Of Health and Men

The traditional, stereotypical man might have historically avoided seeking treatment for health problems, but the gender from Mars is becoming more concerned and proactive about their health and survival, especially when it comes to the major killers of men. The male shopper, however, continues to create a marketing confusion among retailers trying to reach this underdeveloped category of health consumers. This is particularly a problem in the natural health sector. Fortunately, manufacturers are creating more products that men want and need, and experienced marketing consultants have compiled a wealth of marketing information in the area of male consumerism.

Men Are Not Gods

What is finally beginning to awaken the generally stubborn male with regard to health are the alarming statistics that show a crisis in male well being. According to the Men's Health Network, a non-profit educational organization, data from the Centers for Disease and Prevention (CDC) and the National Center for Health reveals that the gap has widened between the life expectancy of a man and that of the longer-living woman. In 1920, the gap was only one year, but as of 1998, the gap had grown to six years, with the average man living to 73.8 years. The same set of data showed that men have a higher death rate than women for each of the top 10 causes of death in America.

Moreover, a higher percentage of men are living without health care coverage and make fewer visits to physicians each year. More alarming is that research on male-specific diseases receives less funding, according to the Men's Health Network. The National Cancer Institute spent more than $400 million on breast cancer research in the year 2000 and only $200 million on prostate cancer research in the same year. According to Men's Health magazine, nearly $5 billion went to women's health initiatives last year, compared to less than $1 billion directed towards men's. As yet, there is no male counterpart to the federal Office of Women's Health, though initiatives have been taken.

What all these statistics tell us is that there is currently a health crisis for men. Natural products can and should step in to make a difference. But reaching the male consumer is no easy task, as women far outpace men in retail purchases, and retailers have a hard time catering to men who do enter their stores. One of the first steps for retailers is to learn more about the top men's health concerns and how the supplement industry addresses them.

Have A Heart

The top killer of men is also one the most robust sales categories for men's health products. Heart disease kills more than 350,000 men each year, almost twice the number of women so afflicted. Smoking, cholesterol and high blood pressure all figure prominently in developing heart disease, but these can be controlled through dietary changes and exercise. Many men, and people in general, hate to give up great tasting but less healthy foods even in the name of extending their life span; and exercise can be tough at older ages. This is where supplements can really help.

First up for heart health is vitamin E, which is favored by men treating heart disease, according to data from the Natural Marketing Institute (NMI). The antioxidant vitamin is one of the most researched nutrients in this area and is credited with reducing macrophage- mediated (inflammatory) damage to endothelial cells, thus preventing the production of foam cells and plaque, which are characteristic of arteriosclerosis (a series of diseases in which the walls of the arteries become thickened and lose their ability to stretch). Recent research has shown vitamin E is effective in preventing heart attacks and strokes. In the famous 1996 Cambridge Heart Antioxidant Study (CHAOS), 400 to 800 IU of vitamin E reduced the incidence of heart attacks by about 47 percent. Other antioxidant vitamins have proven useful, including vitamin A (beta-carotene) and vitamin C, low levels of which were linked to increased risk of heart disease (Am J Epidemiol, 1996).

Coenzyme Q10 is a heavyweight in the heart health arena, as it has been shown in several scientific studies as beneficial in preventing congestive heart failure, ischemic/coronary heart disease, heart valve disease, rheumatic heart disease and arrhythmia. Yadu Moharir, Ph.D., vice president of scientific affairs and head of the research department at Phoenix-based Olympian Laboratories, reported that common cholesterol lowering drugs such as Lovastatin or Simavastatin can affect the body's production of CoQ10. He suggested 10 mg to 30 mg/day of CoQ10 for healthy individuals, 30 mg to 150 mg/day as a preventive dosage for patients with cardiovascular concerns or those taking Lovastatin, and a higher dosage for cancer patients or patients with compromised immune function. Considering it would take two pounds of beef to reach the desired level of CoQ10, supplementation is a real benefit.

Two nutraceuticals making big headlines recently due to their winning heart health claim approvals from the Food and Drug Administration (FDA) are soy and omega-3 fatty acids. Soy protein containing isoflavones, especially genistein, won praise for its ability to interfere with the action and accumulation of platelets by reducing the production of platelet-derived growth factors. It also inhibits the action of thrombin, an enzyme that plays a role in blood clotting. The wealth of studies on soy have determined that 25 g/day of soy protein can reduce high cholesterol and heart disease risk. In late 1999, FDA ruled that products containing at least 6.25 g/day of soy protein, less than one gram of saturated fat and less than 20 mg of cholesterol per serving could use the following label claim: "Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of (name of food) provides __ grams of soy protein." Even the American Heart Association (AHA) adopted soy protein into its family of heart healthy foods.

Omega-3 fatty acids had a tougher time winning the FDA's praises, receiving a "qualified" health claim, but should nonetheless be considered essential to men looking to reduce coronary heart disease (CHD) risks. Proponents of omega-3s were vying for the claim: "Omega-3 fatty acids may reduce the risk of CHD." Instead, the FDA allowed: "The scientific evidence about whether omega-3 fatty acids may reduce the risk of coronary heart disease (CHD) is suggestive, but not conclusive. Studies in the general population have looked at diets containing fish and it is not known whether diets or omega-3 fatty acids in fish may have a possible effect on a reduced risk of CHD. It is not known what effect omega-3 fatty acids in fish may or may not have on risk of CHD in the general population." The problem is that the wealth of science supporting omega-3's heart benefits involves the long-chain omega-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). FDA determined that the benefits associated with EPA and DHA were not reflected in LNA (linolenic acid, which is found in flaxseed), another omega-3.

The landmark study of marine omega-3s was published in the August 1999 Lancet and reported some of the most powerful evidence of omega-3s and cardiovascular disease. Among the 11,000 participants, there was a 43-percent reduction in risk of sudden cardiac death and a 20-percent drop in overall mortality. The fish oil used in the study even beat out vitamin E. Again, the AHA stepped in with its support, advising the public to consume at least two 3-oz. servings of fatty fish each week. The FDA advised that consumers consume less than two grams of omega-3s, noting that every person has a different baseline level of the nutrient.

While not the most dominant health area for men (in the number of men affected), prostate problems are perhaps the most popular and best-selling area of men's natural products. According to NMI, 23 percent of men reported having problems with their prostate, a walnut-shaped gland that regulates urine and semen flow through the urethra. The category of prostate issues splits into benign prostatic hyperplasia (BPH) and prostate cancer.

Prostate cancer can be deadly, though only a relatively small number (32,203 in 1998, according to the CDC) of the 156,000 men who develop prostate cancer annually will die from it. Generally, men become concerned about prostate cancer as they approach 40 years of age, but younger men should be similarly concerned and at least adopt preventive practices.

As with most cancers, antioxidants, especially the vitamins, are extremely helpful. Vitamin C and lysine are factors in the production of glutathione and GST (glutathione S-transferase), which are used to dismantle toxins and have been found in low supply in many prostate cancer patients. However, the big gun antioxidant for this specific male cancer is lycopene, the substance in fruits and vegetables (including watermelon and guava, but namely tomatoes) that creates the red color. Harvard researchers deemed lycopene the only carotenoid (beta-carotene being another carotenoid) to affect prostate cancer risk (Giovannucci, et al. J Nat Cancer Inst, 87:1767-76, 1995).

Selenium, an antioxidant mineral, has also been a big hit in the prostate cancer field. Scientists report that it is vital for glutathione peroxidase, an enzyme that hinders cancer formation. In 1998, researchers from many different prestigious American universities found that selenium supplementation decreased the incidence of prostate cancer by 63 percent among the 974 participants (Clark, L.C. et al. Brit J Urol 81:730-734, 1998). Total mortality and total cancer incidence were also lower in the selenium group. In this study, a group of subjects took 200 micrograms of selenium per day.

Beyond prevention, a maitake mushroom extract has demonstrated positive effects against prostate cancer cells. Maitake D-fraction extract supplied by Paramus, N.J.-based Maitake Products exhibited a cytotoxic (cell killing) effect on prostate cancer cells (Fullerton, S et al. Molecular Bio 4(1): 7-13, 2000). The trial was conducted on human prostate cancer cells in test tubes, but researchers recognized the potential of the extract in fighting prostate cancer, even when maitake was combined with vitamin C. In fact, almost complete apoptosis (cell death) was achieved in 24 hours using amounts greater than or equal to 480 micrograms per mL of Grifron D-fraction.

Often confused with prostate cancer, BPH is not a cancer but a gross swelling of the prostate gland that decreases a man's control over urine and semen flow. This can cause urinary emergencies, a build-up of urine in the tract and a number of other urinary inconveniences. Scientists are not completely certain, but the cause has been attributed to the stimulation of excess prostate cell multiplication by dihydrotestosterone (DHT), a hormone.

The fruit or berry from the saw palmetto plant (Serenoa repens) has been the shining star for treating this condition. Grown mostly on Florida plantations, saw palmetto is the preferred BPH treatment in Germany, where insurance widely covers it, and is gaining ground with American men. Great debate exists between herbal advocates and pharmaceutical fans over the best remedy for BPH, but saw palmetto is not without scientific support. A French study concluded that saw palmetto significantly improved BPH symptoms in 50 men who took 160 mg/d while in the early stages of BPH (Brit J Clin Pharma, 1984). A 1999 American study showed similar results, with 44 early-stage BPH patients taking 320 mg of saw palmetto and gaining a modest reduction in symptoms. Retailers will find saw palmetto frequently combined with the herb pygeum, which is thought to enhance the BPH remedy.

Other herbs indicated as useful in BPH treatment include stinging nettle and medicinal pumpkin, but plant isoflavones have taken a bigger step forward. Research reported at ENDO 2000, the Endocrine Society's 82nd annual meeting, discovered that red clover isoflavones improved symptoms in men suffering from clinical BPH. The theory behind the action of these isoflavones is that they reduce the conversion of testosterone to DHT and have an additional anti-estrogenic effect on the stroma or connective tissue.

Sexual Healing

Of all the health problems facing men, sexual function gets the most attention. More than 30 million men suffer some form of sexual dysfunction. Men report much higher rates of treatment of low sex drive than do women, according to NMI. The group also reported that 13 percent of men report impotence, though pinning an exact figure on this is difficult, because men tend to refrain from reporting this problem.

Many factors contribute to a man's sense of power and dominance, but sexual virility reflects man's ability to reproduce, which by many assertions is the primary reason for being. Whether the trouble is in securing and maintaining erections or increasing count and effectiveness of sperm, any lapse in sexual performance can drive most men to seek help. High fat intake and high cholesterol levels have been shown to greatly affect a man's sexual health. Keeping those levels in check will help, but a number of natural products have surfaced as worthwhile supplements for sexual function in men.

The most oft reported sexual problem in men involves erections--lack of them or lack of good ones. In moments of erection, blood fills the caverns of the penis and is held in by special constriction muscles. Thus, aiding blood flow to the penis is crucial. There is no surprise that the vasodilator (widens blood vessels) ginkgo biloba is popular with men combating sexual problems (and heart disease). In one study, the herb improved sexual function in 23 of 30 men (J Clin Psych, 1997). In another study, 60 mg of ginkgo daily for 12 to 18 months helped generate erections in almost half of 60 men who suffered from circulatory-based erectile dysfunction and were not helped by medications (Urology, 1989).

Addressing the erectile situation in name and in action is horny goat weed. Used traditionally in China and Japan for sexual health, the herb most recently surfaced in a formula that also contains maca, velvet bean and polypodium vulgare, a fern. In an April 2001 study conducted in New York by internist Steven Lamm, M.D., a daily dosage of a horny goat weed formula supplied by Bodyonics Inc. enhanced sexual satisfaction in men. In the course of the study, subjects took 1,616 mg/d of the formula and an additional 3,232 mg one to two hours prior to sexual activity. There were 13 men who needed and were using Viagra, and there were 25 men who did not need Viagra. The formula led to a 60-percent increase in sexual satisfaction in the no-Viagra set and a substantial increase in many of the Viagra subjects.

The formula also contained maca, which was no mistake. The South American herb has been used by men in the Amazon and the basin of Peru for thousands of years as a sexual aid. Maca is said to act on the endocrine gland hormones (such as testosterone), stalling the hormonal changes associated with aging, preserving libido and extending sex drive. In a recent trial, rats and mice treated with maca (supplied by Pure World Botanicals) for 22 days showed improved sexual performance.

Also making headway on its biological merits as well as its suggestive name is muira puama, or potency wood. The roots and bark of this Brazilian herb are believed to increase circulation in both men and women. A study reported in 1993 showed that 62 percent of 262 patients taking 1 g to 1.5 g of muira puama extract daily experienced increased libido. Plus, 51 percent of those patients also reported improvement to erectile dysfunction.

Yohimbe is certainly not to be bypassed by men looking to boost sexual virility and performance. This herb is derived from the bark of an African tree and contains yohimbine, the active ingredient. Many studies have shown sexual benefits, but one study of 82 impotent men taking 42 mg per day of yohimbine for one month resulted in the restoration of full and sustained erections in 14 percent of the men, with partial erectile response in an additional 20 percent of the men (J Urol, 141(6):1360-3, 1989).

For many men, the erection is only part of the battle, or it may not even be the problem. Sperm health or function is an important area of male sexual virility that has surfaced more frequently in recent years. Of course, only the strongest sperm survive and fertilize the egg, but strengthening total sperm supply could be key to helping the leader of the pack get the job done.

Sperm is produced in the testicles' Sertoli cells, where the omega-3 fatty acid DHA is in extremely high supply. Theory abounds that DHA in the sperm tail provides the necessary elasticity for normal movement. Low levels of DHA have been found in the sperm of infertile men (Hula, N et al. Ukr Biokhim Zh, 65:64-70, 1993). Further evidence was uncovered by researchers whose male patients with abnormal integration and low levels of DHA in the retina also had fertility problems (Conner, W et al. Lipid Res., 39:1401-1411, 1997).

L-carnitine has also made some ground in the area of sperm health, as it helps deliver fatty acids to sperm for use as metabolic energy. The evidence for carnitine's fertility benefits is expanding. A multi-center study of 100 males with decreased sperm motility (percentage of sperm in motion) showed that 3 g of carnitine supplementation daily for four months increased sperm concentration and count, percentage of motile sperm and the percent of sperm with rapid linear progression. The same dosage of carnitine (but for only three months) increased sperm count, percentage of motile sperms and percentage of sperm with rapid motility in 37 of 47 men in another study.

A very popular men's health category, one that sees the most male consumers, is sports nutrition. Many men are looking to achieve or improve fitness, and most often turn to creatine. This supplement remains hot in the market and in the mass media, so men are still highly interested in the products. For muscle building, proteins and testosterone aids are the perennial favorites among active men. Andro has suffered some highly publicized negative press and scientific criticism in recent years, and sales have suffered accordingly, but deer antler and various proteins are still very popular. With the robust profile of soy protein (see heart health above), these products are gaining increased attention in the active male market. Recovery, bone and joint strength and energy are other important categories of sports nutrition and there are many products--such as glucosamine, chondroitin, ginseng and carnitine--available and backed by science. (For a more in-depth look at sports nutrition, be sure to check out next month's HSR for a feature story on sports and fitness.)

The Elusive Male Consumer

Becoming educated about the major male-specific health problems and the natural products that can assist in preventing or dealing with those issues is only half of the sales effort. The next step is getting these helpful products in the hands of the men who need them. This is tricky at least in the sense that about 70 percent of natural products consumers, those who physically shop in stores for products, are women. Most of the time, the wives, girlfriends, mothers, sisters, etc. become the gateway to the male natural products consumer.

"We talk to the women a lot," confirmed Paul Willis of Cypress Systems, manufacturer of selenium supplements. "When we write an article or present information for selenium and prostate cancer, we focus on the women by telling them to get their men involved--educate them, get them in to see a doctor to increase their chances for early detection." He stated that women can play a key role in prostate health in America.

Linda Bryer, owner of Bryer Advertising and Public Relations, noted that men count on their female partners to read labels for them and find the right products for their needs. She added that because of the female dominance in natural products shopping, more companies and more retailers concentrate on women's products. This has not deterred her and others from taking on men's products, because the key is to go through the women. In her many years of experience in this industry, and in men's products in general, Bryer has learned an important marketing method. "Address the female, but tailor the packaging towards men," she said. "The bottom line for me is that you communicate with men very directly but also very simply."

Packaging for men's products largely depends upon the nature of the product, but a few things work well across the board. "Men like bold colors such as red and black," Bryer said. The male gender also prefers strong font styles, big and bold typeface and less copy. Sure, these are generalizations, but there are a few givens, according to marketers. The masculine eye is drawn to tech-looking graphics and images of strength and virility. "A really sexy woman, whether holding a golf club or posing on a car, is going to get a guy's attention," affirmed Bryer. One look at the number of beautiful women luring people to various booths at industry shows provides ample evidence of this marketing staple.

Interestingly, Rainbow Light, which admittedly focuses more on women's products, does not market its men's products differently. "Our men's supplements have the same look as all our other products, which are geared more towards women," said Marci Clow, director of research and quality. "It is actually quite a feminine look." However, the company has taken other steps to win men over. Its flagship male product, a multivitamin designed specifically for men, is a one-a-day, which suits men just right. "Our marketing team has done a lot of research and found that men don't like to take as many tablets as women do," said Clow. The product sells better than the company's six-a-day multivitamin, which is geared more toward active males.

While marketing to men might be tricky and difficult, retailers would do themselves and the public a great service by stocking products that meet men's most important and pressing health needs. Sally Byrd of Tree of Life (TOL), noted that even though there are still four times as many women's products on the market as men's, supplements addressing the major men's health concerns are more abundant. "In short, TOL is carrying more sports nutrition, stimulant-type items, antioxidants and essential fatty acids," she said. "Even single men are asking more questions as mortality issues become more evident with every passing birthday."

Whether addressing their largely female clientele or the male counterparts who manage to come into the store, retailers will be more successful if they present the alarming information and statistics they've learned about men's health concerns and show the consumer products that can help with those health issues. Only then will the supplement industry reach more men.

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