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Best Supplements for Mens Health,

Strength, and Virility

P. D. Mangan


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Disclaimer: The author is not a medical professional and this book does not constitute medical
advice. This book contains the opinions and ideas of its author, who is not engaged with
rendering health services with this book, and it is not intended to be a substitute for qualified
medical care. The information and opinions in this book are designed to help the reader make
informed decisions. The information presented here is believed to be accurate, but the author
makes no warranties regarding its accuracy. The author shall not be liable for inaccuracies
nor for any actions taken as a result of the information and opinions presented in this book.
The author specifically disclaims all responsibility for any liability, loss, or risk, personal or
otherwise, which is incurred as a consequence, directly or indirectly, of the use and application
of any of the contents of this book. The reader should consult a qualified medical professional
before adopting any of the suggestions in this book or taking any vitamin or supplement
product.
Copyright 2014 by P. D. Mangan
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Contents


1. Introduction: How supplements can benefit mens
health, strength, and virility
2. Whey
3. Creatine
4. Zinc and Magnesium
5. Vitamin D
6. Testosterone and Aromatase Inhibitors
7. Omega-3 Fats
8. Resveratrol
9. Vitamin C, or should you take antioxidants?

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Introduction: How supplements can benefit
mens health, strength, and virility

The obvious first question when delving into taking supplements for mens health and
strength is, why? Theres a naturally skeptical attitude around that holds that
supplements, whether of vitamins, minerals, protein, or anything else are not necessary,
that a decent diet affords everything in the way of nutrients necessary for a healthy
body. A slightly different angle holds that a putative need to take supplements is the
invention of the supplements industry trying to make money off the ignorance or
paranoia of well-intentioned people who are just trying to stay healthy. In this
introduction Ill show that, while there are grains of truth in both these positions, they
are not the whole story by any means. For most people who want to attain or remain in
optimal health, certain supplements are completely necessary.

A healthy diet may offer everything needed, in certain circumstances, to attain a healthy
body. But complications arise when different people have different needs, or when they
have different objectives (such as excelling in a sport, or building muscle through
weightlifting), or when they find themselves in varying circumstances in life, for example
being older, or trying to recover from an illness. However, many people dont eat an
optimally healthy diet, or even if we think that we do, we may be missing nutrients that
we believe are in our food but are either not present at all or in dangerously low
amounts.

I would go so far as to assert that most people dont eat optimal diets for their goals.
Eating out at restaurants or fast food joints has become increasingly common, for
instance, and you are all but guaranteed to eat unhealthy food in those places. Even
when eating at home, processed food from packages, which have had many nutrients
taken out (whether deliberately or not), has become the norm. Consumption of empty
carbohydrates, such as sugar, bread, pasta, and breakfast cereals, makes up a huge
portion of many peoples diets.

Men - and thats who this book is all about - have certain nutritional needs that may
very well not be satisfied with diet alone. For example, testosterone levels have been on
a long-term decline (A Population-Level Decline in Serum Testosterone Levels in
American Men). Men concerned with this - and if youre a man, you should be - will want
to supplement optimally to be sure that testosterone levels and sperm counts are where
they should be. Older men face not only declining testosterone levels, but also issues of
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sperm quality and, especially, declining libido and sexual function. Optimal supplements
can make the difference between healthy sexual function beyond middle age and a
listless existence devoid of sexual enjoyment. Not to mention the beneficial effects these
will have on mens marriages and relationships, as well as their overall happiness.

But, before we get to supplements, what is the optimal diet? This may have different
answers depending on the person and age, but in general I believe a relatively
low-carbohydrate, paleo-style diet is best. This way of eating provides a high level of
nutrition per calorie consumed, and it also has little in the way of harmful anti-nutrients,
such as the phytates found in wheat and legumes, the trans and high levels of omega-6
fats found in vegetable oils, or gluten and sugar and a number of other things. However,
not everyone will agree with this, and even if they did, theres controversy over exactly
what constitutes paleo eating. So another way of looking at it can be found in the
acronym JERF: Just Eat Real Food. What this means is dont eat industrially
processed foods that come in boxes and bags. Dont consume food or drink with added
sugar and a list of chemical ingredients.


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Whey

One nutrient that has in recent decades been overlooked or dismissed as not being of
great importance is protein. The government and popular health writers have all
discussed how we need to limit our intake of fat, and this has caused a disaster called the
obesity epidemic - although that is a bit beyond the scope of this book. However,
relevant to attaining better health, the avoidance of fat has led to the avoidance of meat,
and since meat comes with a healthy dose of both fat and protein, many men do not get
enough of either. The relation between protein intake and obesity has been shown in
Obesity: the protein leverage hypothesis. The upshot here is that humans as well as
other animals (down to the fruit fly) strongly regulate the amount of protein they
consume, since it is a critically important nutrient. When foods that are relatively
dilute in protein are consumed, more food (and more calories) are eaten in an attempt
to increase the amount of protein. Hence the consumption of empty junk food low in
protein - think potato chips, sodas, Starbucks milkshakes, bagels, the list is nearly
endless - can cause higher calorie consumption, leading to overweight and obesity. So,
seemingly paradoxically, eating meat and other foods high in protein can help men stay
lean.

Protein also has huge effects on health. Inadequate dietary protein can result in immune
dysfunction and oxidative stress, which in turn can lead to premature aging. Sarcopenia
is the condition of muscle wasting seen in older people, and sufficient dietary protein can
prevent it: Dietary protein recommendations and the prevention of sarcopenia. In this
study, the authors state:

On the basis of recent work, we propose a novel and specific dietary approach to
prevent or slow-muscle loss with ageing. Rather than recommending a large,
global increase in the recommended dietary allowance (RDA) for protein for all
elderly individuals, clinicians should stress the importance of ingesting a sufficient
amount of protein with each meal. To maximize muscle protein synthesis while
being cognizant of total energy intake, we propose a dietary plan that includes
2530g of high quality protein per meal.

Men who lift weights and are trying to increase their muscle mass also need greater
amounts of protein, approximately 1.8 grams per kilogram of body weight. Our
consensus opinion is that leucine, and possibly the other branched-chain amino acids,
occupy a position of prominence in stimulating muscle protein synthesis; that protein
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intakes in the range of 1.31.8 g kg
1
day
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consumed as 34 isonitrogenous meals will
maximize muscle protein synthesis. (From Dietary protein for athletes: from
requirements to optimum adaptation.) But they need no more than that, which would be
needless expense. (But theres little evidence that more protein than that damages
health.)

With that preamble, we now discuss whey, a great source of protein and one of natures
miracle foods.

Whey is the fraction of liquid that remains after milk has been curdled, and represents
about 20% of the total protein, casein being the other 80%.

Now, not all protein is the same; it varies greatly in quality. The reasons for this are at
least two. One, protein is made up of amino acids and the content of these varies with the
protein source; for instance egg and legume protein have differing amino acid contents
and their value as protein sources varies with this. The second reason is that the body
uses dietary protein to synthesize its own proteins, and needs amino acids to be present
in the right proportions within a short time window.
Biological value is the measure of the amount of protein that can be incorporated into a
living organism, that is in human terms, how much of the protein you eat will actually be
used to build your body, and how much wasted or burned for energy.

The biological value of proteins ranges from a low of 64 for wheat gluten, to 100 for eggs,
to 104 for whey protein, so as you can see, whey protein is of the highest quality, in some
ways better even than eggs. This means that whey has an optimal ratio of amino acids,
and this in turn means that muscle growth will be optimized by whey better than any
other protein.

Wheys optimality doesnt end there, however. One of the constituent amino acids that
whey abounds in is cysteine. To explain the importance of cysteine, we need a slight
detour into the physiology of oxidative stress. In oxidative stress, the bodys antioxidant
system has become unbalanced. Normal metabolism generates free radicals, also known
as radical oxygen species, and the cell wants to keep these well under control, as they
can be damaging to cell structures. The main way the cell quenches free radicals is
though a small molecule called glutathione, which is the bodys main internal antioxidant.
In cases in which large amounts of free radicals are generated, glutathione can be used
up, and if the proper nutrients are not supplied, glutathione levels can remain low, and
radical oxygen species can run amok, causing much cellular damage. In this case, the cell
is said to be in a condition of oxidative stress.
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Oxidative stress is a principal feature of many health conditions, as well as aging. So its a
condition that you want to avoid, and this can be done by ensuring that ones glutathione
levels are up to snuff.

The so-called rate-limiting component of glutathione is the amino acid cysteine, and as
mentioned, whey is an excellent source of it. Cysteine is so important that some
scientists have even gone so far as to call aging a cysteine deficiency syndrome; see
Oxidative stress and ageing: is ageing a cysteine deficiency syndrome? In this review
study, the author, Wulf Droge, shows how glutathione levels decline and oxidative stress
rises with increasing age, and that provision of cysteine can restore glutathione levels to
normal and greatly decrease oxidative stress, along with its partner, inflammation. Any
man who wants to combat aging and maintain optimal health should heed this.

Cysteine can also be replenished through the over-the-counter supplement
n-acetylcysteine. However, as whey contains more of the correct ratio of amino acids, I
believe that whey makes a better choice here.
Properly manufactured whey protein also contains bioactive peptides, such as beta
lactalbumin and immunoglobulins. These peptides retain their activity when ingested.
(This seems to question the dogma that proteins are always completely broken down
into amino acids, if youre interested.) These peptides are retained only when the whey
is not denatured, so this feature of whey will only be found in a subset of them, as well
discuss. (But dont worry, if you dont opt for non-denatured whey, the other benefits
will still be there.) A small study done in mice found that those fed undenatured whey
protein had higher glutathione levels in their tissues, and that their immune responses
were better than those not fed whey. (The biological activity of undenatured dietary
whey proteins: role of glutathione.)
A point that Ive made a number of times in blogging and my previous book (Smash
Chronic Fatigue), is that aging not only predisposes to any number of illnesses, but also
resembles those crucially in many ways. To put it another way, aging just is a form of
illness. So, as we just saw, low glutathione levels are a manifestation of aging, and as well
are seen in many forms of illness. Maintaining glutathione at optimal, i.e. youthful, levels,
is critical for health, and whey will help do this. So whether you are older or not, whey
will help this critical aspect of your health.

The next aspect of whey we want to discuss is its ability to promote muscle anabolism.
Now, any man interested in maintaining his youth, his virility, and his health ought to be
weightlifting - yes, that goes for all of you, even the 80-year-olds out there. However, all
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too often one reads that supplements arent necessary for maximal muscle anabolism
with weightlifting. While they not be strictly necessary, you will have better results if
you supplement with whey. Lets look at a few reasons.

When ingested, protein breaks down into its constituent amino acids, which the body
then uses to build up its own proteins, for example in muscle. Amino acids can be divided
into two kinds, essential and non-essential. Non-essential amino acids are those that we
do not need to consume, since we have the capability of making them ourselves from
other dietary components. We do need to consume the essential aminos, not being able
to make them. The key points here are: 1) the presence of the non-essential aminos in
protein does nothing for muscle synthesis, except perhaps in extreme cases of critical
illness, such as burns or trauma; only the essential amino acids will build muscle; 2)
whey has a very high fraction of essential amino acids at around 50%. This makes whey
the ideal protein for hypertrophy and for keeping one in a state of good health in general.

Muscle anabolism is controlled by the amino acid leucine, one of the so-called
branched-chain amino acids, or BCAAs. (Until quite recently, it was thought that all
three BCAAs were involved in anabolism, but more recent research has zeroed in on
leucine as the key molecule.) Other things being equal, protein with a higher leucine
content stimulates anabolism more than protein with a lesser amount. Leucine acts as a
signaling molecule that tells the cellular machinery to make more muscle.
The effects of amino acid intake on protein synthesis in the intact rat appear to be
mediated almost entirely by a single amino acid: leucine. (From Leucine and protein
synthesis: mTOR and beyond.) Another take on this has it that leucine content is a
critical factor evaluating the quantity and quality of proteins necessary for stimulation
of muscle protein synthesis. (From Leucine content of dietary proteins is a determinant
of postprandial skeletal muscle protein synthesis in adult rats.) Its quite clear that for
purposes of muscle anabolism, high-quality protein has a high content of leucine, and
thats what whey delivers. Whey contains about 3 grams of leucine per 20 gram serving,
more than any other type of protein. (Leucine: Where whey protein gets its magic.)
The high leucine content of whey also makes it great for fat loss and body recomposition,
that is, more muscle and less fat. Leucine alters energy partitioning between fat cells and
muscle, meaning that when leucine is present, ingested calories tend to be sent
preferentially to muscle and not fat. In overweight subjects, 2.25 grams of leucine daily,
in divided doses and taken with 30 mg of vitamin B6, increased fat oxidation by about
50%. This combination also improved insulin sensitivity and reduced oxidative and
inflammatory stress. (Effects of a Leucine and Pyridoxine-Containing Nutraceutical on
Fat Oxidation, and Oxidative and Inflammatory Stress in Overweight and Obese
Subjects.)
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With the combination of preferential partitioning of nutrients to muscle, as well as
increasing fat oxidation, whey with its leucine is ideally placed for use as a supplement
for weight loss. In a study of overweight subjects on a weight-loss diet, those taking
whey protein lost much more body fat and lost much less lean mass (muscle) than those
taking a placebo. (A whey protein supplement increases fat loss and spares lean muscle
in obese subjects.) If you are trying to lose weight, the addition of of whey protein to
your diet will improve fat loss and spare your muscle, which is the ideal of weight-loss
diets.

Back to anabolism. How much does whey protein help resistance-trained men build
muscle? There are a number of studies on this, but heres an example: The effect of
whey isolate and resistance training on strength, body composition, and plasma
glutamine. In this study, recreational bodybuilders supplemented their diets with an
equal amount of either whey protein isolate or casein protein. The amount supplemented
was quite a bit, 1.5 g/kg body weight a day, which for a 75 kg man translates into an
extra 112 grams of protein a day. Those taking whey gained 5 kg of lean mass and lost
1.5 kg fat - compared to 0.8 and 0.2 respectively for the casein group. Now, these were
not newbies to bodybuilding, so the gain of 5 kg muscle and loss of 1.5 kg fat is huge, a
very big deal.

I think these results show that if you want better results from your weightlifting, you
need to be supplementing with whey.

Whey has yet other benefits as well. A recent study by an Italian group found that
branched-chain amino acids, in which whey is abundant, actually increases lifespan in
mice. They found that

Dietary supplementation with essential and/or branched chain amino acids
(BCAAs) exerts a variety of beneficial effects in experimental animals and
humans and has been recently demonstrated to support cardiac and skeletal
muscle mitochondrial biogenesis, prevent oxidative damage, and enhance physical
endurance in middle-aged mice, resulting in prolonged survival. (Branched-chain
amino acids, mitochondrial biogenesis, and healthspan: an evolutionary
perspective.)

Whey also increases satiety in addition to its effects on fat burning, so that makes it ideal
for weight loss. (Whey Protein and Satiety: Implications for Diet and Behavior.)

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Now, we still have a few more questions about whey when it comes to using it as a
supplement: the type of whey, the amount, and when to take it.

Ideally, the kind of whey you take will be non-denatured and therefore high in
biologically active peptides. This type of whey, cold- and not acid-processed, may be a
little harder to find. My favorite source is NutraBio. (I am not compensated for
recommending them.) That being said, if you cant possibly get whey from that source,
the garden-variety type used by bodybuilders and available in health-food stores or
online at Amazon will be decent substitutes, still containing most of the healthful,
anabolic ingredients of whey, such as high leucine and cysteine content.

One can also find whey protein as either isolate or concentrate, the former having a
somewhat higher protein concentration than the latter, about 95% compared to 90%.
Isolate is also more expensive, and has less lactose. But unless you have severe digestive
issues with lactose, it isnt necessary to buy the isolate; concentrate will do just as well.

If you really want to go all out, there are organic and/or grass-fed versions of whey, as
well as versions with no flavor or sweeteners, artificial or otherwise, added. You will of
course pay considerably more for these, and personally I find them not necessary.

As to how much whey should you take, this will depend on your goals, but at a minimum,
I suggest one 20 g shake daily. If you are an older man who is trying to reverse
sarcopenia, that is, muscle loss, you will probably want to take more, perhaps two to
three a day. If you are bodybuilding, drink one shake daily either before or immediately
after your workouts. (More on the question of protein timing below.) If you are trying to
lose weight while minimizing muscle loss, again, a couple shakes a day would make sense,
and using at least one as a meal replacement will work nicely. Keep in mind that none of
this is set in stone, and data as to real world effects are somewhat lacking. In most
studies, large amounts of whey, branched-chain amino acids, or leucine are used, since
the researchers want to see results from their expensive research. In real life, one may
have to figure this out for oneself.

To the question of protein timing and workouts, numerous studies have found enhanced
benefits of taking whey - and other types of protein as well, though whey has been the
most studied - near in time to exercise sessions, either immediately before or after.
Many of these studies conflict with one another, but there does indeed seem to be some
benefit to timed protein. Myself, I like to drink a whey shake immediately before a
workout; in this way, the amino acids from the protein are coursing through ones
circulation at a time when, during the workout, the bodys muscle-synthesizing
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machinery is ramping up. If you are more concerned with fat loss, fasting workouts are
to be preferred, and protein should be taken after exercise.

That being said, theres actually some ambiguity as to whether protein timing is
necessary or even works at all, as compared to just having extra protein in the diet, as
whey will do. In a recent paper, Nutrient timing revisited: is there a post-exercise
anabolic window?, the authors state:
Despite claims that immediate post-exercise nutritional intake is essential to
maximize hypertrophic gains, evidence-based support for such an anabolic
window of opportunity is far from definitive. The hypothesis is based largely on
the pre-supposition that training is carried out in a fasted state.

So, while we need to acknowledge the uncertainty in the concept of protein timing, its
also better to be on the safe side. We dont want to lift weights with no result. If youre
lifting for hypertrophy, and you dont normally eat a meal before your workouts, take a
whey shake before your gym session. If you do not normally work out fasted, whey
protein after your session will likely work as well. But whether before, after, or some
time elsewhere in the day, whey will maximize hypertrophy.



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Creatine

Lots of misinformation has been spread about creatine, so lets try to be entirely factual
here and see what creatine will or wont do, whether it is safe, and whether you should
take it.

Creatine is a naturally occurring molecule that is made by mammals, including humans,
who make it at the rate of about one gram per day. Someone eating a balanced diet will
get another approximately one gram from food, mainly from meat and eggs. So, right at
the start we can disarm one of the main tenets of criticism of creatine, by showing that it
is a completely natural substance synthesized in the body that serves a useful and
obligatory purpose.

What is that purpose exactly? Creatine inside cells cycles between its normal,
low-energy state and an activated form called phosphocreatine. Normally, creatine
stores will consist of about 60% of the activated form, 40% of the low-energy form; an
average 70 kg young man has a total creatine store of around 120 grams or so, which
varies according to amount of muscle mass - most creatine is found in muscle - and diet.
Vegetarians get little creatine in their diets and thus have lower creatine levels, which
makes them the users most likely to benefit from creatine supplementation. (Although if
youre reading this, youre probably not a vegetarian, which is highly suboptimal for
health and in some cases positively dangerous. On this, see for example Vegetarianism
produces subclinical malnutrition, hyperhomocysteinemia and atherogenesis. Among
other things, vegetarianism results in lower lean body mass.)

Phosphocreatine acts as a store of energy, and it allows muscle to increase the intensity
of exercise. With greater intensity comes greater hypertrophy. Supplementation of
creatine causes more creatine to be taken up by muscle, and this allows the muscle to
exercise more intensely. Many studies have shown the benefits of creatine for exercise
and hypertrophy. For example, in a study of resistance-trained men, the group getting
creatine increased its lean mass more than twice as much as those getting placebo, 6.3%
vs 3.1%. (Performance and muscle fiber adaptations to creatine supplementation and
heavy resistance training.) A meta-analysis found that those using creatine gained an
average of 8% more in strength than those not using it. (Effects of creatine
supplementation and resistance training on muscle strength and weightlifting
performance.) It will be obvious that an 8% advantage is more than the difference
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between winning and losing an event, and it is enough that any weightlifter should
consider it.

One could go on in this vein quite awhile, citing study after study, but suffice it to say
that if you exercise intensely, and even if your preferred form of exercise is endurance
training such as running, you should consider creatine.
What about other effects of creatine on health, those that have nothing to do with
exercise? For starters, mice supplemented with creatine lived 9% longer and performed
better on neurobehavioral tests. (Creatine improves health and survival of mice.)
Creatine may be a promising food supplement to promote healthy human aging. So, its
helps prevent aging and increases lifespan.
Creatine has been shown to be a promising supplement in many diseases and conditions
of aging.

Recent findings have indicated that Cr [creatine] supplementation has a
therapeutic role in several diseases characterized by atrophic conditions,
weakness, and metabolic disturbances (i.e., in the muscle, bone, lung, and brain).
Accordingly, there has been an evidence indicating that Cr supplementation is
capable of attenuating the degenerative state in some muscle disorders (i.e.,
Duchenne and inflammatory myopathies), central nervous diseases (i.e.,
Parkinsons, Huntingtons, and Alzheimers), and bone and metabolic disturbances
(i.e., osteoporosis and type II diabetes). In light of this, Cr supplementation could
be used as a therapeutic tool for the elderly. (Exploring the therapeutic role of
creatine supplementation.)

In summary, creatine can promote hypertrophy and strength gains in weightlifters, it
can slow the aging process, functions as a protector of the brain and nervous system, and
shows great promise in treating several diseases of aging such as Alzheimers.

A further question on creatine is its safety, as lots of misinformation has been spread on
this. Lets quote in full the abstract from a paper looking into its safety, published in the
journal Amino Acids in 2011:

Doubtful allegations of adverse effects of creatine supplementation have been
released through the press media and through scientific publications. In the
present review we have tried to separate the wheat from the chaff by looking for
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the experimental evidence of any such claims. Anecdotal reports from athletes
have appeared on muscle cramp and gastrointestinal complaints during creatine
supplementation, but the incidence of these is limited and not necessarily linked
to creatine itself. Despite several unproved allegations, liver (enzymes, urea) and
kidneys (glomerular filtration urea and albumin excretion rates) show no change
in functionality in healthy subjects supplemented with creatine, even during
several months, in both young and older populations. The potential effects
(production of heterocyclic amines) of mutagenicity and carcinogenicity induced
by creatine supplementation have been claimed by a French Sanitary Agency
(AFSSA), which might put consumers at risk. Even if there is a slight increase
(within the normal range) of urinary methylamine and formaldehyde excretion
after a heavy load of creatine (20 g/day) this is without effect on kidney function.
The search for the excretion of heterocyclic amines remains a future task to
definitively exclude the unproved allegation made by some national agencies. We
advise that high-dose (>35 g/day) creatine supplementation should not be used
by individuals with pre-existing renal disease or those with a potential risk for
renal dysfunction (diabetes, hypertension, reduced glomerular filtration rate). A
pre-supplementation investigation of kidney function might be considered for
reasons of safety, but in normal healthy subjects appears unnecessary. (Studies
on the safety of creatine supplementation.)

If you have a pre-existing health condition such as hypertension, diabetes, or kidney
disease, you should consult a doctor before beginning creatine. But, as the study says, in
normal healthy subjects this appears unnecessary.

As to the kind of creatine one should take, creatine monohydrate, the most common type
available, appears to be fine and as good as anything else. There is some concern about
impurities in creatine, and since the dose is relatively high at several grams a day, this
may be worth considering, since this would imply a relatively high intake of the
impurities as well. At least a couple of brands of creatine exist that are manufactured to
a high degree of purity, 99.8% or better, and I recommend these. One is called Creapure.
Another is made by the previously mentioned NutraBio. There may be other kinds that
are manufactured to the required degree of purity, so be sure to check.

How much creatine to take? One way to start is through a loading phase, by taking 20
g a day for 5 days, and thereafter a dose of 3 to 5 g a day. If you skip the loading phase
(and I personally have never done a loading phase), then about 3 to 4 weeks of a daily
dose of 5 g a day will get you to creatine saturation. Lower doses may suffice also, say 3
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grams, and if you weigh less then use less, the formula being 0.03 g per kg body mass a
day. So for example a 60 kg man would need only 1.8 g a day.


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Zinc and Magnesium

Our cells require a number of minerals in order to be healthy, two of the more important
being zinc and magnesium. Of course all essential minerals are important, but some of
them are not usually in short supply. Calcium, for instance, which were often told that
many people lack, will be relatively abundant in a decent diet that features plenty of
meat, dairy, and vegetables; in fact, supplementing with calcium seems to be a really bad
idea, as this is associated with increased risk of heart attack and possibly stroke as well.
(http://www.bmj.com/content/341/bmj.c3691.long) Men are at greater risk of heart
disease and at less risk of osteoporosis, so calcium supplements should be off-limits for
men - although they also increase heart attack risk in women too, and at about the same
rate.

Many people in the modern, developed world can be and are deficient in some required
minerals, zinc and magnesium among them, so supplementing makes sense.
growth-stunting zinc deficiency has been found in the U.S., with supplementation causing
increased growth. Zinc deficiency has been implicated in many disease states, from the
common cold to chronic fatigue syndrome to poor wound healing. A study of free-living,
healthy elderly people found that fully a third of them were deficient in zinc:
supplementation improved their immune function.
(http://www.ncbi.nlm.nih.gov/pubmed/8353362) One reason for zinc deficiency is the
food we eat: the best sources of zinc are to be found in meat, and some foods, such as
wheat and other grains, contain phytates, which bind zinc and other minerals and
prevent their absorption.

While severe zinc deficiency causes major problems, such as stunted growth and severe
immune deficiency, its unlikely that normal, seemingly healthy men will be suffering
from this. Marginal zinc deficiency is more of a problem in this country, and its more
common among the elderly and among vegetarians. (Another good reason not to be a
vegetarian.) As mentioned, zinc deficiency impairs the immune system, and it may do
this even in marginal cases.

For men, one of the more ominous results of zinc deficiency is low testosterone (T). In
one study of 40 normal, healthy men, aged 20 to 80, serum zinc concentrations were
significantly and fairly strongly correlated with serum testosterone levels. Also in this
study, some of the younger men were placed on an experimental, zinc-deficient diet for
20 weeks, and their T levels plummeted to only one quarter of their previous, normal
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level. And in 9 elderly men who were marginally zinc deficient, as measured by serum
zinc levels, zinc supplementation caused their T levels to approximately double. (Zinc
status and serum testosterone levels of healthy adults.)

So, you can see that zinc has a powerful effect on T levels. There is a caveat, however,
and that is that if a man has enough zinc in his body, taking more will not increase T
levels. While there are numerous studies showing the efficacy of zinc on T levels, those
who showed increased T were all at least marginally deficient to begin with. In other
studies with presumably zinc-replete men, no effect was found.

Take, for instance,a well-known supplement known as ZMA, much touted for its ability
to increase T. One study found increased that ZMA increased T levels in young football
players. (http://www.nutrabio.com/Products/zma_references.htm) Others, however,
found no effect. (http://www.nature.com/ejcn/journal/v63/n1/abs/1602899a.html,
http://www.biomedcentral.com/content/pdf/1550-2783-1-2-12.pdf) So one cant
expect miracles here with regard to T levels.

Theres another wrinkle with taking zinc as a supplement, and that is that too much can
be toxic. Zinc causes a decrease in the absorption of copper, and copper deficiency is thus
the main toxic effect of zinc. (That is, other than when huge, acutely toxic amounts are
taken.) Ive read of bodybuilders and others who announce that they take 100 mg of zinc
daily; this is just folly if done for any length of time.

The Linus Pauling Institute, a reliable source, recommends taking a multivitamin that
will ensure an intake of 15 mg a day, including dietary sources. If you eat a diet that had
plenty of meat and is low in grains -and you should be - you may already be getting
enough zinc.

My own practice is to take one 50 mg zinc tablet once a week, for insurance. This way I
can be sure that I wont be deficient, yet I will also avoid toxicity.

If you have low T levels, a serum zinc level from your doctor may be necessary. If you
decide to take zinc supplements more than once a week, then no more than 15 mg a day
as per the Pauling Institute would be the thing to do.

Magnesium is another story, with little risk of toxicity. However, in the developed world,
people seem to be even more prone to magnesium than a zinc deficiency. One study
from 2005, the latest for which solid data seems available, found that a full 68% of
American adults did not consume enough magnesium, as defined by the Recommended
19
Daily Allowance - and those who consumed less than the RDA were nearly twice as likely
to have elevated levels of inflammation. (Dietary Magnesium and C-reactive Protein
Levels) With such high odds of being deficient, and with such nasty consequences -
elevated inflammation, among other things which well discuss - you might not want to
trust your mag levels to an iffy diet. Magnesium supplementation can be of great service
to good health.

One reason for such widespread deficiency is that many of the foods that are high in
magnesium, such as chocolate, nuts, and shellfish, are not a major part of the diet for
most people. processed junk, which forms a major part of many peoples diets, is very
low in magnesium, and phytates in the grains and cereals that so many people are fond
of can prevent its absorption from the gut. One last reason for low mag levels is that a
major source of it is hard water, and most people dont drink much of that anymore.
Numerous studies have found an association between high levels of magnesium in water
and decreased rates of heart disease, including coronary artery disease and sudden
death. (See The high heart health value of drinking-water magnesium, as well as
references therein.)

Low magnesium excretion in the urine, which is a proxy for dietary intake, is associated
with increased risk of ischemic heart disease - about 60% higher in the lowest quintile of
intake. (Urinary and plasma magnesium and risk of ischemic heart disease.) However,
no association was found between serum magnesium and heart risk, and the reason for
that is important. Most magnesium in the body is stored within the cells and in the
bones, about one half in each, with only about 0.3% to be found in the blood serum.
Therefore, serum magnesium levels are a poor indicator of total body magnesium status.
If you went to a doctor asking to have magnesium levels analyzed, you will get tested for
serum magnesium, which will be of little help.

Magnesium is required by more than 300 enzymes in the human body. Protein
synthesis, muscle and nerve function, energy production, blood sugar and blood pressure
control all require it. It is crucially involved in metabolic pathways for ATP and
mitochondrial energy production. Disease states associated with magnesium deficiency
include not only the aforementioned heart disease, but hypertension, insulin resistance
and obesity, anxiety and depression, osteoporosis - and this is not even a complete list.

How can one tell if one is deficient in magnesium? To begin with, unless you eat a superb,
paleoish diet, low in grains (with their phytates), and drink hard water, it may be a good
idea to assume that you are deficient, at least marginally. One of the first symptoms of
low magnesium is muscle cramps, especially in the legs and feet. Many people wake up
20
at night with quite painful cramps in their feet; magnesium supplementation usually
takes care of it. Insomnia, depression, headaches, fatigue, heart palpitations, all of these
can be symptoms of deficiency. (Nota bene, these can all be caused by other things as
well.)

Magnesium deficiency has been shown to be associated with depression, and
administration of magnesium can ameliorate it. (Magnesium and depression: a
systematic review.) Animal studies have shown that deficiency leads to anxious,
depressive-like behavior, and that giving the animals magnesium alleviates the behavior.
In humans, magnesium supplements appear to alleviate depression rapidly. (Rapid
recovery from major depression using magnesium treatment.) Some of the abstract
from this study is worth quoting:

Case histories are presented showing rapid recovery (less than 7 days) from
major depression using 125300 mg of magnesium (as glycinate and taurinate)
with each meal and at bedtime. Magnesium was found usually effective for
treatment of depression in general use. Related and accompanying mental
illnesses in these case histories including traumatic brain injury, headache, suicidal
ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol
and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ
loss were also benefited. Dietary deficiencies of magnesium, coupled with excess
calcium and stress may cause many cases of other related symptoms including
agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache,
delirium, hallucinations and hyperexcitability, with each of these having been
previously documented. The possibility that magnesium deficiency is the cause of
most major depression and related mental health problems including IQ loss and
addiction is enormously important to public health and is recommended for
immediate further study.

Now, some of this may be hyperbole, but this and other (less hyperbolic) studies point
towards the involvement of magnesium deficiency in depression. For anyone who is
depressed, mag supplementation would seem to be a low-risk line of attack.

Magnesium deficiency is also associated with low testosterone. In a study of men 65
years of age or older, the relationship between magnesium and total testosterone
remained strong and highly significant... In a cohort of older men, magnesium levels are
strongly and independently associated with the anabolic hormones testosterone and
IGF-1. (From Magnesium and anabolic hormones in older men.) It has also been found
that magnesium supplementation can increase T levels, even in a cohort of young,
21
healthy athletes. (Effects of Magnesium Supplementation on Testosterone Levels of
Athletes and Sedentary Subjects at Rest and After Exhaustion.) So, it looks like if you
want to maximize T levels as well as anabolism (IGF-1), then you want to ensure that
your mag levels are up to snuff.

As noted, magnesium plays a role in over 300 enzyme systems, and importantly, energy
production is one of them. My book on chronic fatigue (op. cit.) noted the pivotal role it
has in fatigue states. Feeling tired much of the time? Ensure youre getting enough mag.

Magnesium affects exercise, as is to be expected. A study of novice weightlifters found
that strength increases were greater in mag supplemented subjects.
(http://www.ncbi.nlm.nih.gov/pubmed/1619184.) A review article on magnesium and
physical function states, These lines of evidence led to consider magnesium as
potentially limiting element for human physical performance, creating the rationale for
the routine use of magnesium supplementation during intense endurance exercise. (The
Interplay Between Magnesium and Testosterone in Modulating Physical Function in
Men.) Magnesium wont boost performance in men who have no deficiency, but will most
assuredly harm their performance if they do have one. And given that so much of the
population does not consume enough magnesium, one doesnt want to take the chance of
deficiency.

Magnesium has a low risk of toxicity, which usually occurs in people with some degree of
impaired kidney function. If one has kidney or heart disease, a doctor should be
consulted before supplementation. That being said, most people will benefit from several
hundred milligrams of magnesium daily, a typical daily dose being 400 mg, in divided
doses. Certain forms of magnesium (milk of magnesia, Epsom salts) are used in laxatives,
so diarrhea may be a sign that youre taking too much, although as Ill discuss this should
not be a problem with the form of mag that I recommend.

The type of magnesium you take is quite important. If you decide to supplement and
head to your local drug store, youre likely to find magnesium oxide. This form has been
shown to be very poorly absorbed; in some studies none of the magnesium oxide taken
was absorbed from the gut. One feature of the laxative forms of magnesium such as milk
of magnesia is that they are not absorbed at all. Magnesium aspartate is another form
that I do not recommend, as the aspartate can potentially cause a form of of toxicity call
excitotoxicity, which affects neurons and brain tissue.

22
The type you want is magnesium citrate, which is readily absorbed and has a low toxicity
profile. Most kinds come in tabs or capsules that contain 200 mg mag. (Dont confuse the
total weight with the mag content.)

As I mentioned above, lack of magnesium can cause insomnia, and provision of it can
reduce anxiety and induce relaxation. So, the best time to take supplemental magnesium
is at bedtime. This can help ensure a good nights sleep. For those who suffer from
muscle cramps at night, this can also put an end to those.




23
Vitamin D

Consciousness of the importance of vitamin D has greatly increased in the past decade or
so. Not only is it vitally important for good health, but the rate of deficiency is quite high.
Thats why its being discussed here: many people likely dont get enough, and
supplementing is a good way to remedy that.

Vitamin D is in reality not so much a vitamin as it is a hormone. It is made in the skin via
the action of sunlight on cholesterol, and transformed in the body into calcitriol, for which
target receptors exist in most body tissues. Its protective against heart disease, immune
disorders, infections, diabetes, cognitive disorders including dementia, osteoporosis, and
muscular disorders.

Vitamin D deficiency is strongly associated with all-cause mortality, as well as mortality
from cardiovascular and respiratory diseases, and cancer.
(http://ajcn.nutrition.org/content/97/4/782.short) You do not want to be deficient,
especially since supplementation is cheap and easy.

Besides deficiency being associated with increased mortality, supplementation has been
shown to decrease mortality.
(http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007470.pub2/abstract) In
one study, supplementation with vitamin D resulted in a nearly 80% decrease in the risk
of cancer. (http://ajcn.nutrition.org/content/85/6/1586.short)

Of particular interest to men, vitamin D levels are associated with testosterone levels;
causality seems to be the case here, since T levels show the same seasonal variation as
vitamin D; T levels were about 20% higher in August than in March. (Association of
vitamin D status with serum androgen levels in men.) Vitamin D receptors and
metabolizing enzymes are found in the male reproductive tract
(http://humrep.oxfordjournals.org/content/25/5/1303.short) Vitamin D levels are also
positively associated with sperm motility, and could be an imprtant factor in male
infertility; at least, this is the case in animal studies, in which vitamin D increased
fertility. http://humrep.oxfordjournals.org/content/26/6/1307.full)

Vitamin D plays an essential role in muscle function, and low vitamin D levels are
associated with an increased risk of sarcopenia (loss of muscle mass).
(http://press.endocrine.org/doi/abs/10.1210/jc.2003-030604) In a clinical study, 93%
of patients presenting with musculoskeletal pain were deficient in vitamin D.
24
(https://www.sciencedirect.com/science/article/pii/S0025619611627420?np=y) While
all of the studies that I could find relating to vitamin D and muscle focused on either
pathological states or normal function, theres good reason to think that being low on
vitamin D could impair athletic performance. In order to optimize your workouts in the
gym, you will want to ensure optimal vitamin D status. Dr. John Cannell has written a
nice roundup of the possible effects of vitamin D on peak athletic performance, and
several lines of evidence, as well as older research from Germany and Russia, point to
the fact that D is necessary for athletes.
(https://www.vitamindcouncil.org/newsletter/newsletter-peak-athletic-performance-a
nd-vitamin-d/ )

Deficiency of vitamin D is strongly suspected of playing a role in major depression.
(http://jop.sagepub.com/content/25/10/1320.short) If you are depressed, getting a
vitamin D test is recommended.

How ill you know if you need to take vitamin D, or get it from other sources such as
sunlight? The gold standard is a blood test, but this obviously costs money for both your
doctor and the test.

Its also possible to take too much vitamin D, although fear of toxicity seems to be
exaggerated.

If you decide to supplement with vitamin D, how much should you take? The Vitamin D
Council has a nice table
(http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-bo
dy-needs/ ) which shows the recemmendations of three different groups. The Council
itself recommends 5,000 IU daily for adults; The Endocrine Society, a group of
professionals including doctors and scientists, recommends 2000 IU daily; finally, the
Institute of Medicine, which speaks for the U.S. government, recommends a mere 600
IU daily. I believe that the Council recommendation of 5,000 IU is about as high as
youd want to go, unless you have demonstrated deficiency. If you are on the small side,
consider that as well, since dosage varies by body weight. However, the only way to
know whether you need vitamin D is through taking a blood test.

If you work or play a lot outdoors in a sunny climate, you likely dont need any D
supplements, although people who do just that have sometimes actually been in a
deficient state. And the darker your skin, the harder it is to make vitamin D in the skin
via sunlight, so that needs to be factored in as well.

25
Testosterone and Aromatase Inhibitors

Testosterone normally declines with age in men, but for a man trying to get decent
information about whether his T levels are normal for his age or not, he can have a hard
time. The so-called normal range for T covers a wide swath of androgenic territory, for
instance one source (and sources will vary somewhat, which is fine) has it as 270 to 1070
ng/dl (thats nanograms per deciliter). Thats a nearly four-fold range from low to high.
It doesnt take much scientific or medical knowledge to see infer that a man with a T
level four times higher than another may have a very different masculine experience -
more energy, higher sex drive, better body composition - and yet the medical profession
may very well tell both men that they are normal.

The European Male Aging Study defines testosterone deficiency as a level less than 320
ng/dl; yet some labs and doctors define that as normal, so you see the problem. Many
men report symptoms, such as low libido or fatigue, at levels higher than this.

Heres what a recent article, Testosterone Deficiency, had to say:

Testosterone deficiency (TD) afflicts approximately 30% of men aged 40-79
years, with an increase in prevalence strongly associated with aging and common
medical conditions including obesity, diabetes, and hypertension. A strong
relationship is noted between TD and metabolic syndrome, although the
relationship is not certain to be causal. Repletion of testosterone (T) in T-deficient
men with these comorbidities may indeed reverse or delay their progression.
While T repletion has been largely thought of in a sexual realm, we discuss its
potential role in general men's health concerns: metabolic, body composition, and
all-cause mortality through the use of a single clinical vignette.

Low T levels seem to increasingly be found in younger men, even below the age of 40.
There has been a long-term, population-level decline in T levels in American men; men
20 years ago had higher T levels in general, even at the same age. The reasons are still
up for debate: rising obesity appears to be ruled out, but endocrine disruptors have not.
Endocrine disruptors, such as phthalates and other chemicals, are found in soaps,
cosmetics, and plastics, among other things, and we appear to be increasingly exposed to
them. Furthermore, estrogens from birth control pills have been found in drinking
water.

Whatever the cause, T levels are on the decline, and the next victim may be you.
26

The first thing that needs to be done is to get tested, and most doctors will at least do
this. But as noted above, the normal ranges are indeed very wide, and if you come in
above, say, 270, your doctor may just tell you that youre normal and then youre out of
luck, unless you can talk him into a course of action. Well discuss how to do that below.

Doctors have a small problem in that testosterone is classified as a Schedule III drug by
the DEA. (Schedule III drugs have a moderate to low potential for physical and
psychological dependence.) This means that a doctor faces extra scrutiny when
prescribing T, and he may be unwilling to face that scrutiny.

One solution is to find another doctor, which may of course be time-consuming and
expensive. Another solution is to get your doctor to prescribe you an aromatase
inhibitor. To describe what that is and what it does, we need a brief excursion through
the physiology of testosterone.

The testes make T, and its production is under the control of luteinizing hormone (LH),
which is made in the pituitary gland. LH is under negative feedback control by estrogens,
especially estradiol, the most potent estrogen. All men naturally have some estrogens,
which are required for things like bone growth. These estrogens are made from T by the
action of an enzyme, aromatase. As men get older - although this can occur in younger
men too - the activity of aromatase increases, and more estrogens are made from T.
When the estrogen level rises, it causes feedback inhibition of LH, which then causes a
decrease in T production. So youve got a double whammy: both increased estrogens,
and decreased T. As you can imagine, that could put a sizable dent in ones masculinity,
in addition to increasing the risk of diabetes, obesity, and frailty.

Enter the aromatase inhibitor, a drug that does exactly that. When the aromatase
inhibitor goes to work, less T is converted to estrogens, there is now less feedback
inhibition of LH, which then rises, and in turn this causes an increase in T levels.

To see whether and how this works, lets turn to a neat piece of research: Effects of
Aromatase Inhibition in Elderly Men with Low or Borderline-Low Serum Testosterone
Levels. This study looked at men aged 62 to 74 with low T levels, and put them on the
aromatase inhibitor anastrozole. Importantly, the subjects were divided into two groups;
the first group received anastrozole, 1 mg, daily for 12 weeks. The second group took 1
mg anastrozole only twice a week, on Monday and Thursday, for the same 12 weeks.
Free and total testosterone was measured. The results were quite good: free T levels
27
more than doubled in group 1, and rose about 50% in group 2. Total T levels rose about
50% in group 1, 20% in group 2. See charts below.

As can be seen, virtually all of the rise in T levels occurred in the first 4 weeks. But this is
even a bit misleading, since it was only at week 4 that the first T measurement was
made; very likely the rise in T occurred much sooner than week 4.




Quote from the study:

This study demonstrates that aromatase inhibition is an effective
means of increasing testosterone production in elderly men with low
or borderline low serum testosterone levels. Specifically, in this study we
have shown that anastrozole, even at low doses, increases serum LH and
testosterone levels robustly while decreasing serum estrogen levels in a more
modest fashion.

Current testosterone replacement methods have important limitations. Oral
androgens are potentially hepatotoxic and injectable testosterone esters result in
supraphysiological peaks of testosterone levels followed by hypogonadal troughs
(39). Transdermal testosterone patches frequently cause local skin reactions and
are associated with a decline in serum testosterone concentrations toward the end
of the treatment period (40). Testosterone gels appear to cause fewer
dermatological reactions but can be associated with transmission of testosterone
from male patients to female partners (41). Thus, a well-tolerated orally
administered agent may have unique potential as a means of
androgen replacement therapy. Furthermore, gynecomastia is a common
28
side effect of current modes of androgen administration (27) but does not occur
with aromatase inhibition as estrogens are reduced.

So, anastrozole boosted T levels robustly, and the authors of the study are quite
enthusiastic about its ability to do so. They discuss how the prescription of an aromatase
inhibitor has many advantages over pills, patches, gels, and injections of T.

So, you may be asking yourself, thats all well and good, but these were older men,
clinically hypogonadal, low T, etc., but can this work on younger men with normal T
levels? Why, yes, it can. Pharmacokinetics and Dose Finding of a Potent Aromatase
Inhibitor, Aromasin (Exemestane), in Young Males. (Note that this study used a
different aromatase inhibitor, exemestane, but the principle is the same.) These
subjects, who began with T levels in the 500s, saw an increase in T of about 60%.

A paper took a look at therapies: Aromatase inhibitors in men: effects and therapeutic
options. Aromatase inhibitors may be an attractive alternative for traditional
testosterone substitution in elderly men because these compounds can be administered
orally once daily and may result in physiological 24 h testosterone profiles.

To summarize: aromatase inhibitors may be a decent option for raising T levels. They
have few side effects, work well, and doctors may be more likely to prescribe them.
Furthermore, the most prominent inhibitor, anastrozole, is generic and cheap - as little
as a few, single-digit, dollars a month. Obviously a prescription drug such as anastrozole
doesnt fall under the heading of supplements, but few enough men have heard of
them that they are well worth discussing here.

Now, T replacement therapy will cost a lot more, but it may be the thing to do for those
with either very low T levels to begin with, such as some elderly men, or those who want
to boost their T to supraphysiologic levels. TRT does have a few drawbacks. T for
injection, e.g., must be injected (usually) weekly, and results in a cycle of T, higher just
after injection, and then decreasing until the next one. This is not a normal, physiological
course for T to take.

Gels can also be expensive, although the main one, AndroGel will soon be going generic;
currently it may cost hundreds of dollars a month. Gel must be kept firmly away from
women and children - they are not even supposed to touch you where youve applied it,
as it risks their virilization. (Easily understood with most men having ten times the T
level as women - a small amount goes a long way with them, and with children.) T
patches, which run on the same principle as gel, may also be quite expensive.
29

Also, as noted above, oral forms of T may have problems of hepatotoxicity.

Specialized anti-aging clinics may be much more willing to prescribe testosterone, but of
course this is also an expensive option.




30
Omega-3 Fats

Heart disease and cancer are leading causes of death for men; for heart disease, in fact,
after age 25, men die of heart disease at 1.5 times the rate of women, and after age 65, at
2.5 times the rate. Men also have higher death rates from cancer, ranging from about
double the rate of women for leukemia and about five times the rate for laryngeal
cancer. (Men Have Higher Cancer Death Rates Than Women.) So men in particular will
want to do everything in their power to reduce their chances of cancer and heart disease,
since they are at such increased risk for them. This is where omega-3 fats come into
play. As we will see, they have some other beneficial effects which will be of particular
interest to men.

Heart disease and cancer are in large part due to increased levels of inflammation. In
recent years, one cause of that inflammation has come to light, and that is the imbalance
in the diet between omega-3 and omega-6 fats.

Omega-6 fats in the diet come largely from vegetable oils and the processed foods that
use these oils as an ingredient. (You should avoid vegetable oils whenever possible,
which means avoiding processed food.) Omega-6 fats are required in the diet; the
problem comes with the massive amounts we are exposed to in the modern era.

So what are these omega-6 and -3 fats? These are polyunsaturated fats, which are
distinguished from saturated fats and from each other by their chemical structure.

Much evidence suggests that humans evolved with a diet that provided them with a
ratio of omega-6 to omega-3 essential fats of about 1. But in the modern West, the ratio
of the two is much higher, as high as 20 to 1 or more. So the problem is either or both an
excess of omega-6 fats or a deficiency of omega-3. It is currently thought that the ratio
of the two is more important than absolute amounts.

The much higher ratio of these two that is present in the modern Western diet promotes
cancer, cardiovascular disease, autoimmune diseases. Men should avoid having a high
omega-6/3 ratio, and should also avoid sources of large amounts of omega-6 fats, such as
vegetable oils.
31
Lets look at some of the evidence for this. In a study of male physicians, The n-3 fatty
acids found in fish are strongly associated with a reduced risk of sudden death among
men without evidence of prior cardiovascular disease. (Blood levels of long-chain n-3
fatty acids and the risk of sudden death.)
The following is from the conclusion of a paper representing the official position of the
American Heart Association, Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and
Cardiovascular Disease.
Omega-3 fatty acids have been shown in epidemiological and clinical trials to
reduce the incidence of CVD. Large-scale epidemiological studies suggest that
individuals at risk for CHD benefit from the consumption of plant- and
marine-derived omega-3 fatty acids, although the ideal intakes presently are
unclear. Evidence from prospective secondary prevention studies suggests that
EPA+DHA supplementation ranging from 0.5 to 1.8 g/d (either as fatty fish or
supplements) significantly reduces subsequent cardiac and all-cause mortality.
For -linolenic acid, total intakes of 1.5 to 3 g/d seem to be beneficial.
Collectively, these data are supportive of the recommendation made by the AHA
Dietary Guidelines to include at least two servings of fish per week (particularly
fatty fish).
As for cancer, one review states, Data on marine omega-3 fatty acids for cancer
prevention have been suggestive but inconsistent.
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253961/) From one of those
suggestive studies: Our results from this long-term prospective study suggest that
intakes of fish and long-chain n-3 fatty acids from fish may decrease the risk for
colorectal cancer. (http://www.ncbi.nlm.nih.gov/pubmed/18483335)

In animal models, omega-3 fat supplementation offers significant protection against
Alzheimers disease and decline of cognitive function.
(http://www.ncbi.nlm.nih.gov/pubmed/22002791) In a review of human evidence, the
authors state:

Aging contributes to physiological decline and vulnerability to disease. In the
brain, even with minimal neuronal loss, aging increases oxidative damage,
inflammation, demyelination, impaired processing, and metabolic deficits,
particularly during pathological brain aging. In this review, the possible role of
docosahexaenoic acid (DHA) [an omega-3 fat] in the prevention of age-related
32
disruption of brain function is discussed. High-fat diabetogenic diets, cholesterol,
and the omega-6 fatty acid arachidonate and its prostaglandin metabolites have
all been implicated in promoting the pathogenesis of Alzheimer's disease.
Evidence presented here shows DHA acts to oppose this, exerting a plethora of
pleiotropic activities to protect against the pathogenesis of Alzheimer's disease.

One recent study found that DHA supplementation increased memory and reaction time
in healthy young adults. (http://ajcn.nutrition.org/content/97/5/1134.full) The effects
on Alzheimers, cognitive function, memory, and reaction time all make sense when one
understands that the brain has a high concentration of DHA and is a necessary
component of the cell membranes of neurons. Without enough DHA, the brain simply
doesnt function as well as it should.

For men on the self-improvement track, omega-3 fats increase anabolism. Omega-3
polyunsaturated fatty acids augment the muscle protein anabolic response to
hyperaminoacidemia-hyperinsulinemia in healthy young and middle aged men and
women. In this study, the anabolic response to amino acid and insulin infusion increased
by about 50% in the subjects who had supplemented with fish oil for 8 weeks. Fish oil
makes all cell membranes normally flexible and responsive, as they should be, and
therefore receptors require less stimulation to function properly.

The same phenomenon of increased anabolism with fish oil was also found in older
adults. (http://ajcn.nutrition.org/content/93/2/402.short) Many observers believe that
fish oil might be of great use in the prevention of sarcopenia, or muscle wasting in older
people.(http://link.springer.com/article/10.1007/s10522-012-9385-4)

Undoubtedly youve seen many older men who, though they may have kept their
stomachs flat and their figures lean, also have little muscle left. Stick legs and arms, no
rear end. Thats sarcopenia, and thats why every man getting older needs to be aware
of this condition and do something about it. Doing something would include resistance
training, fish oil, creatine, and a few other things well be discussing later.

So, the evidence appears fairly good that omega-3 fats will prevent cardiovascular
disease, but somewhat equivocal that they will prevent cancer. The evidence seems
quite a bit better for effects on the brain. Theres extremely good evidence for the
increased anabolism effect of fish oil. What I think important here is to realize that
omega-3 fats are not a cure-all, but likely provide a certain amount of insurance or edge
for the man wanting to take charge of his health.

33
There are three main kinds of omega-3 fats that one should be aware of. One is alpha
linoleic acid (ALA), and this is found mainly in plant foods such as nuts and flax seeds.
However, it must be converted into one of the other two omega-3 fats to be used in the
body, and this conversion process is slow and inefficient. For the purposes of
supplementation, I recommend that you use the other two omega-3s directly.

Those other two omega-3 fats are EPA and DHA, which are found mainly in fish and fish
oil. These are the fats that can be used directly by the body without conversion.
Unfortunately, not that many men eat fish (anymore), so supplementation with fish oil is
a quick and easy way to get your omega-3s.

Fish oil capsules have become common as a way to supplement omega-3 fats. However,
due to both the way they are made and the way they are distributed to the customer,
the oil in these capsules is much more likely to become oxidized. They may be shipped in
warm weather and they may sit for months or perhaps years on store shelves at room
temperature. Fish oils are very readily oxidized, and the conditions of fish oil capsules
makes that likely. You do not want to take oxidized fish oil, as that will negate any
possible advantages or might even be actively harmful.

Cod liver oil is a better choice. Bottles of cod liver oil are tightly sealed and most or all of
them are flushed with nitrogen to remove any trace of oxygen. After the bottle is
opened, it must be refrigerated.

How much to take? While this will depend on your individual needs and circumstances,
its important not to take too much. Large amounts of fish oil have been associated with
bleeding and cerebral hemorrhage. Large amounts of polyunsaturated fats, especially
omega-6s but also omega-3s, do not appear to be healthy.

The American Heart Association recommends 1 gram of EPA plus DHA daily for people
with heart disease. (And if you do have heart disease or any other health condition, you
should consult a doctor before supplementing with fish oil.) While there are no standard
doses of fish oil, we could take that 1 gram recommendation as an upper limit for healthy
people. If you are healthy, and you have eliminated major sources of omega-6 fats, such
as vegetable oils, from your diet, a much smaller dose should do the job. Personally, I
take one teaspoon of fish oil about three days a week. (I do not have heart disease or
anything similar.)

One teaspoon of cod liver oil contains just under one gram of DHA and EPA combined,
the rest of the oil being saturated and monounsaturated fat. A typical fish oil capsule
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contains about 300 mg of omega-3s, or about a third the amount in a teaspoon of cod
liver oil.

Are we done here? Make sure you get enough omega-3 fats in the form of fish oil. A
teaspoon of cod liver oil a few times a week ought to suffice, unless you have special
health needs, such as heart disease; in which case, talk to a doctor.


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Resveratrol

Resveratrol barely needs an introduction, having become known as the premier
anti-aging supplement in recent years. Thats because it works. Animal studies have
shown robust effects on metabolism, (anti) obesity, and longevity, although human
studies are fewer in number and show somewhat less dramatic effects. The literature on
resveratrol is by now immense, so lets just touch on a few key ones, and especially those
that will be of most interest to men.

Calorie restriction has been shown to be the most effective anti-aging method around,
and resveratrol is essentially a calorie restriction mimetic. In mice fed a high-calorie diet,
resveratrol improved survival and increased insulin sensitivity, among other beneficial
changes. (http://www.nature.com/nature/journal/v444/n7117/abs/nature05354.html)

Resveratrol enhances exercise performance: Improvements in skeletal muscle strength
and cardiac function induced by resveratrol during exercise training contribute to
enhanced exercise performance in rats. The study found that the addition of resveratrol
to the diet increased fat burning by about 20%. In another study using mice, it was
found that mice treated with resveratrol could swim to exhaustion a full 2.5 times longer
than untreated mice. (Resveratrol protects against physical fatigue and improves
exercise performance in mice.)

Resveratrol enhances exercise and increases fat-burning through an increase in the
number and efficiency of mitochondria, the cells powerhouses.
(https://www.sciencedirect.com/science/article/pii/S0092867406014280?np=y) The
maladies of aging are largely due to, or at least accompanied by, mitochondrial
dysfunction. So the mitochondrial action of resveratrol is important and significant.

Resveratrol looks to be a potent cancer preventative. Quote: The remarkable message
emanating from these three preclinical efficacy papers is that exquisitely low daily doses
of resveratrol (between 200 g/kg and 2 mg/kg)... suffice to exert potent cancer
chemopreventive efficacy and pharmacodynamic activity in three chemical-induced rat
carcinogenesis models. These reports render resveratrol one of the most potent
diet-derived chemopreventive dietary polyphenols ever described. The dose described
would be up to about 150 mg for a 75 kg man. No more than that appears to be
necessary for cancer prevention.

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Since resveratrol is cheap, appears to have very low toxicity, and has the potential to
prevent cancer, all these make it a supplement worth taking.

It also seems to have potent effects against heart disease, in part by preventing platelet
aggregation and protecting heart cells against oxidative stress. (Resveratrol in
cardiovascular health and disease.)

A potent anti-aging process found in all cells is called autophagy, in which cells break
down older constituents, including proteins and organelles, for recycling. Autophagy
declines with age, and is upregulated by fasting. (This is perhaps the main reason why
intermittent fasting is a very healthy practice.) Resveratrol also upregulates autophagy.
(Caloric restriction and resveratrol promote longevity through the Sirtuin-1-dependent
induction of autophagy.)

Resveratrol appears to work through hormesis; that is, a small dose confers protection
and larger doses are either not better or possibly toxic. That means that more is not
necessarily better. The dose mentioned above, 20 mg per kilogram of body weight, will
work just fine. The amount of resveratrol found in red wine is quite small at about 5 mg
per liter, which means that youd have to drink an awful lot of wine to get enough of it.
Supplementing makes a lot more sense.

Perhaps the cheapest way to supplement resveratrol is to by it in bulk. This comes in
loose form with a small scoop; the one drawback to this is that it takes like I imagine dirt
tastes like. So dont add it to anything like a shake, just dump that small scoopful into
your mouth and relish it.


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Vitamin C, or should you take antioxidants?

Now well discuss a somewhat controversial aspect of supplements, vitamin C and
antioxidants in general. What, you didnt realize that vitamin C was controversial? Ill
show you why.

Vitamin C has gone back and forth in the public mind from something that prevents or
cures colds, to a useless waste of money, to a damaging cause of kidney stones, and back
again to its current status, which is, I would say, mixed.

The main reason that vitamin C and some other vitamin supplements, notably vitamin
E, have become controversial is because of their effect on exercise. Awhile back, some
researchers found that vitamin C actually abolished the healthful effects of exercise.
Ristow et al.: Antioxidants prevent health-promoting effects of physical exercise in
humans. In essence, they found that exercise alone does what its supposed to do, one of
which is to increase insulin sensitivity. But they found that exercise did not accomplish
that in the presence of antioxidants, namely 1000 mg of vitamin C and 400 IU of
vitamin E daily. To give an idea of this studys importance, its been cited 565 times as of
this writing, a large number for a study on exercise physiology.

There have been a number of criticisms of this study, which well get to in a moment. But
for now one that Ill point to for our purposes is that both C and E were used, so we dont
know which one, or both, or only both in combination, caused this effect.

Another study by a group of Spanish scientists found that Oral administration of vitamin
C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations
in endurance performance. Quote:

The administration of vitamin C significantly (P = 0.014) hampered endurance
capacity. The adverse effects of vitamin C may result from its capacity to reduce
the exercise-induced expression of key transcription factors involved in
mitochondrial biogenesis. These factors are peroxisome proliferatoractivated
receptor co-activator 1, nuclear respiratory factor 1, and mitochondrial
transcription factor A. Vitamin C also prevented the exercise-induced expression
of cytochrome C (a marker of mitochondrial content) and of the antioxidant
enzymes superoxide dismutase and glutathione peroxidase.

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At this point you may be thinking that youll just skip the vitamin C, since it appears to
put a big dent in the physiological benefits of exercise. Not so fast. Normal adaptations to
exercise despite protection against oxidative stress. In this study, the scientists studied
rats who were given large dose of both vitamin C and E, and studied their responses to
exercise. They found increased numbers of GLUT4 receptors, increased numbers of
mitochondria, and higher levels of superoxide dismutase, an internal antioxidant
enzyme, and vitamin supplementation did not affect this. The authors of this study
criticize both of the two previously cited studies on methodological grounds, essentially
saying that they didnt do measure what they wanted correctly. They also make the
following perceptive statement:

A large proportion of endurance athletes, including elite athletes, take vitamin
supplements, often in large amounts (28). If taking ascorbic acid and -tocopherol
markedly reduced the effects of training on VO2 max and endurance (6) and
prevented the adaptations in skeletal muscle that mediate increased endurance
and the enhancement of insulin action responsible for glycogen
supercompensation (6, 23), taking antioxidant vitamins would make
competitive athletes noncompetitive. It seems unlikely that a
phenomenon of this magnitude would not have been noticed over the
long period that these vitamins have been available. It also seems
improbable that an effect of this magnitude would not have been recognized in the
numerous training studies that have been reported. Training studies
conducted to determine whether antioxidant vitamins improve
exercise performance and/or enhance the effects of training on VO2
max and exercise capacity have generally not shown an improvement
in performance (4, 14, 18). However, they have also not shown any
reduction of the adaptive response, which argues against the
conclusions of Gomez-Cabrera et al. (6), Ristow et al. (23), and
Strobel et al. (30). Antioxidant vitamins do have a protective effect against
exercise-induced oxidative stress (27), and therefore, it is possible that
antioxidant vitamins could have a protective effect against cumulative effects of
strenuous exercise-induced free radical damage to heart and skeletal muscle.
[Emphasis added.]

Another study, this time on humans, had similar results: Antioxidant supplementation
does not alter endurance training adaptation. Two groups of men in a randomized,
double-blind study were taken through a course of strenuous, stationary bike training, 5
days a week for 12 weeks. One group took vitamins C and E, the other placebo. At the
end of 12 weeks, they found that the exercise had produced large physiological effects,
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notably increases in VO2max, and in mitochondrial enzymes; however, no differences
were found between the groups.

Many more studies have been done: Antioxidant supplementation reduces skeletal
muscle mitochondrial biogenesis. High-dose antioxidant vitamin C supplementation does
not prevent acute exercise-induced increases in markers of skeletal muscle
mitochondrial biogenesis in rats. Antioxidant supplements in exercise: worse than
useless? Ill spare you (and me) the rest.

Given all of this, many of you may be thinking that youll just skip the vitamin C, since it
may have an effect on exercise adaptation. But its not that easy. Vitamin C may be of
great benefit to health, and even exercise. For example, Human skeletal muscle
ascorbate is highly responsive to changes in vitamin C intake and plasma concentrations.
This study found that supplementation with modest amounts of vitamin C in the form of
kiwi fruit led to a 3.5-fold increase in the amount of C in muscle tissue, while white blood
cell concentrations only increased 2-fold. The conclusion, according to the paper:

Human skeletal muscle is highly responsive to vitamin C intake and plasma
concentrations and exhibits a greater relative uptake of ascorbate than
leukocytes. Thus, muscle appears to comprise a relatively labile pool of ascorbate
and is likely to be prone to ascorbate depletion with inadequate dietary intake.

So it seems for optimum muscle health, vitamin C is necessary, albeit in relatively small
amounts. Nevertheless, many people dont even get the RDA for C, so many people
would benefit from C supplementation.