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What’s Good for the Heart; Testosterone Levels; ED and Your Health

For a gland the size of a golf ball, the prostate sure does cause a lot of trouble, and treatment can be all-consuming.  That’s why this website has so much “prostate-forward” content.  But guess what?  There are other body parts you have to think about proactively, too!  Don’t forget about the rest of your body!

            This means you still need to think about screening for other cancers, such as colon cancer and skin cancer.  You still need regular checks for blood cholesterol, liver function, kidney function, and diabetes – the lab tests doctors usually order at a routine yearly physical.  You need someone to listen to your heart and check your blood pressure.  If, like many men, you don’t have a family doctor or internist, but only go to the urologist, make sure your urologist is aware of this, and be sure to raise any health concerns at your office visit.

Be Good to Your Heart

            Right up there at the top of your health goals should be cardiovascular wellness.  Here’s one big reason why:  “If you have localized prostate cancer and are treated successfully for it, your biggest risk of dying is of a heart attack,” says Edward “Ted” Schaeffer, M.D., Ph.D., chairman of urology at Northwestern University.  He made this point in our book.

            “Even if you don’t have prostate cancer, heart disease remains the number one cause of death in men,” he continues.  “If you have advanced prostate cancer and are on androgen deprivation therapy (ADT), your risk of a heart attack goes up.  Thus, focus on being heart-healthy!”

            What’s good for your heart?  It’s pretty straightforward:  Eat a diet rich in fruits and vegetables and low in processed foods, fried foods, and sugar.

            Now, what does this actually mean?  I’m not going to tell you never to have cookies, cake, burgers, hot dogs, pizzas, etc.  Just don’t make that the vast majority of what you eat.  Think of an old-fashioned scale, like the scales of justice.  On one side is all the stuff you do eat, whatever it is.  On the other side is what you don’t eat.  It’s not eating vegetables and fruits. Not getting enough protein — your sins of omission are every bit as bad, maybe worse, than any sins of commission (eating a cinnamon roll as big as your head).  You need a lot more protein than you may think:  about 30 grams PER MEAL.  For a 185-pound man, that’s at least 90 grams a day.  There is no shame to protein shakes!  It’s a great way to get a big honking dose of protein.  Other sources:  nuts (6 grams in an ounce of almonds), eggs (a boiled egg has 6.3 grams), a meat bar such as Epic makes (7 grams in one bar), a Kind bar (7 grams in a peanut butter/dark chocolate bar).

            Back to our scale:  whatever goes into the one side should be balanced by the other.  If you eat a slice of pizza, have a salad or a vegetable side.  If you have a scoop of ice cream, make it healthier by putting raspberries or blueberries on top.  Try not to eat a lot of processed meats – but if you do eat a hotdog, or chicken apple sausage, or salami, or pepperoni, try to get the healthier kind without additives.  And know this:

The vast majority of processed food is not good for you.  It’s just convenient.  Even prepackaged food that is marketed as “healthy” actually is often full of junk!

Take, for example, the 25-ingredient veggie burger, which contains few vegetables and is packed with additives.  What the heck is carrageenan, anyway?  (It’s in a lot of prepared foods, and it is not good for you!)  I just interviewed Weill-Cornell medical oncologist David Nanus, M.D., who is Principal Investigator of a study looking at a whole-foods, plant-based diet for men on ADT.  I will report on this soon; the initial findings are exciting and hopeful.  Nanus offers this advice for anyone trying to eat a healthy diet:  “If it’s got more than five ingredients, don’t eat it.”

Or consider the chicken-teriyaki meatballs with 750 mg of sodium in one serving – and one serving is four small meatballs!  Let’s not even get started on fast food and chain restaurants, which make money by offering high-calorie, high-sodium and high-sugar food that pleases the palate but adds to the waistline.  The stakes (and steaks!) are high.

           If you drink alcohol, do it in moderation – although again, many studies show health benefits to red wine.  Aim for some moderate exercise every day.  It doesn’t have to be a heroic effort; just do something.  Anything is better than just sitting around looking at a screen.

Testosterone and Your Overall Health

            Note: If you have advanced or high/risk prostate cancer and you need ADT, then do it.  “That’s the most important issue right now,” says Schaeffer, “keeping the cancer under control.”

            But for men who are not on ADT, men who don’t have prostate cancer or men who have been treated successfully for localized prostate cancer are in a different situation.  They do need testosterone for good health.  “Male hormones play a big role in keeping your body healthy,” says Schaeffer.  “Ideally, men should have testosterone levels that are in the normal range.”

            This can be a tough concept to grasp, says Johns Hopkins neuro-urologist Arthur Burnett, M.D.   “Ever since (Nobel prize-winning scientist) Charles Huggins made the observation 70 years ago that in advanced prostate cancer, if you shut down the male hormones, that will cause a regression of the disease, there’s been widespread notion that if you have prostate cancer, you need to get the testosterone down.  The reality is, if you are cancer-free, if you have low testosterone, you should get to a normal testosterone level.” Even in men who have not been treated with ADT, testosterone can be low for other reasons, including age, obesity, and certain chronic medical conditions.

            Burnett, with investigators at Harvard, is conducting a trial of supplemental testosterone in men after prostatectomy.  The hypothesis is that restoring low testosterone to the normal range “is safe and efficacious, that it can improve cognitive function and some physical limitations that some men have when their testosterone is low, and that there might be some sexual benefit from getting testosterone back into the normal range.  For men who have radical prostatectomy or radiation therapy for localized disease who happen to be testosterone-deficient, rather than condemn them for the rest of their lives to having too little testosterone, how do you help them achieve maximal health?”

              The key is to keep testosterone in the normal range of between 300 and 800 ng/dL, says Schaeffer.  Among other things, “very low testosterone levels can raise the risk of a heart attack or stroke, decrease muscle mass, weaken bones, impair cognitive function, increase the risk of metabolic disease, frailty and depression.” If you are experiencing symptoms such as fatigue or low sex drive, speak to your urologist or primary care physician.

 “Sexual Health is a Barometer”

            Both surgery and radiation therapy for localized prostate cancer can cause temporary or longer-lasting difficulties with erectile function.  But other medical conditions can cause erectile dysfunction (ED), too.  Burnett, a pioneer in the field of men’s sexual health – whose scientific discoveries about the role of nitric oxide in erection led to development of the drug Viagra – has written about this in detail in his book, The Manhood Rx: Every Man’s Guide to Improving Sexual Health and Overall Wellness.

            For example:  “Heart disease and ED, the two entities are linked,” he says.  We have previously discussed that here.  “Erection is a matter of vascular function in the genitalia.  Heart disease affects more than the heart – the entire cardiovascular system.  It can cause cerebral vascular disease, peripheral vascular disease, and penile vascular disease.  Erection is all about blood flow and how it’s regulated.”  In fact, “ED is a marker, not only for heart disease, but for diabetes, metabolic syndrome, some autoimmune diseases, and systemic inflammation (diseases including gout, inflammatory bowel disease, gastritis, and prostatitis).”  Being overweight can affect erectile function, as well; basically, fat cells raise estrogen levels, and reduce testosterone.

            There are many ways to treat ED, including drugs such as Viagra and Cialis, penile injections, and surgery to implant a penile prosthesis.  “Sexual health after prostate cancer requires a multifaceted approach that begins with the patient,” says Burnett.  “Healthy living, preserving your best health after prostate cancer – eating a balanced diet, exercising, avoiding smoking and moderating your alcohol intake – can help maximize blood flow to the penis.  You won’t get your 25-year-old penis back, but it may help preserve the function you have.  And more proactively, talk to your urologist.  Seek out interventions.  If you don’t respond to a PDE5 inhibitor (Viagra or similar ED drug), there are nonsurgical interventions, including pumps or penile injection, and surgical intervention, implantation of a penile prosthesis.  Don’t give up!”   Seriously.  Look through this website.  There is a lot about ED, including the inspiring story of Serge Thomas.   There is always hope.

In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

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Heart Attack Triggers: The Four Deadly Horsemen

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.”

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

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ED and Your Cardiovascular Health

railroad manED and Low T:  Don’t Just Treat the Symptoms!

Part One of my series with Urologist Kevin Billups, M.D.

 If you have erectile dysfunction (ED) or low testosterone, and you go see a doctor about it, that’s good:  Because in both cases, there’s probably something else going on.

I interviewed urologist Kevin Billups, M.D., formerly Director of the Brady’s Men’s Health and Vitality Program at Johns Hopkins Medical Institutions and now Medical Director of the Billups Center in Murfreesboro, Tenn.  Billups has treated thousands of men with these problems.  “These are symptoms that will get a man interested in seeking help,” he says.  But they’re generally not the only things he ends up treating. “The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.”

The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.

If you are a man between the ages of 40 and 50 and you have ED, growing evidence suggests that you could have nearly a 50-fold increased risk of developing heart disease over the next 10 years, Billups says.  “It’s a group we’re really looking at.”  He believes many of these men need a more aggressive workup, “not just with the standard stress test,” which he sees as more of a fitness test, but with a coronary CT scan to look for coronary plaque.  “You can get a coronary cat scan now for $75.  I’ll be very honest when I talk to these guys.  I’ll say, ‘Your insurance may not cover this.  But if you turn out to have plaque in any of these arteries, I will manage you differently.”

Let’s just take a moment here to note that if you have ED and you just take a drug like Viagra or Cialis, you probably aren’t doing yourself a favor.  “Treating that one symptom without finding the underlying cause would not be a good idea,” says Billups.  “Here’s my biggest concern:  When a guy has ED, that may be a symptom that will actually get him to come to a doctor,” and that’s an opportunity to improve his overall health.  “If you just get medicine, that will mask the real problem in a number of men.  Then you’re just pushing everything back.  So this 40-year-old guy who’s having problems, maybe the medicine will fix what he cares about,” and the man has a heart attack several years later that might have been preventable.

What else could be going on?  “We do a very thorough evaluation to find out,” looking for, in addition to cardiovascular risk factors, diabetes or pre-diabetes, chronic sleep problems, urinary problems, and prostate problems.  Billups refers many of his patients to general urologists, primary care physicians, sleep specialists, or preventive cardiologists for further testing or more aggressive treatment when needed.  “We’re offering very integrated, multidisciplinary care.”

Billups, who sees patients from all over the country, estimates that more than half of his patients are self-referred; many have seen one of his videos addressing key issues related to men’s health.  He has made more than 25 short videos about specific symptoms — any one of which might get a man through the door of the doctor’s office, where Billups then goes on to treat the whole patient. “Yeah, I’ll treat your ED, but what else do you have going on?”

In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

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