded conflicting results concerning this trace element’s protective efficacy. It is thought that selenium’s antioxidant properties may help repair deoxyribonucleic acid (DNA), prevent cell invasion, and stimulate the signaling of transforming growth factor beta.
The Nutritional Prevention of Cancer Trial, which studied 1,312 men with low selenium levels, found a 63 percent reduction in prostate cancer incidence in men supplemented with selenium, compared with placebo. The men showed a 49 percent lower risk of prostate cancer through a seven-plus-year follow-up period. Reaching opposite conclusions, the Selenium and Vitamin E Cancer Prevention Trial of 35,000 men concluded that selenium and vitamin E, taken alone or together, do not prevent prostate cancer.
The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Trial studied the protective effects of vitamin E and beta-carotene in 29,133 male smokers age fifty to sixty-nine. In this trial, vitamin E supplementation led to a 32 percent reduction in prostate cancer incidence and a 41 percent decrease in prostate cancer deaths. Despite this, though, when one study compared participants diagnosed with prostrate cancer between 2006 and 2010 with those diagnosed between 2011 and 2016, a 48 percent decrease was found in the use of supplemental vitamin E. However, the same study found a 108 percent increase in supplemental vitamin D use.
Herbal therapy. Interest has been growing in the use of herbs in preventing prostate cancer. Among these agents, the catechins in green tea have shown encouraging results. In a one-year trial, men with precancerous changes in the prostate received green tea extract providing 600 milligrams of catechins per day, or a placebo. Prostate cancer developed in 3.3 percent of the men receiving green tea extract and in 30 percent of those given a placebo.
Benign Prostatic Hyperplasia
CAM therapies have also been useful in treating benign prostatic hyperplasia (BPH), an affliction that eventually affects at least 80 percent of men after age fifty. BPH is not related to cancer and is more bothersome than dangerous. The cause is thought to be related to variations in levels of hormones such as dihydrotestosterone or estrogen (or both), causing enlargement of the prostate, which partially blocks the urethra and hinders urinary voiding.
Some nutraceuticals have produced results equal to or better than pharmaceuticals prescribed to treat BPH. Several meta-analyses suggest clinical efficacy and good tolerability for extracts from Serenoa repens (saw palmetto), Pygeum africanum (from the bark of the African plum tree), stinging nettle, and pumpkin seeds.
Saw palmetto extract, derived from the fruit of S. repens, the American dwarf palm, is the botanical best studied and most used to treat symptoms of BPH. It appears to contain substances that have activity similar to (but weaker than) 5-alpha-reductase inhibitors, which prevent conversion of testosterone to dihydrotestosterone. Some studies have found that the efficacy of S. repens extract is comparable to that of finasteride and alpha-blockers.
Extract of the bark of the African plum tree P. africanum moderately improves urinary symptoms associated with BPH. Numerous studies report that pygeum significantly reduces urinary hesitancy, frequency, nocturia, and pain with urination in men with mild to moderate symptoms.
Clinical studies have shown that pumpkin seed oil (Cucurbita pepo), in combination with saw palmetto, effectively reduces symptoms of BPH. Researchers have suggested that the zinc, free fatty acid, or plant sterol content of pumpkin seeds may account for their efficacy.
Stinging nettle root (Urtica dioica), in combination with other herbs (especially saw palmetto), is effective in relieving symptoms of BPH. Clinical studies have shown stinging nettle to be comparable to finasteride in slowing the growth of certain prostate cells. Unlike finasteride, however, the herb does not decrease prostate size.
Erectile Dysfunction
The inability of men to achieve or maintain an erection sufficient for satisfactory sexual function can have considerable impact on interpersonal relationships and quality of life. According to Douglas MacKay, writing in Alternative Medicine Review, erectile dysfunction (ED) affects nearly 40 percent of men forty to seventy years old and 70 percent of men seventy years and older in the United States; by extrapolation, about thirty million men in the United States are affected. While prescription drugs have proven valuable in managing ED, they are not without limitations.
Over the centuries, many products have been touted as enhancing male vigor and libido. While the effectiveness of many of these substances cannot be adequately confirmed, arginine, yohimbine, Panax ginseng, and Ginkgo biloba all provide some degree of evidence that they are helpful for treating ED.
Nitric oxide (NO) is intimately related to penile erections. When a man becomes aroused, NO secretion begins in the blood vessels that lead into the penis, allowing the vessels to relax and widen to allow an increased flow of blood to enter the penis and harden it. NO levels decline as men age, resulting in ED. L-arginine, an amino acid found in muscle and cell tissues, is the biological precursor of NO. The formation of NO depends on sufficient levels of L-arginine in the body. L-arginine supplementation is particularly effective for treating men with abnormal NO metabolism, and most clinical trials have shown positive treatment results, often doubling levels of vascular NO.
Derived from the bark of an African evergreen tree (Corynanthe yohimbe or Pausinystalia yohimbe), yohimbine (also known as yohimbe) is regulated as a drug in some countries, where it is pharmacologically classified as an alpha-2-adrenergic receptor antagonist. As such, it blocks brain receptors involved in releasing norepinephrine in the genitals. Norepinephrine is the principal neurotransmitter involved in the vascular smooth muscle contraction that reduces penile blood flow, ending an erection. Therefore, blocking norepinephrine receptors helps prolong tumescence. Yohimbine increases the amount of blood that is allowed to flow into the penis and prevents it from flowing out.
For more than two millennia, P. ginseng has been used by Chinese healers for its restorative properties. Modern scientists have identified active constituents, including triterpene saponin glycosides known as ginsenosides, which may be responsible for some of ginseng’s antioxidant and health-preserving properties. Ginsenosides have been shown to increase the release of NO, and preliminary studies suggest that this is ginseng’s primary mechanism of action, resulting in improved penile hemodynamics.
The herb Ginkgo biloba also has vasodilating properties. It is used in many alternative herbal supplements to help increase blood flow to the genitals. Recent evidence supports indications that Ginkgo biloba extract is effective in the treatment of ED caused by the lack of blood flow to the genitals. It enhances blood circulation and appears to help ED by increasing blood flow to the penis. It can also relax the muscles and assist with penis blood flow.
Infertility
According to the Center for Disease Control, between 2015 and 2019, some form of infertility was seen in 11.4 percent of men between the ages of fifteen and forty-nine and 12.8 percent of men between the ages of twenty-five and forty-nine. Male infertility is usually associated with a decrease in the number, quality, or motility (power of movement) of sperm. Taken together, low sperm count in the semen, decreased sperm motility, and abnormal shape of the sperm are responsible for about 40 percent of the infertility issues in men.
Excessive reactive free radicals can be very damaging to sperm. Elements in the sperm cell membrane are highly susceptible to oxidative damage. Several antioxidant supplements that regulate the effects of oxidative stress, such as vitamin C, vitamin E, glutathione, selenium, and coenzyme Q10 (CoQ10), have proven to be effective in treating this cause of male infertility.
The effects of oxidative DNA damage and the role of dietary ascorbic acid (vitamin C) in preventing this damage have encouraged examination of these factors in relation to human sperm DNA. One study showed that dietary ascorbic acid protects human sperm from oxidative DNA damage that could affect sperm quality and increase the risk of genetic defects. Another study found that daily supplementation with 200 to 1,000 milligrams of vitamin C increased the fertility of men with a condition called agglutination, in which sperm stick together.
Vitamin E supplementation has been shown to enhance fertility in men, most probably by decreasing free-radical damage to sperm cells. In another study, men with low fertilization rates were given 200 IU (international units) of vitamin E daily. After one month of supplementation, fertilization rates increased significantly, and the amount of oxidative stress on sperm cells decreased.
Glutathione and selenium are vital to the antioxidant defenses of sperm and have shown positive effects on sperm motility. Deficiencies in either of these substances can lead to defective sperm motility. In a clinical study of twenty infertile men, glutathione demonstrated a statistically significant improvement in sperm motility. Another study reported that fertile males had significantly higher selenium levels in their seminal fluid than infertile men.
Zinc deficiency is associated with decreased testosterone levels and reduced sperm count. An adequate amount of zinc ensures proper sperm production and motility. Several studies have found supplemental zinc to be helpful in treating cases of low sperm count or of decreased testosterone levels.
The amino acid L-arginine is a biochemical precursor of substances that are thought to be essential to sperm production and motility. L-arginine is also essential for the production of testosterone, the predominant hormone necessary for healthy sperm production. In one study, 74 percent of men with low sperm count experienced significant improvement in sperm count and motility after taking 4 grams of L-arginine per day for three months.
Carnitine, derived from an amino acid, contributes directly to sperm motility and may be involved in the successful maturation of sperm. This is especially important because sperm tend to accumulate carnitine while in the epididymis. Low levels of carnitine lead to potential alterations in sperm motility. One study found a direct correlation between semen carnitine content and sperm motility.
CoQ10 is concentrated in the mitochondria of sperm cells, where it is involved in energy production. It also functions as an antioxidant, preventing lipid peroxidation of sperm membranes. In one study, 10 milligrams per day of an analog of CoQ10 was given to infertile men, resulting in increases in sperm count and motility.
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