Turek On Men's Health » alternative medicine

The Essential Beginnings of a Vitamin

Paul Turek, MD — Mon, 16 Apr 2012 15:00:57 +0000

Petroglyphs and Paleo: Inspiration for Essential Beginnings

Honestly, my opinion about nutritional supplements has evolved dramatically. Historically, the value of prenatal vitamins for women is well recognized and uncontested. For example, calcium keeps mom’s bones healthy as developing fetuses borrow mom’s calcium for their own bones. And iron prevents the anemia of pregnancy. Folic acid clearly prevents neural disorders and birth defects in children. No doubt, prenatal vitamins for women make sense.

Do Vitamins Treat Cancer?

However, with heart disease or cancer, the story is quite different. In 1998, the government set out to test herbal and other alternative health remedies to find the ones that work for cancer and other diseases. After spending $2.5 billion, the disappointing answer was that none of them help prevent or treat these diseases. As noted here several years ago, vitamins got an “F” for cancer. To top this off, newer data from just last month suggests that excess vitamins supplements may actually lead to an earlier death. Now what’s a guy to do?

Do Vitamins Help Men Conceive?

Thankfully, what is more encouraging is the value of antioxidant supplements for male infertility. In 2011, An august research group in England published a Cochrane Review that analyzed 34 studies of 3876 infertile couples using assisted reproduction to conceive. The meta-analysis found that the partners of men taking antioxidant supplements were 4-fold more likely to get pregnant and 4-fold more likely to give birth than couples in which the male partner was not taking supplements.

The Idea of a Male Prenatal Vitamin

This study changed my worldview to the following:

A large chunk of male infertility (maybe half) is due to what’s called “oxidative stress.”
Antioxidants are a good defense against oxidative stress.
The best antioxidants are found in the diet, and the Paleo diet appears to be the best.
Most men have terrible, antioxidant-poor, diets
If men ate more fruits and vegetables, maybe fertility would improve.
Barring this, men should view antioxidant supplements as prenatal vitamins.

The Essential Beginning

Motivated by this epiphany, I and several trusted colleagues, including fertility physicians and nutritionists, set forth to create a male prenatal supplement that would be better than eating airport food for fertility. We wanted it to be made in California and support the local economy, be certified-organic, and to reflect the latest findings in antioxidant research. It would contain vitamins, minerals and organics with high bioavailability, instead of just putting stuff on a label without regard to whether or not it is absorbed well by the body, like most other supplements. We wanted it to be available online, to avoid the middleman markup, and to be reasonably priced.

After a year of pretty intense work, it has arrived. It is called XY (your chromosomes, get it?). And not only that, we continued our research and developed an entire fertility product line for women all the way from pre-conception through breast-feeding with XX (women’s prenatal), Z (pregnant prenatal) and Z+ (post-natal and breast feeding).

Do all men need a male prenatal? Probably not, because as I said, nothing replaces a healthy antioxidant diet. But if you are like most of us, creatures of habit eating airport food and busting our chops to put food on the table daily, it is to you that I dedicate Essential Beginnings, XY.

Let’s Go Fishing

Paul Turek, MD — Sat, 02 Oct 2010 17:29:02 +0000

JFK supported teaching us to fish to eat for a lifetime

What’s 4000 years old and still alive and kicking? Traditional Chinese medicine. It’s a form of complimentary or alternative medicine that should be better integrated into our modern medicine healthcare toolbox in the future to keep America’s reproductive age men healthy.

Why do I say this? Because I like to face facts. Currently, alternative medicine is used by about 48% of the U.S. population in general and by about 30% of male infertility patients. That means that just as many men are using alternative medicine than Western medicine.

Why is complimentary medicine gaining traction in America? For a variety of reasons, not the least of which is because of a perceived dissatisfaction with the doctor-patient relationship. It simply takes too long to see a doctor. And when the visit actually materializes, it lasts about as long as a cat on a hot tin roof. To me, this is a quiet but strong statement about how Western medicine is simply not meeting the needs of modern men.

Complimentary and alternative medicine includes acupuncture, homeopathy, massage, aromatherapy, reflexology and herbal medicine as well as combinations of these employed in traditional Chinese medicine. Although their approaches may differ, alternative medicine is generally perceived as having natural effectiveness, being safe and non-invasive, and addressing the holistic and spiritual dimensions of healing and treatment. Most importantly for men, it is philosophically “patient-centered” rather than provider-centered which leads to a more positive patient-practitioner relationship.

Understanding men as men (and not women or children) is a key first step in drawing them back into an enabling and therapeutic healthcare experience. It involves playing to their strengths and not their weaknesses. You know, the old empowerment idea. As trite as the old Chinese proverb is, complimentary and alternative medicine, unlike most of Western medicine, provides a better opportunity to teach men how to fish so that they can eat for a lifetime rather than give them fish so that they can eat for a day. It’s the much-needed secret sauce to men’s health.

True, traditional Chinese medicine and most other forms of alternative medicine lack the spirit of scientific inquiry, being based almost entirely on anecdotes and stories rather than controlled experiments. But scientific medicine has generally ignored the powerful mind-body interaction so crucial for true health wellness. So, although the language of each approach is different, they really share the same goals. With this belief, I have taken the steps that I can to help this integration happen on a national level.

Men are looking for more than what Western medicine offers—the facts are clear. We in healthcare need to respond to this need and offer a taste of the secret sauce during those precious few moments when men ask for more.

Medicine Light

Paul Turek, MD — Sun, 08 Aug 2010 18:23:14 +0000

Spoon bending power to heal.

Can prayer heal? Does touch matter in medicine? Long considered a nonrational part of Western medicine, these “lighter side” topics are now receiving close attention and study.

I am reminded about distant healing on the anniversary of the death of a medical school classmate and friend Dr. Elisabeth Targ. As a psychiatrist, daughter of a parapsychologist and niece of chess champion Bobby Fischer, she was not only bright, but also a bit paranormal herself. As a child, she played hide-and-seek with friends and would attempt to use clairvoyance to find them. She was also expected to call out her Christmas presents before opening them. As a trained scientist, she performed some of the best studies showing the effect of prayer or “distant healing” on extending the survival of AIDS and breast cancer patients.

In her study of how prayer can heal, Dr. Targ used scientific methods to determine whether “intention” from others 1500 miles away could help treat medical ills. In small studies of AIDS patients before current treatments were developed, she showed that they could live longer and spend less time in the hospital with distant healing. Her papers are in no way definitive and are highly criticized, but to date remain the best and most scientific attempts the world has seen in the last 150 years to define the potential of faith to heal.

What made Elisabeth Targ a unique force in her field is that she refused to speculate about how or why distant healing works. She had a simple goal: to define the existence (or not) of the effect. Her boyfriend, Mark Comings, however is more daring in this regard. A theoretical physicist, he suggested that if we actually live in an eight-dimensional universe instead of the accepted three dimensions, then we might be more interconnected than we currently understand, and this could explain how a healer in Santa Fe could influence a patient in San Francisco. Sadly, Elisabeth died at age 41 years of a brain tumor. Ironically, it was the same kind of tumor that she was studying with distant healing treatment.

What about the role of touch in medicine? Clearly, patients who visit doctors for terrifyingly short visits feel that the visit is incomplete without a physical exam. The doctor’s visit is just not the same as that with your accountant, lawyer or financial advisor. The laying on of hands is a special part of the medical relationship and has been for millennia. In fact, there is good science to show that the physical exam is not as good at disease detection as a good patient history. What needs more study is what makes touch so special, almost medicinal, in the doctor’s office. Can it cure disease? I wish that my friend Dr. Targ were around for this one. She might be able to help us decide whether, in the words of Diane Ackerman: “touch seems to be as essential as sunlight.” My view as a men’s health specialist is that if it has the potential to heal, then use it, regardless of whether we understand why or how it works.

Freud’s Vasectomy

Paul Turek, MD — Mon, 26 Jul 2010 03:06:14 +0000

A man looking for his mojo.

Do you know why Sigmund Freud, esteemed psychoanalyst, had a vasectomy when he was 67 years old? How about William Butler Yeats, the famed writer, having his vasectomy at 69 years of age. Were they that sexually active and worried about conceiving? God bless them if this is true!

Hardly. Believe it or not, vasectomies were done in the roaring twenties and thirties in Austria by an endocrinologist named Steinach for physical and mental rejuvenation. “It revived my creative power,” wrote Yeats in 1937. This may be true as Yeats wrote a crop of poems during this period that rank with his best work. At that time, a vasectomy was considered the “holy grail” of perpetual youth. Steinach felt that by blocking sperm flow, male hormone production in the testis would improve.

The idea of hormonal rejuvenation really started in earnest with an acclaimed endocrinologist named Brown-Sequard who in 1889 injected himself with testicular extracts from rats and dogs. This led to the trend of “organotherapy” in which all sorts of animal organs were injected for every conceivable human illness. Sound familiar at all? It also led to serious and productive experimental research on the function of glands in the body.

The rejuvenating vasectomy was not an isolated claim to fame by Eugen Steinach from Vienna. He was nominated for a Nobel Prize six times for innovative studies that showed that male or female development depended almost entirely on the sex glands and their secretions. Give this theory a pinch of salt to incorporate modern genetics and is it true enough today.

What went wrong with Steinbach’s vasectomy idea was that he believed that narrow biologic principles could be used to treat the wide and complex condition of human sexuality. The funny thing is, almost 100 years later, we are still trying to figure out how to stay young forever.

No Fizzy Colas in the Cathedral

Paul Turek, MD — Mon, 05 Apr 2010 05:35:13 +0000

Did Warhol know about the "cola limit?"

How much coffee or tea do you consume everyday? Since many of us buy Slurpee sized cups of coffee in the morning, you should break those down into units of 8 ounce cups. How about cans of soda and in particular colas? Might be a good idea to keep track of this for a moment, as a recent study of 2,554 young Danish man has suggested that excessive cola intake could lead to lower sperm counts.

For comparison, the average young Danish military recruit consumes about 1 cup of coffee and 1 can of soda daily. This is in addition to about a half of cup of tea and 2 small chocolate bars (why not, Danish chocolate is yummy). This intake was associated with normal semen quality. However, the semen quality of young Danish men who consume more than 2 liters (2.1 quarts) of fizzy colas daily had a 30% less ejaculated sperm than men who drank no colas.

Interestingly, although colas are a weak source of caffeine (ounce for ounce, colas have 65% of the caffeine in coffee) there were no strong correlations between any amount of caffeine intake (even up to 7 cups of coffee a day!) and semen quality in these men. So, it is not likely that caffeine is the issue.

So what is the issue among those men who drink colas in excess? Well, the same issue as those who drink almost anything in excess—they have unhealthier lifestyles than those who consume in moderation. More burgers, more smoking, more alcohol, and fatter.

So, does drinking cola make men infertile? I doubt it, as the average sperm counts in men from all different levels of cola intake in the study were all normal by established fertility standards. Plus, fertility was not actually studied in these men, only a single semen sample. And even a good man can have a bad day.

There is a deeper truth running through this though. And you have heard this from me before. To be the best that you can be reproductively (and in life), do all things in moderation and treat your body like a temple.

Stem Cells are People Too

Paul Turek, MD — Sun, 14 Mar 2010 23:37:28 +0000

A stem cell in a dish is worth a hundred different therapies.

Not all stem cells are alike. News to you? Maybe not, but it has hit researchers pretty hard over the past several weeks. As you may have garnered from prior essays on this blog, stem cells are potentially capable of morphing into many different tissues, such nerves, heart or liver, and are the next wave in medical therapy for all kinds of diseases affecting both the young and the old. The medical treatment that they will bring to the table is called “personalized, cell based therapy.”

One huge problem is that the best kind of stem cell, the one that can do the most, is created from embryos. The embryonic stem cell has many “issues” though: derived from embryos, retrieval ethics, not patient specific, created by cloning, inefficient to produce and the like. Because of this, research has focused on alternatives like transformed adult stem cells or our very own untransformed testicular stem cells. The news today concerns the quality of adult-type stem cells that are “reprogrammed” and transformed into embryonic-like stem cells, also termed induced pluripotency stem (iPS) cells.

Well, there appear to be growing pains for the iPS cell, an embryonic stem cell alternative. Developed in 2006 from adult skin cells, researchers genetically manipulated a specialized adult cell, transforming it back to an unspecialized state. Since then, hundreds of labs have leaped into the burgeoning adult stem cell field.

The ideal stem cell is like a blank slate. It is capable of becoming any other tissue, and is immortal. True embryonic stem cells are like this, but, according to several recent publications, many iPS cell lines are not really blank slates. Also, it appears that nerve and blood cells made from iPS cells grow poorly and age quickly and may even “remember” what cell from whence they came. Some even conclude that iPS cells may not even be considered a practical choice for cell-based therapy down the line.

The realization that iPS cells are not exactly like the gold standard embryonic stem cells has slowed the field down a bit, but it is an important observation. Like people or even wine, stem cells are a bit different from one another, each with their own personality, temperament and potential. Some do this better than that, and others do that better than this. It suggests that stem cell-based therapy may eventually involve tapping into a mixture of different stem cells to cure the problem. Now that’s an old fashioned idea: a little of this and a little of that…

Good Job Government!

Paul Turek, MD — Sun, 28 Feb 2010 19:03:39 +0000

The best medicine for man is man…and good government

A couple sees a reproductive specialist for infertility. She gets a complete evaluation and he gets a semen analysis checked. It looks like his semen quality is low and they are recommended to pursue in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to conceive, the highest level of what is termed “assisted reproduction.” They try this at significant expense and it fails. They try again and it fails again. At this point, the man sees a urologist and, after a proper physical examination, he is told that he has a testis mass and is diagnosed with testis cancer.

The point: Male infertility can be a symptom of another medical condition.

The question: What would have happened to this man if they had successfully conceived with IVF-ICSI?

This scenario is not all that uncommon in our field. And it is why I gladly accepted the invitation to go Washington D.C. and consult with the National Institute of Health (NIH) last fall regarding where government research monies should be spent in the future in the field of male reproductive health. At that meeting, I suggested that we start calling infertility a medical disease, just like any other, and get men the medical care that they deserve. I expect several great grant initiatives to stem from this gathering and was honored to have participated in it.

This scenario is also why I am excited to have been more recently invited to join the Medical Advisory Board of the Cooperative Reproductive Medicine Network at the National Institute for Child Health and Diseases (NICHD) at the NIH. The RMN, established in 1989, is a cooperative effort of seven universities and the government and is charged with conducting and publishing high quality clinical research studies in reproductive medicine. Thankfully, one of the areas of focus is on male infertility. So, I will be taking my “infertility as a disease” mantra to Washington quite a bit this year as I believe scenarios like the case outlined above should never happen in modern medicine.

Weighing Your Options

Paul Turek, MD — Sun, 10 Jan 2010 17:05:57 +0000

Bacchus is no longer a role model…

What you weigh affects how your sperm play. And your fertility. Overweight men tend to have lower semen volumes, less sperm and more oddly shaped sperm. The same is also true for men who are too thin. So, along with the many other health hazards associated with obesity, add poor semen quality to the list.

Obesity in both sexes is known to be associated with heart disease, diabetes, hypertension, and metabolic syndrome among other nasty conditions that can shorten your life. Typically, obesity is measured with BMI or body mass index, which looks at weight in relation to height. Not a perfect measure, but reasonably accurate. Using this tool, the ideal BMI for men (and women) is considered to be 20-25. A Danish study of 1600 men showed that overweight men with a BMI > 25 had a 22% lower sperm concentration compared with healthy weight men. Interestingly, a BMI of <20 was also associated with poor semen quality. For optimal sperm production, then, it helps to be not too fat and not too thin.

But what about fertility? Is it also affected by obesity? Yup. Another recent study showed that for every 20-pound increase in a man’s weight, there is a 10% increase in the chance of infertility. And this remained true when other factors that might influence the results were accounted for, including obesity status of the women, the man’s age, cigarette smoking, alcohol intake, and solvent and pesticide exposure. In addition, obesity was associated with infertility in both older and younger men.

So what is it about weight that influences men’s sperm production and fertility? One theory is that sex hormone metabolism is altered by changes in weight. Sex hormones are the “fuel” for the engine (testis) to make sperm. Obesity increases fat stores and fat converts male hormones (testosterone) into female hormones (estrogens). Too much estrogen in men is bad for sperm production. Another theory posits that normal 2-degree difference in testis temperature relative to the body is lost with obesity, as excessive fat provides too much insulation and results in overheating. On the other hand, when a man is too thin, he may take on a “catabolic” metabolic state. With a body in “starvation mode,” fertility is not the first thing on its mind and sperm production and fertility suffer.

So, is the epidemic of obesity the reason why sperm counts have been falling in Western countries over the last 50 years? Maybe. But this problem is unique in that it is utterly and entirely preventable. Eat well and in moderation, sleep well and treat your body like a temple. You used to it for your own health; now do it for the health of your future family.

Breakfast: The Best Fuel For the Engine

Paul Turek, MD — Mon, 29 Jun 2009 16:47:07 +0000

Run clean, run hard, run fast…with breakfast

Most Americans wake up, rub the sleep out of their eyes, clean up and rush out the door. Breakfast is an afterthought. But soon after that, stomachs start to growl for some food energy. But by now it’s gotten a bit too late, and no oatmeal or egg will suffice. It’s time for doughnuts, or candy at the receptionist’s desk, or the potato chips in the vending machine.

There’s a good reason for this behavior. It’s called blood sugar. And blood sugar is at its lowest upon waking. Hypoglycemia is associated with slowness, dullness, sleepiness, crankiness, and it sparks feelings of hunger. For sugar. And once we have it, we feel sated and comfortable again, not to mention more awake, because sugar gives us a burst of adrenaline. Tasks are done with a flourish. Until about 10 o’clock in the morning. Then there’s another crash.

The high levels of sugar in our blood cause the pancreas to secrete insulin. With the help of insulin, sugar moves from the blood stream into the body’s cells to do work. This lowers blood sugar levels again, and the body goes back to feeling irritable and hungry. And so we make a midmorning beeline for the Jelly Bellies to receive another jolt, another spike in our blood sugar, and the vicious cycle continues. In the end, this cycle causes weight gain and fatigue, and affects overall and sexual health.

One thing can help with this, and that’s something called “breakfast.” Statistic after statistic tells us how important breakfast is, especially one that contains whole grains and protein. The Imperial College of London found that people who ate breakfast were far less likely to give in to fatty foods later in the day. Another study showed that drinking fat-free milk at breakfast helped people to feel fuller, more satisfied and to eat fewer calories at lunch. Yet another study reported that people who ate two eggs for breakfast lost 65% more weight and felt more energetic than people who ate bagels for breakfast. And the list goes on. Suffice it to say, starting the day with a good breakfast should help you to actually lose weight and improve your overall health and sex life. It is by far the most important meal of the day.

Eating a proper breakfast, before you get too hungry, makes it easier to resist sugar cravings and helps you make healthier choices at lunch and dinner. Stick to whole foods and grains as much as possible, and include protein in your breakfast. A well designed breakfast takes longer to digest and will cause less of a spike in your blood sugar. Apples or bananas paired with almond or peanut butter, for instance, could pass for breakfast. Whole grain toast with nut butter; yogurt and fruit with a handful of nuts; even a protein shake can make the grade. Opt out of the French toast and go for the scrambled eggs. Another trick is to make breakfast more convenient than a trip to Starbucks. Get it into your system before a croissant does. Trust me, the rest of the day will be a cakewalk.

You Are The Pill That You Eat

Paul Turek, MD — Tue, 09 Jun 2009 14:59:56 +0000

Amber waves of grain, the stuff of our Neolithic ancestors

At some point as we evolved, well after the Neolithic period, we started thinking that there must be a better way to get nutrients, something faster and more efficient, than through the food we have eaten for tens of thousands of years. Our fantasy of the future was encapsulated with TV shows like The Jetsons and Star Trek, where roast chickens and earl grey tea were produced by the touch of a button. Nowadays, grocery stores offer fruit smoothies, breakfast bars, energy drinks and microwave pizzas, so we can fuel up quickly and efficiently. Why sit down when you can eat while running? We take vitamins with the idea that we can rectify any potential deficiencies and even prevent illness, with the swallow of a pill. How simple, how easy, how efficient.

As a society, we are in love with “nutriceutical” supplements. About half of all adults take a multivitamin everyday and it is estimated that $75 billion worldwide is spent annually on nutriceuticals. And nonvitamin and nonmineral natural product use is so prevalent in the U.S. (40% of Americans) that the National Institutes of Health has even commissioned a new branch devoted entirely to the pursuit of complementary and alternative medicine research. This effort will undoubtedly unleash the true potential of alternative medicine. But let’s drill down on vitamins for a minute. What does the evidence really show? Well, it appears that taking vitamin supplements may not as beneficial as previously thought. Several major studies have now shown that vitamin supplements do little to prevent cancer and heart disease, while other studies report that vitamins and antioxidant supplements may actually increase cancer rates. One study concluded that folic acid supplements actually increased rates of precancerous colon polyps, and another study linked beta-carotene to higher lung cancer rates. Are vitamins then, failing us as supplements?

No one discounts the necessity of vitamins for our body’s function. Indeed, many diseases are associated with a deficiency in one or another vitamin. But we do place rather high expectations on vitamins. It’s rather narrow-minded of us to tout only a few particular nutrients in food and assign them letters of the alphabet, when many others may be just as essential to our primitive bodies, yet are unfamiliar to us intellectually. Vitamins do not exist in a void, but are part of a complex mixture of substances called food that is the real stuff of life. If anything, the fact that vitamins are getting an F in cancer prevention suggests that the way that they are absorbed in a pill is not the same as the way we extract them from whole foods that we eat.

My patients frequently ask me what supplements they should take to enhance their sexual health or fertility. The truth is that because sexual health is so thoroughly intertwined with overall health, I emphasize a whole-body approach. I don’t recommend a specific course of supplements, but antioxidants may have some value. If they wish to take a supplement, they may, but the important thing is that they get all nutrients necessary for their bodies to function optimally. The real solution to this is a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits, and vegetables. That said, I do realize how resistant many people can be to changing their diet. If a patient feels they must take a supplement to compensate for poor eating habits, I steer them towards whole food supplements that contain a larger and more complex spectrum of nutrients than that found in traditional multivitamins. In all honesty however, I firmly believe in carrots from the earth and apples from trees, just like our Neolithic ancestors did.