If you're interested in testosterone

Two interesting reports out about testosterone this week.

One study’s headlines claim that contrary to the popular belief that testosterone (T) levels drop a lot as men get older, testosterone levels do not have to drop with age, although that’s not really what the study found.

Rather, this Australian study found that certain factors can make T levels drop faster than they otherwise might, and those factors include the two unsurprising ones of depression and obesity but also the very surprising one of quitting smoking, but please, please don’t take that to mean that if you’re an aging male smoker and you want to slow down the drop in your T levels that you should continue to smoke.

The other benefits of quitting smoking – at any age (including in a recent study in one’s 80s) are too huge to ignore.

The second study confirmed one of these findings by concluding that overweight men can raise their T levels by, surprise, surprise, losing weight.

Now the last thing the world may need is men with more circulating testosterone but for that small proportion of men who suffer from T levels that are so low as to impact their health, here’s one way to improve those levels.

Should you take extra vitamin D and calcium?

Here’s the problem if, as most people do, when you run across a medical news story that might affect you, you read only headlines or at most a paragraph or three: you often get a totally wrong impression of what that study or report was really about.

That’s certainly what’s going to happen to a lot of people who only cursorily read a recent report about vitamin D and calcium supplements, a report that affects millions and millions of people.

This report was a draft recommendation from the U.S. Preventive Services Task Force, a government body with a mandate to review current preventive strategies and recommendations, and the experts on this body often swim against the popular tide, as they did in coming out recently with a recommendation against routine screening for prostate cancer.

So in their most recent recommendation, the USPSTF has really roiled some experts because it has come out strongly opposed to low-dose supplementation with vitamin D and calcium for the prevention of fractures in post-menopausal women.

Please note: that’s low-dose supplementation, which the PSTF defined as 400 IU of vitamin D and 1,000 mg of calcium.

When it comes to higher doses, such as the one so many experts think may be appropriate for such women, namely 800 IU of vitamin D, the PSTF says there is not enough evidence either for or against this dose; in other words, it might work, it might not.

Yet nearly every news story about this recommendation came out with a headline like this one: USPSTF Says No to Vitamin D, Calcium for Older Women.

Well, no, it didn’t.

It said no to a low dose, maybe to a higher one, so women taking a higher dose may be doing the right thing although we need way more data about that choice.

Equally interesting, the PSTF came out very strongly opposed to recommending the use of vitamin D for cancer prevention, which flies in the face of recommendations from many authoritative groups like the Canadian Cancer Society for example, who do recommend taking vitamin D for cancer prevention.

But as I have been saying for years and the PSTF agrees with me, it’s still very unclear that extra vitamin D will in fact reduce the risk of cancer.

Even if it is an anti-cancer agent, we still don’t know what form of vitamin D to recommend for that purpose (vitamin D is sold mostly as vitamin D 2, although lots of experts believe that vitamin D3 is far more effective at doing what vitamin D is supposed to do.

And we clearly also don’t have a clue about the dose that’s needed. Or whether some people are genetically more susceptible to(or protected against) a low vitamin D blood level.

Andon and on.

Whether or not to take vitamin D supplements (and/or calcium supplements, which have been linked several times to a higher risk of heart attacks) remains an individualized decision based on many variables: inform yourself thoroughly about the pros and cons and then decide for yourself what to do. 

Sleep and ye shall not eat - junk

Two reasons you get fatter if you don’t sleep enough or sleep well enough?

One is that when we’re up, we eat. Period. After all, do you visit the library when you’re awake at 2 AM, or the fridge?

But the 2^nd reason is also important: when you do visit the fridge after hours, and trust me, we all do (but often only to check that you have milk for the next day’s coffee, and if you believe that’s the real reason anyone checks the fridge at night, you’ll also believe what politicians say), according to a new study presented at the recent annual meeting of the Associated Professional Sleep Societies, you will pick junk food.

In this study, the researchers found that functional MRIs of the brain, which measure brain activity in real-time, when people were made to be sleep deprived and they were also exposed to junk food, their areas of the brain that are “more involved in addiction” became way more active than when those people were not sleep deprived.

In other words, sleep and you will eat less. And you will eat better.

How easy it is to get the wrong message

The comedian Tommy Chong has just announced that he has been suffering from prostate cancer for 8 years, and that he has been treating it with hemp and cannabis, a happy message that will unfortunately be mis-interpreted by far too many people who will conclude, as Mr. Chong has clearly concluded, that the hemp and cannabis is the reason he’s still alive, although the evidence for that is less than slim.

First of all, the kind of prostate cancer Mr. Chong said he has – he described it as a "slow Stage 1 – has a terrific prognosis, and it’s likely that a majority of men with this kind of cancer would still be alive at 8 years post-diagnosis even if they were treating it with only mother’s love and chicken soup.

Second, and equally important, one person’s story should never make a case for a more universal approach since there are so many variables that could account for why one person has survived on a particular therapy.

The upside of prominent people discussing their own health status and a particular health problem is that it focuses the public’s attention on that problem, and that means in turn, more people become comfortable admitting that they also have that problem, which is a very good thing.

The downside is that when those people promote a particular therapy, even if it’s an off-the-wall therapy, a lot of people will conclude that that’s what they need, and that road is not a good one to go down.

Sleeping well is vital for your brain

In a study presented at the Associated Professional Sleep Societies annual meeting in Boston, researchers have concluded that in normal-weight people (both midlifers and seniors) without sleep apnea, that is, in people who do not already have 2 key risk factors for stroke (being overweight and suffering from sleep apnea), there is as much as a fourfold increase in the risk of 

stroke.

Why?

Probably because lack of proper sleep leads to hormonal and metabolic changes, is linked to a higher risk of inflammation (which is now known to play a key role in many chronic health problems), and the one that is probably particularly important, is also linked to a higher risk of high blood pressure, the major risk factor for stroke.

Bottom line: get your sleep – not just in terms of hours but also in terms of good quality – it’s crucial for brain health.

ASA not ASAP

If you’re one of the millions and millions of people who’ve decided to take ASA every day to prevent a heart attack even though you’re not at a huge increased risk of suffering one, a new huge study from Italy published in the Journal of the American Medical Association might make you think twice about your decision because there is a huge downside to taking ASA regularly (which most people rarely consider when they pick up some over-the-counter ASA), and for most people at average risk of heart attack (which is the great majority  of us), this study has concluded that downside pretty much balances out the potential gains.

More specifically, this study concludes that while taking a low-dose ASA every day will reduce the overall risk of heart attack by about 2 per 1000 users, it also increases the risk of severe and sudden bleeding by roughly the same amount.

And severe sudden bleeding with ASA carries a significant potential risk of sudden death, too, not only from bleeding from the gastrointestinal tract, but also from bleeding into the brain, what’s known as a hemorrhagic stroke, which carries a pretty grim prognosis.

As usual, there are several problems with this study, of course, starting with the fact that the researchers here defined “low dose” as anything under 300 mg/day, and most Canadians who use ASA use a lower dose than that, plus the fact that the researchers could not account for other factors that may have also contributed to a higher risk of bleeding in the ASA users such as the use of other drugs in the ASA family.

That said, it’s a very good study and pretty much backs up what lots of others have found, albeit with an overall risk of bleeding that was higher in these Italians than in other groups that have been looked at.

Bottom line: if you’re at pretty high risk of suffering a heart attack in the near future (a window of 5-10 years), most studies show a significant overall benefit to taking ASA regularly.

If, however, you’re taking an ASA every day because you’ve been suckered in by the advertising or you just think, “What the hell, there’s really nothing to lose”, well, you might want to think again.

Best thing to do is to sit down with your family doc, talk about your risks (there are terrific charts that can tell you what risks you run for a heart attack over the next 10 years), and then decide if ASA is really for you.

It might be.

And it might not.