Men's Health: A Deeper Look at a Familiar Field

The study of men’s health began as the study of testosterone, erectile dysfunction, and male infertility. Since then, it has rapidly grown and changed. The ability to treat male-specific issues has spurred increased recognition of the study of men’s health, especially since population predictions show that nearly 2 billion men will be over the age of 50 by the year 2020. Furthermore, men’s health issues are not solely the concern of older men: all men can benefit from healthcare.

For one thing, recent research has proven that erectile dysfunction and men’s infertility can be the initial presenting symptoms of common medical conditions like diabetes, hypertension, coronary artery disease, obstructive sleep apnea, renal insufficiency, and even some forms of cancer. One of the primary roles that a men’s health center serves, beyond the treatment of erectile dysfunction and male infertility, is to help with the early identification of these other medical conditions. The paradigm of men’s health should focus on the delivery of comprehensive healthcare.

As part of our recognition for male-directed health, of course, it is important to ensure that we do not take away from women’s healthcare. A look at the numbers, though, shows the obvious importance of men’s healthcare:

  • According to the Massachusetts Male Aging Study, 52% of men have erectile dysfunction. This number rises to above 70% in men over 70 years old.
  • In 2013, the annual sale of testosterone supplements in the U.S. was an estimated $2.4 billion.
  • 233,000 men are annually diagnosed with prostate cancer.
  • In 2011, nearly 2.7 million men in the U.S. had prostate cancer.
  • According to the American Heart Association’s 2013 update, 52% of men 55-64 years old have been diagnosed with hypertension. This number rises to 72% in men over 75 years old. *
  • According to the 2009-2012 National Health and Nutrition Examination Survey, 15.5 million men in the United States have diabetes.

Male-directed care is an exciting field that requires healthcare providers to stay current with rapid changes in technology and research.  It may be most prominent in the context of urology, but the study of men’s health has implications for all areas of medicine.


Vitamin B12 deficiency can be sneaky and harmful.


What harm can having too little of a vitamin do? Consider this: Over the course of two months, a 62-year-old man developed numbness and a “pins and needles” sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more.

What does vitamin B12 do?

The human body needs vitamin B12 to make red blood cells, nerves, DNA, and carry out other functions. The average adult should get 2.4 micrograms a day. Like most vitamins, B12 can’t be made by the body. Instead, it must be gotten from food or supplements.

And therein lies the problem: Some people don’t consume enough vitamin B12 to meet their needs, while others can’t absorb enough, no matter how much they take in. As a result, vitamin B12 deficiency is relatively common, especially among older people. The National Health and Nutrition Examination Survey estimated that 3.2% of adults over age 50 have a seriously low B12 level, and up to 20% may have a borderline deficiency.

Are you at risk?

There are many causes for vitamin B12 deficiency. Surprisingly, two of them are practices often undertaken to improve health: a vegetarian diet and weight-loss surgery.

Plants don’t make vitamin B12. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods from animals. Strict vegetarians and vegans are at high risk for developing a B12 deficiency if they don’t eat grains that have been fortified with the vitamin or take a vitamin supplement. People who have stomach stapling or other form of weight-loss surgery are also more likely to be low in vitamin B12 because the operation interferes with the body’s ability to extract vitamin B12 from food.

Conditions that interfere with food absorption, such celiac or Crohn’s disease, can cause B12 trouble. So can the use of commonly prescribed heartburn drugs, which reduce acid production in the stomach (acid is needed to absorb vitamin B12). The condition is more likely to occur in older people due to the cutback in stomach acid production that often occurs with aging.

Recognizing a B12 deficiency

Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. Given the array of symptoms it can cause, the condition can be overlooked or confused with something else. Symptoms may include:

  • strange sensations, numbness, or tingling in the hands, legs, or feet
  • difficulty walking (staggering, balance problems)
  • anemia
  • a swollen, inflamed tongue
  • yellowed skin (jaundice)
  • difficulty thinking and reasoning (cognitive difficulties), or memory loss
  • paranoia or hallucinations
  • weakness
  • fatigue

While an experienced physician may be able to detect a vitamin B12 deficiency with a good interview and physical exam, a blood test is needed to confirm the condition.

Early detection and treatment is important. “If left untreated, the deficiency can cause severe neurologic problems and blood diseases,” says Dr. Bruce Bistrian, chief of clinical nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center.

B proactive

It’s a good idea to ask your doctor (or your Blueprint Health nurse) about having your B12 level checked if you:

  • are over 50 years old
  • take a proton-pump inhibitor (such as Nexium or Prevacid) or H2 blocker (such as Pepcid or Zantac)
  • take metformin (a diabetes drug)
  • are a strict vegetarian
  • have had weight-loss surgery or have a condition that interferes with the absorption of food

A serious vitamin B12 deficiency can be corrected two ways: weekly shots of vitamin B12 or daily high-dose B12 pills. A mild B12 deficiency can be corrected with a standard multivitamin.

In many people, a vitamin B12 deficiency can be prevented. If you are a strict vegetarian or vegan, it’s important to eat breads, cereals, or other grains that have been fortified with vitamin B12, or take a daily supplement. A standard multivitamin delivers 6 micrograms, more than enough to cover the average body’s daily need.

If you are over age 50, the Institute of Medicine recommends that you get extra B12 from a supplement, since you may not be able to absorb enough of the vitamin through foods. A standard multivitamin should do the trick.

Not a cure

The Internet is full of articles lauding the use of vitamin B12 to prevent Alzheimer’s disease, heart disease, and other chronic conditions or reverse infertility, fatigue, eczema, and a long list of other health problems. Most are based on poor or faulty evidence.

Take Alzheimier’s disease as an example. “Although there is a relationship between low vitamin B12 levels and cognitive decline, clinical studies—including those involving people with Alzheimer’s disease—have not shown improvement in cognitive function, even doses of the vitamin as high as 1000 micrograms,” says Dr. Bistrian.

For now, it’s best to get enough vitamin B12 to prevent a deficiency, and not look to it as a remedy for what ails you.

Subcutaneous vs visceral fat. Which do you carry?

We all store body fat in slightly different ways, leading to a multitude of body shapes and sizes. Some of us store it on our thighs and buttocks, others more on their upper arms and chest. Some of us have a more even spread while others will have body fat concentrated in specific areas. While fat in certain places may concern us, a bulging waist-line is the biggest cause for health concerns and this relates to the different types and volumes of fat stores we have in our bodies.

The two main types of fat stores in our bodies are subcutaneous and visceral fat:

Subcutaneous fat is the body fat which is found directly under your skin and is normally pinchable and can be measured with body fat/skin fold callipers.

Visceral fat (also known as abdominal fat) is found within the abdominal cavity, between the stomach, intestines, liver, kidneys etc., making it much trickier to measure.

What’s the difference?

Both subcutaneous and visceral fat, as well as being energy stores, also have endocrine functions. They release hormones and proteins such as leptin, adiponectin, IL-6, TNF-α and angiotensin, which help regulate other organs and processes in our bodies. However, the hormones and proteins secreted by visceral fat are thought to be more pro-inflammatory than subcutaneous fat.

This is one of the reasons why excess visceral fat is more strongly associated with metabolic disease (i.e. – insulin resistance & type 2 diabetes) and cardiovascular disease, than excess subcutaneous fat. The proximity of visceral fat to the portal vein (a vein that carries blood directly to the liver) is another hypothesis why excess visceral fat has greater negative effects on health.

So how do I know if I have excess unhealthy visceral fat?

For a start, men are much more likely to store fat as visceral fat whereas women are more likely to store it as subcutaneous fat. This is mainly due to sex hormone differences, but once women reach menopause, it is slowly reversed and they become more inclined to store it as visceral fat.

Like with BMI and obesity, your genetics are another factor that could predispose you to having excess or unhealthy visceral fat. Where you store your fat has been shown to be heritable. In the Quebec Family Study, heritability was estimated to be 56% for visceral fat and 42% for subcutaneous fat1. Other studies have given heritability estimates of over 70% suggesting a very strong genetic influence on fat distribution2.

Recent scientific research has uncovered some of the genetic variations which might impact fat distribution. In overweight (BMI >25) Korean women, the G allele of PPARG was significantly associated with greater amounts of both subcutaneous and visceral fat compared to those who were CC, although the effect on subcutaneous fat seemed larger3. Another study showed that while G allele carriers had a higher BMI they had a similar waist circumference. This suggested that G allele carriers might be carrying less visceral fat.

Many other genes and their variants have also been associated with fat distribution. Recently a multi-national research consortium published a paper identifying 7 new genetic variations associated with fat distribution traits such as the volume of visceral and subcutaneous fat and the ratio of visceral to subcutaneous fat5.

There are numerous types of scans (at various price points) that can identify your ratio and volume of subcutaneous and visceral fat. However, an easy and free estimate can be obtained via the simple tape measure. Although it's not going to give you exact numbers on the quantity of the different types of fat, simply measuring your waist circumference (WC) can be very informative. Men with a WC of >40 inches (102 cm) and women >35 inches (88cm) will likely have excess visceral fat and should be taking immediate action to reduce it. Measuring your hip circumference (around the widest portion of your buttocks) is another good measure as it can be combined with your WC to give your waist-to-hip ratio. A ratio of >0.9 for men and >0.85 for women is an indicator of serious central obesity and an excess of visceral fat. Although these measures are far from perfect, they are easy and convenient for almost everyone to do, and tracking these over time will let you see if your dropping weight and fat from the abdominal area.

What can you do if you suspect you are carrying a lot of visceral fat?

Well it's no different to losing body fat from anywhere else on your body. The only difference is that losing visceral fat can improve metabolic and inflammatory health markers more than losing subcutaneous fat, evidenced by liposuction (which only removes subcutaneous fat) not having much effect on these health parameters.

Leading an active lifestyle along with a healthy, well-balanced diet is the best way to reduce all types of body fat. Some studies have shown that high-intensity exercise is particularly beneficial for fat loss and specifically visceral fat. So get sprinting hard and lifting heavy!

How to start shifting the fat

If you do happen to be carrying a lot of fat around your abdomen (or elsewhere) and can't sprint on a treadmill or struggle to work at a high intensity generally, try the following:

Instead of running intervals on the treadmill by increasing the speed, select a comfortable walking pace while the incline/gradient on the treadmill is flat and spend 5 minutes warming up. Then to increase the intensity, ramp up the incline/gradient (between 8-15%) for 30-60 seconds before returning it to its flat position for 1-2 minutes of active rest. If in the beginning you need to stop completely to catch your breath, that's ok. Do this for 10-20 repetitions, depending on how you feel. As you get fitter and start dropping body fat, gradually either increase the pace, the gradient, the time at higher intensity, the number of repetitions or reduce the time of the active rest periods.

This is great for people who carry a lot of weight as it can be much kinder on their joints than trying to sprint or even jog. If you do have problems with your joints (i.e. – knees or hips) and even walking is too much stress then getting in the pool will probably be best thing for you. You don't necessarily need to use the pool to swim in a traditional horizontal manner (e.g. doing lengths of front crawl or breast stroke etc.) if this is too taxing. You could exercise in a more vertical manner, such as running on the spot, jumping jacks, squat or lunge jumps or variations and combinations of any of these movements. The same principle applies in regards to intervals, rest periods and repetitions.

Blueprint now provides comprehensive medical weight-loss that range from non-prescription meal replacement, to the prescription hCG Diet. Contact your Blueprint Health Care Representative for more information.