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Men’s Health

Dr. Chris Habib
5 May 2014

Men’s Health
Often neglected, but important issues

by: Chris Habib, ND,
Abrar Negahban, ND(c),* Liam Latouche ND(c),
Katarina Vaculik, ND(c), and Maria Wong, ND(c)
Robert Shad Naturopathic Clinic
1255 Sheppard Avenue East
Toronto, Ontario

Men’s Health

Men’s Health Overview

According to the National Institutes of Health, more men need to pay attention to their health. Compared to women, men are more likely to smoke and drink, make unhealthy choices, and delay checkups and medical care. For many men, these obstacles are compounded on top of any underlying health issues they may have or that may run in their families. There are also conditions that impact only men, such as prostate issues and erectile dysfunction. Some health conditions are particularly overlooked in men, such as major depression. In younger men, it is important to screen for diseases and assess the risk of future medical problems. In particular, it may be important to check blood pressure and cholesterol regularly. These can be early indicators of future heart disease. If heart disease is present, foods that are high in monosaturated fat, such as avocados, can be helpful in keeping cholesterol in check. Fatty fish like salmon, herring, and halibut are also sources of healthy fat (in particular omega-3 fatty acids). These can lower the risk of heart disease. Other screenings to keep in mind are dental exams and eye exams. As men age and hit the age of 50, it becomes more important to screen for colon cancer and potentially osteoporosis.

There are many naturopathic therapies that can help to prevent and treat conditions related to men’s health. For example, maintaining a healthy diet, exercising, and getting adequate amounts of sleep can be useful for preventing certain conditions and improving others (like depression, which we will discuss below). There are many nutritional supplements that impact testosterone, which can help with prostate issues, and potentially with hair loss. Other supplements help with vasodilation, which can help with the symptoms of erectile dysfunction. For example, simple changes in diet can improve blood flow. Chocolate contains certain compounds called flavanols ** that can help improve cholesterol levels, improve circulation, and keep blood pressure in check. Men who have reduced blood flow are more likely to have erection problems, so hearthealthy foods may be useful for a healthy sex life. In any situation, it is always a good idea to check-in with your naturopathic doctor to get appropriately screened and treated for any existing conditions. Most importantly, your naturopathic doctor can ensure that the supplements and herbs you are taking are safe and appropriate for you.

Depression Depression

It is commonly thought that depression is a woman’s problem, but did you know that American men have a 12% lifetime risk of depression and are 4 times more likely to commit suicide than women?[1] This means that 1 out of every 8 men will develop depression in their lifetime. So what can be used to treat depression naturally? Studies show that some herbs and supplements can be just as effective as medications for mild to moderate depression. St. John’s Wort, also known as Hypericum, is one of the most common natural antidepressants.[2] The majority of the evidence shows that St. John’s Wort helps to improve mood as well as insomnia in patients with mild to moderate depression.[3, 4, 5] (Improving sleep is important because studies have shown that men who have difficulties falling asleep were two times more likely to have depression.[6]) To see effects, the research suggests it is better to have a product that is standardized to 0.3% hypericin or 3–5% hyperforin, and taking a dose of 300 mg three times a day.[2] Talk to your naturopathic doctor if you are on any medications, because St. John’s Wort can interact with many common medications such as digoxin and warfarin.

SAMe (S-adenosylmethionine) is a naturally occurring substance that is essential in many body processes. However, levels start declining with age, and lower levels of SAMe has been found in patients with depression.[2] Studies show that taking 200–400 mg of SAMe 2–4 times a day is as effective as some antidepressants in treating depression.[7, 8, 9] The benefit is that SAMe has few interactions with medications. However, SAMe can be quite pricy! Fish oils with omega-3 fatty acids are also used to improve the symptoms of depression, usually in combination with conventional medications. Current research suggests that taking fish oils with both EPA and DHA lowers the risk of depression and suicide.[2] One study demonstrated that taking 6.6 g/day of omega-3 fatty acids on top of the usual medications further improved the course of the illness.[10] With depression, it is always prudent to seek counseling to help to address the root cause of the illness. However, the herbs and supplements discussed above can help to alleviate symptoms associated with the depression. As mentioned, self-care is important, and it is always important to ensure that you are maintaining a healthy diet, exercising, and getting adequate amounts of sleep.

Erectile Dysfunction Erectile Dysfunction

Excess stress, sedentary lifestyle habits, obesity, and alcohol and tobacco use can have a negative impact on sexual performance. Erectile dysfunction (ED) in men can result from a medical condition, prescription medication, or be psychogenic in origin.[11] An erection requires sexual stimulation that leads to the release of nitric oxide (NO) into the penis. Presence of NO in the penis ultimately leads to increases in blood flow and engorgement.[12]

Nutritional supplements that have been found to be helpful in ED include l-arginine, a precursor to NO, and pycnogenol, which stimulates an enzyme that enhances the production of NO.[13] These therapies are useful when the cause of ED is related to impairment of NO activity. The combination of 1.7 g of l-arginine and 80 mg of pycnogenol daily has been shown to be safe, and can significantly improve ED in men.[13] Another supplement proven to be effective in the treatment of mild to moderate ED is l-citrulline, a precursor to l-arginine. A small study revealed that 1.5 g of l-citrulline per day for a month improved erectile function and satisfaction with sexual performance.[14]

Furthermore, several herbal remedies have been postulated to help with ED. Pausinystalia yohimbe at 5–10 mg can enhance blood flow to the regions of the penis responsible for erection integrity and doses of 10–20 mg daily have been shown to significantly improve ability to obtain and maintain an erection before and during intercourse and penile firmness, particularly in those who are nonsmokers, and did not increase blood pressure or pulse rate.[15, 16] Another herb that has can be beneficial is Korean ginseng, which at 900–1000 mg taken three times per day, has been shown to significantly improve scores on the International Index of Erectile Function (IIEF-5), as well as rigidity and maintenance of erections; not to mention its cost-effectiveness, with a 500 mg capsule costing about $0.06 compared to one sildenafil tablet, a prescription medication for ED, costing about $10.[17, 18, 19] Other herbs that show merit include Lepidium meyenii (commonly known as maca), which improved IIEF-5 score at 2400 mg daily, as well as Schisandra chinensis, which can potentiate the effects of sildenafil in those who do not respond to the drug alone.[20, 21] It should be noted that herbs can interact with pharmaceutical drugs as well as other herbs, so it is important to seek the care of a licensed naturopathic doctor to ensure effectiveness and safety.

Benign Prostate Hyperplasia Benign Prostate Hyperplasia

Benign prostate hyperplasia (BPH) is the most common condition in older men, and can lead to urinary symptoms including increased urinary frequency, incontinence, urgency, and dribbling. Hyperplasia refers to increase in number of cells in the prostate. The chance of getting BPH increases with age. By age 60 over half of men have some prostate enlargement.[22] As men age, the levels of the hormone testosterone decreases and levels of the hormone estrogen increases. This can lead to high levels of another hormone called dihydrotestosterone (DHT), which in turn leads to an enlarged prostate gland. In addition to lifestyle and diet changes, there are various herbs and supplements that can be used to treat BPH that your naturopathic doctor might consider for you to improve urinary symptoms, and most importantly, improve the quality of life of the men affected.

Serenoa repens, commonly known as saw palmetto, is one of the herbs studied for its effectiveness in treating BPH. It is known to be beneficial due to its anti-inflammatory, antiproliferative and antiandrogenic properties, meaning that it helps shrink the enlarged prostate and also reduces the levels of DHT. Clinical trials have shown taking it orally improves urinary symptoms including frequent daytime and nighttime urination, painful urination, hesitancy, urgency, and perineal heaviness.[23, 24] It has also been shown to prevent progression, and has no undesirable effects in individuals using to for over 10 years.[25]

Extracts of pumpkin seeds (Curcubita pepo) have also been used to treat BPH. Studies have shown taking extracts of the seeds orally helps in reducing painful urination and incontinence.[26] Another common herbal supplement used for BPH is Prunus africana, commonly known as pygeum. Pygeum has been observed to improve urinary symptoms including hesitancy, frequency during the day and night, and painful urination. It does this by reducing inflammation and reducing growth factors, which may play a role in the enlargement of the prostate.[27] Other nutritional supplements that have shown to benefit BPH positively in conjunction with saw palmetto are selenium and zinc, that function mainly by promoting an optimum antioxidant/oxidant balance.[28] Some men may have low levels of serum zinc, which can potentially lead to BPH, and therefore may benefit by supplementing with zinc.[29]