Men’s Health—An Opportunity for the Food Industry
The Women’s Health Initiative has focused national attention on medical problems affecting more than half the female population. Disease specific to males may now deserve some additional emphasis. Prostatic disease, for example, especially among men over 65 years of age, is a serious clinical concern that may be one target for the food industry.
Nearly 100% of all males over 50 years of age present symptoms associated with benign prostatic hyperplasia (BPH)—noncancerous prostate enlargement and cell proliferation. While most men develop BPH, approximately 1 out of 6 males are at risk for developing prostate cancer over their lifetime (Epperly and Moore, 2000). Prostate cancer remains the second leading cause of death among men.
A diagnosis of BPH is based on histological evidence and gland volume, typically >30 mL. The clinical diagnosis of BPH is presumptive, based on three basic symptoms: irritation, obstruction, and infection.
Current medical literature is replete with discussion of dietary approaches to the prevention and management of BPH. These include a variety of food components as well as plant and herbal extracts frequently found in dietary supplements. Food components include resveratrol, soy, tomatoes, and n-3 fatty acids. Among the more popular dietary supplements are saw palmetto, prunus, nettle root, and milk thistle.
Resveratrol and its trans isomer are phytoestrogens found in the skin of red grapes. There is emerging evidence that resveratrol suppresses the expression and function of a variety of androgen-regulated genes, including the androgen receptor in at least one prostate cancer cell line. Preliminary in-vitro research suggests that these grape skin extracts possess antioxidant and antiproliferative properties, and that resveratrol may promote nitric oxide production, thus mitigating some of the potential sequelae associated with BPH and prostate cancer treatment (Bhat et al., 2001).
Soybean-derived products such as soy “milk” and tofu contain an array of phytoestrogens. One of the best studied is the isoflavone genistein. While the most intriguing data are derived from human histoculture studies (and thus must be interpreted carefully), there is epidemiologic evidence that the relatively low prevalence of prostate disease in Asia may be associated with high dietary soy consumption. Apart from inhibition of multiple hormone-dependent and hormone-independent prostate cancer cell lines, there is evidence that other soy-derived isoflavones and their metabolites may be more active in suppression of tumor growth and inflammation.
Several recent prospective surveys suggest that a high intake of cruciferous vegetables may offer some protection against prostatic disease. The polyphenols in fruits, vegetables, red wines, coffee, tea, and even juices may be responsible for some of these effects. For example, lycopene, a carotenoid found in high amounts in tomatoes and tomato products, typically concentrates in the prostate and retinal tissues (Clinton, 1998). Again, epidemiologic data among Mediterranean populations are intriguing, implying an inverse association between the consumption of high proportions of lycopene-containing foods, thus possibly reducing oxidative stress, and lower rates of prostate disease. However, the overall data are inconclusive, especially when considering advanced prostatic cancer in older men.
Numerous clinical studies suggest that the consumption of n-3 fatty acids, specifically eicosapentaenoic and docosahexaenoic acids (EPA and DHA), from fish and plant sources may contribute to a healthy heart. These fatty acids also inhibit prostatic cell proliferation, yet dietary α-linolenic acid may increase growth of these cells, and possibly contribute to BPH. Future dietary studies that assess the risk of BPH and prostatic disease could contribute to our understanding of the dynamics of this disease process, and lead to additional food products and public health intervention strategies (Leitzmann et al., 2004).
Prostate disease will affect nearly every male who lives beyond 50 years. Whole foods and food components from fruits and vegetables, including phytoestrogens, antioxidants, selected fatty acids, and other macronutrients, may be useful adjuncts in limiting the risk of prostatic enlargement and BPH.
by ROGER CLEMENS, Dr.P.H.
Director, Analytical Research
Professor, Molecular Pharmacology & Toxicology
USC School of Pharmacy, Los Angeles, Calif.
by PETER PRESSMAN, M.D.
Assistant Professor, Clinical Medicine
USC School of Medicine, Los Angeles, Calif.
Epperly, T.D.D. and Moore, K.E. 2000. Health issues in men: Part I. Common genitourinary disorders, Am. Fam. Physician 61: 3657-3664.
Bhat, K.P.L., Kosmeder, J.W., and Pezzuto, J.M. 2001. Biological effects of resveratrol. Antioxidants Redox Signaling 3: 1041-1064.
Clinton, S.K. 1998. Lycopene: Chemistry, biology, and implications for human health and disease. Nutr. Rev. 56: 35-51.
Leitzmann, M.F., Stampfer, M.J., Michaud, D.S., Augustrsson, K., Colditz, G.C., Willett, W.C., and Giovannucci, E.L. 2004. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am. J. Clin. Nutr. 80: 204-216.