Men's health: checking under the hood.

Men. Go figure.

They're more likely than women to die at every point in life from the womb to old age. Of the 15 leading causes of premature death in the U.S., 12 hit men harder than women. By age 65, only 80 men are left for every 100 women; by age 85, it's down to just 40.

Yet the typical male is as likely to schedule a routine checkup as he is to stop and ask for directions. Less than half of men aged 45 to 64 have had a physical exam during the past year.

"What's really funny about men is that if a man's car makes a strange noise, he's under the hood in a snap, like a bolt of lightning," says Jean Bonhomme, an Atlanta public health physician and spokesperson for the Men's Health Network in Washington, D.C.

"If we can get men to take care of their bodies the way they take care of their cars, they would live a lot longer."

Here's a checklist to help men dodge several major health threats.

[check] CHOLESTEROL, ETC.

"Men experience a gradual increase in their risk of cardiovascular disease as they age, unlike women, whose risk increases precipitously at menopause," says researcher Alice Lichtenstein of the U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.

"But much of the risk starts when men are relatively young," she adds. "So the type of diet and lifestyle they adopt as they grow older can have a really big impact on whether or not they develop cardiovascular disease."

Heart disease kills more men every year than any other disease. Among the key risk factors: high LDL ("bad") cholesterol, high triglycerides, and low HDL ("good") cholesterol levels can lead to clogged arteries, which cause not only heart attacks and strokes, but dementia and impotence. Smoking, high blood pressure, and too much weight also take their toll.

When it comes to treatment, men have an advantage, Lichtenstein notes, "because men in our society are screened and treated more aggressively for heart disease than women are."

The good news: men (and women) can slash their LDL cholesterol by cutting back on bad fats. That means minimizing saturated fats (in red meats, full-fat dairy foods, butter, and fatty sweets) and avoiding trans fats (in many fried foods, fatty sweets, hard margarine, and shortening). And people can lower their triglycerides and raise their HDL cholesterol by replacing bad fats with good (unsaturated) fats in oils, nuts, fish, avocado, salad dressing, and mayonnaise.

[check] BLOOD PRESSURE

High blood pressure (hypertension) damages blood vessels, which can lead to heart disease, strokes, dementia, and impotence.

The higher number--systolic pressure--is the force that blood exerts on the artery walls when the heart beats. The lower number--diastolic pressure--is the force between heartbeats.

As people age, it's usually their systolic pressure that climbs the most. "Eventually, 90 percent of us get systolic hypertension," says William Manger, chairman of the National Hypertension Association in New York City.

Apart from age, the biggest factor m rising blood pressure is weight. "If you're obese, your chance of developing hypertension goes up eight times," says Manger.

If weight is the big culprit, a high-sodium diet is clearly an accomplice. "If we cut our salt intake by one-half in this country," says Manger, "we would save 150,000 lives a year."

You can also keep a lid on blood pressure by following a DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low-fat or fat-free dairy foods (see Nutrition Action, Apr. 2004, p. S). The DASH diet also replaces bad fats with good ones, limits sweets, and loads up on potassium-rich foods.

[check] PROSTATE CANCER

Prostate cancer is the most frequently diagnosed cancer and the third leading cause of cancer death in men (after lung and colorectal cancers). On an average day in the U.S., 640 men are diagnosed, while 75 die of prostate cancer.

How can men cut their risk? "We have some evidence that lycopene or something else in tomatoes is associated with lower rates of prostate cancer," says Eric Rimm, associate professor of epidemiology and nutrition at the Harvard School of Public Health in Boston. Several studies have found a lower risk in men who eat tomato sauce at least twice a week.

Some studies also suggest that selenium may prevent prostate cancer, adds Rimm. But until several large trials on selenium and vitamin E end, he says, "I don't think people should be running out and taking supplements." Instead, it makes sense to eat more (selenium-rich) seafood and whole grains. "The grains generally will have some selenium depending on where they're grown," says Rimm.

Another consistent finding: vitamin D seems to lower prostate cancer risk while high intakes of calcium appear to raise it. "Calcium may increase insulin-like growth factor, which may increase the rates of prostate cancer growth," says Rimm. Men need some calcium, he adds, but "there's no good reason for them to be taking excessive amounts." (See "What to Do & Why," p. 7.)

To get enough vitamin D, you may need a supplement because your skin can't make vitamin D from sunlight during winter if you live north of the line running between Los Angeles and Atlanta. "I think 800 to 1,000 IU a day is probably where men are at lowest risk for prostate cancer," says Rimm.

Warning signs

An enlarged prostate (benign prostatic hyperplasia, or BPH) often has the same symptoms as prostate cancer. See a doctor if you have any of the following:

* difficulty starting, continuing, or stopping the urine flow

* need to urinate frequently, especially at night

* painful or burning sensation during urination

* blood in the urine

* continual pain in the lower back, pelvis, or upper thighs

Your doctor will probably test your PSA (prostate-specific antigen), which is a protein produced by the prostate. Physicians seldom worry unless a PSA score exceeds 2.5 nanograms per milliliter. Rising PSA levels can be caused by either a benign enlarged prostate or prostate cancer.

[check] BLOOD SUGAR

If your body's insulin isn't efficient at getting sugar from your bloodstream into your body's ceils, you have insulin resistance (see "Insulin: Going Up"). If that causes your fasting blood sugar levels to hit 100 milligrams per deciliter, you have pre-diabetes. If your fasting blood sugar rises above 125, you have type 2 diabetes.

The disease damages blood vessels throughout the body. If they're large arteries, the result can be foot ulcers or heart disease. If they're small ones, it could be blindness or dementia.

And if they're in a certain area, it could affect your love life.

"Diabetes is one of the leading causes of impotency," says Robert A. Rizza, president of the American Diabetes Association. "This is a big deal for an otherwise healthy male. Fifty to 60 percent of men who don't take care of their diabetes could be at risk for impotency."

Men with erectile dysfunction should have their blood sugar checked, says Rizza, who is also director for research at the Mayo Clinic College of Medicine in Rochester, Minnesota. That's because "men can show signs of impotency before they realize they have diabetes."

If nothing else, the risk of impotency might motivate a man to have his blood sugar checked regularly. Good thing, since avoiding diabetes can save his life.

"Diabetes is one of the major causes of heart attacks in men," says Rizza. "Fifty to 75 percent of people who have a heart attack have diabetes or pre-diabetes. Some of them know it, some of them don't. You don't want to wait until you have your heart attack to find out you have diabetes."

Losing excess weight and staying active are far and away the best ways to prevent diabetes. But studies suggest that it also helps to replace sweets and refined grains with whole grains, which are rich in fiber and magnesium. Replacing bad fats (especially processed meats) with good fats (especially oils and nuts) may also cut the risk. (See Nutrition Action, June 2004, cover story.)

[check] EXERCISE

Inactivity is a real killer. It affects just about everything: brain, heart, blood vessels, bones, liver, gut, sleep, anxiety, mood, self-esteem, and your body's ability to process sugar. It's also critical if you don't want to gain back lost weight.

"Most middle-aged and older men probably do more strenuous activities than women, like cleaning out the gutters and mowing the lawn," says exercise expert Mary Ann Kluge of the Beth-E1 College of Nursing and Health Sciences at the University of Colorado at Colorado Springs.

"But they're not doing what I call the foundation fitness activities to improve their flexibility, strength and balance, and cardiovascular health."

Flexibility suffers the most as men age, says Kluge. "Everyone loses elasticity in their connective tissue. Many men end up with problems like low back pain, muscle pulls, and other aches and pains. Flexibility is not something you can pick up as you're gardening. It requires deliberate attention and exercise."

What keeps men from getting in shape?

"Some feel that they're supposed to know everything when they come into the weight room," says Kluge. "They're afraid of being laughed at."

Some men have other fears. "If middle-aged men go out and do something the way they used to do it, which is to take the bull by the horns," says Kluge, "many worry that they could fall over dead."

Her advice: start slowly. "Think about the things you liked to do. Are there some that you can still do? Many communities have senior games where older people can do physical, competitive things.

"If we can get men to the YMCA or somewhere where there's an active adult program," says Kluge, "they have a cheap way to get healthy."

[check] COLORECTAL CANCER

While 76 men in the U.S. die of colorectal cancer every day (lung cancer is the only cancer that kills more), the disease is often easy to prevent.

That's because most tumors start out as benign growths in the colon called polyps. It can take years for a polyp to turn into cancer. If it's removed before that happens, the cancer never occurs.

"If everyone over 50 got colonoscopies and other screening tests when they should, we could save about 30,000 lives each year in the U.S.," says the American Cancer Society's Anne Isenhower.

How else can people cut their risk? "Keep exercising and watch your weight," says Harvard's Eric Rimm.

As for food, studies find a higher cancer risk among red-meat eaters. "We don't know if it's because sometimes when you cook red meat at a high heat, that increases the carcinogens or if it's the saturated fat or something else," says Rimm. "We try to account for other factors, like how much men exercise, but it still seems to be red meat and not other lifestyle characteristics." Either way, "it's beneficial to limit red meat and have chicken or fish instead."

Folate, the B vitamin that can help prevent birth defects, may also protect the colon. "If you're eating a healthy diet that has plenty of fruits and vegetables, you're probably already getting a reasonable amount," says Rimm.

"Some people also take a multivitamin or eat cold cereal that's fortified," he adds, so they may be getting 600 to 800 micrograms of folic acid a day. "That's probably more than enough."

Alcohol may also play a role. "Someone who's at high risk for colorectal cancer should have no more than two drinks a day at the most," says Rimm. That matches experts' advice to lower the risk of high blood pressure and heart disease.

Warning signs

* blood in the stool or rectal bleeding

* a change in stool shape

* a cramping pain in the lower stomach

* an urge to have a bowel movement when there is no need to have one

[check] WAIST

Body fat comes in two varieties: subcutaneous fat lies just below the skin; visceral fat is buried deep in the abdomen.

When you measure your waist circumference, you're indirectly measuring your visceral fat. And that's the worst kind to have. Men who measure more than 40 inches around the middle have a greater risk of heart disease, diabetes, and dementia. (For women, a waist that's more than 35 inches spells trouble.)

Why do men tend to store fat deep in their bellies? Blame it on testosterone.

"That was clearly shown by a study of transsexuals," says Philip Wood, professor of genetics, nutrition sciences, physiology, and biophysics at the University of Alabama at Birmingham. Wood is the author of How Fat Works (Harvard University Press, 2006).

"Visceral fat increased in females who had become males and were taking testosterone, while it decreased in males who had become females and were taking estrogen."

But you don't need to switch genders to pare down your visceral fat. In fact, that's the easiest fat to shed.

"The visceral fat cells are much more sensitive than other fat cells to signals from the body to break fat down for energy," says Wood. "So, if someone reduces the calories they eat or increases the calories they burn, visceral fat can be reduced quite impressively before fat in other areas of the body is lost."

What about sit-ups and abdominal crunches? While they tighten the abdominal muscles, they don't make much of a dent in the visceral fat that's underneath.

Your waist size isn't the only way to gauge if you're at an unhealthy weight. You can also use your body mass index (see "BMI Oh BMI"). Your BMI shows how close you are to being overweight (25 to 29) or obese (30 or higher).

What's the best way to drop excess pounds? Cut expendable calories from bad fats, bad carbs, and sweetened beverages (see "Diet Diet. On the Wall." p. 8).

[check] DEPRESSION

An estimated six million U.S. men suffer from depression. They're less likely to admit it than women and doctors are less likely to suspect it in them.

When men do seek help, "typically it's because a wife or daughter has pushed them," says Thomas R. Insel, director of the National Institute of Mental Health (NIMH) in Bethesda, Maryland.

Depression can be difficult to recognize in men, says Insel, "because they are more likely to feel irritable than they are to feel sad." Men often mask their depression with alcohol or drugs or by working excessively long hours, according to the NIMH.

"Depression in men is a serious, serious problem," says Insel. "Although women are twice as likely to suffer depression, men are four times more likely to die from it because they're more likely to kill themselves."

And even those who don't turn to suicide are more likely to die because depression increases the risk for heart disease.

When researchers at Johns Hopkins University in Baltimore tracked 1,500 people for 14 years, those with a history of depression were four times more likely to suffer a heart attack than those without depression.

Do you have depression?

Have you had five or more of these symptoms every day for at least two weeks? If so, you may be suffering from depression, especially if they have interfered with your routine daily activities, says the NIMH:

* persistent sad, anxious, or "empty" mood

* feeling hopeless, pessimistic

* feeling guilty, worthless, helpless

* loss of interest in hobbies and activities that you used to enjoy, including sex

* decreased energy, fatigue

* difficulty concentrating, remembering, making decisions

* insomnia, early-morning awakening, oversleeping

* appetite or weight changes

* thoughts of death or suicide

* restlessness, irritability

WAIST NOT ...

How to measure your waist circumference: Place a tape measure snugly around your bare abdomen just above your hip bone, Exhale, then take the measurement.

[ILLUSTRATION OMITTED]

Source: National Institutes of Health, The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (www.nhlbi.nih.gov/guidelines/obesity/prctgd b.pdf).

INSULIN:
GOIN UP

If you have at least three of the following five risk factors, you
probably have the metabolic syndrome (also known as insulin
resistance syndrome), which raises your risk of heart disease,
diabetes, and probably dementia. The underlying cause: too
much weight and too little exercise.

1. Waist circumference     Women: more than 35 inches
                           Men: more than 40 inches *

2. Triglycerides           150 or higher

3. HDL cholesterol         Women: under 50
                           Men: under 40

4. Blood pressure          Systolic: 130 or higher or
                           Diastolic: 85 or higher

5. Fasting blood sugar     110 or higher **

*  For some men, a 37- to 39-inch waist can be a risk factor.

** Recent recommendations classify a fasting blood sugar of 100 to
125 as "pre-diabetes."

Source: National Heart, Lung, and Blood Institute.

STAYING UNDER
WARRANTY

Here's how often men should get what checked. Anyone at high risk
may need tests more frequently or at a younger age. As part of any
routine checkup, the American Cancer Society recommends that doctors
also check a man's lymph nodes, mouth and throat, skin, thyroid, and
testicles.

To Protect
Your                  Get a              Every          Optimal is

Heart           Fasting              5 years          Total
                cholesterol test                      cholesterol:
                (LDL, HDL,                            under 200
                triglycerides)
                                                      LDL: under 100

                                                      HDL: 60 or
                                                      higher

                                                      Triglycerides:
                                                      under 150

Heart & Brain   Blood pressure       2 years          Under 120/80
                reading

Heart,          Waist                                 40 inches or
Insulin, etc.   circumference                         less
                measurement

Blood Sugar     Fasting blood        3 years if 45+   Under 100
                sugar test

Prostate        PSA test and/or      Yearly if 50+    Discuss results
                digital rectal       or if 45 and     with physician
                exam                 high-risk

Colon           A. Fecal occult      every year
(starting       blood test or
at age 50)      fecal
                immunochemical
                test
                plus
                flexible             every 5 years
                sigmoidoscopy

                or

                B. Double-contrast   every 5 years
                barium enema

                or

                C. Colonoscopy       every 10 years

Weight          BMI calculation                       Less than 25

Sources: American Cancer Society, American Diabetes Association,
American Heart Association, U.S. Preventive Services Task Force.

BMI Oh BMI

Your body mass index (BMI) gauges your
weight in relation to your height. If your BMI
is 25 or more, you're overweight. Once it hits
30, you're obese. Although a BMI between
18.5 and 24.9 is considered normal, the risk of
diabetes and high blood pressure (and breast
and uterine cancers in women) stars to climb
above a BMI of 23.

BMI

            23       25       27       30       35

                     (overweight)        (obese)

Height                 Weight (lbs.)

5'0"        118      128      138      153      179
5'1"        122      132      143      158      185
5'2"        126      136      147      164      191
5'3"        130      141      152      169      197
5'4"        134      145      157      174      204
5'5"        138      150      162      180      210
5'6"        142      155      167      186      216
5'7"        146      159      172      191      223
5'8"        151      164      177      197      230
5'9"        155      169      182      203      236
5'10"       160      174      188      209      243
5'11"       165      179      193      215      250
6'0"        169      184      199      221      258
6'1"        174      189      204      227      265
6'2"        179      194      210      233      272
6'3"        184      200      216      240      279
6'4"        189      205      221      246      287

Note: Don't use BMI to evaluate the weight of
children, the frail elderly, serious bodybuilders, or
pregnant or breastfeeding women. If your extra
weight comes from muscle, not fat, you may have
a high BMI even though you're healthy. Frail or
older people may be unhealthy even though they
have a normal or low BMI.

Source: National Institutes of Health, The Practical
Guide: Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults (www.nhlbi.nih
.gov/guidelines/obesity/prctgd_b.pdf).

WHAT TO DO
& WHY

Here's a crib sheet to help cut a man's risk of five major
diseases.

                                              Heart
                                             Disease
Consume More          How Much               & Stroke    Hypertension

Fruits and            at least 5-10          [check]       [check]
vegetables            servings a day

Fish                  A least 2-3            [check]
                      servings a week

Fiber                 at least 30 grams a    [check]       [check]
                      day for men over 50
                      (38 grams a day for
                      younger men)

Tomato sauce          at least twice a
                      week

Phytosterols (in      0.8 grams (800         [check]
foods like Take       milligrams) a day
Control Spread,       (2 servings of most
Yoplait Healthy       foods that are
Heart Yogurt, and     fortified with
Minute Maid Premium   phytosterols)
Heart Wise Orange
Juice or in pills)

Whole-grain breads    in place of refined    [check]
and cereals           grains

Unsaturated fat       in place of            [check]
(oils, nuts,          saturated fat (red
salad dressing,       meat, full-fat
mayonnaise, etc.)     dairy foods,
                      butter, fatty
                      sweets, etc.)

Potassium (from       4,700 milligrams       [check]       [check]
foods like fruits     a day
and vegetables,
fish, and milk)

Consume Less          How Much

Saturated fat (red    no more than           [check]
meat, full-fat        20 grams a day
dairy foods,
butter, fatty
sweet, etc.)

Trans fat (fatty      as little as           [check]
sweets, french        possible
fries, and other
foods made with
partially
hydrogenated oil)

Red meat              no more than 3         [check]
                      servings a week

Sodium                no more than 2,300     [check]       [check]
                      milligrams a day;
                      1,500 mg if you're
                      middle-aged or
                      older

Alcohol               no more than 2         [check]       [check]
                      drinks a day

1 Calcium             no more than 1,500
                      milligrams a day
                      from food and pills

Sweets                no more than 5         [check]       [check]
                      servings a week

Weight & Exercise     How Much

Waist                 if it's over 40        [check]       [check]
                      inches, cut
                      calories and
                      exercise

Moderate-Intensity    at tat 30 minutes a    [check]       [check]
aerobic exercise      day (to keep off
(like brisk waking,   lost weight, at
dancing, swimming,    least 60 minutes
and cycling)          a day)

Strength training     at least 8-10                        [check]
for arms, shoulders,  exercises 2-3
chest, abdomen,       times a week
back, hips, legs *

Stretching routine    at least 2-3 times
(reduces exercise     a week
injuries

                                                           Prostate
Consume More          How Much               Diabetes       Cancer

Fruits and            at least 5-10          [check]
vegetables            servings a day

Fish                  A least 2-3
                      servings a week

Fiber                 at least 30 grams a    [check]
                      day for men over 50
                      (38 grams a day for
                      younger men)

Tomato sauce          at least twice a                     [check]
                      week

Phytosterols (in      0.8 grams (800
foods like Take       milligrams) a day
Control Spread,       (2 servings of most
Yoplait Healthy       foods that are
Heart Yogurt, and     fortified with
Minute Maid Premium   phytosterols)
Heart Wise Orange
Juice or in pills)

Whole-grain breads    in place of refined    [check]
and cereals           grains

Unsaturated fat       in place of            [check]
(oils, nuts,          saturated fat (red
salad dressing,       meat, full-fat
mayonnaise, etc.)     dairy foods,
                      butter, fatty
                      sweets, etc.)

Potassium (from       4,700 milligrams
foods like fruits     a day
and vegetables,
fish, and milk)

Consume Less          How Much

Saturated fat (red    no more than
meat, full-fat        20 grams a day
dairy foods,
butter, fatty
sweet, etc.)

Trans fat (fatty      as little as
sweets, french        possible
fries, and other
foods made with
partially
hydrogenated oil)

Red meat              no more than 3                       [check]
                      servings a week

Sodium                no more than 2,300
                      milligrams a day;
                      1,500 mg if you're
                      middle-aged or
                      older

Alcohol               no more than 2         [check]
                      drinks a day

1 Calcium             no more than 1,500                   [check]
                      milligrams a day
                      from food and pills

Sweets                no more than 5
                      servings a week

Weight & Exercise     How Much

Waist                 if it's over 40        [check]
                      inches, cut
                      calories and
                      exercise

Moderate-Intensity    at tat 30 minutes a    [check]       [check]
aerobic exercise      day (to keep off
(like brisk waking,   lost weight, at
dancing, swimming,    least 60 minutes
and cycling)          a day)

Strength training     at least 8-10          [check]
for arms, shoulders,  exercises 2-3
chest, abdomen,       times a week
back, hips, legs *

Stretching routine    at least 2-3 times
(reduces exercise     a week
injuries

                                            Colorectal
Consume More          How Much                Cancer

Fruits and            at least 5-10
vegetables            servings a day

Fish                  A least 2-3
                      servings a week

Fiber                 at least 30 grams a
                      day for men over 50
                      (38 grams a day for
                      younger men)

Tomato sauce          at least twice a
                      week

Phytosterols (in      0.8 grams (800
foods like Take       milligrams) a day
Control Spread,       (2 servings of most
Yoplait Healthy       foods that are
Heart Yogurt, and     fortified with
Minute Maid Premium   phytosterols)
Heart Wise Orange
Juice or in pills)

Whole-grain breads    in place of refined
and cereals           grains

Unsaturated fat       in place of
(oils, nuts,          saturated fat (red
salad dressing,       meat, full-fat
mayonnaise, etc.)     dairy foods,
                      butter, fatty
                      sweets, etc.)

Potassium (from       4,700 milligrams
foods like fruits     a day
and vegetables,
fish, and milk)

Consume Less          How Much

Saturated fat (red    no more than
meat, full-fat        20 grams a day
dairy foods,
butter, fatty
sweet, etc.)

Trans fat (fatty      as little as
sweets, french        possible
fries, and other
foods made with
partially
hydrogenated oil)

Red meat              no more than 3         [check]
                      servings a week

Sodium                no more than 2,300
                      milligrams a day;
                      1,500 mg if you're
                      middle-aged or
                      older

Alcohol               no more than 2         [check]
                      drinks a day

1 Calcium             no more than 1,500
                      milligrams a day
                      from food and pills

Sweets                no more than 5
                      servings a week

Weight & Exercise     How Much

Waist                 if it's over 40        [check]
                      inches, cut
                      calories and
                      exercise

Moderate-Intensity    at tat 30 minutes a    [check]
aerobic exercise      day (to keep off
(like brisk waking,   lost weight, at
dancing, swimming,    least 60 minutes
and cycling)          a day)

Strength training     at least 8-10
for arms, shoulders,  exercises 2-3
chest, abdomen,       times a week
back, hips, legs *

Stretching routine    at least 2-3 times
(reduces exercise     a week
injuries

* For a strength-training guide, see
www.cdc.gov/nccdphp/dnpa/physical/growing_stronger/index.htm or
Your Exercise Rx (Nutrition Action, Dec. 2002). for sample
stretching exercises, see www.nia.nih.gov/HealthInformation/
Publications/ExerciseGuide/chapter04c.htm.

Sources: American College of Sports Medicine, American Diabetes
Association, American Heart Association, Center for Science in the
Public Interest, Dietary Guidelines for Americans 2005, Food and
Drug Administration, Institute of Medicine, National Cholesterol
Education Program, National Heart, Lung, and Blood Institute.