Turek On Men's Health » longevity

The Skinny on Obesity and Male Fertility

Paul Turek, MD — Mon, 09 Apr 2012 15:00:13 +0000

Whipped cream: an unnecessary evil.

You have often heard me say that sperm production is an engine that really wants to run hard and fast. And, that by not taking great care of yourself, sperm quality and fertility can suffer. Given that 1 in 3 Americans have it, one of the biggest elephants in the room is obesity. Now, the literature is oozing with new data that puts real live numbers to the obesity and fertility problem.

Obesity and Sperm

As discussed before in this forum, there appears to be a direct relationship between a man’s weight and not only his semen quality but also his fertility. However, a brand new study out of Paris has now put more meat on this bone. In this meta-analysis of 14 prior studies and 10,000 subjects, new facts were put forth on the obesity and infertility issue. Here they are in a nutshell:

Obese men are 42% more likely to have low sperm counts than men of normal weight.
Obese men are 81% more likely to be sterile (have no ejaculated sperm) than men of normal weight
For every 20 pound increase in a man’s weight there is a 10% increase in the chance of infertility

Is that enough fodder to make the changes you need to make? If not, then read on.

Fat and Male Fertility

Clearly, a large chunk of the obesity problem is related to diet. Junk in means waistlines out. In the first study of its kind published last week, researchers from Harvard collected semen samples from 99 mostly (71%) overweight or obese infertile men and assessed the fat intake in their diets over the previous year. Here is what they found:

Eating a lot of saturated fats was associated with lower sperm counts
Eating omega-3 polyunsaturated fats — the fats commonly found in fish and plant oils — was associated with better quality sperm

Of course complicating the study is the fact that most of the men were obese and all of them were infertile. Although the study included weight in the analysis, they did not consider conditions such as diabetes, heart disease, cholesterol issues and sedentary lifestyle that are associated with being overweight. Ultimately, such “details” have been known to kill a study over time. Regardless, dietary fats are now key suspects in the link between obesity and infertility. In other words, sperm are feeling the weight of obesity.

Now What?

As a men’s health specialist, I am always searching for lifestyle changes that can improve male fertility and health. As you can imagine, I was ecstatic to publish the first paper linking hot baths to lower sperm counts, as this identified an easily modifiable lifestyle issue: just say no to tubs! Well, here, my friends, is another one: Losing weight and eating well. This is a good thing! Maybe not as easy to fix as getting out of tubs, but one that is also much more germane to a long and prosperous life. So try The Turek Clinic Weight Control Plan. I have heard nothing but good feedback.

Try Not Sitting

Paul Turek, MD — Mon, 27 Feb 2012 16:00:24 +0000

The chair: good for the eye, but bad for health

Have you heard about a new disease that affects almost half of Americans and is lethal if it goes unchecked? It’s called “sitting disease.” It’s real and it’s the new smoking.

The Chair as Enemy

Sitting is an example of a “sedentary” behavior. Either at work or at home as a couch potato, it is considered a “low fitness” activity. Some might argue that it should not even be considered an “activity” given how unfit it is for you. So, why is screen-watching so bad for you?

It’s because several recent studies on sitting, conducted in America and elsewhere, have all observed similar results. People who sit a lot have 50% higher rates of heart disease, diabetes and obesity. And, conversely, if people who sit a lot also take frequent small breaks like standing up to stretch or walk down the hall, they have smaller waists and improved sugar and fat metabolism than those who don’t take breaks. Could this explain the obesity epidemic in our country? Many think it does, and in both children and adults.

Another interesting finding from these studies is that the risk of disease with sedentary lifestyles is unrelated to overall exercise levels. The amount of time you spend sitting and the amount of time you exercise each have their own separate risk for heart disease. So, the cure for too much sitting isn’t more exercise, it’s less sitting.

Facts about Standing

What if you just stand up more? Could this help? You bet and here’s why:

There are roughly 639 muscles in the human body. 300 of them are used for balance when you stand still. Far fewer are needed to sit.
Standing instead of sitting for 4 hours daily burns an extra 200 calories a day
Standing improves your posture and reduces aches and stiffness.
By using large muscle groups, standing improves fat and sugar metabolism
And walking is even better than standing for overall health

The Cure for Sitting Disease

The good news is that this disease is curable and curing it can add years to your life.You know what to do at home: spend less time sitting in front of a screen, whether TV or computer. At work, here are some useful suggestions:

Get up more often throughout the day
Walk to talk to your colleague down the hall, don’t email
Hold walking staff meetings
Take a walk during your lunch break
Park farther away in the parking lot
Use ergonomically designed, elevated desks
Use slow treadmill-based desks

At this point, I’m afraid that I have to disagree with Albert Einstein when he said: “A table, a chair, a bowl of fruit and a violin; what else does a man need to be happy.”

Your Hair or Your Hormones

Paul Turek, MD — Mon, 30 Jan 2012 16:00:25 +0000

Be nice to have Superman's hair…but at what price? (Courtesy; MovieBlog.com)

It’s the perfect drug for 40 million men in America who are going bald. Take it once a day to keep the hair on your head and shrink the prostate, which also commonly bothers men as they age. It’s a pill that has been used by at least 2 million reproductive age men over the last decade. But is it too good to be true?

The Best Hair Pill Yet

This magic pill is finasteride (trade names; Propecia, Proscar, Avodart). It represents a class of drug called the 5-alpha reductase inhibitors. These pills act as enzyme blockers: they prevent the male hormone testosterone from converting to its metabolite dihydrotestosterone (DHT). Although testosterone is responsible for a lot of our “male” features, DHT is more potent than testosterone for scalp hair and our internal reproductive organs (prostate, seminal vesicle). These drugs work by lowering DHT production and protect the gloriously youthful hair on our heads and the enviable ability to write your name in the snow while urinating.

And these drugs work well. More effective than topical or “rub in” medications, finasteride is great for what’s called “male pattern” hair loss which is due to a receding hairline or balding on the top of the head. In essence, it slows the growth phase of hair in these areas. However, it doesn’t treat hair loss on the sides or temple area.

Finasteride, Sex and Male Fertility

Although it may keep you looking like Clark Kent, many male infertility specialists, including myself, have concerns about finasteride. First, there is a 10% chance of sexual side effects that include erectile and ejaculatory dysfunction and lowering of sex drive. These issues can be subtle while on the pill but become very obvious when men stop it; many of my patients have noted a sexual “curtain being lifted” or “coming alive” after discontinuing the pill.

Second, there is an even more profound concern about finasteride among specialists: male infertility. Before it received FDA approval, the drug trials showed that it lowered ejaculate volume but did not change sperm count or motility on semen analysis testing (actual human fertility studies are not routinely required by the FDA). Now that it has been on the market for 10 years, though, impressive declines in semen quality have been observed and published with finasteride by many of us. This effect is not subtle either, as patients with complete sterility (azoospermia) have had recovery of their sperm counts after stopping finasteride!

There are several clues that this effect on fertility was possible. The rabbit studies done for FDA approval of the drug actually showed this effect. At 3 months, there was no effect on rabbit fertility. But, when followed longer, rabbits showed significant decreases in natural fertility. In addition, while I was writing a recent reproductive physiology chapter for Campbell-Walsh Urology, our leading urology textbook, I researched at what levels the 5-alpha reductase enzyme is found in the human testis and epididymis. Lo and behold, there are gobs of this enzyme in these important organs for sperm production and maturation, implying that the blocking agent finasteride would have an effect. So now what do we do?

At this point, controlled clinical trials are needed to prove this effect on fertility. For the time being, current thinking is that finasteride may not dramatically change sperm production in healthy men, but can impair semen quality in infertile men. Typically, the effects of medications on male infertility are reversible. So, to be proactive men should consider stopping the pill at least 6 months prior to trying to conceive. And, have confidence that she loves you just as much for other reasons. As Telly Savalas once said: “We’re all born bald, baby!”

A Secret to Living Longer

Paul Turek, MD — Sun, 11 Jul 2010 18:17:07 +0000

The beauty of a balsa wood board.

Up at dawn, and while waiting for a perfect, crumbling long board wave at Waikiki this past week, I recalled that Hawaiians live longer than the rest of Americans and wondered why. For some reason, life expectancy at birth in Hawaii is among the longest in the nation. Indeed, people born in Hawaii have a life expectancy of almost 81 years, at least three years longer than the US average. Why is this?

While watching rainbows appear and fade as early morning showers give way to the rising sun over Waikiki, I thought that it must be the fabulous and consistent climate. Then, as I saw surfers stream out to the break that I was tending before their workday started, I figured it must be that “island fitness” that pervades the tropics. Taking a large breath, I was reminded of the lack of air pollution and the sweet smell of jasmine, orchid and hibiscus flowers that blossom everywhere on the island. Could this be their secret?

A relaxing evening luau with soothing traditional aloha music and dancing accompanied by light, aromatic, almost Mediterranean dinner fare suggested that reducing stress and eating well and in moderation may also have something to do with it. Witnessing the deep respect held for family elders, for the community at large, and for the beauty and health of their island must also contribute in some way to longevity.

And then it hit me. Balance. The backbone of many older cultures is that they have found and maintain a seemingly harmonious balance as a civilization. They are aligned with others as individuals, with nature and with their place as a society on this good earth. The stress of extremes is present but not pervasive in such self-realized cultures and this is obvious in the genuinely large smiles that greet you at every corner of the island. So, let me propose a formula for staying healthy: realize that it is not life’s moments themselves that define you, but how you choose to live them.

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