Solving the Mystery of the Multivitamin Part III

This article is the third in the series begun with “Solving the Mystery of the Multivitamin” and continued with “The Special Nutritional Needs of Women.” Here it is observed again you do not need to believe “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As it is often remarked, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

General Nutrition for All Men
In the case of men, as is true of women to a striking extent, food processing and the consumption of refined and processed foods by themselves largely account for obesity, diabetes and many other health problems. There is a large overlap between men and women in general nutritional needs, but also some striking divergences, such as in the cases of calcium and iron.

Minerals—Keep the Magnesium, Hold the Iron
Physiologically, men are better suited to “fight or flight” than women, but less well suited for handling chronic low-level stress. This suggests that men actually need to be more physically active than women to maintain health and nutrients should be balanced to reflect both the greater physical activity and the poorer management of stress. Sadly, our modern food options may be letting us down. Calcium, magnesium, potassium and other nutrients have decreased in many instances between 20 and 90 percent in staple foods over the last 60 years. This means that basic nutrition from grains such as corn and vegetables and from broccoli and tomatoes just is not what it once was.

Magnesium—For men, bone health in later life is not the issue that it is for women. Calcium not only is less critical for men, but too much can increase the risk of prostate issues. In contrast, men are more prone to the Metabolic Syndrome and inflammation, both of which commonly reflect magnesium status. Dark green leafy vegetables, nuts and seeds are generally the best sources for magnesium. The suggested intake level for magnesium is 400 mg per day (DV), but trials have produced good results in the areas of insulin levels and inflammation at 500 mg per day using a form of magnesium that is less likely to speed bowel transit than is magnesium oxide. Magnesium is one of the cofactors that keep calcium in the bones rather than in the soft tissues.

Potassium—Supplementation in capsules and tablets is regulated at the absurdly low level of 99 mg per dose. Potassium is well represented in avocado, apricots, cantaloupes, lima beans, oranges, green leafy vegetables and nuts. Meats tend to be high in potassium, but also are high in sodium at the same time, which is counterproductive. Americans consume on average 2.8 grams of potassium per day, which is far below the suggested 4.7 grams and below the amount shown to improve blood pressure in the DASH (Dietary Approach to Stop Hypertension) diet. Tomato juice is a convenient source of potassium.

Iron—Not normally needed by men except for those engaging in certain specialized sports, such as marathon racing.

Selenium and Zinc—The usually suggested intakes are 15 mg per day zinc and 70 –100 mcg selenium, but not more than 200 mcg. (See the discussion of prostate health.)

Antioxidant Vitamins and Phytonutrients
Men have greater risks for cardiovascular and a number of other conditions than do women. In part, this is because until menopause women are protected by estrogen, which exerts significant anti-inflammatory effects in the body. Inflammation and oxidized low density lipoprotein are key issues. Higher concentrations of oxidized LDL are associated with increased incidence of metabolic syndrome overall, as well as its components of abdominal obesity, hyperglycemia, and hypertriglyceridemia.

Antioxidant Vitamins C, E and CoQ10—The Reference Daily Intake of vitamin C is 60 mg per day. This amount prevents scurvy, but vitamin C is useful in many other areas, such as the production of collagen. The reduced levels of vitamin C found in modern foods can stand for reduced levels of other vitamins and phytonutrients. Another antioxidant vitamin, E, has exhibited consistent benefits usually only when supplemented in conjunction with vitamin C. Similarly, there is good evidence that coenzyme Q10 may be important for determining the body’s benefit from vitamin E by, for instance, significantly enhancing the anti-inflammatory effect. Overall, cardiovascular benefits have proven to be both greater and more consistent with the tocotrienol members of the vitamin E family than with alpha-tocopherol. Those supplementing vitamin E should focus on gamma-tocopherol and the tocotrienols.

Phytonutrients—It is a good idea to increase consumption of brightly and deeply colored vegetables and fruits, especially various deep-colored berries and green leafy vegetables. Supplements might include anthocyanidins, proanthocyanidins, resveratrol, pterostilbene, quercetin, catechins, curcumin, chlorgenic acid and polyphenols more generally.

Vitamin D—Research shows that vitamin D3 (cholecalciferol), the form that can be synthesized by humans in the skin upon exposure to ultraviolet radiation from sunlight, is more useful than vitamin D2 (ergocalciferol). Aside from bone health, vitamin D has been shown to be important for immune health, insulin secretion and glucose tolerance, blood pressure regulation and other purposes. A recent Institute of Medicine (IOM) report, which included no vitamin D experts on the panel, concluded that individuals between the ages of one and 70 do not need more than 600 IU of vitamin D daily with an upper limit of 4,000 IU. However, this report has been greeted by harsh criticism. As noted in previous Total Health Online articles, many experts argue for a normal intake in the range of 2,000 to 2,500 IU with an upper limit of 10,000 IU.

Supplement Omega-3 Fatty Acids
Increased ratios of omega-3 fatty acids versus omega-6 fatty acids in the diet are associated with reduced risk of cardiovascular diseases, cancer, immune and inflammatory conditions. The omega-3 fatty acids include DHA (docosahexanoic acid) and EPA (eicosapentaenoic acid) found in fatty cold-water fish ALA (alpha-linolenic acid) found prominently in flax seed oil and walnuts. Animals foraged on grass, roots and barks contained substantial omega-3 fatty acids in their meat and eggs, and even the butter of grass-fed cows supplies omega-3 fatty acids. Prior to the development of modern agricultural practices and the use of special pressing equipment to extract omega-6 oils from oilseeds, the ratio of omega-3 to omega-6 fatty acids (including linoleic acid/LA) was on the order of 1:2 to 1:5. Today the ratio is more on the order of 1:10 to 1:20 or even higher. According to one authoritative review, “a ratio of 2–3/1 [omega-6:omega-3] suppressed inflammation in patients with rheumatoid arthritis, and a ratio of 5/1 had a beneficial effect on patients with asthma, whereas a ratio of 10/1 had adverse consequences.” Note it is the ratio that counts, not the total consumption of omega-3 fatty acids. Clinical trials have validated supplementation of combined EPA + DHA of 850–1,800 mg/day and ALA of 2,900 mg/day, but remember it is the ratio of omega-3 to omega-6 fatty acids that counts. There is recent suggestive evidence that women receive superior anti-inflammatory benefits from DHA and men receive superior anti-inflammatory benefits from EPA.

Special Needs—Prostate Health
Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, for men ages 40 to 59, nearly 60 percent are likely to already suffer from BPH. This usually does not present a noticeable problem until after age 50 but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer, although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers.

Antioxidants, Essential Fatty Acids and Minerals
Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruits and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a negative impact upon prostate health. The best positive nutrient associations for reducing the risk of BPH are lycopene, zinc, and supplemental vitamin D along with moderate regular alcohol consumption. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism.

Isoflavone Herbal Preparations
Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represents a promising approach to prostate health management. Lignans from flax and the lignans from sesame seeds are beneficial for the prostate as well as for cardiovascular health. Also useful are extracts of saw palmetto berries and of flower pollen. Indeed, flower pollen extracts have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis (prostate inflammation) and prostatodynia (prostate-associated pain).

Sports Aches and Pains of the Weekend Warrior
Exercise is especially important for men. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

Performance Enhancers
Conditioned athletes are actually able to produce more of certain anti-oxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. A small number of nutrients have been shown to improve various aspects of performance. These include coenzyme Q-10 (100–300 mg per day, but cut back to 100 mg if this amount interferes with sleep) and astaxanthin (8–12 mg per day). There appears to be a potential role for certain supplements taken routinely (vitamin C, vitamin E, flavonoids, and L-carnitine) to improve the symptoms of skeletal muscle injury. Grape seed extracts (300 –400 mg) may help prevent bruising and improve performance. Glutamine (750 mg to several grams daily) has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion. Finally, athletes using creatine should consider avoiding the 75 or more grams sugars often used to improve uptake and try, instead, 1 gram Russian tarragon (an insulin mimetic) extract for the same results.

Hair Loss
Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. Extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence this problem is not always cosmetic and concern may not be limited to vanity.

Hair Nutrients
Deficiencies in the B-vitamins biotin, inositol, pantothenic acid and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that highpotency supplementation with the entire range of B vitamins with special attention paid to biotin, inositol and pantothenic acid may prove to be helpful. Vitamin C (1 to 2 grams daily) is important for circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–100 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1 to 3 grams daily), also supplemented as N-acetyl-cysteine (NAC, 750 mg daily), can help to increase the speed at which the hair grows. No major improvements in scalp health or hair loss should be expected in less than three months (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function.

Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, we recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

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