Turek On Men's Health » women’s health

The Incredible (Renewable?) Egg

Paul Turek, MD — Mon, 05 Mar 2012 18:32:47 +0000

The human egg: a thing of beauty…now a renewable resource?

It’s hard to keep up anymore; things are changing so quickly in fertility medicine. Just in the last week, a Harvard researcher discovered stem cells in the human ovary and a 66 year old just became a mom to twins in Switzerland. There goes the rug, being pulled out from under our scientific feet yet again.

Testicular Stem Cells

A couple of years ago, we published a paper confirming the presence of cells in adult men that were long though to exist: testicular stem cells. These are “multipotent” cells unlike most other cells in the body: they not only renew themselves, but they can also become sperm and may even be coaxed into becoming other organs in the body. The really convenient thing is that they are not derived from embryonic stem cells (a political minefield) a fact that makes them prime candidates for stem cell-based treatments in the future.

The Dogma About Eggs and Ovaries

But eggs are not sperm. Sperm are made constantly throughout a man’s life, like blood cells, and therefore it makes sense that there are stem cells running the show. However, for at least as long as I have been in medicine, it has been thought that women are born with all of the eggs they will ever have, some 1-2 million, and lose them throughout life, most obviously through monthly ovulation, until they are gone. The basket empties of eggs somewhere in the 40’s for most women, about 10 years before menopause. This lack of new egg production has led to the belief that, unlike within the testicle, adult stem cells do not exist in the ovary.

Ovarian Stem Cells

But Dr. Jonathan Tilly at Harvard thinks otherwise. He believes that women indeed have adult stem cells in the ovary that might be able produce new eggs during a woman’s lifetime. And maybe even after her traditional reproductive window has closed.

Dr. Tilly first showed this in mice and published it in 2004. He recently extended this work to women by locating an incredibly scare biological resource: fresh ovaries donated by Japanese women undergoing sex change procedures. Within this tissue, he found cells that showed classic stem cell characteristics using genetic markers. But this only means that they “look” like stem cells. To prove that they can “act” like real stem cells, he isolated these cells in a Petri dish and watched them turn into real, live, immature eggs. More convincingly, he then transplanted them into mice and they continued to develop into even more mature eggs, passing through meiosis in some cases which is a characteristic process occurring only in eggs and sperm.

So what are the implications of this technologically mind-bending work? Hard to know, but down the line it may mean that women may be able to make new eggs when we thought that they couldn’t. Maybe their baskets never really empty of eggs and that their fertility can be extended beyond what we now think is possible.

Regarding the 66 year old women who just had twins…it’s not clear to me how many genetic parents were involved, how long it took, and how heroic the effort was, but I can guarantee you that she will have her hands way too full for the next several years to keep up with this science.

Rise of the Instant Family

Paul Turek, MD — Mon, 09 Jan 2012 16:00:47 +0000

IVF: The elephant in the nursery room

Using sex to conceive, the chance of having twins or higher multiple births is about 1-2%. With assisted reproduction, including intrauterine insemination (IUI) in the office and in vitro fertilization (IVF) in the lab, the chance of twins, triplets or high order births ranges from 30-50%. That’s quite a big difference!

Twins have fascinated us for eons. They run in families but a twin gene has not been found. More twin babies grow up to be left handed than you’d expect, and identical twins built of the exact same genetic blueprint have similar brain wave patterns and may think the same, but have different fingerprints.

Since records have been kept starting in 1915, our multiple birth rate has been stable at 1-2% throughout most of the last century. IVF arrived in 1978 and is now 33 years old and is now performed over 120,000 times annually. One would expect it to affect our birth rate numbers at some point. Well, the data is in and it has.

The Instant Family

The Centers for Disease Control and Prevention (i.e., CDC) just published the information on twin births over the last 3 decades (1980-2009). Here are the key findings:

The twin birth rate rose 76% over this time, from 19/1000 births to 33/1000 births.
In 2009, 1/30 U.S. births was a twin compared to 1/53 babies 30 years ago. Among multiple births reported in 2009, 96% were twins.
Twin birth rates increased by 100% in women ages 35-39 years and by over 200% in women ages 40 years and older.
If the twinning rate had not changed, almost 1 million fewer babies would have been born over the last 30 years.

Since only about 1/3 of the rising twin rate can be ascribed to older moms in the study, this leaves the rise of IVF and fertility treatments as the only elephant left in the room.

An Epidemic of Multiples

Although convenient for many couples as the entire family is complete with a single birth event, the twinning epidemic has other implications. Here are some of them that concern the CDC:

Higher risk to moms health (eclampsia, gestational diabetes)
Higher rate of premature births
Less healthy, smaller sized babies (about half of twins)

When I see those twin strollers while walking down the street, I think “chock it up to technology changing the face of humanity yet again.” For the couple pushing those strollers, you will never seen bigger, or more tired, smiles. In the words of Josh Billings: “There are two things in life for which we are never truly prepared: twins.” But there is something to be said for getting the family built in one fell swoop.

Women: They’ve Got Me Covered

Paul Turek, MD — Sat, 07 May 2011 07:09:42 +0000

There she goes again, rolling those eyes…

I think it was Jim Carrey who said, “Behind every great man is a woman rolling her eyes.” Ok, maybe that’s not always the case, but there are several women who have fundamentally shaped my life. Here’s my short list of Happy Mother’s Day recipients:

Mother: For obvious reasons (“I wouldn’t be here without you”), I honor you first. I remain only a couple of pounds heavier than I was in college because you raised us to believe that carob was tastier than chocolate and that a good orange is sweeter than ice cream. And thanks for the ongoing reminders to wear a coat when I go outside.

Oma (Grandmother) Turek: Although eulogized in this forum after your death at 99 years of age, you still inspire me daily to make a difference, never stop learning, do things well or not at all, and fight for what you believe. And, by the way, thank you for single handedly bringing our family to America from Czechoslovakia through Nazi Germany so that we could start a new life.

Tante (Aunt) Betty: Your life of 90 years was a study of consistency and habit. You were the family clock, sending cards on every occasion to everyone every year. Thanks for the $5 bill in each birthday card from you for 48 years and for teaching me the value of ritual to a full and considered life.

Sister Karin: Thanks for being that older sibling who always got better grades than I did in elementary school and for making straight A’s in school de rigueur for Mom and Dad. Never bothered me a bit that you could smoke all your classes and be a varsity athlete in I don’t know how many different sports.

Mother-in-law Thelma: Hard to believe that I am one of those guys who actually likes and admires his mother-in-law. Given your background as a published writer and English major, thank you for not constantly correcting my spoken word and for letting me wax as colloquially as I wish in my blog.

Dearest Ashley: How do I thank you? Wife, lover, friend, ally, competitor, teacher, closet politician, therapist and mother of our children. No limerick can hold a candle to your beauty and grace. And kudos to you for always letting me believe that I am running the show, and for never letting me see you rolling your eyes.

Royal Advice for the Ages

Paul Turek, MD — Sat, 30 Apr 2011 17:10:40 +0000

Prince William's personal royal crest.

Dear Duke and Duchess of Cambridge,

I watched your lovely wedding at Westminster Abbey this week. So sorry that I couldn’t make it to the Abbey for the ceremony, but I had to operate that day (and you didn’t actually invite me). All is forgiven, as I was privileged enough to watch the marriage (from the streets) of Lady Diana and Prince Charles some 30 years ago when I was in London as a college student doing research at St. George’s Hospital. It must have been a great affair and it looked like you both enjoyed yourselves immensely.

I know that it’s early in your relationship, but sooner or later you will look in each others’ eyes (or be told by the Queen) and say “it’s time to start a family.” Best be prepared as it’s gonna happen…to keep the lineage going and all that.

For this reason, I’m be happy to offer you some royal advice on this matter. No, don’t bother to thank me; it’s my pleasure to help out. Here are 10 tips for successful family building that I have handed out countless times to couples trying to conceive and it’s worked well for them. Feel free to tuck it away in your nightstand until the time comes or “ring me up” anytime you like:

Duchess Catherine, although you looked fabulous in that wedding dress, you really must put on a stone or two (a few pounds) of weight. Being too thin or too heavy reduces chances of conception. Aim for a body mass index of 19-25.
Duke William, spend a little less time with your buddies at the Mahiki or Pig’s Ear tavern and painting the town red; too much sauce (alcohol), fags (cigarettes) and fries (even with vinegar) are poisonous for sperm. Like I always say: All things in moderation; treat your body like a temple.
On that note, the “bangers and beans” served for breakfast at Bucky Palace do not constitute a good antioxidant diet for either of you. Take my advice and start on the Paleo diet, rich in fruits, vegetables and nuts along with occasional bison, boar or elk meat from the palace grounds at Balmoral.
Better yet, head south to the Mediterranean and eat like they do, as they have the single best antioxidant diet for a healthy heart and good fertility.
Surely it must be stressful to be a royal. And believe me, stress wreaks havoc on fertility as well as your relationship. How will you achieve that necessary balance in your lives? Avoiding the paparazzi is one way. Regular exercise, yoga, acupuncture and massage are others. Wouldn’t surprise me at all to learn that your level-headed grandmother isn’t doing something like this in her antechamber.
Duke William, stay out of hot baths, tubs, and saunas as these will drop your sperm count like a lead balloon. Showers are fine, especially gold plated ones.
Duchess Catherine, I know that you know that timing is everything. Well, it is also true of conception. Use basal body temperatures or ovulation predictor kits to let you know when to flash that great smile at the Duke.
Duke William, trying to conceive is like hunting. You need to know when to fire and when to reload the gun. Every other day is optimal for baby-making.
Duchess Catherine, consider cutting out the caffeinated coffee at the Ritz, as excess coffee consumption reduces fertility. I’ll get back to you about the tea there as it goes so well with the crumpets and finger sandwiches.
And both of you, get enough rest! For a good sex life, you need energy, you need to relax, and you need time. Remember that the mind is the largest sexual organ and it controls your “mojo” as Mr. Powers put it, so take care of it. Hit the kill switch on the TV and computer earlier in the evening. Turn off Facebook and face each other. Simply sleep; the sex will follow.

A Primer on Radiation

Paul Turek, MD — Sat, 26 Mar 2011 17:22:32 +0000

Are we at risk of nuclear fallout from Japan?

We are all concerned for the Japanese after their recent, unheard of, triple cataclysm of earthquake, tsunami and nuclear meltdown. The catastrophe was horrendous and the photo-footage of the disaster is mind numbing and knee buckling. And next on our minds, occurring on the heels of the Haiti earthquake is what’s next for Japan: infectious disease epidemics and, even more frightening, nuclear fallout. Although I’ve addressed the issue of the Chernobyl nuclear fallout on male infertility in prior posts, it’s fresh in our minds again after “3-11” in Japan.

Radiation is scary. You can’t see it but you know it’s there. It’s like the adult version of ghosts for kids. Technically, radiation is a simple form of matter or energy like any other and was first defined in the 19th century when Bavarian professor Wilhelm Roentgen discovered X-rays. Nuclear radiation, like X-rays, is a form of “ionizing radiation,” which is energy that strips orbiting electrons from atoms forming charged particles called ions and creating molecules called “free radicals.” These substances are damaging to living systems, as they don’t behave as their neutral counterparts do, and generally mess up the physics and chemistry of life.

The First List: Typical Radiation Exposure

We are all exposed to radiation every day as it a part of the normal environment in which we live. In fact, if you are interested in calculating your annual exposure to radiation, click on this EPA website. You’d be amazed at what actually contributes to our radiation exposure every day: breathing air at different altitudes, airplane flights, luminous watch dials, irradiated (sterilized) food, watching TV, using a computer, having teeth with porcelain fillings or crowns or a wearing plutonium pacemaker to name a few. For perspective, here is a list of radiation levels from just living and breathing and also from common medical procedures:

2.5 mSv= Annual natural exposure to radiation
1 mSv= Chest X ray
2 mSv= Head CT scan
3 mSv= Screening mammography
25-50 mSv= Full body CT scan

The Second List: Radiation Exposure and Disease

100 mSv= Radiation dose causing temporary loss of sperm counts
500 mSv= Radiation dose causing permanent male sterility
170 mSv= Average per person exposure to radiation in the Ukraine in the year of the Chernobyl meltdown (1986)
30 mSv= Average exposure in the Ukraine two years after Chernobyl (1988)
1000 mSv= (Single dose) causes non-fatal, temporary radiation sickness (nausea, vomiting, low white blood cell count)
1000 mSv= (Accumulated dose) significant increased risk of cancer, premature aging
10,000 mSv= (Single dose) fatal radiation sickness

The Third List: Japanese Radiation Levels

400 mSv/hour= Peak radiation levels at the Fukushima nuclear power plant, March 14, 2011
173-181 mSv= Range of exposures of three nuclear plant workers
20-50 mSv= Radiation levels in tainted milk from Japan
5-10 mSv= Radiation levels in tainted spinach from Japan
Unclear= Radiation levels in canola and chrysanthemum greens
Unclear= Levels of radioactive iodine in Tokyo tap water

The Anti Radiation Diet

We are certainly concerned for the Japanese in their time of need. Should we also be concerned about nuclear fallout 5000 miles away? All federal agencies and most experts feel we shouldn’t be. However, if that answer is just not good enough, consider the anti-radiation diet:

Miso soup
Kelp (natural iodine helps prevent the uptake of iodine-131)
Brassica vegetables (rutabaga, turnips, cabbage, sprouts, cauliflower and broccoli)
Beans and lentils
Potassium, calcium and mineral rich foods
High nucleotide content foods (yeast, sardines, liver, anchovies, mackerel)
A good multivitamin supplement enriched with antioxidants

Bringing Africa Home

Paul Turek, MD — Sat, 13 Nov 2010 22:06:13 +0000

Keeping the memory of Africa alive.

During medical school, I spent several months at Hopital a la Dantec in urban Dakar, Senegal, West Africa. I saw things the unimaginable and the unbelievable. The ravages of polio and typhoid, amoebic abcesses, and tumors growing in places that I did not think possible. Without much of modern technology, medicine was a high art with diagnoses based on fever curves, skin turgor, lumps and bumps and the scattered, disconnected gaze of the truly ill.

It was there that I first learned that the odds of survival were stacked in favor of biology over medicine. It also became clear that the best medicine combines knowledge of, and respect for, your fellow man. Stripped to its essence, medicine is not about robots that fill rooms or drugs that delay the inevitable. Rather, in its purest form, medicine is simply a combination of touch, empathy and hope.

After leaving Africa, moved by the experience, I vowed to return. Not to Africa, but to these core values of medicine. And recently, this transpired in my own backyard. Several years ago, Janet Reilly approached me and asked whether I would help her start a free medical clinic in San Francisco. A clinic that would provide primary medical care to the working uninsured and their families: free care using volunteer retired doctors, for productive individuals who, despite their long days and nights on the job, simply do not earn enough money to afford medical insurance. Even with a busy men’s health practice in full swing, without hesitating, I said: “count me in; how can I help?”

Three years later, Clinic by The Bay is now open for business. Our opening event was last week. Located in the heart of the Excelsior district of San Francisco, the Clinic will become a much-needed medical home for the community. In a bright, open space on Mission Street, the Clinic is filled with care providers who believe that the practice of medicine is about respect and hope. It is a place where providers actually spend time with patients and listen to them. You have heard the promise of “personalized care” touted by genomic medicine, but honestly it doesn’t hold a candle to a good doctor who listens and responds to the real needs of patients.

Giving back to mankind in faraway places is indeed exotic, life changing and personally fulfilling. But giving back to your own community is all that and so much more. You make a difference every day, not just while you’re away. To me, it is the essence of noblesse oblige. In the words of Winston Churchill: “We make a living by what we get, but we make a life by what we give.” A salute to Clinic by the Bay, for helping me keep my promise.

Bringing It Home

The Age of Aquarius

Paul Turek, MD — Sun, 19 Sep 2010 02:11:58 +0000

Is this the dawning of the Age of Aquarius?

It really seems like the moon is in seventh house, and that Jupiter is aligned with Mars. Why? Because our government gets it and want to know how it can help.

Last week, I spoke at a stakeholder meeting about men’s reproductive health, held at the Centers for Disease Control (CDC) in Atlanta. You may have heard of the CDC, begun in 1946, as the American government’s disease surveillance unit. Answering to the executive branch of the government and not to Congress, the CDC has a storied history over the past 60 years, being integral to the worldwide eradication of smallpox and to the control of measles and rubella and more recently, HIV. And who can forget the role that the CDC played in identifying the cause of Legionnaires disease, toxic shock syndrome and SARS? Well now they are interested in men’s reproductive health. You gotta believe.

What’s wrong with men’s reproductive health care in the U.S.? Well, in a sense, it doesn’t exist. Most men who are infertile do not get the care that they should; most male sexual health issues are verboten topics for public discourse; and men’s roles in family life and contraceptive planning are paltry at best.

It warms my heart to know that among all the government branches that could have taken men’s reproductive health seriously, the CDC has picked up the ball. After all, they are interested in assessing populations at-risk and controlling epidemics. And that is exactly the kind of thinking that will improve men’s reproductive health in the U.S., a condition that could certainly be termed an epidemic. A couple of years ago, I wrote an NIH grant (that was funded no less!) to help train male reproductive specialists at UCSF that began with the following sentence: “Men’s reproductive health is a large and underserved area of medicine in the U.S.” Amen.

This first-of-its-kind meeting was brimming with excitement. Attended by non-profits, academics, urologist thought leaders and numerous federal agencies, it was clear that the time had come to rethink the way we take care of young men. The definition of men’s reproductive health that guided the discussion was “the ability to have a responsible, satisfying and safe sex life and the capability to reproduce and the freedom to decide if, when and how often to do so.” In this context, awareness, public health, barriers to care, messaging, resources, engagement, and communication were terms addressed as if this topic were a true, national epidemic. In the words of Wallace Stevens: “Thought is an infection. In the case of certain thoughts, it becomes an epidemic.” For the good of a large chunk of our population, let’s hope that this issue goes viral.

Where There’s Smoke

Paul Turek, MD — Sat, 11 Sep 2010 07:00:16 +0000

All smokers eventually quit…

Smoking is bad for men’s fertility. Not unexpected, you might add, since 1000 smokers die each day around the world from smoking related diseases. But what else is new? A lot. And this matters because 25 million men in America smoke. Along with 21 million women. Any other condition this common would certainly be considered a frightening epidemic.

Although we always suspected that smoking impairs sperm quality and quantity, two papers published this week shed light on ways in which this could occur. Mechanistic in design, this research approached the problem from different angles and each made unique observations.

One study compared the integrity of sperm DNA in smokers and nonsmokers. As background, realize that a sperm’s job is to deliver a neatly packaged DNA payload to the egg during what is called fertilization. The egg then molecularly “undresses” the sperm DNA and decides over the next day or two whether that genetic payload is of high enough quality or integrity to proceed down the pathway toward becoming an embryo and then a fetus. If not, an executive decision is made by the fertilized egg to stop dividing and call it a day. Protamines are molecules that protect the DNA in sperm so that it remains neatly packaged, and in this study, the smoker’s sperm had significantly disrupted protamine protein levels compared to the sperm of non-smokers. That explains the sperm quality problem: smoking poisons sperm.

A second study took a different look at smoking and infertility. It assessed the impact of maternal smoking habits during early pregnancy on male fetal development. Based on the examination of miscarriages, they found that number of testicular stem cells that are destined to become sperm later in life in the male fetuses of mothers who smoked was half of that of their nonsmoking counterparts. And this observation held true when other social drugs like caffeine and alcohol were taken into account. Fewer stem cells in the developing testicle could mean fewer sperm and a higher risk of infertility in adult sons. This might explain a sperm quantity issue in some infertile men–in men who don’t even have to smoke to have the problem.

So ditch the coffin nails and let your life burn bright in other ways. There are many ways to have your breath taken away. As Woody Allen said: “Remember, if you smoke after sex, then you are doing it too fast.”

Babies…Naturally

Paul Turek, MD — Sat, 14 Aug 2010 15:35:08 +0000

The magic bullet? You decide.

In my daily fertility practice, while trying to help couples to conceive, I’ve noticed a trend lately. Patients are less interested in using high levels of “assisted reproduction” to have children. In particular, they would like to avoid in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the Cadillac of all techniques. Even before they meet me, they have decided against it. Not all couples, mind you, but certainly more than before.

Briefly, IVF-ICSI is a busy month for women. It involves stimulating them with daily, injectable hormones during the first half of the menstrual cycle to generate more eggs than normal within the ovary. Ovulation of eggs is induced by injection of a second hormone, which is closely followed by egg retrieval using needle aspiration under anesthesia. Retrieved eggs are then stripped of their cell coats in a dish and a single sperm is individually injected into each egg by an embryologist. The criteria for choosing sperm are: good looking and hopefully moving. Eggs then become embryos in a Petri dish and are transferred back to the female reproductive tract three to five days later, depending on how they develop. Extra embryos can be frozen for future use. A pregnancy test is obtained two weeks later.

As a male fertility specialist whose practice mantra has been “treat the male, cure the disease,” I find this trend very interesting. Assisted reproduction is almost always an option for couples, but I have spent a good deal of time publishing research showing that classic male infertility treatments such as varicocele repair and vasectomy reversal are very cost-effective ways to conceive compared to more expensive techniques like IVF-ICSI. On the other hand, these techniques are the only option for many men with azoospermia, or the absence of ejaculated sperm, and I am glad that it exists for this.

I wrote down what patients said when I asked them why IVF-ICSI is not an option on the table for them and here are some of the responses:

“It seems pretty invasive and unnatural.”
“Isn’t it relatively new?” (IVF is 32 years old, ICSI is 18 years old)
“Who selects the sperm?” (Since it is not God or Darwin)
“Wasn’t ICSI developed as an experimental mistake?” (Yes)
“How do we know that those are our eggs and our sperm? (Rare)
“It’s only a single try at having children.” (Maybe two)
“Isn’t there an issue with higher birth defects and syndromes in babies” (Very likely)
“Are our children going to be infertile?” (Unknown)
“We’d prefer to have the hope of trying every month at home.”
“IVF-ICSI is too expensive”

What I think is happening is that as IVF-ICSI is being offered to consumers more often than ever (currently 1-2% of U.S. babies are born from these techniques), patients are becoming better educated about the technology and are making more informed, personal choices. My gut also says that good, old-fashioned sex has a strong following among infertile couples as a way to conceive. In the words of Woody Allen in Annie, “that was the most fun I’ve ever had without laughing.”

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.

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.

No related posts.

The Curse of Women’s Urine

Paul Turek, MD — Sun, 25 Apr 2010 22:21:26 +0000

Estrogens and the manly man.

There must be something in the air… or water. The Bolivian President Evo Morales recently asserted publicly that hormones found in mass-produced foods are “feminizing” men. Speaking about chicken in Bolivia, which he believes are “loaded with feminine hormones,” he suggested that when men eat chicken “they are diverted from their nature as men.” So, is this how metrosexuals came to be?

But wait, the Vatican commented on this issue a year earlier, although they blamed female hormones from birth control pills for the increased estrogens in ground water. Pedro Castellvi, writing in the Vatican newspaper L’Osservatore Romano in 2009, stated: “we have sufficient data to affirm that one of the reasons for the not insignificant rise in male infertility in the west, is the environmental contamination caused by the pill.” Actually, it’s not the birth control pill itself but the urine from women taking the pill.

In fact, to date, the urine of women taking birth control pills has been blamed for worsening sperm counts in men, the growth of female sex organs in male fish, breast growth in young men and the early onset of puberty in young girls. What next?

Can I add a little balance to this discussion? First of all, exactly what is happening to men in Bolivia such that the President is not happy with them? Are they more civilized and less disruptive? Second, male infertility is not necessarily increasing in the western world; it may even be true that men have lower sperm counts now than a generation ago not because they are less fertile but because women are more fertile. Third, estrogens are found everywhere in the environment including in many plants (phytoestrogens) such as soy and legumes, and are not produced exclusively from the urine of women. Fourth, the intersex conditions that have been reported in many animal species tend to be caused by a very specific exposure at a very specific time point during fetal development and have been linked to pesticides, bisphenol A, dioxins and other environmental contaminants (xenoestrogens). Fifth, did we somehow forget about the worldwide obesity epidemic in humans and the fact that fat converts male hormones to female hormones? Lastly, there is little evidence that substantially increasing a man’s estrogen levels as an adult will dramatically alter anything, except maybe waist size and color preferences. Where the truth lies in all of this is currently unknown, but it is hard for me as a urologist to see how women’s urine could be blamed for so much.

Your DNA Barcode

Paul Turek, MD — Mon, 22 Feb 2010 02:03:04 +0000

Can we be DNA barcoded like a soup can in a grocery store?

How many of you would take a blood test to learn exactly how long you will live? How about whether or not you will become demented? Since the Human Genome Project ended, the genes and mutations associated with a vast array of diseases are being discovered daily and it is pretty easy to just put them on “chip” and make them available to the public.

Don’t get me wrong; gene testing already has already improved our lives. Such tests can clarify a diagnosis and better direct care, while others allow families to avoid having children with life-threatening or disabling conditions. They can be used to prevent disease before it happens, as with monitoring and removal of colon growths among those who have a gene for familial polyposis, and can diagnose common iron-storage diseases early enough to treat them and prevent them from becoming fatal. They can also help to positively identify murderers two decades after the crime.

One real problem is that many commercialized gene tests are targeted to healthy people who might be at high risk because of a strong family medical history for a disorder. Unfortunately, because of how complex we are as biological organisms, the tests give only a “probability” for developing the disorder. That means that some people who carry a mutation may never develop the disease. Another limitation is the possibility of laboratory errors. What this means is that the tests are not perfect and could be wrong.

And what happens to your job prospects and health (or life) insurance rates when it is learned through genetic testing that you might develop a significant disease? Well…nothing. Because of the federal GINA Law (Genetic Information Nondiscrimination Act) passed in May 2008, insurance companies and employers cannot discriminate on the basis of information derived from genetic tests. So, genetics has now been added to the list of characteristics first embodied by the Civil Rights Act of 1964, that states that U.S. employers cannot discriminate according to race, color, national origin, sex, or religion. And this is good.

So, go ahead and take the “23 and Me” “DeCode” or “Navigenics” genomic screens if you so desire. Get to know your DNA barcode. Maybe you will get an idea of what may be around the corner for you. And maybe, just maybe, you will take better care of yourself knowing more about your genes. Just understand that many in the medical community feel that uncertainties surrounding test results, the current lack of available treatment options, the tests’ potential for provoking anxiety and social stigmatization could outweigh the benefits of testing. You know the saying: “Too much information…”

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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.

A Woman Among Women

Paul Turek, MD — Sat, 12 Dec 2009 23:45:01 +0000

A woman whose independence lasted longer than most countries.

Excuse my diversion from men’s health, but a very important woman in my life has just passed away. My last grandmother (known as Oma) lived a fiercely independent life for over 99 years, longer than most countries.

She brought our family to America from what is now Czechoslovakia in 1950, after 1000 years of farming the land and a generation of recent persecution. She brought a husband, a son (my father) and her daughter, each with a single suitcase, to Connecticut to start life anew. And we have prospered here since. A typical immigrant story.

She lived in her own home for 56 years, preparing every meal from scratch, and died there. A simple humble, life and a simple humble death. If you got to her house too late in the morning after a winter storm, you would find her clearing the snow from her driveway well into her 90’s. I only knew her as a gray-haired grandmother, but she was a constant and a compass to the entire family: our north, our south, our east, and our west. Rooted, decisive and opinionated, she was usually right, but never wrong.

She was a woman of the land, a gardener and a grower. In the words or Rilke, she knew the sound that small flowers make when they open in the morning.

The Germans play a card game call Setback, like Bridge. If you played on her team, you usually won. It was something about those million fine wrinkles that gave her the perfect poker face.

She leaves to 6 grandchildren and 8 great-grandchildren on both coasts a spirited legacy of wisdom, willfulness and fortitude that will survive for generations.

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