The Invisible Man ... No More

The Invisible Man ... No More
Natural health solutions stir interest in common Men’s Health issues.
by Steve Myers

Issues of spirit aside, a man is his brain. Women may jokingly question the existence or location of the male brain, but men are concerned about the health of their body’s control center (see Market Research article on page 66). As expected, the brain is quite a complex organ, including neurons, neurotransmitters and tissue; and, the best neurological preventive measures relate to preservation of existing components and providing the brain all the nutrients it needs to function.

Increased intake of essential fatty acids (EFAs) from exogenous sources—fish, flax and various other plants—is needed for maintenance of neuronal cell membrane phospholipids.¹ EFAs may also help prevent age-related deterioration of the brain, as research has shown aging causes deleterious alterations in the fatty acid composition of structural phospholipids, particularly docosahexaenoic acid (DHA).² Depletion of these important lipids in the brain could affect memory, and an animal study showed supplementation with DHA could correct age-related depletion of EFA levels in the hippocampus.³

Long- or short-term supplementation with the phospholipid phosphatidylserine (PS) may have the ability to reverse memory deficits associated with catecholamine depletion—which is more prevalent in women, but men aren’t too far behind. In a Japanese animal trial, 60 days of PS supplementation improved cognitive performance and increased release of acetylcholine, a neurotransmitter that suffers depletion in aging.⁴ Acetylcholine is made from the B complex vitamin choline, which has been shown to speed hippocampal maturation.⁵ A meta-analysis of 12 clinical trials found citicoline, a form of choline, improves memory, behavior and overall clinical impression in aging people.⁶ And citicoline (as Cognizin™, from Kyowa Hakko) improved memory in a proprietary animal study.

Inhibiting acetylcholinesterase, the enzyme that breaks down acetylcholine, is another theory studied for memory benefit. Huperzine A, derived from the Chinese herb Huperzia serrata, may help control or reverse cognitive decline, as evidenced by animal research.⁷

Protecting the brain is a huge task, and antioxidants are a huge class of natural substances effective at protecting against the free radicals and oxidative damage that can speed up aging and cognitive decline in the brain. In fact, a seven-year study conducted at the University of Washington, Seattle, found supplementation with antioxidants, including vitamins A, C and E, along with the minerals selenium and zinc, can reduce risk of developing cognitive impairment or cognitive decline.⁸ Vitamins E and C have demonstrated additional efficacy in protecting against dementia while improving cognitive function in later years,⁹ with vitamin E showing a particular benefit to cognitive preservation.¹⁰

In the areas of the brain most susceptible to oxidative damage— hippocampus, striatum, hypothalamus and cerebellum—researchers have discovered the antioxidant acetyl carnitine is neuroprotective, preventing DNA damage associated with aging.¹¹ This amino acid ester also combats cognitive decline by facilitating the transportation of fats to cell mitochondria instead of nervous brain tissue, where accumulation of fats dulls mental capabilities over time.¹²

Plant-based antioxidants also protect the noggin. Phycocyanins in spirulina can neutralize numerous key free radicals¹³ and curb betaadrenergic activity.¹⁴ It can not only protect against dangerous lipid peroxidation in the brain, but also can protect endogenous brain antioxidants from depletion.¹⁵ Increased consumption of green tea has been linked to lower cognitive impairment;¹⁶ its main phytochemical epigallocatechin gallate (EGCG) is particularly protective of hippocampal cells exposed to reactive oxygen species (ROS) and amyloid beta protein,¹⁷ which is indicated in development of Alzheimer’s disease (AD). Ginseng, which has reduced cognitive impairment and loss of brain cells in degeneration models,¹⁸ has been shown to protect against neuronal damage in AD¹⁹ and against various toxic effects in the brain, including memory impairment following excessive oral alcohol administration.²⁰

Two other botanical ingredients have proven beneficial to brain health and function due partially to their ability to improve blood flow to the brain. Ginkgo biloba, a known vasodilator, has improved cognitive function in a model of existing cognitive impairment,²¹ as well as one of mild, age-related memory loss.²² In a similar vein, supplementation with vincamine, an alkaloid of Vinca minor, or the semi-synthetic derivative of vincamine called vinpocetine has improved memory scores in healthy subjects,²³ while its moderate benefit to patients with existing cognitive decline was less conclusive.²⁴

While improving blood flow is important to feeding the brain and other crucial organs and tissues, it is also important to tend to the variable substances found in the blood, namely those that correlate to diseases and conditions that plague men.

For example, sugar and spice may be more commonly associated with the fairer sex, but men would do well to gain control over their blood sugar levels, the major factor in the male enemy #6, diabetes. According to the American Diabetes Association (ADA), diabetes affects 10.9 million men, slightly more than it affects women. Fortunately, as is the case with other top men killers, the more common form of diabetes—type II—is both preventable and controllable.

The household spice cinnamon is among the many blood sugar modulators heating up the more recent diabetes research scene. Early theory is type-A polymers in cinnamon can increase insulin receptor sensitivity by stimulating autophosphorylation of a truncated form, according to U.S. Department of Agriculture (USDA) research, which suggested the spice acts similar to insulin. In one USDA trial, type II diabetes patients, who are marked by their inability to properly utilize insulin thereby causing dangerously high blood sugar levels, have experienced reduced blood sugar levels when supplementing with cinnamon in the absence of conventional therapy insulin injections.²⁵ Likewise, a double blind, placebo-controlled, proprietary study conducted by Ohio Research Group showed supplementation with cinnamon extract (as Cinnulin PF™, from Integrity Nutraceuticals International) significantly lowered fasting blood glucose levels and improved insulin sensitivity in pre-diabetics, without any significant changes in clinical blood chemistry.

Banaba, Lagerstroemia speciosa, provides additional herbal remedy to blood sugar levels. In 2002, Japanese researchers hypothesized ellagitannins from banaba acted as activators of glucose transport.²⁶ In a proprietary study, type II diabetics given 48 g/d of a 1-percent corosolic acid concentration of banaba (as GlucoTrim®, from OptiPure® Brand Chemco Industries), in lieu of hypoglycemic medications, experienced a significant drop in blood sugar levels.

Other herbs demonstrating considerable contribution to management of blood glucose include bitter melon,²⁷ fenugreek galactomannins (as FenuLife®, from Actaris),²⁸ gymnema,²⁹ and French maritime pine bark (as Pycnogenol®, from Natural Health Science).^30,31 In addition, one herb used as both a natural remedy and alternative sweetener—stevia—contains steviosides shown to both reduce postprandial blood glucose levels and increase glucagon (a protein opposite in action to insulin) in type II diabetics.^32,33

Fiber has also been shown to modulate blood glucose,^34,35,36 especially in the form of oats,³⁷ an action primarily attributed to its beta-glucan content. In fact, one trial reported a 50-percent reduction in glycemic peak, achieved with a concentration of 10-percent beta-glucans in cereal food.³⁸ Demonstrating its functional capability, beta-glucan-rich oat bran flour (as Natureal™, from GTC Nutrition) lowered postprandial glycemic response in type II diabetics following administration of an oral glucose load.³⁹ Similar glucose regulation has been associated with supplementation of barley beta-glucans (as Barlív™, from Cargill).^40,41

Despite the encouraging results from herbal trials on diabetes, minerals have enjoyed a lion’s share of recent research on blood glucose and metabolic syndrome. In various forms, chromium has been shown to enhance the efficiency of insulin use in the body, possibly by enhancing insulin receptor signaling in muscle tissue.⁴² Chromium picolinate (as Chromax®, from Nutrition 21) boosted energy balance and insulin function in one trial,⁴³ and improved fasting and postprandial glucose levels, insulin and HbA1c (a marker of longterm glucose control) in type II diabetics in another trial.⁴⁴ A 0.7-percent to 1.9-percent point reduction in serum concentrations of HbA1c and significantly reduced insulin resistance was achieved by combined supplementation of chromium picolinate and biotin (as Diachrome®, from Nutrition 21) in type II diabetes patients.⁴⁵ Bound with niacin, chromium polynicotinate (as ChromeMate®, from InterHealth) given to type II diabetics significantly lowered fasting glucose levels and HbA1c.⁴⁶ Similar blood sugar reduction was also shown in a trial featuring combined supplementation of chromium polynicotinate (as ChromeMate), zinc monomethionine (as L-OptiZinc®, from InterHealth) and grape seed extract.⁴⁷

Diabetes greatly increases the risk of cardiovascular disease, which strikes diabetics more than twice as often as it does non-diabetics and is the number one killer of men. Diabetes can change the chemical composition of the blood, leading to atherosclerosis. Key markers for heart disease (HD) are blood levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol, triglycerides and apolipoprotein-B (apo-B).

As in diabetes, fiber in various forms—including from oats, psyllium and barley—can help lower LDL, total cholesterol and apo- B.⁴⁸ In fact, oat beta-glucans have also been shown to help control triglycerides, C-reactive protein (CRP), glucose, insulin and homocysteine.⁴⁹ Broad lipid maintenance has also been attributed to EFAs from both vegetable and marine sources—fish oil even aids endothelial function.^50,51 Most recently, monounsaturated fatty acids (MUFAs) were found to lower both systolic and diastolic blood pressure, a benefit researchers reported did not occur in subjects given fish oil.⁵²

Among vitamins, niacin is noteworthy, raising beneficial HDL levels while reducing LDL quantity and particle size.^53,54 Folic acid can improve risk of stroke and heart attack, most likely by limiting dangerous levels of homocysteine.⁵⁵ The ever-ubiquitous vitamin C has improved parameters of atherosclerosis⁵⁶ and, combined with vitamin E, optimized post-stroke lipid and inflammation levels.⁵⁷

Of the heart healthy carotenoids, lycopene conveys antioxidant benefits to blood lipid levels⁵⁸ and has exhibited anti-thrombotic actions, indicating efficacy against cardiac events such as heart attack and stroke.⁵⁹ Antioxidant benefits in HD have also been shown by selenium, which targets lipid peroxidation;⁶⁰ low levels of selenium have been linked to increased homocysteine and risk of cardiac death.⁶¹ Serum levels of magnesium and chromium have also been inversely associated with risk of HD, including hypertension, heart attack, CHF and arrhythmias.⁶²

Coenzyme Q10 (CoQ10) has demonstrated actions against major factors for atherosclerosis, including blood pressure,₆₃ hyperlipidemia⁶⁴ and oxidative damage.⁶⁵ This vitamin-like nutrient also improves cardiac function and output in CHF patients,⁶⁶ attributed to its effect on energy at the mitochondrial level.

L-carnitine and L-arginine are two conditionally essential amino acids that support nitric oxide-induced vasodilation, which improves blood flow. Based on this action, arginine has been shown to reduce complications following infarctions and thrombosis (stroke),⁶⁷ and carnitine has been found to relieve hypertension and improve heart function following heart attack or failure.⁶⁸

Phytonutrients from numerous herbs and plant-based foods have shown potent actions against lipid peroxidation and harmful blood lipid levels. Citrus bioflavonoids have helped manage LDL, total cholesterol, triglycerides and apo-B,⁶⁹ as have soy isoflavones genistein and daidzein,⁷⁰ garlic organosulphanes,⁷¹ guggulsterones,⁷² and grape seed extract flavans, anthocyanins, quercetin, myricetin, kaempferol and resveratrol.⁷³ Cocoa flavanols⁷⁴ and tea catechins (specifically EGCG) have also shown potent antioxidant effects on lipid health and against atherosclerosis;^75,76 a recent trial further linked increased cocoa intake to lower high blood pressure and decreases in both cardiac and all-cause mortality.⁷⁷ Similar anti-atherosclerotic results were attributed to phytonutrient-rich juice from bitter melon⁷⁸ and pomegranate,⁷⁹ which has most recently been credited with improving blood flow to the heart.⁸⁰

According to a recent South African review, sterols and stanols from plants may be effective adjuncts to traditional therapy for people with familial hypercholesterolemia (FH), a condition marked by severe LDL levels.⁸¹ Researchers noted total cholesterol was reduced by as much as 11 percent, while LDL was reduced by as much as 15 percent.

The major complications of poor vascular and lipid health are locked in a chicken-and-egg cycle. For instance, a study reported in the Journal of the American Heart Association concluded men experiencing silent, or symptom-less, coronary artery disease (CAD) and type II diabetes were nine times as likely to have erectile dysfunction (ED) as were diabetic men with more noticeable CAD symptoms.⁸² However, a JAMA trial found men diagnosed with incident ED have a 25 percent higher risk of CAD than do men with no ED,⁸³ while risk in men with prevalent ED rose by 45 percent.⁸⁴

Erection science gets quite complicated, as numerous physical and physiological factors can play a role in the readiness of the male sex organ; but, at its most basic, an erection requires blood to fill the caverns of the penis and stay there long enough for successful function.Thus, improving blood flow is a crucial aspect of counteracting ED. As evidence that men’s hearts are involved in sex, ingredients affecting vascular health and blood flow in HD, diabetes and cognitive function are also indicated for use in ED. Interestingly, Italian researchers discovered a direct relationship between male copulatory performance and NO synthase activity in the hypothalamus region of the brain.⁸⁵ As a mediator of NO-dependent vasodilation, arginine is a proven booster of sexual activity, including ED.⁸⁶ Combined with yohimbine, arginine effectively improved erections in males with mild to moderate ED.⁸⁷ One research review concluded arginine and yohimbine, as well as panax ginseng, maca and the vasodilator ginkgo each displayed some degree of benefit in men with ED, noting the actions of these agents appears to be due to improvements in penile endothelial L-arginine-NO activity.⁸⁸ South Korean scientists found 900 mg of panax ginseng given three times daily to patients with clinical ED significantly improved their Mean International Index of Erectile Function scores compared to patients given a placebo.⁸⁹

Another ingredient in the vascular health arsenal, pine bark extract (as Pycnogenol), is also useful against ED. Researchers from Slovakia reported Pycnogenol reduced ED from severe to mild in 21 patients while also increasing plasma antioxidant activity and reducing in total cholesterol.⁹⁰

Much to the chagrin of countless men, impotence and infertility often go hand-in-hand. Carnitine, which has exhibited some benefit to ED,⁹¹ has a good deal of research support for its role in male fertility, especially in the area of sperm health and function. Both carnitine and acetyl carnitine are highly concentrated in the epididymis and play a crucial role in sperm metabolism and maturation,₉₂ as well as sperm motility and overall quality.^93,94 According to scientists, infertile men have significantly lower seminal carnitine levels than do fertile men,⁹⁵ and carnitine is more active than testosterone in boosting nocturnal penile tumescence (swelling) and International Index of Erectile Function scores.⁹⁶

Sperm support is also a benefit ascribed to vitamin and mineral supplementation. A study conducted in Nijmegen, the Netherlands, combined zinc sulfate and folic acid treatment in both subfertile and fertile men resulted in increased total normal sperm count.

Additional sperm support can be provided by maca, which has been shown to increase testosterone,⁹⁷ improve sperm production and motility,⁹⁸ limit spermatogenic disruption⁹⁹ and stimulate spermatogenesis.¹⁰⁰ In fact, between 48 g/d and 90 g/d of maca extract has been indicated to spark and fuel spermatogenesis in animal models.¹⁰¹

Even if a man can achieve healthy erections and has healthy sperm, reproductive function and sexual performance are nowhere without sufficient libido, or sexual desire. Many ingredients are promised to increase libido and sexual energy, but few have any recent research support.However, Eurycoma longifolia jack has been linked to increased sexual desire and intensity,¹⁰² decreasing hesitation time in non-copulatory animals.¹⁰³ According to Malaysian scientists specializing in E. longifolia research, the herbal extract can enhance sexual function via various aspects of penile structure, promoting the growth of both ventral prostate and seminal vesicles¹⁰⁴ and increasing the size of the levator ani, a thin muscle of the pelvis.¹⁰⁵

Many men measure their manliness not only in terms of virility, but also strength, energy and appearance, all under the guise of the need to improve male performance.

Proving broadly applicable to men’s health concerns, carnitine increases energy production by supplying fatty acids to the mitochondria and beneficially impacting glucose homeostasis.¹⁰⁶ This amino acid metabolite also improves muscular response to training, increases resistance to muscle fatigue, and optimizes training, competition and recovery from strenuous exercise by reducing accumulation of toxins in plasma.¹⁰⁷ Additionally, carnitine can benefit body composition and muscle mass.¹⁰⁸

Ribose, a component of the energy molecule adenosine triphosphate (ATP), facilitates recovery of ATP levels following highintensity exercise and curbs post-workout oxygen free radical production.¹⁰⁹ A naturally occurring pentose carbohydrate, ribose also has displayed some ergogenic benefits, increasing both full workout power output and total work performed.¹¹⁰ CoQ10, which is present in every body cell, also supports ATP production. In a Finnish study, CoQ10 administered to world-class cross country skiers improved all measured indexes of physical performance, including aerobic exercise training, anaerobic exercise and VO2max.¹¹¹ The herb guarana addresses energy and performance by stimulating the nervous system and increasing metabolism.¹¹² In a Japanese study, guarana increased blood glucose levels, decreased liver glycogen content and significantly suppressed exercise-induced hypoglycemia.¹¹³ B vitamins can help attenuate stress-related parameters of physical activity, and vitamin B3 (niacin) helps release energy from carbohydrates.^114,115

An energy and performance enhancer popular with active males is creatine, an amino acid derivative that delivers ergogenic benefits by converting to phosphocreatine (PCr), an energy source useful for activities requiring high-intensity bursts of energy. In one trial, male athletes administered creatine experienced a significant increase in body mass, decrease in maximum heart rate and decrease in submaximal VO2.¹¹⁶ It is particularly useful in resistance training, according to Canadian research showing creatine supplementation following arm training resulted in greater increases in muscle thickness of the arms, particularly in males.117 Magnesium-creatine chelate (as Creatine MagnaPower™, from Albion Advanced Nutrition) can more effectively enhanced ability to generate and regenerate ATP for muscular performance,¹¹⁸ and has helped delay exhaustion in runners by addressing accumulated oxygen deficit.¹¹⁹

On its own, magnesium partially regulates B vitamin mobilization and is involved in numerous aspects of physical performance, including neuromuscular, cardiovascular, immune, metabolic and hormonal functions.₁₂₀ The mineral is readily lost in sweat,¹²¹ and deficiency is linked to metabolic impairment, increased oxygen requirement and decreased endurance.^122,123

Metabolism is as crucial to active men for energy management and endurance as it is for body composition. While chromium can deliver ergogenic benefits, including increased exercise performance, strength and carbohydrate metabolism,^124,125 it is also an important ingredient for controlling body composition.¹²⁶ Niacin-bound chromium (as ChromeMate) has been shown to trade fat mass for more lean body mass (LBM).¹²⁷

A handful of herbs have been researched for benefits to achieving and maintaining LBM. Researchers have hypothesized forskolin (from Coleus forskolhii) may stimulate 3’5’adenosine monophosphate (AMP), a compound involved in the release of fatty acids from adipose tissue, leading to improved thermogenic response and increases in basal metabolic rate and body fat consumption. Intake of 250 mg of 10-percent forskolin extract (as ForsLean®, from Sabinsa Corp.) twice daily for 12 weeks improved body composition while concurrently increasing bone mass and serum free testosterone levels in overweight and obese men.¹²⁸

Citrus aurantium, or bitter orange, addresses body composition via thermogenesis. In studies, bitter orange (as Advantra-Z®, from Nutratech) increased thermogenic response and metabolic rate in lean men who took either a supplement or a functional bar,¹²⁹ and heightened thermogenic response, without raising blood pressure, in men supplementing without ingesting food.¹³⁰

A non-stimulant, thermogenic ingredient for management of weight and body composition is 7-keto DHEA (3-acetyl-7-oxodehydroepiandrosterone), which is found commonly throughout the body and is a metabolite of DHEA. Men have, on average, 30 percent more DHEA than do women, but levels of both DHEA and 7-keto diminish in the aging body, declining as much as 40 percent between the ages of 20 and 40. Supplementation with DHEA helps restore those waning levels in the body, which are inversely linked to decreased resting metabolic rate (RMR) and increased obesity—the rate of obesity is steadily rising in men, while leveling off in women.¹³¹

As far as supplementation, 7-keto is less likely than DHEA to produce steroid hormones, such as sex hormones estrogen and testosterone. Also, unlike other DHEA metabolites, 7-keto induces key thermogenic enzymes. According to recent research, 7- keto (as 7-keto™ “naturlean™”, from Humanetics Corp.) activates three thermogenic enzymes, increasing RMR and burning fat without the use of stimulants.^132,133 In a pair of human trials, subjects given 100 mg twice daily of 7-keto DHEA along with regular, supervised exercise and calorie-restricted diet significantly reduced body weight and body fat, compared with exercise and a reduced-calorie diet alone (which can actually lower RMR).^134,135 Researchers noted the 7-keto treatment was well-tolerated, with no significant changes to vital signs, blood sugar, testosterone and estradiol levels, liver and renal function, or thyroid stimulating hormone (TSH).

Also thermogenic is green tea, which may affect body composition via either sympathetic activation of thermogenesis, fat oxidation or both.¹³⁶ Researchers have suggested green tea extract can stimulate fat oxidation, prevent obesity and increase endurance.^137,138,139

Another scientifically supported body composition ingredient is conjugated linoleic acid (CLA), which can reduce body fat mass (BFM) while preserving or even increasing LBM.^140,141 Administration of either CLA-free fatty acid or CLA triglycerides (as Tonalin®, from Cognis) in both men and women led to significant decreases in BFM, with the CLA-free fatty acid also increasing LBM.¹⁴² In another trial, supplementation of CLA (as Clarinol™, from Lipid Nutrition) caused a significant reduction in body fat and an increase in body cell mass in both novice and advanced resistance athletes.¹⁴³

Exercise and sport at any intensity can cause fatigue and wear-andtear to muscles, bone, joints and other body components. Among the natural ingredients that aid recovery and minimize exercise-induced damage, ginseng’s adaptogenic properties have proven useful in protecting muscles from oxidative damage, inflammation and injury caused by eccentric contraction during exercise;¹⁴⁴ the researchers attributed this effect to reduction of plasma creatine kinase levels, lipid peroxidation and certain inflammatory markers. Vitamin E handles oxidative damage due to both sudden, intense exercise and longer term endurance exercise, inhibiting creatine kinase build-up and lactate dehydrogenase, as well as LDL oxidation.^145,146 Vitamin C has also inhibited lactate dehydrogenase as well as oxidative stress marker serum uric acid.¹⁴⁷ Vitamin C also promotes recovery in men, affecting muscle soreness and function, and plasma concentrations of malondialdehyde.¹⁴⁸

For bones and joints, men have increasingly turned to a number of natural remedies, including glucosamine, chondroitin and collagen. In an Australian trial, glucosamine reduced joint pain in 88 percent of subjects with exercise-induced knee injuries;¹⁴⁹ and chondroitin decreased pain and improved joint function in a Switzerland study on knee osteoarthritis.¹⁵⁰ Popular in combination, 500 mg/d glucosamine hydrochloride (HCL) and 400 mg/d chondroitin sulfate (as CS™ BioActive, from Bioiberica S.A.) compared favorably to conventional arthritis treatment celecoxib on knee pain reduction in the recently published Glucosamine/chondroitin Arthritis Intervention Trial (GAIT).¹⁵¹ Glucosamine sulfate produced similar results, compared to acetaminophen, on pain and function in the Glucosamine Unum In Die Efficacy (GUIDE) study.¹⁵²

In an animal study, supplementation with glucosamine and chondroitin combined with undenatured collagen type II (as UC-II®, from InterHealth) better improved pain and lameness than glucosamine-chondroitin alone.¹⁵³ A structural protein lending strength and flexibility to the joints, muscles and tendons, collagen may protect articular cartilage from degradation and boost collagen synthesis. Collagen hydrolysate can protect articular cartilage from degradation and boost collagen synthesis,¹⁵⁴ as well as relieve pain associated with OA of the knee and hip.¹⁵⁵ Formulated with hyaluronic acid and chondroitin sulfate, collagen hydrolysate (as BioCell Collagen II™, from BioCell Technologies) has reduced joint pain and stiffness in patients with OA of the knees, hips or hands.¹⁵⁶

Cetylated fatty acid esters (as Celadrin®, from Imaginetix) have improved joint function, mobility, stability and trainability in various OA sites.^157,158,159 And, concentrated milk proteins (as MicroLactin®, from Humanetics Corp.) have alleviated joint pain, joint stiffness and immobility in OA,¹⁶⁰ in addition to promoting recovery and LBM, and decreasing muscle damage.¹⁶¹

A powerful contributor to performance issues in men is stress, both acute and chronic, which affects sleep, ripens the body for oxidative stress/damage and is often accompanied by increases in cortisol levels that have a tendency to depress immune function. Melatonin can help limit increased cortisol activity and immune depression,^162,163 as can magnesium, which has been shown to target cortisol activity related to sleep and mood disturbances, as well as exercise.^164,165

Stress may make a man want to pull his hair out, but nature often does a fair of job of promoting hair loss on its own. While there is certainly a strong genetic predisposition at work in hair loss, dihydrotestosterone (DHT), a metabolite of testosterone produced by the enzyme 5-alpha-reductase, has been identified as the specific androgen in the pathogenesis of androgenetic alopecia (AGA), or male pattern baldness. Thus, natural hair re-growth therapies include ingredients that inhibit DHT and 5-alpha-reductase, such as saw palmetto and pygeum.¹⁶⁶ Recently, flax lignans (as LinumLife® EXTRA, from Actaris) given to men of varying ages and severities of AGA resulted in modest improvement in hair retention, with the most dramatic results reported by men with more severe AGA.¹⁶⁷

DHT and 5-alpha-reductase are also central to the development of benign prostatic hyperplasia (BPH),¹⁶⁸ which causes urinary tract dysfunction and discomfort, and accounts for at least 1.7 million doctor’s office visits per year, according to the National Institutes of Health (NIH).

Again, saw palmetto (Serenoa repens), which has been one of the top 10 selling herbs since the 1990s, according to the American Botanical Council (ABC), is indicated for its inhibition of 5-alphareductase. ¹⁶⁹ Used around the world for stage one and two BPH cases, including as a prescription preparation in Germany, saw palmetto extract possesses anti-estrogenic activity and increases urinary flow rate while decreasing nocturia, residual urine and painful urination.

While a trial published recently in NEJM found no benefit to BPH symptoms from saw palmetto, ABC and other herbal experts noted the trial focused on men with moderate to severe BPH symptoms, as opposed to men with mild to moderate symptoms, the focus of more than 21 previous trials showing positive saw palmetto benefits. Among these historical trials, a review published in JAMA revealed saw palmetto extract was both safe and effective in improving symptoms in men with mild to moderate BPH.¹⁷⁰ The herb has even compared favorably to conventional 5-alpha-reductase inhibitor finasteride.¹⁷¹

Pygeum, which is often taken in combination with saw palmetto, and its phytochemicals beta-sitosterol, pentacyclic terpenes and ferulic esters help control harmful testosterone activity in the prostate gland. Research has found pygeum extract can attenuate DHT and counteract gland enlargement indicated in BPH pathology.¹⁷² Pumpkin seeds may also inhibit DHT, as well as tame inflammatory factors in BPH.¹⁷³

The male prostate gets little respect from degenerative diseases, as aging men are not only affected by BPH, but also 230,000 men will develop prostate cancer annually, with about 30,000 of these men dying each year.

One of the most researched nutrients for prostate cancer, lycopene has been linked to decreased risk of developing this cancer, decreased PSA scores and reduced prostate tumor size.¹⁷⁴ However, the Food and Drug Administration (FDA) concluded there was insufficient scientific evidence for tomato-based products and lycopene to approve a health claim, instead approving a series of qualified health claims for the carotenoid and various cancers, including prostate.

Fellow botanical remedy acetyl-11-keto-beta-boswellic acid (AKBA), a component of Boswellia serrata, was shown to promote apoptosis induced by cytokines and chemotherapeutic agents, as well as inhibit invasion and suppress osteoclastogenesis through inhibition of NF-kappaB-regulated gene expression.¹⁷⁵ Pomegranate fruit extract, which contains potent antioxidant phytochemicals, inhibited cell growth and induced cancer cell apoptosis in an animal prostate cancer trial.¹⁷⁶ Likewise, both garlic and soy have exhibited additional protection against prostate cancer.^177,178 Clinical research has revealed garlic can lower PSA scores,¹⁷⁹ as can soy and its isoflavones genistein and daidzein, which can also limit prostate tumor growth and development.¹⁸⁰

Further evidence of the role of phytoestrogens in prostate cancer was reported by two trials showing serum enterolactone levels can influence development of the disease. In a 2005 Swedish trial, phytoestrogen intake was inversely associated with risk of prostate cancer.¹⁸¹ And Finnish researchers reported plant lignans (as HMRlignan®, from Linnea) inhibited growth of LNCaP human prostate cell line, resulting in smaller tumor volume, lower tumor take rate, higher tumor cell apoptosis score and increased proportion of nongrowing tumors.¹⁸²

Vitamins and minerals are also useful against prostate cancer. In a recent animal study, vitamin E succinate, a vitamin E analogue, dose-dependently inhibited proliferation and induced apoptosis in prostate cancer cell lines and a xenograft model of prostate cancer.¹⁸³

And selenium intake, which has been linked to reduced risk of prostate cancer,¹⁸⁴ also has been found to promote apoptosis in prostate cancer cells while decreasing cancer-causing DNA damage.¹⁸⁵ The National Cancer Institute (NCI)-sponsored Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest ever prostate cancer trial, will investigate the effects of Lselenomethionine (as Selenium SeLECT®, from Sabinsa Corp.) on cancer prevention in more than 32,000 men. Selenium also protects against chemotherapy toxicity.¹⁸⁶ In a 2006 study on cancer drug irinotecan, the co-administration of selenomethionine significantly reduced the irinotecan biliary index, which has been associated with gastrointestinal toxicity.¹⁸⁷

Selenium also helps men manage colon cancer. According to a recent trial conducted at Roswell Park Cancer Institute, Buffalo, selenium supplementation is associated not only with reduced risk of colorectal cancers, but also with significantly reduced risk of prevalent adenomas in patients with low serum selenium levels and in smokers.¹⁸⁸ Similarly, data from the NCI-coordinated Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial also indicated selenium may reduce the risk of developing advanced colorectal adenoma, particularly in high-risk smokers.¹⁸⁹

The polyphenolic antioxidant curcumin has exhibited potent anticancer activity in patients with advanced colorectal cancer.¹⁹⁰ Researchers noted 3.6 g/d of curcuminoids appear to help prevent colorectal by inhibiting prostaglandin E2 (PGE2) production by as much as 62 percent.

As a healthy digestive system is key to preventing development of colorectal cancers, various natural digestive aids have been studied for colon cancer risk reduction. Probiotics, such as Lactobacillus GG, Lactobacillus reuteri and Saccharomyces boulardii, have been shown to reduce the prevalence of colorectal cancer,¹⁹¹ while prebiotics may reduce risk by protecting against inflammatory and cancerous processes.¹⁹²

As men age, their sometimes abrasive lifestyles catch up with them. Excessive, long-term alcohol use and environmental toxic exposure tax the male liver, leaving men at a greater risk of malnutrition and associated health problems. S-adenosylmethionine (SAMe), a glutathione precursor, can enhance the metabolism of drugs, alcohol and environmental toxins in the liver. Specifically, SAMe inhibits oxidative damage and encourages production of interleukin-6, a cytokine with anti-apoptotic and anti-inflammatory effects.^193,194,195 Production of SAMe is depleted in alcoholics,¹⁹⁶ and researchers have reported supplementation with SAMe can help prevent alcoholic liver disease as well as cirrhosis.^197,198 Similarly, the botanical milk thistle, which contains antioxidant silymarin, is theorized to limit alcohol-related liver injury by stimulating recovery of liver microsome and mitochondria membrane fluidities, as well as by competing with toxins for receptor sites in liver cells.^199,200 Clinically, milk thistle has proven useful against liver cirrhosis and hepatic fibrosis.^201,202 Additional liver protection has been observed with supplementation of the antioxidants vitamin C and E and superoxide dismutase (SOD).²⁰³

Although women are more prone to eye problems, men have become increasingly concerned about eye health.²⁰⁴ The carotenoids lutein and zeaxanthin are concentrated in the macula region of the eye, and low levels of the two nutrients have been linked to increased risk of age-related macular degeneration (AMD).²⁰⁵ Obesity, oxidative stress, inflammation and altered lipid profile might all contribute to decreased circulatory lutein and zeaxanthin to the macula, thus promoting AMD.²⁰⁶ Fortunately, supplementation can help prevent or slow AMD development and progression. Research has shown 10 mg/d of purified lutein (as FloraGLO® Lutein, from Kemin Health) may benefit various stages of AMD,²⁰⁷ while 20 mg lutein ester (as XANGOLD®, from Cognis Nutrition & Health), which supplies 10 mg/d free lutein, increases plasma lutein and early factors in AMD development.²⁰⁸ Likewise, Harvard researchers reported zeaxanthin supplementation increases serum, liver and retinal zeaxanthin concentrations, and dosedependently reduced light-induced photoreceptor apoptosis upon exposure to UV light in an animal model.²⁰⁹

Additional protection from eye diseases and conditions, such as AMD and cataracts, can be achieved via supplementation with zinc and antioxidants,^210,211,212 including vitamin C²¹³ and vitamin E.²¹⁴ Also, the carotenoids lycopene²¹⁵ and astaxanthin (as XANTHIN®, from Valensa)²¹⁶ convey additional help against oxidative stress in the eye, as have flavonoids and assorted phytonutrients from various plants, including tea,²¹⁷ bilberry,²¹⁸ Pycnogenol,²¹⁹ black currant²²⁰ and ginkgo.²²¹

For men, staying healthy and maintaining a high quality of life is challenging and complex, but attainable through improved diet and nutritional supplementation. Researchers have focused as much on men as on women, providing ample scientific basis for numerous ingredients that can enhance any men’s health formula.

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