June 2004

Vol. 3    No. 6

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My Favorite Five Articles Found in Recent Medical Journals

Eat Healthier for Better Sex

Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial by Katherine Esposito in the June 23/30, 2004 issue of the Journal of the American Medical Association reported on obese men aged 35 to 55 years with erectile dysfunction.  One group of 55 men was assigned to a healthier diet (lower in fats and higher in complex carbohydrates) and another group of 55 men did not change their diets.  The first group also reduced its (calorie) intake and increased physical activity.  After losing about 10% or more of their total body weight (on average 15 Kg = 32 pounds) about one third of obese men showed improvement in sexual function.  Not much else changed, e.g., cholesterol, triglycerides or glucose.  Their blood pressure decreased a little from the diet, exercise and weight loss.


My first experience with sexual function and diet came from my formative years as a doctor on a sugar plantation in Hawaii in the early 1970s.  Anyone familiar with the lives of people on the rural sugar plantations knows the truth of my story.  A common practice was for an elderly Filipino gentleman to retire after years of hard work and saving his money – and then travel to the Philippines to marry a young bride.  Every day there came into my medical office a family consisting of a man in his 70s, with a woman in her 20s, with several small children.  I was impressed by his ability to father these children (since many men I personally knew were having erectile dysfunction (ED) in their 40s and 50s), and by his optimism – in thinking that he would live long enough to see these children grow into adulthood.  You may have guessed the secret to his sustained abilities was a diet based upon vegetables and rice.

Multiple studies have shown that the rich American diet is at the root of erectile dysfunction.  The blood vessels to the penis close, just as those to the heart close, from a diet high in fat and cholesterol.  Nerve damage to those nerves that regulate blood flow to the penis that control an erection also occurs from unhealthy eating practices. In addition, because of all that poor health, many men are on blood pressure and other medications that are “erection destroying.”

So the solution, just like with other diseases of over-nutrition, is to change to a healthy diet and exercise.  Of course, there is Viagra for those too stubborn to change – but Viagra does nothing for the unattractive pot belly that is also sexually inhibiting.  Better to go for the all-encompassing cure – a plant-food-based diet and exercise.

Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F, D'Armiento M, Giugliano D.  Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial.  JAMA. 2004 Jun 23;291(24):2978-84.

Can’t Suck off the Fat for Better Health

Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease by Samuel Klein in the June 17, 2004 issue of the New England Journal of Medicine found abdominal liposuction does not improve the metabolic complications related to obesity.  After sucking off more than 20 pounds (10Kg) of fat, on average, from each person, these investigators found no improvement in many of the risk factors (like insulin resistance) that predict a person’s chance of having a heart attack.


Overweight and obesity are associated with poor health because the same foods and lifestyle practices cause both conditions.  In other words, the accumulation of the excess abdominal fat is not the cause of heart disease, but just one more result from gorging on high-fat, high-calorie, usually high-cholesterol foods, like NY sizzling steaks, fried chicken, and slices of Parmesan cheese.  So reducing the body fat will do little, if anything, to bring about better health – unless this is accomplished by addressing the root of the problem.   Weight loss accomplished by changing to a healthy diet and exercise is associated with improved insulin sensitivity, lower blood pressure, and reduced blood sugar, triglycerides, and cholesterol.  But most importantly, people are healthier and feel and look better.

This lesson can also be valuable when evaluating other unconventional means of losing weight, like low-carb (Atkins-type) diets.  Because the weight loss is accomplished by means other than by correcting the cause (people are made sick by the bizarre makeup of the components of the food – too much fat and protein and too little carbohydrate), followers may become thinner, but not healthier – and trimmer, sick people with lethargy, nausea, headaches, bad breath, and constipation are what you see with those following this form of weight loss (See my May 2004 newsletter article: The Atkins Scientific Research – Deceit and Disappointment).

Obviously, to get the health and appearance you deserve you must go to the common denominator of the problem: consumption of too much rich food.  The solution is to eat a diet based on starches, vegetables and fruits and exercise (See my November 2002 Newsletter article: Successful Weight Loss Tips.)

Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, Mohammed BS. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease.  N Engl J Med. 2004 Jun 17;350(25):2549-57.

Bubbly Mineral Water Reduces Heart Attack Risks

A sodium-rich carbonated mineral water reduces cardiovascular risk in postmenopausal women by Stephanie Schoppen in the May 2004 issue of the Journal of Nutrition found that the consumption of carbonated mineral water decreases total cholesterol (6.8%) and “bad” LDL-cholesterol (14.8%), and increases “good” HDL-cholesterol (8.7%).  Moreover, there were signs of improvement in the health of the blood vessels (less endothelial dysfunction).  Blood sugar levels also improved, and no adverse effects were seen on blood pressure, even with the additional sodium from the water.

The water consumed was supplied by Vichy Catalan and contained significant amounts of bicarbonate, sodium, chloride, and some potassium.  Subjects drank one liter (a quart) a day for the 2 months of the study.

Even though sodium has been condemned because of effects on elevating blood pressure, there is also evidence that says sodium in the diet helps lower cholesterol – ingestion of carbonated mineral water may enhance the conversion of cholesterol in the liver into bile salts, which are then removed from the body with bowel waste.  Additionally, the bicarbonate form of sodium may be less detrimental to blood pressure, than is the chloride form (table salt).


Water is seldom discussed in terms of health, yet people often consume one to five liters a day and our body masses are made up of 70% to 75% water.  Just in terms of volume, water has the potential to have a great influence upon our health.

My recommendations are: First, your water source must be clean – free of environmental contaminants.  Clean water may be obtained from many sources (tap, bottled, distilled, filtered, etc.).  Sometimes laboratory testing is needed to assure purity.  Second, you should drink sufficient amounts to satisfy your thirst drive.  I do not have a rule that forces people to drink 8 glasses a day – I assume their highly efficient thirst drive will meet their needs.

I really like this article because I have a habit of drinking one to three liters of carbonated bottled water a day – and I love to hear good news about my habits.  One additional advantage of carbonated water is that it may be good for your bones, not just because it is loaded with minerals, including calcium, but, most importantly, because it is alkaline in nature (See my January 2003 Newsletter article:  The Right Diet Will Save Your Bones).

Schoppen S, Perez-Granados AM, Carbajal A, Oubina P, Sanchez-Muniz FJ, Gomez-Gerique JA, Vaquero MP.  A sodium-rich carbonated mineral water reduces cardiovascular risk in postmenopausal women. J Nutr. 2004 May;134(5):1058-63.

Save Your Eyes with a Healthy Diet – Glaucoma

Statins and other cholesterol-lowering medications and the presence of glaucoma by Gerald McGwin in the June 2004 issue of the Archives of Ophthalmology found long term use of oral cholesterol-lowering medications (statins) may reduce the risk of developing the most common form of glaucoma (open-angle) in Western societies, especially for people with a history of high cholesterol and/or heart disease.  The benefits may be from improvement in blood flow to the eyes and the flow of fluids within the eye.


In the United States, approximately 2.2 million people age 40 and older have glaucoma, and of these, as many as 120,000 are blind due to the disease.  In glaucoma, fluid builds up, increasing the pressure inside the eye to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma and vision loss may result.

I have had personal communication with an ophthalmologist friend concerning her experiences with eye pressure and diet.  She has found that, like blood pressure, eye pressure is reduced with a healthier diet (low-fat, plant-based) and an exercise program.  These findings are yet to be published and confirmed, but this report from the Archives suggesting protective effects from statins is encouraging and hopefully will cause researchers to look at a healthy diet as a means to both prevent and treat glaucoma.  In the meantime, if you have glaucoma and have changed your diet you should have your eye pressure monitored closely.  If you have a doctor who is willing to work with you, then there is a good chance you can reduce the use of eye-pressure-lowering drops by monitoring your eye-pressure and making appropriate adjustments in your medications with your doctor’s supervision.

McGwin G Jr, McNeal S, Owsley C, Girkin C, Epstein D, Lee PP.   Statins and Other Cholesterol-Lowering Medications and the Presence of Glaucoma.  Arch Ophthalmol. 2004 Jun;122(6):822-826.

PSA for Early Prostate Cancer Detection Fails Again

Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter by Ian Thompson in the May 27, 2004 issue of the New England Journal of Medicine found men with “normal” PSA levels (below 4 ng/ml) often have prostate cancer and thus this test should give little reassurance to men that they do not have this disease.1  In this study of almost 3000 healthy participants (age 62 to 91 years), 15 percent of the men with a “normal” PSA actually had prostate cancer based on the needle biopsy results.


Prostate cancer is common among middle-aged and older men, with a 16 percent chance of being diagnosed with this disease in a man’s lifetime, but only a 3 percent chance of dying of this disease.  (Which means 13% of men who have a prostate cancer diagnosis may have been better off not knowing about it.)  PSA (prostate specific antigen) testing has increased the number of men diagnosed with the disease without reducing the risk of suffering or dying from it.  In fact, a case can be convincingly made that the test has increased suffering because many more men must live their lives knowing they have cancer and suffering with the side effects of treatment, such as urinary incontinence and impotency (with no increase in years from all these expensive and painful treatments).

Being diagnosed with cancer changes people in three profound ways:2

1) Once the diagnosis is made the label of “cancer victim” sticks for life.  Regular reminders come from doctor’s visits, friends and stories in the media about cancer.

2) Cancer causes people to lose trust in their bodies.  “The body becomes a house of suspicion.”  “I don’t get the flu anymore, I get recurrent lung cancer.”

3)  Survivors feel a separation from the ones they love because of this profound experience – no one else really knows the effects this disease has had on the person with cancer.

Therefore, before someone is asked to take a test that could negatively change his life forever, then the doctor had best be sure that the benefits will far outweigh the harms – and to date there is no convincing evidence that the use of PSA testing reduces the risk of dying from prostate cancer.1  (For a thorough discussion of this topic see my February and March 2003 lead Newsletter articles.)

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr.   Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004 May 27;350(22):2239-46.

Little M.  Chronic illness and the experience of surviving cancer.  Intern Med J. 2004 Apr;34(4):201-2.

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