June 2015 Issue Nutrition and Healthy Aging for Men By Judith C. Thalheimer, RD, LDN Today's Dietitian Vol. 17 No. 6 P. 44 Learn more about five common nutrition-related health concerns that affect older men and how best to counsel them for prevention. As men get older, their risk of developing chronic diseases increases. Adopting healthier lifestyle habits can decrease that risk and help ensure a higher quality of life for years to come. "Eating a well-balanced diet with a variety of foods can help men promote their overall health and reduce their risk of chronic diseases," says Ximena Jimenez, MS, RDN, LD, a national spokesperson for the Academy of Nutrition and Dietetics (the Academy). By sharing that wisdom with male clients in a way that empowers them to take control of their health through lifestyle choices, nutrition professionals can have a major impact on their lives. Here's a closer look at five of the most common health conditions that affect men as they age, and how better nutrition and lifestyle changes can dramatically reduce their risk. 1. Heart Disease The statistics are clear: More men die from cardiovascular disease than any other condition. According to the American Heart Association (AHA), more than one in three adult men has some form of cardiovascular disease.1 The good news is that men can take control of their heart health. The best weapons against heart disease are diet and other lifestyle choices. The AHA recommends watching calorie intake to control weight, and including fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts, while limiting red meat, sugary foods and beverages, saturated fat, trans fat, sodium, and high-calorie/low-nutrient foods.2 This dietary pattern is good for preventing and treating hypertension, high LDL (bad) cholesterol, diabetes, and, when paired with portion control, overweight and obesity—all of which are risk factors for cardiovascular disease. In addition, avoiding smoking and getting at least 30 minutes per day of moderate physical activity can help protect men's hearts throughout their lifetimes.2 Jim White, RDN, ACSM HFS, a health fitness specialist and spokesperson for the Academy, says increasing activity should be a priority for longevity. "Physical inactivity is a major risk factor for cardiovascular diseases," White says. "Thirty minutes of additional exercise each day is easy to add in if you split it up throughout the day." He recommends planning an activity that's enjoyable, since sticking with that choice is important when looking to see long-term results. 2. Cancer According to the American Cancer Society, an estimated 848,200 men will be diagnosed with cancer in 2015, and more than 300,000 will die.3 Research has shown that both poor diet and inactivity increase a person's cancer risk. In fact, one-third of the cancer deaths in the United States each year are linked to poor diet, physical inactivity, and being overweight.4 "We now know that cancer develops in a series of steps over time," says Karen Collins, MS, RDN, CDN, FAND, nutrition advisor to the American Institute for Cancer Research (AICR). "Healthful eating can act throughout the cancer process to reduce risk. Diet can provide nutrients and phytochemicals that may help deactivate carcinogens before they can even begin the cancer process, decrease the chronic low-grade inflammation that can promote cancer, turn on tumor suppressor genes and alter cell signaling pathways that regulate cell growth, and stimulate apoptosis, the process in which abnormal cells self-destruct." Weight has emerged as an important factor in cancer risk. "Diet can affect cancer risk both directly and through its influence on weight," Collins continues. "Analysis of all available high-quality research supported by the AICR and World Cancer Research Fund now ties excess body fat to increased risk of nine different cancers." The AICR recommends people reduce their cancer risk by aiming for a healthy weight, being physically active every day for 30 minutes or more, and eating a plant-based diet that limits red meats and avoids processed meats.5 The following are the most common nutrition-related cancers in American men. Prostate Cancer Prostate cancer is the most common cancer in American men.6 "Though many risk factors for prostate cancer lie outside of our control," Collins says, "there's strong and consistent evidence that staying at a healthy weight lowers risk for advanced and aggressive prostate cancer. AICR estimates that approximately one in 10 cases of these prostate cancers is related to carrying excess body fat." Colorectal Cancer Colorectal cancer is the third most common cancer in American men, and the third highest cause of cancer death.6 "Colorectal cancer is strongly linked to overweight and obesity," Collins says. "According to the latest AICR analysis, the combination of a healthful diet, weight, and regular physical activity could prevent half of today's colorectal cancer in the United States—making it one of the most preventable cancers through a healthful lifestyle." "There's convincing evidence that foods such as red meat and processed meats increase risk of colorectal cancer," White says. According to Collins, red meat (beef, pork, and lamb) should be limited to no more than 18 oz per week. Processed meats, such as bacon, sausage, and hot dogs, should be limited to occasional use only, since they're even more strongly linked to colorectal cancer risk as well as risk of cardiovascular disease. "Dietary fiber is also strongly linked to lower risk of colorectal cancer," Collins adds. "It's best to get fiber from whole plant foods, because they also provide a variety of nutrients and phytochemicals that may bring additional, or perhaps even synergistic, protective benefits." Other Cancers Collins recommends men avoid high-sodium foods to help reduce risk of stomach cancer, and limit alcohol intake to two or fewer drinks per day. "While men may hear of alcohol as a heart-healthy choice, it's important to remember that excessive amounts are linked with increased cancer risk. Amounts beyond three drinks per day are now linked with increased risk of liver cancer. Excess alcohol also increases men's risk of both mouth and esophageal cancers," Collins says. She recommends a diet focused on an abundance and variety of whole grains, vegetables, fruits, legumes, nuts, and seeds as the best choice to lower cancer risk. 3. Diabetes According to the Centers for Disease Control and Prevention (CDC), an estimated 15.5 million men over age 20 in the United States are living with diabetes. An estimated 86 million more have prediabetes.7 The good news is diet and other lifestyle changes have been proven to lower risk, even in people diagnosed with prediabetes. "A lot of people think you have to cut carbs to prevent diabetes," says Eileen Sturner, RD, MS, CDE, BC-ADM, manager of the Abington Health Diabetes Centers in Abington, Pennsylvania, "but what you really need to do is cut pounds. For at-risk individuals, losing just 5% to 10% of starting weight can reduce diabetes risk dramatically," she says. The CDC-led National Diabetes Prevention Program (NDPP) has successfully demonstrated how lifestyle changes can reduce the risk of developing type 2 diabetes. This yearlong evidence-based lifestyle change program lowers diabetes risk by 58%. For participants over age 60, risk reduction is even greater, at 71%. Emphasis is placed on eating less fat (each participant is given a personal daily fat intake goal) and fewer calories, and increasing exercise to 150 minutes per week (ideally with no more than two days between activity sessions). "Having the fat gram goal works well," says Sturner, whose group is one of the program sites for the NDPP. "It allows participants to choose their own foods, and even splurge occasionally, as long as they can work it into their plan." In addition to the nutrition and exercise components, the program includes problem-solving and coping skills. "This is about long-term lifestyle change," Sturner explains. "We've found that the detailed food and activity records, the group setting, and the availability of lifestyle coaches are particularly helpful to participants." "Permanent behavior change is difficult to achieve," Sturner says, "but people with prediabetes or a high risk of developing type 2 diabetes are often intrinsically motivated to change. A program like this empowers at-risk people to take control. The men in the program feel they have the ability to take charge of their health and well-being, and that's key." 4. Vision Loss An even greater concern for men as they age is eye health. Reading glasses and bifocals may seem like a normal part of aging, but more than 8 million men across America suffer from significant vision loss or blindness.8 The leading causes of blindness in the United States are cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD).9 According to Emily Y. Chew, MD, deputy clinical director at the National Eye Institute of the National Institutes of Health, data on the impact of diet on cataracts and glaucoma are lacking or inconclusive, but a definite link exists between nutrition and AMD. A leading cause of blindness in Americans aged 60 and older, AMD is a condition that destroys the central part of vision needed to see objects clearly.9 "AMD accounts for 50% of blindness in the United States," Chew says. "People can have signs of AMD for years before symptoms appear, so regular eye exams are crucial." Research shows that good nutrition is crucial as well. The Age-Related Eye Disease Study (AREDS), which initially launched in 1992 and followed nearly 5,000 people for more than a decade, concluded in 2001 that a supplement containing vitamins C and E, beta-carotene, and zinc reduced the risk of developing advanced AMD by 25% in five years.10 "The macular pigment, which is at the center of the retina, is made up of two types of carotenoids, lutein and zeaxanthin," Chew says. "When evaluating diets, researchers found that people who had the highest dietary intake of lutein and zeaxanthin (found in green leafy vegetables such as kale, collard greens, and spinach) had a 40% lower risk of having macular degeneration than those with the lowest dietary intake." AREDS 2, launched in 2006, tested replacing the beta-carotene in the AREDS 1 formulation with lutein and zeaxanthin, and adding omega-3 fatty acids.10 Since beta-carotene increased the risk of lung cancer in people who were current or former smokers, and there was an increased benefit of lutein and zeaxanthin, these carotenoids were recommended to replace beta-carotene in the supplement.10 "Although omega-3 supplements weren't found to be helpful," Chew says, "eating fish seems to be very consistent with lowering risk in the dietary studies." Chew recommends eating a nutritious diet rich in fruits and vegetables, with an emphasis on lutein- and zeaxanthin-rich dark leafy greens, plus fish at least two times per week. If an eye exam shows early signs of AMD or the presence of the more severe stage of AMD in one eye, the AREDS 2 supplement is recommended to slow progression of the disease. 5. Arthritis In addition to diabetes, achy joints are another concern for men as they get older. Nearly 20% of men have arthritis, and the condition becomes more common with age.11 While there are different types of arthritis, what they all have in common is inflammation.12 Research has shown that some foods seem to increase inflammation, and others may decrease it. The antioxidants and polyphenols found in plants may help fight inflammation. Tomatoes, green leafy vegetables, nuts, and fruits such as strawberries, blueberries, cherries, and oranges are rich in anti-inflammatory compounds, as are olive oil and fatty fish. Fried foods, refined carbohydrates, sugar-sweetened beverages, red and processed meats, and fats such as margarine, shortening, and lard are considered inflammation-promoting.13 Whole grains also have been shown to reduce inflammation,14 and coffee may be protective.13 The Arthritis Foundation further recommends balancing omega-3 and omega-6 fatty acids to reduce the activity of the COX-1 and COX-2 enzymes that are a major cause of joint inflammation. That means individuals should eat more fish such as salmon and tuna, and less egg yolks, meats, and corn, sunflower, safflower, soybean, and cottonseed oils prevalent in snack foods, fried foods, and margarines.14 Trigger foods aren't uncommon in arthritis, and foods that help some people may increase pain in others.14 In addition to diet, exercise has an important role to play in easing arthritis pain. "A moderate walk for simply 10 minutes five days a week allows oxygen to properly flow through the cartilage and reduces pain in joints," White says. "If walking is too difficult at first, I recommend trying swimming or exercising in a pool. Water allows for more resistance but is very easy on the joints." Putting It Into Practice "Some men may wonder whether changes in diet and lifestyle can really make a difference," Collins says. "It's important they understand that research shows it's not all or nothing. Any improvement has benefits over being stuck in really unhealthful habits. Studies show that even a 5% to 10% weight loss changes inflammation, insulin resistance, and hormones. So our advice to men about weight is strong: develop healthful habits to avoid weight gain. If you're already overweight or obese, the 5% to 10% weight loss is shown to help reduce risk of heart disease and type 2 diabetes, and also will likely reduce your cancer risk." Plus, dropping unwanted pounds takes weight off the joints and can lessen arthritis pain. While the most common diseases that affect men as they age all seem different, the diet and lifestyle advice for prevention essentially is the same: eat a nutrient-rich, plant-heavy dietary pattern that includes fish, whole grains, dark leafy greens, and nuts and seeds; be active at least 30 minutes every day; control weight or strive for a 5% to 10% weight reduction; and don't smoke. In fact, the same foods that fight against heart disease, cancer, diabetes, arthritis, and vision loss also are protective against conditions such as depression and Alzheimer's disease.13 "Men can decrease their disease risk by choosing a variety of foods within all the food groups to attain all the nutrients and antioxidants needed to fight disease," White says. "Specific advice can help. For example, I recommend buying five different colors of produce as a great way to attain variety at the grocery store." For those clients looking for diet tips and recipes, the DASH eating plan, the Mediterranean diet, and the New Nordic Diet are some examples of popular plans that meet the dietary intake pattern suggested to lower disease risk, so there's plenty of ready-made guidance both in print and on the Internet. "Registered dietitian nutritionists have a crucial role here," Collins adds, "because we need to show men how to lose weight and maintain a healthful weight, using eating and lifestyle choices that also can do 'double-duty' in reducing cancer and other disease risk directly." — Judith C. Thalheimer, RD, LDN, is a freelance nutrition writer, a community educator, and the principal of JTRD Nutrition Education Services.