Men’s Health Research Review
What do studies conclude about male-centric wellness issues?
When it comes to health, men sometimes seem to get short changed. Compared with women, men die more often of cardiovascular disease and cancer, are less likely to discuss concerns with their doctor, and live an average of about 6 years less than their female counterparts (Icahn 2014). As a fitness professional, you work on the front lines of wellness and are in a prime position to share information that may save a life.
It’s important to have a solid and scientific understanding of male-specific health challenges; for example, do you know how body weight, exercise and nutrition impact prostate health, age-related testosterone deficiency and heart disease? Educate yourself on these and other topics so you can lead and train from a greater knowledge base. You’ll help your male clients to beat the statistics, avoid preventable diseases and achieve optimal health.
To assist you, we have summarized several recent studies that center on men’s wellness issues, with expert commentary on what the findings may mean for men. Each section includes practical guidance and recommendations you can use to help your male clients enjoy good health for the long term.
Men, Metabolic Syndrome and the Mediterranean Diet
WILL A HEART-HEALTHY DIET HELP MEN PREDISPOSED TO HEART DISEASE, EVEN IF THEY DON’T LOSE WEIGHT?
Study reviewed: “Effect of an isoenergetic traditional Mediterranean diet on apolipoprotein A-I kinetic in men with metabolic syndrome” (Richard et al. 2013).
Food choices are undeniably important when it comes to heart health. For example, consider the Mediterranean diet, which is based on the kinds of foods typically eaten in that region: meals rich in vegetables, fruits and whole grains; inclusive of wine and olive oil; and low in red meat. It has been repeatedly shown that this way of eating significantly improves heart health and other markers of well-being (Sofi et al. 2008).
However, in previous studies subjects have typically lost weight on the diet, creating a confounding factor: Was it the Mediterranean-style food or the weight loss that actually made people healthier? To determine the answer, Richard and colleagues (2013) studied a group of 26 male volunteers with metabolic syndrome: a cluster of physiological factors—such as high blood pressure, abdominal obesity and unhealthy measures of cholesterol, triglycerides and/or fasting glucose—that in combination boost one’s risk of developing heart disease (AHA 2014).
For 5 weeks the men ate an isoenergetic (calorically stable) diet that reflected the average macronutrient intake of a typical (unhealthy) North American diet. Then they ate a Mediterranean diet for 5 weeks. Results demonstrated that the heart-healthy food plan helped men at risk for cardiovascular disease to improve their “bad cholesterol” (low-density lipoprotein, i.e., LDL) levels, whether or not they lost weight.
Takeaway tips. Although the study’s authors caution that the results of this short-term study may or may not be reproduced over a longer term, the results are encouraging for men predisposed to heart disease who eat healthfully without experiencing weight loss. “This study supports the Mediterranean diet’s benefits as it directly affects LDL levels and functions,” says industry expert Irv Rubenstein, PhD, an exercise physiologist and founder of STEPS, a personal training center in Nashville, Tennessee.
However, Rubenstein cautions against applying sweeping conclusions. He notes that the study abstract implies that not all participants responded to the diet in the same way (i.e., there were nonresponders). This suggests that some— but not all—people may be able to elicit similar benefits from the Mediterranean diet even if they don’t lose weight, he says. “What you can claim [based on this study] is that a particular diet can make favorable changes in some people’s lipid profiles, regardless of weight or body fat changes,” he says.
With that caveat, it’s useful to remind your clients of the many other benefits of the Mediterranean diet, Rubenstein adds. These include high antioxidants (from vegetables), high fiber (from fruits, vegetables and whole grains) and the benefits of eating lower-calorie, more-filling foods.
Cellular Impacts of Exercise on Prostate Health
HOW DOES EXERCISE AFFECT THE PROSTATE TISSUE OF LOW-RISK CANCER SUFFERERS AT THE CELLULAR LEVEL?
Study reviewed: “Physical activity and prostate gene expression in men with low-risk prostate cancer” (Magbanua et al. 2014).
Among men, prostate cancer is the most common cancer and the second most deadly (after lung cancer) (Icahn 2014). Symptoms may include loss of appetite and/or weight, and— perhaps most relevant to fitness professionals—complaints of low-back, pelvic, hip and/or groin pains (Icahn 2014). Fortunately, exercise usually helps. Men with prostate cancer who exercise vigorously have a reduced risk of all-cause mortality and prostate-cancer-specific mortality (Kenfield et al. 2011). Brisk walking (Richman et al. 2011) and other “vigorous” activities, when done at least 3 or more hours per week, improve prostate-cancer-specific survival. Biking, tennis, jogging and swimming (Kenfield et al. 2011) all fit into this category.
To better understand this phenomenon, in 2014 Magbanua and colleagues studied prostate tissue at the molecular level in
71 men with low-risk prostate cancer. Specifically, the researchers examined the associations between self-reported physical activity and gene expression patterns. (The latter refers to the way in which information “encoded” in our genes is used to create various “building blocks” for our bodies, such as the proteins that form enzymes, cells and other bodily structures.)
The men’s prostate tissue samples were grouped according to type, intensity and amount of physical activity reported. The results at the individual gene level revealed modest differences between men who performed vigorous activity for at least 3 hours per week compared with those who did not. Specifically, the scientists found that cell cycling (the series of events that allow a cell to replicate itself) and DNA repair pathways (the mechanisms by which a cell repairs itself at the genetic level) were upregulated (increased) in men who completed 3 or more hours of vigorous activity per week. In essence, the prostate cells of men who exercised appeared “more active” at the cellular level, in part explaining why vigorous exercise helps to protect against the progression of early-stage prostate cancer.
Takeaway tips. For most men, the threshold of exercise required to reduce risk of disease progression—only 3 hours per week of brisk walking—is achievable and encouraging news. Rubenstein notes that, in this study, participants appeared to be in shape prior to their cancer diagnosis. What’s his takeaway? When low-risk prostate cancer is a concern, fit clients should endeavor to remain fit. Clients who exercise moderately should consider adding intensity. And finally, Rubenstein says, although exercisers may see only modest benefits at the cellular and DNA levels, exercise undoubtedly confers many other wellness benefits and should be encouraged, provided cancer patients have their physician’s clearance.
Hormones and “Male Menopause”
IS THE DECLINE OF TESTOSTERONE OR ESTROGEN LINKED TO “MALE MENOPAUSE”?
Study reviewed: “Gonadal steroids and body composition, strength, and sexual function in men” (Finkelstein et al. 2013).
Male menopause—or “man-o-pause,” as it’s sometimes colloquially called—is a collection of symptoms that some men experience in middle age and beyond. Currently a controversial topic in medicine, male menopause is frequently associated with obesity and general poor health (Paddock 2010). Symptoms include fatigue, depression, decreased libido, erectile dysfunction, and alterations in mood and cognition (Morales Heaton & Carson 2000).
More correctly termed andropause syndrome (AS), the condition is also known as late-onset hypogonadism, testosterone deficiency syndrome, and androgen decline in the aging male, or ADAM (SSAD 2014; Morales Heaton & Carson 2000). As these alternative names suggest, declining testosterone levels are thought to contribute to AS.
Since 2000, the number of men beginning testosterone therapy—the traditional treatment for AS—has almost quadrupled in the United States (Layton et al. 2014). But interestingly, new research suggests it is not just testosterone, but also the hormone estrogen, that impacts the condition. It is known that some of the testosterone in men is converted into estrogen (specifically, estradiol) by the enzyme aromatase. Therefore, men with high testosterone typically have high levels of estrogen. Because the inverse is also true, it is difficult to determine the role of each hormone in certain physiological functions.
A 2013 study by Finkelstein and colleagues examined whether changes that occur in middle-aged and older men are due to low testosterone, low estrogen or both. Three hundred men were randomly separated into two groups. For 16 weeks, one group received daily doses of a testosterone gel or a placebo. In the other group, subjects were given a testosterone gel plus an aromatase inhibitor, which prevents testosterone from converting into estrogen—in effect limiting the amount of estrogen in their bodies.
The group that received the estrogen-inhibiting gel showed similar increases in body fat to what one would expect in males with mild testosterone deficiency, with no changes in lean body mass or leg strength. Overall, these results imply that testosterone levels regulate lean body mass, muscle size and strength; estrogen levels regulate fat accumulation; and both hormones regulate sexual function.
“The biggest surprise was that some of the symptoms routinely attributed to testosterone deficiency are actually partially or almost exclusively caused by the decline in estrogens that is an inseparable result of lower testosterone levels,” said lead author Joel Finkelstein, MD, in a press release (MGH 2013).
Takeaway tips. If you suspect a client has AS-related symptoms, refer him to a physician for screening. Be aware that correlated issues may include underlying cardiovascular disease, diabetes and depression. In some cases, cognitive impairment might also be an issue, which would necessitate exercise programs that are not too complex (Janot 2005).
Dan Ritchie, PhD, is an expert in kinesiology and gerontology, as well as the cofounder of the Functional Aging Institute and owner of Miracles Fitness in Lafayette, Indiana. He notes that many men over 50 experience a decline in testosterone levels, regardless of whether AS symptoms are present or not. For this reason, he argues that fitness professionals with male clients should be aware of how a strength training program can be used to boost testosterone and rebuild lean muscle. Ritchie explains that there is increasing interest in how intense strength training may be the key to boosting testosterone as men age, “which is why older men shouldn’t just ‘take it easy,’ but rather train hard.” Also, “be aware that aging men will often require longer recovery between intense training sessions, as their bodies can’t recover as quickly as [those of] 20 to 30-year-old men,” Ritchie adds.
Heart Disease, Strength Training and Weight Loss
IS REGULAR RESISTANCE TRAINING MORE IMPORTANT THAN LOSING WEIGHT WHEN IT COMES TO HEART DISEASE IN MEN?
Study reviewed: “Untrained young men have dysfunctional HDL compared to strength trained men irrespective of overweight/ obesity status” (Roberts et al. 2013).
In the United States, heart disease is the leading cause of death for men, responsible for roughly 1 in 4 deaths (CDC 2013). It is well known that high levels of high-density lipoproteins (HDL)—the “good” kind of cholesterol—are associated with a decreased risk of developing heart disease (Castelli et al. 1992). However, research now suggests that quality counts: It is not just total HDL levels that matter, but how well one’s HDL functions—whether or not your “good” cholesterol is “healthy,” so to speak (Feng & Li 2009).
To explore this concept further, in 2013 Roberts and colleagues set out to determine if the HDL in overweight men who regularly weight trained was “healthier” (better functioning) than that of overweight, sedentary males. Essentially, the researchers wanted to determine whether losing weight or being strong would be the better predictor of heart health (as correlated to healthy HDL function). They studied three groups of men: 30 lean men who worked out at least four times per week; 30 overweight men who did the same; and 30 overweight, sedentary men. The men ranged in age from 18 to 30.
Would the plus-size men who lifted weights have better-functioning HDL cholesterol than the overweight men who didn’t exercise? To determine the answer, the scientists checked various indices of vascular and metabolic health, including how well the men’s HDL functioned as an antioxidant (an indicator of how well the HDL was working in general). The study authors found that HDL was “healthier” in participants who regularly strength trained, regardless of whether they were thin or plus-size, and its effectiveness as an antioxidant was similar in the two strength training groups (lean and overweight). These findings imply that exercise habits probably predict healthy HDL cholesterol function better than body weight does, and that regular weight training may improve HDL function, even in men who remain overweight.
Takeaway tips. This study provides yet more motivation to encourage male clients to stick with a regular resistance training routine, even if they are not losing weight. Rubenstein cautions that these findings cannot be used to make definitive claims about whether or not thin men who don’t lift have worse HDL function than overweight men who do lift, since the study did not include an analysis of lean, sedentary men. Additionally, the amount of cardiovascular exercise participants engaged in during the study could be a confounding factor, he adds. Nevertheless, “there are many reasons why weightlifting benefits cardiovascular health; that’s been recognized for over 30 years,” says Rubenstein. “This study is a new take on it.”
Nutrition Update: Men and Meat
DO MIDDLE-AGED AND ELDERLY MEN NEED MORE PROTEIN THAN IS CURRENTLY RECOMMENDED?
Study reviewed: “Animal protein intake is associated with higher-level functional capacity in elderly adults: The Ohasama study” (Imai et al. 2014).
Most men get weaker as they get older. Age-related skeletal muscle atrophy (sarcopenia) typically begins in the fourth or fifth decade of life (Robinson et al. 2013). If left untreated, it may lead to functional impairment and physical disability (Janssen & Ross 2005). For adult males, the current Recommended Dietary Allowance (RDA) for protein, as set by the Food and Nutrition Board of the United States National Academy of Science, is 0.8 gram of protein per kilogram of body weight per day, regardless of age (Wolfe, Miller & Miller 2008; IOM 2002). Some researchers, however, argue that an amount closer to 1.5 g protein/kg/day—or about 15%–20% of total caloric intake— seems more likely to improve physical health markers in older people (Wolfe, Miller & Miller 2008). Could eating more meat also improve cognitive function in seniors? A recent Japanese study says that for men (but not women), this seems to be the case.
Imai and colleagues (2014) followed 1,007 older people over a 7-year period in Ohasama Town, Japan (the mean age at the beginning of the study was 67.4). Using a food frequency questionnaire, researchers divided participants into quartiles based on their consumption of animal, plant and total protein. The goal was to determine if a diet rich in animal and/or plant protein could improve higher-level functional capacity—including social and intellectual aspects, as well as measures related to activities of daily living (Wiley 2014)—in seniors.
The results? The men who ate the most protein (i.e., those in the highest quartile of animal protein intake) had a much lower risk of higher-level functional decline than those who ate the least (those in the lowest quartile). Interestingly, these associations were not seen in women, and no consistent association was observed between plant protein intake and higher-level functional decline in either gender. The authors concluded that, along with other modifiable health behaviors, a diet rich in protein may help older adults maintain their functional capacity (Wiley 2014), and men in particular may benefit from more animal protein.
Takeaway tips. Does this study mean your older male clients should eat more meat? Possibly, but correlation is not causation, as the adage goes within scientific research circles. Ritchie explains that in this type of study, many factors—including preexisting health status and socioeconomic influences—could be impacting the results. For example, if the men in the highest quartile ate more meat because they had more money to do so, perhaps the other privileges of relative wealth (access to better health care, lower levels of daily stress, and so on) are what actually helped them retain function over time. And of course, there are dangers in consuming too much of a good thing: Excessive protein intake (defined as intake that constitutes over 35% of total energy intake) is a known health danger and may contribute to nausea, diarrhea, serious medical conditions and even death (Bilsborough & Mann 2006). To avoid toxicity, protein should contribute no more than 25% of an individual’s energy requirements (Bilsborough & Mann 2006).
Nevertheless, this study—in conjunction with other research—is promising. And as a fitness professional, you can remind your older male clients of the importance of protein as a macronutrient, and recommend healthy proteins, such as nuts and legumes as well as fish and lean meats, says Ritchie. He notes that this is particularly important for men who want to regain lean muscle mass. If sarcopenia or functional decline is a concern, recommend that your client discuss his protein intake with a registered dietitian.
Helping Men Stay Healthy
Staying up to date on recent research in men’s health is important for fitness professionals who work with male clients. “A trainer should be more than a ‘muscle-and-heart’ person,” says Rubenstein. “There are too many other areas of wellness that come into play when it comes to fitness.” Compared with women, men die more frequently of preventable diseases, and hormones and aging affect men differently than their female counterparts. Encouraging your male clients to take better care of themselves—through appropriately intense exercise habits, healthy nutrition and regular medical care—can make a major difference in their lives.
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