Men's Health

by Kim Schoenhals

While men's health issues have not necessarily been at the forefront of research, there are numerous reasons this category is an important realm to study. For example, men are more likely to develop heart disease than women, and they have the unique concerns of maintaining prostate and sperm health. In addition, the difference between life expectancy for a man and a woman is becoming more significant, according to statistics from the Centers for Disease and Prevention(CDC) and the National Center for Health. In 1929, the average life expectancy for a man was only 2.9 years less than a woman, and by 1997, that difference doubled to 5.8 years.

Men have a higher death rate than women for each of the top 10 causes of death in America, the top two being heart disease and cancer. And yet, research on male-specific diseases generally receives less funding than women's health. The National Cancer Institute spent more than $400 million on breast cancer research in 2000 and only $200 million on prostate cancer research. According to Men's Health magazine, nearly $5 billion went to women's health initiatives in 2000 while less than $1 billion went to men's.

The No. 1 killer among men is heart disease, which causes more than 350,000 male deaths each year--almost twice the number of female victims. [More can be read about Cardiovascular Health in the 1/14 issue of INSIDER online atwww.naturalproductsinsider.com.] The second most significant cause of death among men is cancer, including prostate cancer.

The Prostate

Prostate cancer affects approximately 156,000 men each year, leading to more than 30,000 deaths. Additional issues affecting prostate health are benign prostatic hyperplasia (BPH)--an enlargement of the prostate gland--and prostatitis--an inflammation of the prostate that is sometimes caused by a bacterial infection. Modern medicine is an obvious course of action for men needing treatment for prostate conditions, although there are preventive and therapeutic measures available from the natural products industry as well.

According to the National Institutes of Health (NIH), more than one-half of the men 50 years of age and older have lower urinary tract symptoms associated with BPH, and the condition accounts for at least 1.7 million office visits per year. Over the next seven years, three divisions of NIH--the National Institute of Diabetes & Digestive & Kidney Diseases, the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements--have earmarked a combined $29 million to study the efficacy of saw palmetto (Serenoa repens) and pygeum (Pygeum africanum) for relieving symptoms associated with BPH. "[T]he use of alternative therapeutic agents to relieve the symptoms of BPH is increasing rapidly," NIH stated in its objectives. "Despite the widespread use of phytotherapy for BPH in the United States, most physicians are reluctant to either discuss or recommend their use since only a modest number of published reports have appeared in the peer-reviewed medical literature about their efficacy. Nonetheless, the available literature supports the hypotheses that these compounds may have some beneficial effects on BPH symptoms."

Saw palmetto is one of the most recognizable supplements in the men's health arena. According to the Natural Marketing Institute's (NMI) Health & Wellness Trends Database, 6.7 percent of male consumers purchase saw palmetto. Berries from the fern are used in natural medicine to treat symptoms of BPH and prostatitis. Currently, researchers at the University of California, San Francisco, are conducting a large clinical trial to determine the effects of saw palmetto on urinary symptoms in patients with moderate to severe BPH. The products being used in this trial (including Indena's Sabalselect^®) were chosen by a panel of experts from NCCAM.

Published research on saw palmetto indicates the herb is helpful in treating symptoms ofBPH. A research review of saw palmetto involving a total of 18 trials and 2,939 men indicated that the extract is more effective than placebo in improving urinary tract symptoms, flow measures and peak urine flow. In addition, saw palmetto was found to be effective for treating BPH in comparison to other phytotherapies (Public Health Nutr, 3, 4A:459-72, 2000) (www.cabi-publishing.org)

Although saw palmetto may benefitBPH, it may not be a preventive treatment for prostate cancer. In a study conducted at the University of California, Los Angeles, researchers randomized 44 men to compare a saw palmetto herbal blend with placebo for improving symptoms ofBPH. At the end of the trial, the saw palmetto herbal blend group demonstrated a slight improvement in clinical parameters, although neither prostate specific antigen(PSA), an indicator for prostate cancer, nor prostate volume changed from baseline in either group. However, when the study was concluded, 41 men elected to continue therapy. Researchers concluded the saw palmetto herbal blend is a safe, highly desirable option for men with moderately symptomatic BPH (J Urol, 163, 5:1451-6, 2000) (www.jurology.com).

Pygeum may also have application in easing the symptoms of BPH andprostatitis. The plant's active constituents include beta-sitosterol, pentacyclic terpenes and ferulic esters, which play a part in controlling testosterone activity in the prostate. Pygeum africanum (as Tadenan^® by Laboratoires FournierSCA) reduces the "obstructive" effects of dihydrotestosterone (DHT, a testosterone metabolite) and counteracts the hormone-induced enlargement of the prostate (Urology, 55, 2:292-8, 2000) (www.meddevel.com). Pygeum is also known to reduce inflammation (Fitoterapia, 71, Suppl 1:S21-8, 2000).

An unpublished study conducted at the Urology Clinic of the University of Cagliari demonstrated that patients with BPH who were treated for two months with a Pygeum africanum extract (as Pigenil^®, a bulk extract belonging to IndenaS.p.A.), exhibited an 11-percent decrease in prostate size as compared to no decrease in the group taking a comparison pharmaceutical(mepartricin). In addition, researchers noted the supplement was well tolerated and brought about a marked improvement in subjective and objective symptoms. While the mechanism of action of this extract is not known precisely, it has many phytotherapeutic effects, according to researchers at the Universidad de Alcala in Spain (Prostate, 45, 3:245-52, 2000) (www3.interscience.wiley.com).

Beta-sitosterol, a phytosterol found in nearly all plants, including pygeum, is independently effective in reducing the symptoms of BPH, as well as inhibiting cancer growth. According to researchers from the State University of New York at Buffalo, phytosterols, including beta-sitosterol, may offer specific protection against prostate cancer (J Nutr, 130, 9:2127-30, 2000) (www.nutrition.org).

Medicinal pumpkin is another herb thought to have application in treating conditions of the prostate because of its active constituents: phytosterols (including beta-sitosterol), essential fatty acids, amino acids, vitamins and minerals. The Commission E, a German committee charged by the federal health agency with reviewing the safety and efficacy of phytomedicines, published a monograph for the use of pumpkin seed for treating symptoms of BPH. Because of the phytosterols in pumpkin seeds, it is thought to act by inhibiting DHT or by anti-inflammatory action (Alt Med Rep, 1, 3:25-36, 2001). "Although drugs that inhibit the conversion of testosterone to DHT (such as finasteride) have not proven to be of great benefit against prostate cancer when used alone, trials have shown considerable positive effects when a DHT inhibitor is added to hormone treatments to reduce testosterone levels and, as a result, increase estrogen levels in the body," wrote Jesse A. Stoff, M.D., and Dallas Clouatre, Ph.D., in The Prostate Miracle: New Natural Therapies That Can Save Your Life (Kensington Publishing Corp., 2000).

Stinging nettle (Urtica dioica) is another herb thought to reduce the symptoms of BPH. Researchers from the Philipps-Universitat Marburg in Germany discovered that the activity of a 20 percent methanolic extract of stinging nettle roots reduced the proliferation of human prostatic epithelial and stromal cells (the spongy protoplasmic framework of some cells) in vitro. Researchers concluded that stinging nettle extract has clear biological relevance for prostate health (Planta Med, 66, 1:44-7, 2000).

Flower pollen extract can be collected from various plants and has been found to have anti-inflammatory properties, to relax the muscles surrounding the urethra and to inhibit growth of prostate cells. "Flower pollen extracts ... can boost the immune system, reduce inflammation and fightBPH," Stoff and Clouatre wrote. One animal study indicated that the anti-inflammatory action of flower pollen extract (as Cernitin^™, manufactured by Saginaw, Mich.-basedGraminex) can inhibit stromal cell proliferation by enhancing cell death in rats with nonbacterial prostatitis (Prostate, 49:122-31, 2001).

Quercetin, a flavonoid found in apples, onions and tea, may also have application in treating men withprostatitis. Researchers from the Harbor-UCLA Medical Center in Torrance, Calif., hypothesized that the condition may be caused by oxidative damage. They tested bacterial specimens from 100 men with chronic pelvic pain syndrome, classified asprostatitis. Oxidative injury was greatly reduced with antibiotics and with aquercetin-containing antioxidant supplement (as Prosta-Q^™, manufactured by Farr Laboratories). Earlier research with the same supplement indicated that quercetin is well tolerated and provides significant improvements in most men with chronic pelvic pain syndrome (Urology, 54, 6:960-3, 1999).

Quercetin may also have application in preventing and even treating prostate cancer. "[The] bioflavonoid quercetin has several important anti-cancer effects, one of which is to help induce apoptosis [cell death]," Stoff and Clouatre wrote. Researchers from Harvard Medical School in Boston discovered that the flavonoid can dose-dependently suppress tumor growth in vivo and in vitro (Int J Hyperthermia, 17, 4:347-56, 2001). According to additional cancer research conducted at the Mayo Clinic in Rochester, Minn., quercetinhas the ability to inhibit PSA and thesecretion of androgen-regulated tumormarkers (Carcinogenesis, 22, 3:409-14, 2001) (http://carcin.oupjournals.org).

Conversely, researchers from the Yamagata University School of Medicine in Yamagata, Japan, noted that quercetin was unable to regulate the cell cycle progression that leads to cancer (Cancer Lett, 176, 1:17-23, 2002) (www.elsevier.com).

However, the same researchers found that genistein, a flavonoid found in soy, inhibits this cell cycle progression, making genistein a potential anticarcinogenic agent. Research conducted at Virginia Commonwealth University in Richmond, Va., demonstrated that genistein enhances resistance to tumor formation by increasing the activities of cytotoxic T cells and natural killer cells (J Nutr, 131, 12:3251-8, 2001). In addition, an animal study conducted at the University of Birmingham in Alabama demonstrated dietary genistein dose-dependently reduced tumor development (Cancer Res, 61, 18:6777-82, 2001). And, according to researchers at the Wayne State University Department of Cancer Biology in Detroit, genistein inhibits cell proliferation independent of PSA, leading researchers to conclude that genistein may be a chemopreventive and therapeutic agent for prostate cancer (Int J Oncol, 16, 6:1091-7, 2000).

Another potential prostate cancer preventive agent is an extract from the Maitake mushroom. Beta-glucan, a polysaccharide of the Maitake mushroom (asGrifron-D^®, by Maitake Products), has potential as an alternative therapeutic regimen for prostate cancer because of its ability to induce more than 95 percent apoptosis in human prostate cancer cells, according to research conducted at the New York Medical College in Valhalla (Mol Urol, 4, 1:7-13, 2000) (www.liebertpub.com).

Antioxidants, in general, may be able to stave off cancer by inhibiting the free radical damage that is thought to be carcinogenic. Epidemiological evidence shows that environmental toxins induce oxidative damage, which in turn can lead to prostate cancer. Antioxidants may also slow the progression of prostate cancer, according to researchers at the University of Toronto (Urology, 57, 4 Suppl 1:90-4, 2001). Specifically, selenium and vitamin E are thought to suppress the formation of prostate cancer.

According to NMI data, antioxidants are the third most popular supplement among men, with 16.4 percent of male respondents purchasing antioxidants. Vitamin E is the most popular dietary supplement among men, with 45.7 percent of males purchasing the supplement, according to NMI.

The National Cancer Institute (NCI) is currently conducting a 10-year trial to determine the efficacy of vitamin E and selenium supplementation for preventing cancer of the prostate. Independently, low plasma selenium has been associated with a four- to five-fold increase in the risk of prostate cancer, according to researchers from the Stanford University Medical Center in Stanford, Calif. (J Urol, 166:2034-38, 2001). Selenium is being studied in several other NCI-funded clinical trials at the University of Arizona Cancer Center to determine the mineral's role in reducing the risk of prostate cancer. (These trials involve Cypress Systems' ingredient, SelenoExcell^®). The trials are based on results found by Larry Clark, M.P.H., Ph.D., in 1996, linking selenium to a decreased risk of prostate cancer (Nutr Cancer, 40, 1:74-7, 2001).

In terms of vitamin E and selenium, researchers from the Johns Hopkins School of Hygiene and Public Health in Baltimore published a retrospective study involving more than 10,000 men in the Dec. 20 Journal of the NationalCancer Institute (92, 24:2018-23, 2000)(http.//jncicancerspectrum.oupjournals.org) regardingalpha-tocopherol, gamma-tocopherol and selenium in cancer prevention. The study indicated that high levels of selenium andalpha-tocopherol were protective only when gamma-tocopherol, a form of vitamin E not usually found in vitamin supplements, was present in high concentrations as well. In support of this finding, researchers from the University of California, Berkeley, found plasma concentrations ofgamma-tocopherol are inversely related to prostate cancer (Am J Clin Nutr, 74, 6:714-22, 2001) (www.ajcn.org).

Another antioxidant with potential for men's health application, specifically for prostate cancer, is coenzyme Q10 (CoQ10), which is used by 6.0 percent of men, according to NMI. CoQ10 is produced by the body, but levels decrease with age or chronic disease such as prostate cancer. "Therefore, supplementary sources are quite important in helping to maintain a normal energy environment within us," Stoff and Clouatre wrote. "... For all its wonderful effects, its activity in prodifferentiation is perhaps most important. Recent medical studies have shown that CoQ10 can, in some cases, induce 'spontaneous remission' even in the face of an advanced cancer with metastasis to the liver."

Lycopene, a carotenoid found in high concentrations in tomatoes, is popular among 1.2 percent of male consumers, according to NMI. This nutrient may also be responsible for reducing the incidence of prostate cancer. Researchers from the University of Illinois, Chicago, studied men who consumed tomato sauce-based dishes (30 mg/d of lycopene) for three weeks preceding a radical prostatectomy. They discovered that after the dietary intervention, serum and prostate lycopene concentrations were significantly increased. In addition, compared with pre-intervention levels, leukocyte oxidative DNA damage was significantly reduced and prostate tissue oxidative damage was also lower in the lycopene group than the control group (J Int Cancer Inst, 93, 24:1872-79, 2001).

Additional research conducted at the Barbara Ann Karmanos Cancer Institute at Wayne State University indicated that lycopene supplementation may reduce the growth of prostate cancer in vivo, although researchers stated that no firm conclusions could be drawn because of their small sample size of 26 men (Cancer Epidemiol Biomarkers Prev, 10, 8:861-8, 2001)(http://cebp.aacrjournals.org). The same researchers noted in a different study that lycopene combined with radiation therapy can inhibit DNA synthesis and inhibit cell division in patients with prostate cancer(Clin Cancer Res, 7, 2:382-90, 2001) (http://clincancerres.aacrjournals.org). Both of these studies involved Lyc-O-Mato^®, a natural lycopene product manufactured byLycoRed/Biodar.

Sperm Health

Male fertility is a function of numerous components, particularly sperm health and motility. While many men opt for pharmaceutical answers to their fertility health questions, the natural products industry has a few answers of its own. Lycopene, selenium, zinc, maca and carnitine are just a few ingredients thought to have application in the realm of male fertility.

One detriment to fertility is low levels of folic acid. Researchers at the University of California, Berkeley, discovered that low folic acid intake could lead to low sperm count, as well as poor development and repair of sperm DNA (Fertil Steril, 75, 2:252-9, 2001) (www.asrm.org).

Selenium deficiency may also lead to fertility difficulties. Rats with a deficiency of dietary selenium experienced immotile, deformed sperm and infertility, according to researchers for the U.S. Department of Agriculture. These researchers also studied the effects of dietary selenium on semen quality in 11 healthy men. Seminal plasma selenium concentration increased 50 percent with high selenium intake (297 mcg/d for 99 days), but decreased 40 percent with low selenium (13 mcg/d for 99 days). However, the fraction of motile sperm in the high selenium group decreased by 32 percent by week 13 and ended 18 percent lower than baseline. Researchers concluded that while decreased sperm motility does not necessarily lead to infertility, these results suggest a need for further trials to fully assess this side effect (J Androl, 22, 5:764-72, 2001).

Another mineral that is thought to improve male fertility is zinc. Researchers at the Sichuan University in the People's Republic of China discovered that a zinc gene family is directly involved in maintaining normal human male fertility (Biochem J, 359, Pt 3:721-7, 2001). However, a clinical trial conducted by researchers from the University of Heidelberg in Germany did not find a direct correlation between zinc levels and sperm health. The researchers monitored 256 men and found that while zinc levels in seminal fluid and serum were not associated with infection, they were not associated with other semen quality parameters either (Fertil Steril, 77, 2:260-69, 2002).

Antioxidant CoQ10 may also be able to treat male infertility, according to a research review printed in Alternative Medicine Review (5, 1:28-38, 2000) (www.thorne.com/altmedrev).

Lycopene, known for its application in prostate health, is also thought to improve male fertility. According to Israeli researchers, lycopene (8 mg/d for one year) enhances sperm count and functional sperm concentrations. Authors noted that there was a 36 percent increase in pregnancy rate among the 50 participants' partners by the end of the study (Ind J Urol, 56:102, 2001). (This study was sponsored by Jagsonpal Pharmaceuticals in New Delhi and Israel-based LycoRed/Biodar.)

L-carnitine, a naturally occurring vitamin-like substance, is one that many people are lacking, leading to obesity, fatigue, elevated triglycerides and heart problems. An L-carnitine deficiency is also a marker for evaluating male infertility, according to researchers at the University Hospital in Crete, Greece (Int J Fertil Womens Med, 45, 3:236-40, 2000). Researchers from the University Hospital Carite in Berlin also noted that concentrations of free and total carnitine are significantly lower in infertile men than fertile control subjects (Hum Reprod, 15, 4:840-5, 2000). Dietary carnitine may be able to reverse the symptoms of carnitine deficiency and improve sperm count and motility, according to a research review printed in Alternative Medicine Review (5, 1:28-38, 2000).

Maca (Lepidium meyenii or Lepidium peruvianum) is an herb studied for its application in sexuality and male fertility. Peruvian researchers found that the herb (L. meyenii) increases seminal volume, sperm count per ejaculation, motile sperm count and sperm motility (Asian J Androl, 3, 4:301-3, 2001).

Although women's health seems to take precedence in the eyes of the world, men's health is an increasingly important realm of the natural products industry. There are dozens of natural products available on the market to improve prostate and sperm health. In the next few years, a number of clinical trials will further elucidate the role vitamins, minerals and herbs play in the men's health arena. Stay posted for future issues of INSIDER for the results of these studies and continually updated research results.