Men's Health

   
Men’s Health
Family Issues
So, as we look at men’s health issues I want to emphasize that responsible parenthood, intact families, and male role models that have integrity are vitally important. Does the behavior of men have anything to do with their health? I believe it does because of several things. The manner in which men maintain their health status, whether they take good care of themselves or not, sets an example within the home environment and in the community at large. Further, men’s behavior reflects their spiritual beliefs and reflects their state of mental health also. 
There is obviously much variability in men’s behavior and so we see men using foul language, smoking cigarettes, neglecting their health, using illicit drugs, cheating on their wives, affiliating with violent gangs, and functioning without an intact conscience. These men typically run from the responsibility associated with their pregnant female partner. 
On the other hand, many boys, male adolescents and men have developed lifestyles that reflect personal responsibility, setting high moral standards, having appropriate concern for others’ needs, and are hard-working and responsible employees.
Within the intact family, the man’s role is entirely necessary as it pertains to the marital relationship and as it relates to the father’s role. Children learn essential lessons about how men treat women by observing their moms and dads, observing the marital relationship; boys and girls in the family learn lifelong lessons about discipline and boundaries, the importance of honesty and integrity, and the role of healthy values as they observe and interact with their father. There appears to be no substitute for a father in the home. And, single-parent families, and families where the father is deceased can present unique challenges. In some cases, fathers are single parents and a lack of a mother in the home in these cases presents parenting challenges and a possible psycho-emotional vacuum. (Zahler, 2019).

Gender and Brain Function
Is the structure of the human brain the same in females and males? Well, not entirely, as emotions originate and are processed by the limbic system of the brain; the amygdala and the hippocampus are parts of the limbic system and are the seat of emotions, especially fear. Emotions are first registered and generated by the amygdala. 
• Research has shown that women have more persistent amygdala responses from multiple repetitions of negative material than men. 
• Individuals with more persistent amygdala responses reported greater levels of negative affect; these findings have implications for gender differences in the incidence of affective (mood) and anxiety disorders. 
• Emotional memory activity is found in the left amygdala in females, whereas for males it was in the right amygdala. 
• Recent neuro-imaging studies confirm gender differences in emotional memory and sexual responses. 
• Sex differences were more pronounced, with increased interhemispheric and intra-hemispheric connectivity in females and males, respectively. 
• Male brains are structured to facilitate connectivity between perception and coordinated action, whereas female brains are more designed to facilitate communication between analytical and intuitive processing modes. 
• Brain-imaging studies indicate that these differences extend well beyond the strictly reproductive domain, adjusted for total brain size a woman’s hippo¬campus, critical to learning and memorization, is larger than a man’s and works differently. 
• Conversely, a man’s amygdala, associated with the experiencing of emotions and the recollection of such experiences, is bigger than a woman’s’ Ingalhalikar,2014; Hamann, 2005).

Erectile Dysfunction (ED) Treatment Side Effects
Research indicates that ED drugs like Viagra, Cialis and Levitra have a series of acute and chronic side effects. 
• The most commonly-observed acute side effects include headache, flushing, stomach upset, runny nose, and vision abnormalities. 
• Chronic side effects from long-term use may include conditions like glaucoma, “one of the leading causes of blindness,” caused by degeneration of the optic nerve.
• Viagra may decrease natural killer cell activity, and natural killer cells are our first line of immune defense against cancer.
• Research has revealed an unexpected connection between Viagra use and melanoma skin cancer, an 84% increased risk of subsequent melanoma. (Arozarena, 2011, Chavez AH, 2013,Mitra,2011 Tsertsvadze, 2009,)

Mind Games
Our self-talk, the dialogs that we rehearse frequently and sometimes only pre-consciously, can be very powerful in guiding our lifestyle behaviors; one of the skill sets to correct this if the self-talk (mind games) are dysfunctional, is to identify the unhealthy messages, to replace them, and to rehearse a new dialogue that will allow us to put a set of new lifestyle behaviors in place in order to achieve and maintain optimal health.

• Many of us think that we should make changes in this or that aspect of our lifestyle, for example being more physically active. However, coexisting with this thought that we should exercise more, is a competing motivation that ‘we don’t want to.’ We’re always assessing the level of discomfort that might be associated with behavioral change. Some people simply do not tolerate the stress and discomfort that might be associated with making new changes. Many people just cannot conjure up a favorable vision that includes a specific change. For example, exercise for them may involve some physical muscle discomfort and require a reorganization of their daily schedule; so, they choose not to do it and miss out on a hugely positive opportunity to improve their health. So, stress, motivation and one’s internal vision are important factors in the inertia dynamics regarding lifestyle change.

• Also, many if not most people are quite dogmatic and rigid in their thinking about the foods they eat. Dr. Garth Davis has written some comments about this topic that are prompted by his experience with his weight loss patients. We are grounded in our habits and we seek to continue consuming foods that we have acclimated to over the decades. In many instances, facts and quality research studies about health and wellness issues are set to the side, and our opinions, although they may be killing us, prevail. This issue is quite a potent impediment to changing our eating habits, our exercise regimen, to changing our sleep hygiene, to make time to get adequate sunshine, and implement all of the other positive lifestyle shifts that are necessary for optimal health.  Oftentimes, there is no magic key to make the process of change easy. So just begin and build momentum in your commitment, and on the way, give yourself some room to adjust to the new changes.

• Some subgroups of patients, for example men with prostate cancer, can be quite complex when it comes to implementing changes in lifestyle, especially changes in diet. In a 2005 study published in the Journal of Urology, volunteers with serum PSA levels of 4 to 10 ng/ml, were randomly assigned to an experimental group that was asked to make comprehensive lifestyle changes. It is instructive to note in this study that almost 25% of the men who were newly diagnosed with prostate cancer stated that they would rather have their lives cut short than do without their traditional diet that included beef and pork! So here we have a very important example of how entrenched we can get with our food preferences. There is a high likelihood that these men were not only habituated to their meat habit, but that they were specifically addicted to the taste of the fat, salt and sugar content of these foods. An interesting addition to the intervention with these men would have been to introduce them to some of the tastiest plant-based dishes early on in the study; it takes several weeks to change and adapt to new food changes. 

• And, we believe that food preparation skills are essential, not optional, because of the lifelong implications for our health. Knowing how to cook is a core task for everyone, but unfortunately, in one study, a significant number of men, at least 25%, have absolutely no cooking skills whatsoever, making them more dependent on very unhealthy fast food and processed food. Cooking skills are a lifestyle issue that can make the difference between contracting chronic disease or not; many men apparently are not standing up to the challenge. 
• Research published in 2011 indicates that some men, in this case male cancer patients, may view consumption of fruits and vegetables as a feminine eating pattern; even with extensive nutritional information and related educational counseling, compliance was a challenge. Further, spontaneous positive behavioral change is hampered when one of the most popular men’s health magazines has articles indicating that men should never apologize for the McDonald’s restaurant chain not offering a vegetarian alternative, and for laughing at people who eat trail mix. Other articles and advertisements indicated that vegetables are for girls, meat is for men, and ‘she’d better know how to grill.’ So here we have some potent marketing messages that reinforce toxic eating and a view of men that is quite narrow, and paradoxically, that can lead to prostate cancer and impotence. Interestingly, this magazine, a health magazine, actually promotes disease via such articles. 

• So, when we contend that the onset of serious disease can be a teachable moment, this is not completely true and it ends up being a somewhat complex process because change is not spontaneous for everyone. In many instances patients need to have time to consider what is really being said in these educational sessions and how it applies to them. Strong emotions can get in the way of behavioral change. Some patients need to finish their educational sessions and go out into their familiar environment and confirm some of the information with confidants. Also, this group of people needs to have a sense that they are in control of their lives and that they are not being coerced into making changes that they are not ready to make. With this group of people, change is a more gradual process and they tend to make the process quite complex. Education and counseling is about more than exchanging information; it is an integrative process that involves potent psycho-emotional issues, various levels of understanding, and timing that varies from individual to individual. Behavioral inertia is a multifaceted issue.  I would recommend that these men, as part of their education about their disease, be reminded that the strongest animals in the world eat only plant foods and that some of the most adept athletes in the world, including Kenyan, Ethiopian, and the Tarahumara Indian runners are primarily plant-based eaters.
• Finally, we have another mind game called ‘Toxic Masculinity,’ apparently part of the toxicity of gender. I am not sure this is worthy of exploration, but it may be. We are in a culture that gives great attention to catchy, emotionally-laden phrases, whether they serve any significant purpose or not. It would be difficult to make the case that men who are intelligent, sensitive, kind, warm, and compassionate deserve to be categorized as part of the toxic masculinity bunch. This Toxic “label appears to be an activist attack on dominant men, men who excel and who provide effective leadership. Those activists apparently feel victimized; this victimization has become a cultural theme on the part of activists who pursue perfect fairness, punishment of those they disagree with, and compensation for those who may fit their definition of ‘victim.’ This victimization trait is contrary to good psychological health and psychological hardiness. There has been a relentless ideological attack on masculinity, stemming from radical feminism, the most recent example of which is this bogus term “toxic masculinity.” It literally seeks to pathologize masculinity in ways that are profoundly harmful to the existential sense of self of young men. Hence, boys may take on a sense of confusion about their gender and confusion about male roles, behavior, and boundaries. (Saad, 2018)

Nutrition
Protein: According to a 2018 study, high protein intake by older men does not help to increase muscle mass or improve well-being. This was a randomized clinical trial published in the Journal of the American Medical Association. There were 78 participants aged 65 and older. Those subjects who consumed more protein did not increase muscle mass or improve physical functionality, well-being, or responsiveness to testosterone. In this study, prespecified energy and protein contents were provided through “custom-prepared meals and supplements.” (Bhasin, 2018)
As we take a critical look at this study, there are questions about what type of protein was consumed, animal- based versus plant-based. Another issue is that participants may have exceeded healthy levels of Insulin Growth Factor-1 (IGF-1), a growth hormone that may have negative health effects at high levels. Also, when new research findings contradict decades of prior research, we need to be cautious about the new results and take a critical look at the research design and conclusions. (Zahler, 2018)

Dairy: It appears that consumption of whole milk and other dairy products increase the risk for prostate cancer recurrence, especially for overweight and obese men. A study of 1,334 men tracked dairy intake and cancer related deaths, recurrences, and treatments. Those men who consumed more than four servings of whole milk per week increased their risk for prostate cancer recurrence by 73%. Those participants with a high Body Mass Index (BMI) increased their risk threefold; possible mechanisms for this included a higher intake of IGF-I and saturated fat and related increases in inflammation. The risk involving high BMI was also linked to insulin resistance. 
There has been very significant continuity in research studies since the 1970s regarding the link between dairy products and prostate cancer. The Harvard Physicians Health Study followed 20,885 men for 11 years and found that having 2 1/2 servings of dairy products per day boosted prostate cancer risk by 34%.
In addition to IGF-I, milk and other dairy products have other mechanisms through which they may add to cancer risk; milk is loaded with calcium that depletes the body’s vitamin D, that may in-tern add to cancer risk. Also, most dairy products are also high in fat which affects the activity of sex hormones that play a major role in cancer. (Chen, 2015; Cohen, 1998)
A healthy cancer prevention eating plan would include
• Vegetables: sweet potatoes, carrots, broccoli, spinach, asparagus
• Fruits: berries, kiwi, melon, bananas, apples
• Whole grains: breads, cereal, oatmeal, pasta, rice; whole grain oats and barley are especially healthy
• Legumes: beans, peas, lentils
• Minimally processed soy foods like organic, non-GMO soybeans and tofu.
• The most healthful diets eliminate meat including fish and poultry, dairy products, eggs, and fried foods. (Zahler, 2018)

References
ArozarenaI,  et al: ‘Oncogenic BRAF induces melanoma cell invasion by downregulating the cGMP-specific phosphodiesterase PDE5A,’Cancer Cell, EPUB Jan 2011.
Bhasin S, Apovian CM, Travison TG, et al. Effect of protein intake on lean body mass in functionally limited older men: a randomized clinical trial.  JAMA Intern Med. 2018;178:530-541.
ChanJM, Stampfer MJ, Ma J, Ajani U, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Presentation, American Association for Cancer Research, San Francisco, April 2000.
Chavez AH, Scott Coffield K, Hasan Rajab M, Jo C. Incidence rate of prostate cancer in men treated for erectile dysfunction with phosphodiesterase type 5 inhibitors: retrospective analysis. Asian J Androl. 2013;15(2):246-248. 

ChenL, Staubli SE, Schneider MP, et al. Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis. Eur Urol. 2015;68(4):674-680. 
CohenP: ‘Serum insulin like growth factor– one levels and prostate cancer risk,Interpreting the evidence,’ Journal National Cancer Institute, 1998.
Davis, Garth with Howard Jacobson.’ Proteinaholic: How our obsession with meat is killing us and what we can do about it,’ HarperCollins publishers, 2015, Pgs 97-111; 256-265. 
Kaku, Michio: ‘The future of the mind: the scientific quest to understand, enhance, and empower the mind,’ double day, 2014.

LalSoliah,JM Walter, SA Jones: ‘benefits and barriers to healthful eating: what are the consequences of decreased food preparation ability?’ American Journal of lifestyle medicine, March/April 2012, volume 6, No 2, 152 – 158.
Mitra D, Ronibson, KC, Fisher, DE: ‘Melanoma and Viagra: An Unexpected Connection,’ Pigment Cell Melanoma Res, 2011; 24 (1): 16-18. 
Saad,Gad: ‘Is toxic masculinity a valid concept?: on the dangers of pathologizing manhood,’ Homo Consumericus, published online March 8, 2018.
TsertsvadzeA, Yazdi F, Fink HA, et al. Oral sildenafil citrate (viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology. 2009;74(4):831-836.e8. 
Zahler, William A: ‘Health, inertia, and information: why are we sick?’ Create Space and KDP, paperback and Kindle editions, March 2018.
Zahler, William A: ‘Synergy in the Dynamics of Lifestyle Change’, Create Space and KDP, published January 2019.

June 2019
William A. Zahler, MSW, ACLM








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