A Walk A Day, and Not An Apple, Keeps the Doctor Away

The baby boomers have arrived in large numbers. They are taking responsibility for their health and are eager to stay well and out of the doctor’s office. This blog will discuss the importance of exercise, even walking, to make you healthy and well. This blog will emphasize exercise and not weight loss as the road to good health and longevity.

A brisk 20 minute walk each day could be enough to reduce your risk of early death. A study of over 334,000 European men and women found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, but that just a modest increase in physical activity could have significant health benefits.
Physical inactivity has been consistently associated with an increased risk of early death, as well as being associated with a greater risk of diseases such as heart disease and cancer. Although it may also contribute to an increased body mass index (BMI) and obesity, the association with early death is independent of an individual’s BMI.
To measure the link between physical inactivity and premature death, and its interaction with obesity, researchers analyzed data from 334,161 men and women across Europe participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over an average of 12 years, the researchers measured height, weight and waist circumference, and used self-assessment to measure levels of physical activity. The results are published today in the American Journal of Clinical Nutrition.

TThe authors estimate that doing exercise equivalent to just a 20 minute brisk walk each day — burning between 90 and 110 kcal (‘calories’) — would take an individual from the inactive to moderately inactive group and reduce their risk of premature death by between 16-30%. The impact was greatest amongst normal weight individuals, but even those with higher BMI or with obesity saw a benefit.
Using the most recent available data on deaths in Europe the researchers estimate that 337,000 of the 9.2 million deaths amongst European men and women were attributable to obesity (classed as a BMI greater than 30): however, double this number of deaths (676,000) could be attributed to physical inactivity.

Bottom Line: So what is the message? This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive. Although we found that just 20 minutes would make a difference. Physical activity has many proven health benefits and should be an important part of our daily life.

Story Source:

Journal Reference:
1. Ulf Ekelund, Heather A Ward, Teresa Norat, Jian’an Luan, Anne M May, Elisabete Weiderpass, Stephen S Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro Ferrari, Idlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H Peeters, Evelyn Monnikhof, H Bas Bueno-de-Mesquita, J Ramón Quirós, Antonio Agudo, María-José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J Key, Ruth C Travis, Kay-Tee Khaw, Søren Brage, Nicholas J Wareham, and Elio Riboli. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, January 14, 2015 DOI: 10.3945/ajcn.114.100065

ED or Impotence May Be Sending A Message To Your Heart and Brain

Having trouble with your erections? You are not alone as nearly 30 million American men suffer from this problem. That’s the bad news. The good news is that erectile dysfunction or ED may be harbinger of something more ominous that may affect your health and well-being. This blog will discuss the connection between ED and heart disease.

No man wants to be diagnosed with erectile dysfunction (ED), but believe it or not, it could save your life. In many cases, ED is a precursor to cardiovascular disease and when diagnosed properly could reduce the chance of having a heart attack or stroke.

ED is the inability to obtain or sustain an erection. It is extremely common, affecting more than half of men over 60. Given our rising rates of obesity and sedentary lifestyles, there is a good chance that performance in the bedroom is not about emotional issues or the male anatomy itself. It may sound strange but the penis is the barometer of a man’s overall health.

You can imagine how a heart artery gets clogged in a person with high blood pressure, high cholesterol or diabetes. When that coronary artery, which measures around 1\8 inch, gets obstructed that little to no blood flows through it, that man is going to experience chest pain (angina) or a heart attack. The same holds true for the carotid arteries, which measure 1\2 inch and take blood up to the brain. When the carotid artery gets blocked, that man will experience symptoms of a stroke. Now imagine the tiny penile artery, measuring only 1\16 inch. Its smaller diameter makes it ultra-sensitive to blockages, resulting in erectile dysfunction the penile artery becomes blocked.

Our entire vascular system is connected and the same things that harm our big blood vessels to our heart and brain will affect our smallest ones as well. The common cause of all this is what’s called atherosclerosis. As the same systemic process takes place throughout our vascular system, it’s these small arteries in the penis that will feel the effects earlier and manifest the symptoms of ED before other organs such as a man’s heart or brain start to suffer.

A lack of erections or difficulty holding an erection may be one of the earliest signs of impending heart disease or a stroke. When a man experiences ED this should an alarm should for men, their partners and their doctors. It’s important to realize that ED and cardiovascular disease have the same risk factors. These include high blood pressure, diabetes, high cholesterol, smoking and excess weight. Realize, too, that all these risk factors are modifiable, meaning you can actually improve them to reverse or halt the damage that is being done.

The message is: the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Studies show that men presenting with only mild ED have a significant amount of undiagnosed high blood pressure, high blood sugar and high cholesterol, among other things. This is why men with mild ED, particularly if they are younger than 50, need to be screened for cardiovascular risk factors and have those risks treated aggressively. This means a visit to a doctor, having an EKG, and a stress test to see if there any decrease in blood supply to the heart.

We’ve come a long way since the days when ED was something men kept to themselves, too embarrassed to discuss with their friends or doctor. The introduction of pills (Viagra, Cialis, Levitra) to treat ED over 15 years ago opened the door for conversations about the condition.

The good news that lifestyle changes to modify risk factors, such as high blood pressure, elevated cholesterol level, obesity, and diabetes, that will provide the greatest benefit to a man’s overall health, not just his penis.

Bottom Line: ED can be a harbinger of impending heart disease or stroke. Don’t dismiss difficulty getting or holding an erection as this may indicate a future heart attack or stroke. See you doctor or urologist.

What You Need To Know About Low T (Testosterone) and Heart Disease

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.