The Harvard Medical School Guide to Men’s Health by Harvey B Simon, MD 2002

The operating manual for the most important machine that you own.

From Publishers Weekly: While it may not be as hot as the latest issue of Maxim, this new health guide should be required reading for any man between the ages of 18 and 80. The book's success is rooted in the no-nonsense approach of author Simon, the founding editor of the wildly successful Harvard Men's Health Watch newsletter, who has long been urging men to get in shape and stay that way. Simon uses the results of three Harvard studies of more than 95,000 men over the last 25 years to provide five main "answers" (diet, exercise, aspirin and other supplements, moderate alcohol, and behavior modification and stress control) to five main "maladies of men" (disorders of the genital area, sexuality and reproduction, benign prostate disorders, prostate cancer, and kidney and bladder disorders). Along the way, he discusses other topics such as reproductive anatomy, vitamins, depression, Viagra and herbal medications. Though it's packed with provocative data (e.g., "every one of the ten leading causes of death in America is substantially more common in men than women"; "even committed teetotalers who review the data will have to agree that light to moderate drinking appears to reduce a man's risk of angina, heart attack, sudden cardiac death, and ischemic stroke"), the book stays focused on Simon's main message: "Above all, men should concentrate on the basics, on the core issues that remain constant in a sea of change." (Sept.) Forecast: Neither overly serious nor laced with chirpy beer-and-babes humor, this tome should remain a steady seller after trendier books are gone.

My comments are in bold italics

Chapter 3: Perils and Problems

“Men who exercise at least once a week are 36% less likely to develop Type 2 diabetes than sedentary men, and men who exercise 5 or more times per week enjoy a 42% risk reduction.” Exercising once a week is key for diabetes reduction. The extra 4 or more exercise sessions don’t seem to add much extra protection.

“Men with highest homocysteine levels were 290% more likely to develop coronary artery disease than men with the lowest levels. For perspective, a 5 point rise in homocysteine appears as dangerous as a 20 point rise in total cholesterol, each increasing risk by about 20 to 40%.”

Rapid metabolism of homocysteine depends on 3 vitamins: B6, B12 and Folic Acid.

Homocysteine causes disease in four ways:” by producing toxic damage to endothelial cells that line the inner surface of arteries, by increasing the activity of free radicals, by stimulating the enlargement of smooth muscle cells in the layer of arterial walls, and by accelerating the clotting process (this also increases the risk of stroke)”

C-Reactive Protein (CRP) and fibrinogen are clotting factors produced by inflammation. “Low-dose aspirin reduces the risk of heart attack by 55% in men with high CRP levels.” An aspirin a day really can pay off! Actually it only takes a mere 30-40 mg of aspirin (about 1/10 of the normal dosage in a single pill!) to gain the benefit, and to take this small dosage every other day. This tiny dosage will saturate all of the clotting factor in your body, and it takes you about 2 days to generate new clotting factor that is not bound to aspriin. Once bound, the clotting factor cannot unbind. Better to take the lower dosage because once you have saturated the clotting factor, the extra aspirin does no good, and can cause stomach bleeding. More on this later in the book.

“Men with the highest levels of insulin like growth factor (IGF-1) are 430% more likely to develop prostate cancer.” Most likely this is an effect not a cause of the cancer. The cancer cells are secreting this growth factor which encourages tumor growth.

“A person’s DNA sustains an estimated 10,000 oxidative hits per day. Most are repaired, but cancer may result if antioxidants fail.” Such a hit rate means that the fidelity of error correction and antioxidation must be extremely high or we’d all be giant tumors!

Chapter 4 The Answers: Diet

British study pegged the ideal BMI at 22; above that very lean level, each increase of 1 BMI point was associated with a 10% increase in the risk of heart disease and overall mortality. Other studies agree: in Japan the ideal BMI was 22.5 and in the Harvard study, it was 22.6. A BMI of 22 for 5’11” man equates to a weight of 157. I need to lose 10lbs to get to a BMI of 22!

Waist size (inches) / Hip size (inches) = W/H Ratio. “Men with ratios above 1 have 200% the death rate of those with ratios below .85. Men with ratios above .98 are 230% more likely to suffer strokes than men with ratios below .89. That is a big effect from just a few inches.” Wow, one belt notch can double your mortality risk!

“The body can produce most of the fatty acids it needs simply by converting one fat into another. But there are two exceptions: because the body cannot produce linoleic acid (omega 6 fat) [good sources are corn (58%) and soybean (51%)] or alpha-linoleic acid (omega 3) [good sources are flaxseed (50%) and canola (11%)], a dietary supply of these two polyunsaturated fatty acids is essential…”

Oleic Acid (omega 9) is another major fatty acid, and is found in Olive (73%) and canola (53%) oils.

Eicoapentaenoic Acid (another omega 3). “The greatest amounts are in oily, dark fleshed fish that live in deep, cold waters, such as mackerel, herring, striped bass, salmon.”

"Monosaturated fats, particulary Oleic acid (think olive and canola oils), help protect LDL from oxidation… In contrast linoleic acid (think corn, soybean and other vegetable oils), appears to make LDL more susceptible to oxidative damage.”

Eating fish. Here’s the summary:
“Eating 5 to 6 portions of fish per week did not provide any more protection against heart attack than 1 to 2 portions.”
“Eating fish once per week was associated with a decreased risk of sudden death… and a lower overall death rate.”
Eat fish twice a week and get most of the benefit!

What eating fat can do to your prostate:
Alpha-Linoleic acid (think flaxseed and canola oils and omega 3 from plants) may increase prostate cancer “men with high levels of Alpha-Linoleic acid in their blood are up to 340% more likely to develop prostate cancer than men with very low levels.” However, Omega 3 from fish lowers prostate risk; “3 studies from around the world have linked a high consumption of fish with a decreased risk of prostate cancer.” “
“Men who ate the most fat were 179% more likely to develop advanced prostate cancer than were men who ate the least. But not all fats were equally harmful; animal fat was linked to the disease, but vegetable fat was not. Red meat was the chief culprit.”
“Men who ate the most beef, bacon, pork and lamb were 260% more likely to develop prostate cancer than men who ate the least. Men who ate chicken with the skin were at increased risk, but men who omitted the skin were not.”

Fiber:
"Men who ate the most fiber (29 grams/day) enjoyed a 41% reduction in heart attacks compared with men who ate the least fiber (12.4 grams/day)… Each 10 gram increase in daily fiber intake, drops heart disease risk by19%.”
“High-fiber diet can reduce the risk of diverticulosis by 42%; insoluble fiber was particularly helpful.”
“The Health Professionals Study casts doubt on the theory (of fiber reducing colon cancer) by finding no protection against colon cancer from dietary fiber.”

Chapter 5 The Answer: Exercise

Based upon many studies “Doctors including the Surgeon General’s current guidelines have concluded that 2000 calories of exercise (about 20 miles of running or 100 miles of cycling or 5 miles of swimming) per week would provide optimal benefits… vigorous exercise produced greater rewards than less intense activities (sorry to you walkers).”

“Men who exercised to the tune of 1000-1999 calories a week enjoyed a 24% reduction in stroke compared with sedentary men…maximum gain (46% reduction in stroke risk) required 2000-3000 calories a week.”

“The most active men had a 47% lower risk of developing colon cancer then men who exercised the least.”

“Men who burn more than 1000 calories per week have ½ the risk of colon cancer as men who expend less than 1000 carlories per week.”

“Men who burn more than 4000 calories a week have reduced risk for prostate cancer.” No benefit was seen for lower amounts. It seems that you can’t run from prostate cancer unless you are perpetually training for a marathon.

“Regular exercise reduces the risk of Alzheimer’s and other cognitive forms of impairment by up to 50%.”

Chapter 6 The Answer: Aspirin

“Platlets (the thing in your blood that triggers clotting) are extremely sensitive to aspirin…doses as low as 10-30 mg (less than 1/10 of a tablet) can inhibit all the platlets in a man’s body. Once inhibited, they stay inhibited, but since new platlets are entering the blood continuosly (10% are recycled each day, and each platelet last about 10 days), the aspirin must be repeated every 24 to 48 hours to keep the vast majority inhibited.”

“Aspirin is most effective before the early morning hours when platlets are particularly likely to stick together and produce clots.”

“Aspirin was effective in preventing heart attacks in men who had angina. Asprin did not prevent healthy men from developing angina because angina is caused by plaques that produce partial blockages, but heart attacks are the result of clots that form on plaques.”

“A high intake of lycopene (especially from cooked tomatoes) was linked to a 20 to 30% decrease in the risk of prostate cancer, and it reduced the risk of the most aggressive prostate cancer by 50%.”

Chapter 7 An Answer for Some, A Peril for Others: Alcohol

“The most important benefit of alcohol is its ability to boost HDL (good) cholesterol. It does not take much alchohol to do the job – just one or two drinks a day will elevate HDL by 5 to 10%. A 10 point rise in HDL is associated with a 40% reduction in cardiac risk.”

“Men who averaged one drink a day enjoyed a 31% percent lower risk of angina and a 35% lower risk of heart attack; men who averaged two or more drinks a day experienced even greater benefit 56% and 47% respectively.”

“Light to moderate rinking is actually associated with a decreased incidence of diabetes.”

“Men who averaged 1 or more drinks per day were 26% less likely to develop peripheral artery disease than non-drinkers.”

“Two drinks a day was associated with a 50% reduction in the risk of ischemic stroke.”

“Australian men who had roughly one drink a day had a 16% lower death rate than teetotalers.”

“Chinese men who drank up to 2 drinks a day had a 19% lower death rate than non-drinkers.”

Chapter 8 The Answers: Behavior Modification and Stress Control

“Healthy men who lost a wife were 210% more likely to die than healthy men who were not bereaved. The risk was greatest from 7 to 12 months after the loss, but an elevated death rate persisted for more than 2 years.”

“People who attended concerts and plays rarely were 280% more likely to die (during the study period) than were people who attended frequently; occasional concert-goers were in between with a death rate of 160% more than frequent goers.” Go see the ‘Stones concert; for health purposes only of course.

“Social disengagment leads a 200% increase in the incidence of cognitive decline. Men with the fewest social ties had the highest risk of dying from heart disease, circulatory ailments, and even cancer.”

“The median survial for married men (with diagnosed terminal disease) was 69 months, for divorced men 55 months, and for single men 49 months, and for recently separated or widowed men just 38 months.”

“Unmarried men were about 30% more likely to die from prostate cancer than married men.”

“Divorce doubles the suicide rate in men, but doesn’t change the rate in women. It also increases the rate of illness during the first year of separation.”

Chapter 10 Sexuality and Reproduction

“Men who exercise 30 minutes a day are 41% less likely to have erectile dysfunction than sedentary men. Men who drink 1 to 2 drinks a day are 33% less likely to be impotent than a non-drinker.”

“Things that damage blood vessels impair erectile function… the penis acts like one big artery.” That’s the bonus of taking care of your heart and arteries.

Viagra specifically targets PDE5, an enzyme breaks down the chemical cGMP which is needed to increase the bloodflow to the penis. Thus less PDE5, means more cGMP, which means more blood available to the penis, which means… well you get the picture. However, the rest of the circulatory system also uses these same enzymes to a certain extent so “Viagra temporarily lowers blood pressure of normal men by a small amount, typically 5 to 8 mmHg.”

“For a healthy 55 year old, the risk of having a heart attack in any given hour is 1 in a million; sex doubles this risk. For men with heart disease their overall risk is 10 times higher… the chance of suffering a heart attack becomes 20 in a million.”

“At age 40 testosterone levels begin to fall…averaging 1% per year, by age 80, a man’s testosterone level is about ½ of what it was at age 18.”

“Testosterone production waxes and wanes over a 24 hour cycle; production is highest at 8AM and lowest at 9PM.”

Chapter 11 The Prostate: Benign Disorders

“The prostate enlarges by 1.6% a year beyond 40.”

“By age 80, 25% of all men will develop enlarged prostates (Benign Prostate Hyperplasia – BPH) severe enough to require treatment.”

“Men who walk 2 to 3 hours per week are 25% less likely to develop BPH than sedentary men.”

“The consumption of 50g of alcohol a day (3 beers) was linked to a 41% reduction in the risk of BPH.”

If you have BPH, “avoid medications that stimulate the muscles in the bladder neck and prostate. Pseudoephederine (Sudafed) and other decongestants are the chief culprits.”

The facts on Saw palmetto
“When American scientists reviewed 18 randomized controlled trials of saw palmetto in a total of 2939 men, they concluded ‘the evidence suggests that saw palmetto improves urologic function symptoms and urinary flow but further research is needed using standardized preparations to determine long term effectiveness and ability to prevent BPH.”
“When Consumer’s Union evaluated various preparations it found that the amount of the herb in each tablet does not always correspond to the claims on the label – but one brand, the CVS brand, contained what it claimed.”
“Saw palmetto produces few side effects… but if it does not seem to help in 1 to 3 months, it is not worth continuing.”

Chapter 12 Prostate Cancer

“32,000 American men will die from prostate cancer this year… but only 1 in 10 men with prostate cancer actually dies from the disease.”

“42% of a man’s risk of prostate cancer could be explained by hereditary factors… if the study is correct, heredity has a greater impact on prostate cancer than on all other common malignancies, including colorectal (35%) and breast (27%).” Choose your parents wisely I always say.

“Men who have a father or brother with diagnosed prostate cancer are about 200% more likely to develop the disease as men whose families are free of it… A man who has several close relatives with the disease, particularly if the prostate cancers were diagnosed before age 55, is up to 800% more likely to develop prostate cancer himself.”

“Men who have special reason to worry about prostate cancer might decide to forego the cardiac benefits of canola and flaxseed.”

A study of 48,000 men evaluated 46 different fruits and vegetables and found that “dark leafy green vegetables appear to reduce the risk of various malignancies, but they do not protect against prostate cancer… Instead the tomatoes emerged as the only item linked to a reduction in prostate cancer.”

“Men absorb 2.5 times more lycopene from tomato paste than from fresh tomatoes.”

“The men eating the most cereal suffered 19.5 fewer prostate cancer deaths per 100,000… for perspective, the protective effect of cereal was even stronger than the deleterious effect of a high fat diet.”

“Men who ate the most vegetable fat were 60-67% less likely to develop prostate cancer than men who ate the least.”

A Selenium study of 1312 men with an avg age of 63 who were followed for 4.5 years proved “that men who took selenium enjoyed a 63% lower risk of dying from prostate cancer than those who took placebos.”

An additional study of 33,737 men showed that “men with the highest selenium levels (equivalent to a daily intake of 159 micograms) had a 67% lower risk of developing advanced prostate cancer as men with the lowest levels (86 micrograms).”

“Men with a high consumption of calcium (more than 2000 mg/day) had an increased risk of advanced prostate cancer… At the same time, the researchers found that a large amount of fructose was protective. The scientists speculate that calcium and fructose are linked to the prostate by Vitamin D. High levels of calcium can reduce the body’s production of active vitamin D by lowering levels of phosphate; low levels of fructose can have the same result.”

“Men who have a high intake of milk low levels of vitamin D, and a 32% increase in the risk of prostate cancer.” Maybe the milk campaign should say ‘Got prostate cancer?’

Chapter 13 Disorders of the Kidneys and Bladder

“1 in 8 of every American men will develop a kidney stone… the highest risk occurs between the ages of 20 and 50. Men with family history of stone disease are 250% more likely to form stones than men without stone-forming relatives.”

“Everyone who has had a kidney stone should drink large amounts of fluid, enough to pass 2 quarts of urine each day (this requires drinking over 10 glasses of fluid daily).”

“50% of stone-formers have an intestinal defect that allows them to absorb excessive amounts of calcium from food. The biggest surprise is that dietary calcium restriction does not prevent stones. On the contrary, in fact, a low calcium diet seems to make things worse.”

“Men who consumed the most calcium from food were 44% less likely to form stones than men who had the lowest levels of calcium.”

“If dietary calcium is low, the body absorbs more oxalate (the stuff that makes your urine smells after eating asparagus)… The calcium in food normally binds to oxalate, preventing the body from absorbing oxalate. Excess oxalate is excreted in the urine, where it can finally bind with calcium – forming calcium oxalate crystals in the kidney.”

“More than 41,000 American men will be diagnosed with bladder cancer, and more than 8,000 (20%) will lose their lives to the disease.”

“A high intake of fruits and vegetables appears to reduce the risk of bladder cancer, while a high fat diet seems to increase risk… Studies have singled out cruciferous vegetables (think broccoli and cabbage) as protective.”

“Men who drank the most fluid (averaging 2.5 quarts per day) were 49% less likely to develop bladder cancer… men can reduce their risk of bladder cancer by 7% for each additional 8 oz of fluid they drink each day.”

Chapter 14 Other Male Medical Problems

“Half of all men snore… 24% of healthy middle aged men have sleep apnea. If you do not snore, you do not need to worry about sleep apnea.” But if you do it means you have a 50% chance of having apnea!

“4 weekly sessions of brisk walking or low impact aerobics added an average of 42 minutes of nightly sleep to middle aged men with insomnia.”

“At birth, the human body is covered with 5 million hair follicles, including about 100,000 in the scalp. The number of follicles remains constant throughout life, but the activity varies to the stage of a person’s life. For balding men, each successive growth phase grows shorter and each resting phase longer. The hair becomes shorter and finer, and less tightly attached to the scalp.”

“Mild vertex baldness was linked to a 23% increase in coronary heart disease, moderate baldness to a 32% rise, and severe baldness to a 36% increase in risk. Frontal baldness (receding hairline) was not associated with cardiac risk”

My summary:
Exercise at least 2000 calories per week and stay as thin as you can.
Follow the dietary guidelines from the Willett book. Eat less, and eat healthy.
Get vitamin D, selenium, B6, B12, Folic Acid (most multivitamins will do)
Don't drink too much - milk.