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Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease: Real-Life Results

 
Most men with testosterone deficiency need testosterone therapy for the rest of their life in order to achieve and maintain best possible health outcomes. Therefore, studies that investigate the effects of testosterone therapy in real-life are needed, to shed light on adherence and health outcomes in routine clinical practice.[1] While randomized controlled trials (RCTs) are gold standard in medical research [2, 3], RCTs are conducted in highly controlled environments and therefore their results may not carry over to the uncontrolled setting of real-life.[1] It is increasingly recognized that conclusions drawn from RCTs are not always a useful aid for decision-making because evaluating the value of a drug or technology requires an understanding of its impact on current clinical practice and management of patients in a real-life setting.[4]
 
A series of “real-life studies” have been conducted, all showing numerous health benefits of testosterone therapy in testosterone deficient (hypogonadal) men and confirming its safety, with an observation period of up to 17 years.[5-23] Here I summarize the results from the most recent real-life study, published February 9th 2017 in the Journal of Cardiovascular Pharmacology and Therapeutics which investigated the long-term effects and safety of testosterone therapy for up to 8 years in testosterone deficient men attending a urological office.[5] Differences in cardiovascular risk factors and deaths with testosterone therapy were compared to those seen in testosterone deficient men not receiving testosterone therapy but attending the same urological office.[5] 
 
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Testosterone treatment is NOT associated with risk of adverse cardiovascular events – the RHYME study

It is well-documented that testosterone therapy effectively restores testosterone levels in hypogonadal men and improves many health outcomes, such as quality of life [1-4], libido [4, 5], metabolic parameters [5-9] and body composition.[4, 5, 9, 10]
 
However, a few conflicting studies raised concerns about the cardiovascular safety of testosterone therapy [11, 12], which in 2015 prompted the FDA to issue warnings to physicians and patients about potential cardiovascular risks of testosterone therapy.
 
In contrast, the European Medicines Agency (EMA) acknowledged the flaws of the conflicting studies and concluded that there is no consistent evidence of harm associated with testosterone therapy, regardless of mode of delivery.[13]
 
Here I summarize the cardiovascular results of the notable RHYME (The Registry of Hypogonadism in Men) study, which contrary to prior clinical trials, enrolled men with a wide range of comorbid illnesses and cardiovascular risk factors.[14] The aim was to evaluate the safety of testosterone therapy in a sufficiently diverse population to reflect real-world, clinical experience.[14]
 
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Testosterone Therapy in Men with Prostate Cancer – Yes or No?

Historically, prostate cancer – both active and treated - has been an absolute contraindication to testosterone therapy and – from a regulatory perspective – still is. The incidence of prostate cancer is higher in older men, in whom prostate cancer accounts for one in five new cancer diagnoses.[1]
 
Thanks to improvement in early detection and treatment of prostate cancer, prostate cancer mortality has decreased 50% during the past two decades, and more men are living with a history of prostate cancer. 
 
The aging of the male population and the increasing number of prostate cancer survivors have resulted in a significant increase in the number of men presenting with hypogonadism and treated prostate cancer. Therefore, it is important to consider the growing number of recent studies which have challenged the long-standing belief that prostate cancer is an absolute contraindication to testosterone therapy.[2-4]
 
Here I summarize the results of a notable study which investigated the effects of testosterone therapy in men with treated and untreated prostate cancer [5], and conclude with the latest recommendations on managing testosterone deficiency in men with history of prostate cancer.
 
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Does Sex Boost Testosterone Levels?

Testosterone is popularly known as the “sex hormone”, with “sex” referring to both its masculinizing effects that gives rise to sex differences between men and women, as well as sex (the activity).
 
In terms of the latter, testosterone is well known for its libido boosting effect, in both men [1-4] and women [5-9] regardless of age.
 
Testosterone increases sex drive even in older women, and has thus been designated as the "infallible aphrodisiac" as early as 1940.[10]
 
But does it work the other way around also… Does sexual activity increase testosterone levels? Let’s see what research shows…
 
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Health Consequences of Subclinical Hypogonadism - riskier than previously thought

 

In discussions about diagnosis and health consequences of hypogonadism, the prime focus is given to testosterone levels and signs/symptoms.[1-3] However, emerging research has identified a less clinically evident gonadal dysfunction called “subclinical” hypogonadism (or “compensated” hypogonadism).[4, 5]
 
Subclinical hypogonadism is characterized by normal testosterone levels in the presence of elevated LH level. As testosterone levels are not markedly reduced in subclinical hypogonadism, intuitively one may think it does not confer negative health consequences.
 
However, a recent study by Corona et al., which specifically was conducted to investigate the potential health ramifications of subclinical hypogonadism, shows that it should not be neglected. Surprisingly, subclinical hypogonadism is associated with an almost 10-fold increased risk of cardiovascular mortality, which is comparable to that for overt hypogonadism! [6]
 
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How well informed are general practitioners and cardiologists about testosterone deficiency and its consequences?

A rapidly growing body of medical research is showing that testosterone deficiency (aka hypogonadism and low-T) is strongly associated with a wide range of detrimental health outcomes [1, 2], and that testosterone replacement therapy improves those health parameters that are negatively affected by testosterone deficiency.[2, 3]
 
Therefore, leading testosterone scientists now view testosterone deficiency as a cardiovascular risk factor that contributes to the development of cardiovascular disease.[4-7]
 
As general practitioners and cardiologists primarily care for these patients with cardiovascular disease, a survey study was conducted to assess their knowledge, beliefs and clinical practice with respect to testosterone deficiency and cardiovascular health.[8]
 
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Testosterone in women - is it physiological and clinically important?

Testosterone is popularly known as the "male" hormone. While it is true that men have much higher levels of testosterone than women, and that testosterone contributes to secondary sex characteristics that physiologically distinguish men from women (increased muscle mass and facial/body hair), this does not mean that testosterone isn't important in women.
 
In the same way that men need estrogen, aka the "female" hormone, for optimal health, women need testosterone for optimal health. This article will describe testosterone physiology in women and its importance for women's health, and refute the two prevailing myths that "testosterone is un-physiological in women", and that "there is no research or clinical experience supporting the use of testosterone therapy in women".... you may be surprised...!
 
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Testosterone Therapy vs. Estrogen Therapy in Surgically Menopausal Women - effectiveness comparison

In a previous article I outlined a study showing the effectiveness of testosterone therapy on menopausal symptoms in pre- and post-menopausal women. Here I will present and comment on an insightful study that compared head-to-head the effectiveness of testosterone therapy and estrogen therapy in surgically menopausal women who had their ovaries removed.[1]
 
STUDY DESIGN:
Before the surgical removal of both ovaries (bilateral ovariectomy) women were randomly assigned to either a testosterone alone, estrogen alone, or placebo groups. There were 10 patients in each group.
 
Mean age of the women was 46 years. They had underwent bilateral ovariectomy due to having uterine fibroids (aka myoma), which are non-cancerous (benign) tumors that develop in the womb (uterus).
 
HORMONE TREATMENTS:
 
The testosterone group received injectable testosterone (enanthate); 200 mg/ml.
 
The estrogen group received injectable estradiol; 10mg/ml.
 
The testosterone/estrogen group received injectable testosterone (enanthate) 150 mg + 8.5 mg estradiol/ml.
 
All groups received 1 ml intramuscular injections every 28 days for 3 months.
 
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Beneficial effects of testosterone therapy on menopause symptoms and quality of life

Testosterone levels in women decline steeply with age during the reproductive years; by the time women reach their late 40, their blood testosterone levels are approximately half what they were in their 20s.[1, 2] 
 
Symptoms of androgen deficiency, including a reduced sense of well-being, dysphoric mood (sadness, depression, anxiety, and irritability), fatigue, decreased libido, hot flashes, bone loss, decreased muscle mass and strength, changes in cognition and memory, and insomnia may occur prior to cessation of menses.[3] Pre-menopausal women frequently report "menopausal symptoms", most of which are not related to estradiol levels.[4]
 
In the past, post-menopausal women with menopausal symptoms have been treated with estrogen, and more recently with bio-identical estrogen. However, new research shows that menopausal symptoms can be treated safely and effectively with testosterone.[5] It has even been shown that testosterone therapy may be more effective than estrogen therapy for treating menopausal symptoms and improving wellbeing.[6] This is great news for women with a family history of breast or emdometrial cancer, who fear taking estrogen.
 
A notable study "Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale" investigated the effectiveness of a 3 month continuous testosterone therapy, delivered by subcutaneous implant, on the relief of somatic, psychological and urogenital symptoms in both pre- and post-menopausal women.[5] This study also investigated long-term efficacy and safety in a sub-group of women who were treated for 2-3 years.
 
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Remnant Cholesterol and non-HDL – What’s that? Why bother?

In a previous article "Blood Cholesterol Testing - don't let the routine standard lipid panel fool you!" I talked about the standard lipid panel that doctors use to check your “bad” cholesterol, aka LDL level. In "Why you need to look beyond your “bad" cholesterol” - level" I’ve also gone into some depth on why a myopic focus on LDL-C can do more harm than good.
 
In this article I will talk about 2 relatively unknown cholesterol parameters and explain why you want to keep an eye on these…
 
The routine standard lipid panel checks your levels of:
 
- Total cholesterol 
 
- LDL-C (or just LDL, low-density lipoprotein cholesterol, the “bad" cholesterol)
 
- HDL-C (or just HDL, high-density lipoprotein cholesterol, the “good" cholesterol) 
 
- VLDL-C (or just VLDL, very-low-density lipoprotein cholesterol) 
 
- Triglycerides (a.k.a. blood fats)
 
If you have read my previous articles you know the limitations of LDL-C and the standard lipid panel. However, while the advanced lipid panel gives you much more accurate information on your health status, the standard lipid panel is not totally worthless if you know what to look for…The caveat is, what to look for - non-HDL-C and remnant cholesterol – are not printed in your standar lipid test results. And your doctor may not even know about non-HDL-C and remnant cholesterol! That’s why I had to write this article…
 
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Why you need to look beyond your LDL - “bad cholesterol” - level

In the United States, cardiovascular diseases account for about 1 of every 3 deaths.[1] The cornerstone in heart disease treatment is reducing elevations of LDL, popularly known as the “bad cholesterol” (see table below “What do the terms mean?”) [2, 3], primarily with statins, the most widely used cholesterol/ heart disease drug.[4]  
 
However, when one looks at the aggregate effectiveness of statin treatment in all studies, morbidity and mortality rates among statin-treated patients still remain approximately two thirds to three quarters of those found in patients randomized to placebo.[5, 6] In the “Treating to New Targets” study there were still 80% cases of cardiovascular disease, despite intensive treatment with high-dose statins.[7]
 
Thus, many patients – even those treated aggressively with statins to meet LDL goals - have residual cardiovascular risk.[8-13] This remaining risk is associated with low levels of HDL, increased levels of triglycerides, and elevated numbers of small, dense, atherogenic LDL particles.[8, 10, 11, 14-17] and other common metabolic abnormalities that you will find out about in this article...
 
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Blood Cholesterol Testing - don't let the routine standard lipid panel fool you!

 

The mere word “blood cholesterol” strikes horror in many people. We have been indoctrinated since the well-known Framingham Study in the 1980s that the higher the blood cholesterol level, the higher the risk of heart disease.[1-3] However, much has been discovered in medical research since then. 
 
Today there is compelling evidence showing that strict reliance on the traditional cholesterol test – aka the standard lipid panel - that is routinely run in primary care, can falsely indicate that you're fine, even when you aren't. 
 
Here you will find out what to look for when interpreting your cholesterol levels...
 
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DHEA supplementation – specific health benefits for menopausal women

  • Published in DHEA

 

In a previous article "DHEA – why it is especially important for menopausal women" I explained why DHEA is especially important for women than men, and even more so for peri- and postmenopausal women. In this article, I will cover specific health benefits of DHEA supplementation for menopausal women.
 
There are indications that women with lower DHEA levels are at higher risk for cardiovascular disease and mortality.[1, 2] In postmenopausal women, lower DHEA(S) levels are linked to higher cardiovascular mortality and all-cause mortality [3] and lower DHEA(S) levels are also associated with a 41% greater risk of stroke, regardless of other risk factors.[4] These observations are supported by experiments showing that treatment with DHEA reduces experimental atherosclerosis [5-7], improves blood vessel (endothelial) function [8-11], and has anti-inflammatory [12-15] and anti-oxidative effects.[8, 12, 16, 17] Notably, some of the anti-atherosclerotic effects of DHEA are mediated by DHEA on its own, and not via its conversion to estrogen.[18]
 
Because DHEA is the major source of estrogen and testosterone in post-menopausal women, this begs the question if not all post-menopausal women should supplement with DHEA? Several studies show that DHEA supplementation confers significant health benefits beyond mere relief of menopausal symptoms. Notable are its beneficial effects on the bone, vagina, skin and prevention of breast cancer.
 
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DHEA - does it have any beneficial non-hormonal effects?

  • Published in DHEA

DHEA (dehydroepiandrosterone) is most known for being a pro-hormone which in the body gets converted to testosterone and estrogen. It is a long held view that DHEA exerts all its effects via conversion to testosterone and estrogen. However, recent studies show that DHEA also has several health promoting non-hormonal actions...

DHEA 101

DHEA is produced mainly by the adrenal cortex, and is rapidly sulfated by sulfotransferases into DHEA-S. DHEA and its sulfated form DHEA-S is the most abundant steroid (pro)hormone circulating in the blood stream.[1] The sulfated from of DHEA has a longer half-life in the blood and its levels remain stable throughout the day, are not altered significantly by the menstrual cycle. When getting a blood test for DHEA, the fraction that is routinely measured is therefore DHEA-S. In response to metabolic demand, DHEA-S is rapidly converted back to DHEA (e.g. is  hydrolyzed to DHEA by sulfatases).

DHEA levels decrease approximately 80% between ages 25 and 75 year.[2, 3] This large decline in DHEA spurred research interest in the possibility that aging related DHEA deficiency may play a role in the deterioration of physiological and metabolic functions with aging, and in the development of chronic diseases.

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DHEA supplementation in older adults helps reverse arterial aging

  • Published in DHEA

When it comes to health promotion and longevity, DHEA is a supplement which deserves more attention than it has been getting.

DHEA levels (the main circulating form of DHEA in the bloodstream is DHEAS) decrease approximately 80% between ages 25 and 75 year.[1, 2]This large decline in DHEA has led to interest in the possibility that aging related DHEA deficiency may play a role in the deterioration in physiological and metabolic functions with aging, and in the development of chronic diseases.

In support of this, it has been reported that DHEA level is negatively correlated with mortality and risk of developing cardiovascular disease (CVD) (i.e. lower DHEA(S) levels are associated with higher mortality and CVD risk).[3-5]More recently it has been found that a steep decline or extreme variability over time in DHEA(S) levels is associated with higher mortality, more so than baseline DHEA(S) levels.[6]

Aging not only reduces DHEA(S) levels, but also results in an increase in arterial stiffness [7, 8], which is an independent predictor of cardiovascular disease (CVD) risk and mortality.[9-11]

It has been reported that DHEA levels are inversely associated with arterial stiffness (i.e. lower DHEA levels are associated with increased arterial stiffness. [7, 12, 13] Therefore, it is possible that DHEA replacement in older adults could reduce arterial stiffness, and thereby contribute to reduction in CVD and mortality...

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Testosterone Thresholds and Muscle Mass Gains Needed to Enhance Muscle Strength and Function

In a previous article "Combined Testosterone and GH therapy for best results on body composition and safety profiles" I covered a study showing that testosterone replacement therapy alone produced significant gains in total lean body mass, leg/arm muscle mass, strength and aerobic endurance, together with significant reductions in whole-body and trunk fat. [1] 
 
In the same study, addition of GH (growth hormone) further enhanced these beneficial results. 
 
In a follow-up to that that study, the researchers looked deeper into the data with the following analyses: [20] 
 
- Pathway analysis to test the hypothesis that testosterone and GH affected muscle mass directly and that a threshold change in lean tissue (muscle) mass was needed to generate significant improvements in muscle performance and physical function. 
 
- Bootstrap analysis to determine threshold hormone levels associated with threshold changes in whole-body and appendicular lean mass that would be necessary for improving muscle performance and functional outcomes.
 
Here I report on the results of this insighful analysis...
 
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Combined Testosterone and GH therapy for best results on body composition and safety profiles

Prevention of age-related muscle loss (sarcopenia)

Many studies have highlighted the importance of investigating all major hormones, and correcting deficiencies and imbalances if present.[1-8] Given the known mechanisms of testosterone and GH/IGF-1 in building muscle (and possibly also DHEA in elderly) it is reasonable that age-related low levels of anabolic hormones contribute over time to sarcopenia and frailty.[1, 2, 4, 7, 9, 10]

Thus, multiple small effects in aggregate can lead to adverse loss of muscle and disability. In this scenario, if replacement was to occur, it would require lower doses of multiple anabolic hormones. An added benefit to this approach would be fewer side effects from the use of lower hormone doses [11]. In addition, multiple anabolic hormone replacement might also have beneficial additive or even synergistic effects.[11-13]

A notable study investigated whether supplementation with testosterone and GH together, in physiological doses, results in greater improvements in body composition and muscle performance in older men, compared to testosterone supplementation alone...

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What's the relation between IGF-1 and Cancer?

In a previous post I outlined the U-shaped relationship between IGF-1 and all-cause mortality.

"Association of IGF-1 (Insulin-Like Growth Factor-1) with Mortality, Cardiovascular Disease, and Cancer"

A growing body of research shows that IGF-1 has a U-shaped relationship with other health outcomes as well, including cancer. This may come as a surprise, as IGF-1 is well-known to increase cancer risk...
 
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Association of IGF-1 (Insulin-Like Growth Factor-1) with Mortality, Cardiovascular Disease, and Cancer

IGF-1 (insulin-like growth factor-1) is a peptide hormone, produced predominantly by the liver in response to pituitary GH (growth hormone).[1] IGF-1 is involved in a wide variety of physiological processes. In adults, IGF-1 has metabolic and anabolic effects, and it mediates many of the effects of GH.[2-4]
 
GH and IGF-1 levels are reduced with normal aging, a phenomenon called somatopause.[5-7] It has been suggested that somatopause is an age-related GH deficiency state.[5] Somatopause has been considered to contribute to physiological deterioration seen with aging, like reduced muscle mass, reduced exercise tolerance, decreased strength, osteoporosis, increased fat mass, elevated cardiovascular risk, impaired quality of life, cognitive/memory decline and reduced immunity.[7-12] These changes are similar to those seen in classic (non-aging related) GH deficiency (GHD).[13, 14]
 
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Multiple Hormonal Deficiencies in Anabolic Hormones in Frail Older Women

Reduced levels of anabolic hormones can contribute to aging and frailty. Most studies that have investigated this focused on the relationship between individual hormones and specific age-associated diseases. An interesting study in older women aged 70-79 years sought to examine the associations of individual anabolic hormonal deficiencies of free testosterone, IGF-1 and DHEA, and to assess their combined effects as well.[1]

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Relationship between Low Levels of Anabolic Hormones and Mortality in Older Men

The anabolic hormones testosterone, IGF-1 and DHEA (a pre-hormone) are receiving more and more attention by health professionals because the anabolic-catabolic imbalance that favors catabolism is a key factor in accelerated physical deterioration aging.[1, 2] Anabolic impairment can speed up the age-related decline in muscle mass and physical performance, increase in fat mass, development of insulin resistance, cardiovascular risk factors, metabolic syndrome and diabetes, conditions that in turn affect mortality.[3-18]

Interestingly, low levels of multiple anabolic hormones, rather than a single one, has a stronger association with age related muscle loss and the frailty syndrome. [19, 20] In men with chronic heart failure, deficiency of more than one anabolic hormone identifies patients with higher mortality rates.[21]

An interesting study sought to investigate the relationship between parallel deficiency of several anabolic hormones and mortality in a general population of older men, regardless of coexisting disease:[22]

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TRT and Fertility – how to get the best of both worlds - Clomid and HCG - part 2

In part 1 - "TRT and Fertility – how to get the best of both worlds" - I covered issues related to the effect of TRT (Testosterone Replacement Therapy) on male fertility. Here I will outline options for men to increase endogenous testosterone production by non-TRT means, and ways to speed up spermatogenesis for those who chose to go the TRT route...
 
The same strategies apply to increasing endogenous testosterone production and speeding up its recovery after supplementation, as illustrated in the figure:
 
 
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TRT and Fertility – how to get the best of both worlds - part 1

The prevalence of testosterone deficiency (aka hypogonadism or Late Onset Hypogonadism), defined as total testosterone (TT) at or below 300 ng/dl is close to 40% in men aged 45 years and older presenting to primary care offices in the US.[1] Year 2006 is was estimated that more than 13.8 million men over 45 years of age visiting a primary care doctor in the United States have symptomatic androgen deficiency.[1] 
 
A large international web survey using the Aging Males' Symptoms (AMS) questionnaire showed the prevalence of symptomatic testosterone deficiency to be 80% in men aged 16–89 (mean 52 years).[2] It is notable that in the survey 40% of respondent were at younger ages when ‘Late Onset Hypogonadism’ is generally not believed to be occurring.[2] The surprisingly high prevalence of raised scores indicating testosterone deficiency in the younger age groups may be due to the increasing prevalence of conditions in these age groups known to reduce testosterone levels, such as obesity [3-7] and chronic work stress. [8-10] Stress induced cortisol elevation, by increasing SHBG, lowers the free active fraction of testosterone and thereby reduces its action.[11] 
 
This large and rising prevalence of testosterone deficiency is gaining recognition among doctors and patients alike. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in infertility...however, in most cases, TRT induced infertility is reversible. If paternity is of interest to you, read on...
 
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Caloric Restriction for anti-aging and longevity - does it work in non-obese humans?

If you are following the anti-aging news, you’ve heard about the supposed benefits of chronic calorie restriction for increasing longevity. These claims are based on research done in various species such as flies, worms and mice.
 
Here I will explain that chronic calorie restriction makes it impossible to implement and reap the health benefits of an active lifestyle with regular exercise, and causes severe health consequences for humans.  
 
While animal studies can and do shed light on what’s going on at mechanistic level, we have to be very careful and resist the temptation to extrapolate results from animal experiments to humans.
 
Here I will make the case that chronic calorie restriction actually counteracts the prospects of a healthy vital long life.
 
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Effect of Fish Oil on Body Composition, Fat Burning & Energy Expenditure

In previous articles I covered the effects of fish oil supplementation on fat loss and muscle growth:
 
 
 
 
Here I will present the results of a more recent study that investigated the effects of fish oil supplementation on body composition and metabolic outcomes.[1]
 
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Ignore the new 2015-2020 Dietary Guidelines!

On January 7th 2016, the new 2015 Dietary Guidelines for Americans were released. One would expect this to be a state-of-the art document with practical hands-on advice that will help people make better food choices and eat healthier. Not so! If you think the new 2015 Dietary Guidelines will tell you everything you need to know about what to eat and what not to eat, you will be greatly disappointed.

I would like to applaud the commentary by Dr. Katz “2015 Dietary Guidelines: A Plate Full of Politics”. Dr. Katz is the director of Yale University’s Prevention Research Center, and president of the American College of Lifestyle Medicine. His summary of the 2015 Dietary Guidelines is “a national embarrassment”.
 
In this article I will point our some issues that Dr. Katz raised, as well as add my own reflections based on avaliable scientific evidence. To make up for the glaring void of food recommendations, I will end with a practical list of foods you want to eat more of and those to avoid...
 
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Young Men, Waist, Testosterone and Erectile Function: Low-T is not only an old man's issue

Most people, including traditional doctors, think that testosterone deficiency is an old man’s issue. This is very wrong! Actually, an excess amount of body fat can cause a man’s testosterone levels drop to as much as 10 years of aging.[1]
 
Several studies have demonstrated that too much body fat is associated with reduced testosterone levels independent of aging.[2-4]
 
Low levels of testosterone (both total and free testosterone) are a consistent feature among young men below 40 years of age with metabolic syndrome, the hallmark of which is an enlarged belly.[5]
 
Young men (20–39 years) with the lowest baseline total testosterone levels have the highest risk of developing cholesterol and blood fat abnormalities (dyslipidemia). [6] Compared to age-matched men with the highest baseline total testosterone levels of 663 ng/dL or higher, those with the lowest baseline total testosterone levels of 418 ng/dL or below had up to a twofold greater risk of developing an adverse lipid profile 5 years later, which in turn could contribute to future risk of cardiovascular disease.[6]
 
Thus, testosterone deficiency clearly has health implications also for younger men. But how much does your belly actually impact your testosterone levels… and erectile function?
 
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Keep your waist to less than half your height - for health and physical attractiveness

 

In a previous article “Watch Your Belly – not just to look good!” I summarized research showing that an expanded belly is a ticking health bomb and manifestation of deteriorating vitality, as well as reduced physical attractiveness. 
 
Measuring your waist circumference is a good starting point to see where you stand (i.e. to get your baseline) and monitor your progress with exercise and healthier eating. And esthetically, your waist measure tells a lot.
 
Nevertheless, accumulating research shows that health outcomes are more strongly associated with the ratio of your waist to your height, i.e. the waist-to-height ratio. The waist-to-height ratio is simply the ratio of your waist circumference to your height (abbreviated WHtR). To stay (or become) healthy, as well as physically attractive, make sure your waist circumference is less than half your height.
 
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Watch Your Belly – not just to look good!

Over the past two decades it has been established beyond any doubt that the amount of fat around the waist (aka abdominal fat and visceral fat) is at least as important, if not more important, than the total amount of body fat in predicting and /or causing complications that have been traditionally associated with overweight/obesity.[1]
 
Abdominal obesity is a strong risk factor for cardiovascular disease independent of BMI (a proxy for obesity) [2, 3] and is thought to affect disease risk through increased insulin resistance.[4, 5]  Actually, the common development of insulin resistance with aging is caused by growing bellies, rather than aging per se.[6] Notably, normal-weight abdominal obesity is associated with higher mortality than generalized obesity (as defined by BMI).[7]
 
An enlarged belly is an especially strong indicator of metabolic risk in men.[8, 9] People with large a waist circumference – i.e. those having a belly - have an increased risk of cardiovascular disease, diabetes and cancer, compared to those with smaller waist circumferences, regardless of BMI. [10-14] Your waist also impacts your longevity, which I covered in a previous article "Watch Your Waist - it may shorten your life!"
 
And your belly can interfere with your sex life...
 
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Dr. Pierce's Medical Organization Affiliations

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