Generally, the subject of men’s health brings to mind a barrage of ads for products and programs guaranteed to create six-pack abs and pump up low testosterone levels, a.k.a. “low T”. But the day-to-day reality is that as men age, the risk of cardiovascular disease, type 2 diabetes, and cancer, especially prostate cancer, loom large.

Moreover, nearly 37% of men over the age of 20 are obese, which increases the risk for both heart disease and cancer (the two leading killers of men) as well as type 2 diabetes. Prostate cancer is the second most common cancer among men in the US, behind skin cancer. About one in seven men will be diagnosed with prostate cancer in their lifetime.

Even if cancer is not the issue, the prostate can still become a serious problem with increasing age. More than half of men over age 50, and nearly all men over the age of 80, develop benign prostate hyperplasia (BPH), enlargement of the prostate. This can reduce or even halt urine flow, among other symptoms, and negatively impact activity and sexual function.

Age and genetics are unmodifiable risk factors for BPH. But the many modifiable risk factors are quite familiar. They include, diet, physical activity, obesity, chronic inflammation, and metabolic syndrome.

Because the progression of both prostate cancer and BPH is generally slow, these maladies have become targets of numerous studies into dietary factors that could protect against them.

These are just some of the physical assaults men face, in addition to the daily stresses of life. Even in leisure, men are more likely than women to choose competitive impact sports for their activity, requiring energy, stamina, and — when they overdo it — nutrients to support healing from incurred stresses and injuries.

For makers of “better for you” foods and beverages, a focus on certain key nutrients beyond protein, healthful fats, and slow-metabolizing carbohydrates is essential. Here are some of the vitamins, minerals, and other nutraceuticals to consider when targeting the needs of today’s men.

Vitamin D Rediscovered

Vitamin D, a fat-soluble vitamin that helps to maintain the steady blood calcium concentrations required for muscle contraction, also plays a key role in bone mineralization. But a wealth of research in recent decades has uncovered a host of benefits to maintaining healthy levels of the hormone-like vitamin. This is especially critical for men, who are more likely than women to be deficient in D.

Historically, humans depended on the sun to produce vitamin D from a cholesterol derivative residing in the skin. The lack of exposure to sunshine and compromised diets have brought vitamin D deficiency back into the population. In spite of the expanded fortification of foods, health experts estimate that around half of men are D-deficient and the figure climbs to nearly seven in 10 men of Hispanic origin and more than eight in 10 African American men.

On the heels of the “rediscovery” of vitamin D that followed this epidemic dietary shortfall, researchers embarked on comprehensive studies to support, confirm, and expand a growing list of benefits associated with the vitamin. For example, research on the potential for dietary supplements to affect the course of prostate cancer was recently outlined in the journal Current Urology Reports.

Prostate cells have receptors for vitamin D, which led scientists to explore whether decreased levels of vitamin D would increase the risk of an enlarged prostate and if vitamin D supplementation could, in turn, provide relief. A number of studies have shown promise in this direction. 

Lowering the risk of prostate cancer and BPH is not the only reason to assure an adequate intake of vitamin D. In addition to calcium and phosphorus balance, which determine bone strength, vitamin D is linked to immune response and cardiovascular health, too.

Studies have linked vitamin D to improved health of the brain and nervous system, kidney function, lung function, blood sugar management and insulin regulation, and mitigation of asthma. Some studies have even shown vitamin D as helping to relieve anxiety and depression.

It takes somewhere between 15 and 30 minutes of sun exposure per day, depending on the individual and location, to meet vitamin D needs. Vitamin D is not widely distributed in foods. Natural sources include fatty fish, egg yolks, organ meats, and mushrooms — especially mushrooms treated with ultraviolet light. Health experts currently recommend 1,000-1,200 IUs (25-30µg) per day, although some have called for as high as 2,000-4,000 IUs (50-100 µg) daily.

Still, there are many opportunities to get vitamin D via fortified products. In addition to RTE cereals, tofu, fortified dairy, and certain juices, the majority of the milk and dairy substitutes currently flooding the market are fortified with vitamin D. These include milk, non-dairy beverages, yogurts, drinkable yogurts, cheeses, and frozen desserts made from soy, grains (such as rice and oats), nuts (from almond and cashew to coconut), seeds, and other sources. Microencapsulation of lipid-soluble vitamin D has made it possible for the nutrient to be incorporated into any number of foods and beverages.

E Four Ways

Vitamin E is a lipid-soluble antioxidant that provides protection for membranes. It occurs in two main forms of four sub-forms each: tocopherols (alpha, beta, gamma, and delta) and tocotrienols (alpha, beta, gamma, and delta).

As one of the most common food antioxidants, vitamin E is often overlooked for its health benefits. In addition to the cardioprotective and anti-inflammation effects of an antioxidant, being a crucial component of cell membranes means vitamin E is involved in nearly every bodily function, while also protecting DNA. It’s important for maintaining immune function and eye health.

Studies suggest vitamin E also is important in hormone balance, including benefiting testosterone levels and fertility. The vitamin has been shown to help with sperm production and function. While having a protective effect against certain cancers, results of vitamin E supplementation with respect to prostate cancer have varied.

While the NIH-AARP Diet and Health Study followed 295,344 men for a year and found no association between vitamin E supplements and prostate cancer risk, a study by the international science organization Association for Tropical Biology and Conservation did show reduced prostate cancer incidence and mortality with alpha-tocopherol supplementation.

Bringing the antioxidant mineral selenium into the picture, the ongoing Selenium and Vitamin E Cancer Prevention Trial (SELECT) concluded, “dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men.” It should be noted that, while the results were statistically significant, the actual number of incidents of prostate cancer in the vitamin E group compared to the control group rose by only 11 subjects (76 v. 65).

This dichotomy led some to suggest that the type of vitamin E may be of great importance and that the mechanism could be something other than antioxidant protection, the reason for looking at vitamin E in the first place.

That signpost pointed in the same direction as a wealth of studies into the tocotrienol form of the vitamin and its anti-cancer ability. Since the 1980s, research has revealed that not only is this form of E a more powerful antioxidant than the tocopherol form, it actually displays the ability to incite certain cancer cells to self-destruct (an action termed apoptosis).

In 2015, researchers in Japan looked into the potential anti-prostate cancer effects of one of the tocotrienols, the delta type isolated from annatto. Derived from the seeds of the achiote tree (Bixa orellana), annatto is commonly used as an orange-red pigment for coloring foods and beverages. This characteristic color is due to the high amounts of carotenoids. Annatto is a rich source of delta-tocotrienol, yet nearly free of tocopherols.

Vitamin E guidelines call for about 12-15mg daily for adult men, although higher amounts are needed with supplements using synthetic forms of the vitamin. As with vitamin D, microencapsulation has allowed this lipid-soluble vitamin to be rendered water-soluble. It can be used even in clear liquid formulations, including enhanced waters, without clouding or impacting organoleptic characteristics.

The best sources from food are nuts, seeds, and whole grains and their oils, with wheat germ being the best food ingredient source. For the tocotrienol form, annatto, red palm oil, and rice bran oil are the best sources.

A/Z

Vitamin A, also a lipid-soluble vitamin, is critical to eyesight, skin integrity, bone strength, immune function, reproduction, cell growth, and cell differentiation. Investigation into whether or not vitamin A can help protect against development of prostate cancer has provided mixed results. However, in several studies, vitamin A-rich fruits and vegetables demonstrated a protective effect. This could be due to the different forms of the vitamin natural to plants.

Vitamin A is found animal products, particularly liver, where it is stored. The precursor to vitamin A, beta-carotene, is the form that exists in fruits and vegetables. Beta-carotene is a strong antioxidant that doubles as an orange pigment. It provides the characteristic color of carrots, pumpkin, sweet potatoes, apricots, mangos, and papayas. The same pigment is abundant in green leafy vegetables but hidden by the overwhelming green color of chlorophyll. 

Among the minerals, zinc is of vital importance to men. The mineral has long been known as a key nutrient in immune function and is vital for the production of DNA and proteins, including the enzymes that are involved in nearly every metabolic process. It also is a key nutrient in the development of sperm. Often, one of the first things fertility specialists look at is zinc status in the man.

Zinc deficiency also leads to low testosterone levels, affecting energy, sex drive, and strength. Researchers have been investigating links between zinc deficiency and erectile dysfunction. Estimates of zinc deficiency in the US range from about one in four to nearly two-thirds.

Animal protein is the best dietary source, with nuts, whole grains, and seeds as the best plant sources of the mineral. While it is recommended that women get at least 8mg zinc per day, the recommended daily intake for men is nearly half again as much at 11mg.

Micronutrients, Major Benefits

Some less commonly talked about nutraceutical ingredients have a prominent role to play in men’s health. Some of them even target diseases or conditions specific to that gender, prostate health and testosterone levels being the most obvious, of course. But some, such as coenzyme Q-10 (CoQ10), serve multiple functions, especially for guys.

CoQ10 is a critical component for every cell in the body, essential to energy production. It also can regenerate antioxidants like vitamin E, even though it’s a potent antioxidant on its own. It helps protect against cardiovascular disease, high blood cholesterol, and insulin resistance. Deficiencies have been noted in conjunction with Chronic Fatigue Syndrome, fibromyalgia, Parkinson’s, and Alzheimer’s.

Men are at particularly higher risk for many of the above diseases and conditions. CoQ10 also has been linked to better fertility and sperm health and motility. Recent research suggests CoQ10 could help alleviate erectile dysfunction (ED).

One of the many ways CoQ10 improves cardiovascular health is by dilating blood vessels and thus increasing blood flow and lowering blood pressure. When there isn’t a strong enough flow of blood, the body struggles to form an erection.

CoQ10 also helps to maintain blood levels of nitric oxide. Nitric oxide is another component involved in regulating blood flow, as well as in muscle recovery, especially during high-intensity activity. Nitric oxide levels increase naturally during arousal to help promote sexual potency, including achieving and maintaining an erection. In fact, most ED medications work by increasing the body’s sensitivity to rising nitric oxide levels.

Levels of the lipid-soluble coenzyme begin to decrease by the mid-30s. Coupling extra CoQ10 with foods and ingredients rich in nitrates (such as beets, onions, and arugula) could help maintain nitric oxide levels. CoQ10 is found in high levels in animal proteins, as well as in legumes (including soybeans and peanuts) and other plant foods.

Glucosamine and chondroitin comprise another ingredient system that has had a share of conflicting results in research studies. The compounds are naturally produced by the body as a part of collagen, and together have become popular supplements in the US for the treatment of osteoarthritis. 

While the effectiveness of glucosamine and chondroitin in combating joint pain and improving joint function is still under investigation, recent evidence suggests they could be protective against certain forms of cancer. According to the VITamins And Lifestyle (VITAL) study, supplements of the two were associated with decreased risk of colorectal cancer. A variety of lab studies, animal studies, and human trials also suggest that glucosamine and chondroitin have anti-inflammatory properties, as well.

Big Botanicals

A number of botanical ingredients targeting men’s health have been gaining attention, not the least of which is saw palmetto (Serenoa repens). A small, long-lived palm that grows in clumps or dense thickets in subtropical areas, it is best known as a traditional medicine used to treat a variety of conditions, most notably BPH.

The results of the use of saw palmetto extract as a treatment for BPH have been mixed, with some studies showing favorable results and others showing it to be no more effective than a placebo.

An article in the January 2019 issue of the journal Food Chemistry gives a different perspective on these mixed results. The focus of the article was on research that separated adulterated saw palmetto extracts from pure and authentic product. It confirmed measurable effectiveness in treating BPH with the plant.

Pycnogenol is a procyanidin compound extracted from the maritime pine tree (Pinus pinaster). As with saw palmetto, it has a traditional history of being an effective remedy for treating BPH. Also as with saw palmetto, results of studies over the years have been mixed. However, a study last August in the Italian science journal Minerva Medica presented strong evidence that pycnogenol could improve symptoms of BPH in otherwise healthy men, including reducing residual urine in the bladder.

The 60-day, placebo-controlled study looked at 75 healthy, normal-weight men divided into three groups: those receiving pycnogenol in three 50mg doses per day, those receiving pharmaceutical intervention, and a control group receiving standard management (SM), that is, no medical or surgical intervention.

Men in the SM group were simply instructed to “void regularly, avoid long seating periods, exercise regularly, hydrate appropriately preferably avoiding caffeine and spices, and follow a low-sugar and low-salt diet.” Interestingly, aspects of this diet could also be included in marketing caffeine-free, low-sugar and low-salt products to men prone to BPH.

According to the researchers’ results, the subjects who received pycnogenol showed significant improvement for all BPH symptoms, including “emptying, frequency, intermittency, urgency, weak flow, straining, nocturia” and noted that comparison with the other two groups also was statistically significant.

Fenugreek (Trigonella foenum-graecum), a common spice in South Asian and Middle Eastern cuisine, has received greater attention recently for helping to increase testosterone levels in men with low T. 

A number of recent randomized, double-blind, placebo-controlled clinical trials have shown significant support for the anecdotal evidence that preceded them. This is especially promising due to the ease of incorporating the spice into food products that conform to the on-trend food products that showcase global flavors.

Other botanicals investigated for scientific evidence of their aid in men’s health—usually related to fertility and sperm production and function—include ashwagandha root (Withania somnifera), ginseng (Panax ginseng), and maca root (Lepidium meyenii). 

Between botanicals and the antioxidant vitamins and minerals, food and beverage developers have ample opportunity to focus on men’s health with products that meet their very specific needs.

Originally appeared in the March, 2019 issue of Prepared Foods as Man Up!