This document summarizes key points from a presentation on men's health and nutrition. It notes a growing elderly population that will increase demand for urologists. It also discusses common urologic issues in men like low testosterone and erectile dysfunction that often go untreated. The presentation emphasizes that nutrition is a powerful tool and discusses how sugars, grains, and processed foods can contribute to disease, while healthy fats and proteins are important. It recommends a low-carb, high-fat diet and addresses common misconceptions about nutrition, exercise, and weight loss.

1. Men’s Health
Thinking Outside the Box
Tarek Pacha DO

2. Massive Need
• Population >65 YO by 2020
• 50 million people (>20%)
• 100 million by 20501
• Urologists
• Currently: 10,ooo
• Projected in 2020: 7500*

3. Men’s Health
• Men’s Health
• Urologic complaint often with an underlying
more serious problem
• 40% men untreated for low T**
• 75% men untreated for ED2
• Who is going to step up?
• Awesome opportunity to heal mind, body, and
spirit

4. Reflect
• Methotrexate
• Adriamycin
• Heroin
• Cocaine
• Prednisone
• Leuprolide

5. The Most Potent Drug

6. Nutrition
• Nutrition is the most powerful drug!
• Heart Healthy = Any Urologic Organ Healthy
• What is Heart Healthy?
• Do we understand Nutrition?
• Do we appreciate the vast effects of Nutrition?
• Do we even address Nutrition?

7. “Education consists mainly of
what we have unlearned”

8. Common Misconceptions
• T or F: A calorie is a calorie
• T or F: Dieting is effective
• T or F: Carbs are essential for life
• T or F: Fat is the enemy
• T or F: Patients are to blame for their obesity
• T or F: Artificial sweeteners are better than sugar
• T or F: Obesity is the central problem

9. Slide from Dr. Lustig lecture: Fat Chance

11. Slide from Dr. Lustig: Sugar the Bitter Truth

12. Slide from Dr. Lustig: Sugar: The Bitter Truth

13. Know Your Enemy: Sugar
• Sugar = Sucrose (glucose + fructose)
• Evolutionary benefit insulin lay down fat
• Problem:
• Refinement
• Coca leaves (healthy) Cocaine
• Poppy seed (healthy) Heroin
• Ubiquitous
• 75% of processed food contain hidden sugar
• Addictive (dopamine over-stimulate limbic system
• Rats prefer sugar to cocaine4

14. Glucose Metabolism
• Glucose:
• 20% liver
• Most  glycogen (unlimited) not toxic
• Tiny amount  VLDL
• Normal insulin sensitivity
• Normal leptin  brain  stop eating + burn
energy
• Energy balance is normal  No disease

15. Fructose is Not Glucose
• Fructose
• does not suppress ghrelin
• insulin resistance  more fat
• More insulin  more fat
• Leptin resistance (eat more conserve energy)
• Blocks Nucleus Accumbans
• Energy balance is altered  disease

16. Fructose is Not Glucose
• Metabolism
• 100% liver
• What do we call a substance that is exclusively
metabolized by the liver?
• Uric acid  Gout
• Uric acid  NO HTN
• 3-4 x substrate  lots of VLDL Dyslipidemia
• VLDL that does not leave the liver  Fatty liver
• Fructose = FAT!

17. Fructose is Not Glucose
• Chronic Fructose exposure = Disease
NOT
• glucose
• Cholesterol (No longer nutrient of concern)
• Good Fat

18. Slide from Dr. Lustig: Sugar the Bitter Truth

19. Guess the Substrate?
• Only metabolized in the liver
• 4x substrate hits the liver
• Acetaldehyde  ROS toxic to liver
• Acetaldehyde Acetate lots of citrate
lots of VLDL Insulin resistance fatty liver

20. Acute vs. Chronic

21. Poison
• Sugar is not empty calories!
• It is ethanol without the buzz!

22. Know your enemy: Sugar
• Should we never eat sugar?
• Average American: 175 lbs/yr
• Recommendation: 5lb/yr
• Caution: Liquid sugar
• Freshly squeezed fruit juices
• Fancy and expensive fruit juices (loaded with sugar)
• Why is fruit ok?
• What about artificial sweetener?
• Probably worse (humans tend to corrupt)
• Carb crave
• Induces insulin response
• Controversial
• Addictive
• Hardest thing I have ever done

23. Slide from Dr. Lustig: Sugar the Bitter Truth

24. FDA/USDA
• GRAS substance
• Only will regulate an acute toxin not a chronic
toxic
• What about the USDA?
• They will not touch it
• Admits that are food is a serious problem
• Its up to Us!

25. Know Your Enemy:
Grains/Starchy Veggies
• Grains:
•Whole wheat toast vs. SnickersTM
• GI: 71 vs 68
• What happened?
•Dwarf wheat
• Highly processed (genetically altered)
• Sky-High GI
• Obesity
• Systemic inflammation

26. Wolf in Sheep’s clothing
Is corn healthy?
• TeosinteMaizeHybrid Corn (1960s)

27. Know Your Enemy:
Processed Foods
• Strip fat and fiber; add sugar and salt
• Increase shelf life  larger profits
• Hyper-palatable chemicals6
• “bet you can’t just eat one”
• 75-80% of packaged food contain hidden sugar
• Nutrient dense
• Malnutrition: not from calories!
• Dying from thirst in the middle of the ocean
• Cheap
• Edible products vs. Food
• Low Fat craze
• Remove the Fat and added the sugar

30. Know your enemy:
Processed Foods
• Know your fats
• Omega 3 vs Omega 6 fatty acids
• Learn to cook!
• Associated with increased Survival7
• Cook 5 times/wk = 50% more likely alive in 10 yrs8
• Family/friend time
• Importance of social network
• Shop at perimeter of grocery store
• Farmer markets
• Buy in bulk
• Freeze

31. Epigenetics
• No control over the genes we inherit
BUT
• Nutrition is key in turning on or off diseased
gene expression.

32. Cholesterol Sugar
Connection
• LDL
• LDL type A
• large, light, buyount
• Neutral
• LDL type B
• Small, dense
• Harmful
• Labs can’t measure the difference
• Check Triglycerides
• If triglycerides go up, more LDL type B
• Carbs (sugar) increase triglycerides not Fat
• Useful measure:
• TGL:HDL
• 1:1 ideal.

33. Nutrition: Final Thoughts
• What do I recommend to my patients?
• 1. Non-starchy veggies
• 2. Meat with the fat (bacon is fine)
• 3. Good fats: Cheese, Avocado, Nuts and seeds, butter,
olive oil, coconut butter/oil
• 4. Dairy is ok (Drink whole milk)
• 4. Limit Sugar, grains, and starchy veggies
• 5. Limit fruit
• 6. Avoid all processed and refined foods
• 7. Avoid all artificial sweeteners
• 8. Wait 20 minutes before 2nd serving

34. Any Takers?
• Would you take the
following supplement?
• What would you be
willing to pay?

35. Dr. Moyad’s No BS Diet Health Advice. 2008

36. Exercise
• T or F: effective for burning calories and losing weight
• T or F: Fitness is more important than weight loss

38. Real Benefit of Exercise
• Causes muscle gain
• Good  more mitochondria  more energy
burn  muscle insulin sensitivity  no
metabolic syndrome
• Endogenous stress reliever
• Reduce stress reduce appetite
• Speeds up the TCA cycle thus not allowing
substrate to turn into fat.
• Many other health benefits but not weight loss!

39. Exercise Misconception
• Does not show up on the scale
• What does the scale measure?
• Better: Measure waist or buy the pant you want
• “if only you would exercise, you would lose
weight”
• Depression
• Quit
• Malpractice

40. More important than being a :
1. Nonsmoker
2. Obesity
3. HTN
4. DM

41. Exercise vs. Activity
• Exercise
• Dose
• Not fun
1. Out of breath
2. muscle burn
3. short duration
4. high intensity
• Times per week: 3-4
• Frequency > >
duration
• Activity
• Do as much you can
• Walking
• Gardening
• Steps (10,000)

42. Exercise Strategies
• Tiny habits
• Buddy system/Trainer
• Make your goals public
(accountability is key)
• Vary the exercise
program
• Pick the program most
enjoyable
• Simplify the program
• Set yourself up to win!
• Celebrate your
successes even if
small.
• Schedule

43. Screen time

45. Stretching/Flexibility/Pos
ture
• Crucial as we get older
• Posture is king
• better posture associated with living longer
• Prevents injury and falls

46. Final Thoughts:
Exercise/Activity
• As much Activity as possible. Have fun
• Reduce screen time
• Reduce sitting time
• Intentional painful exercise 2-4 times wk
• Muscle burn
• Short of breath
• Short time
• Flexibility/stretching/good posture is crucial
• Does not cause significant weight loss.
• Defined abs start in the kitchen!

47. Would you take this pill?
• Increases mental clarity
• Maximizes memory
• Anti-aging
• Boosts the immune system
• Regulates metabolic system
• Aids in weight loss
• Improves mood

48. Impact of Sleep
Deprivation
• “IF you lose one night of sleep, your mental
performance is like you are legally drunk”
Dr. Vgontzas

49. Final Final thoughts
• Triangle of Health
• Are we good examples?
• Are we practicing what we preach
• Do we even know what to preach?
• Are we compassionate?
• What job are we really in?
• “Its not a urology problem, I can’t help you.”
• ED  1st sign of CVD
• Prostate cancer Dx  suicide risk
• Did I improve one thing?
• Good intention  money+ life  ??

50. Thank You!

51. References
• 1. Ortman, JM, Velkoff VA, Hogan H; An aging nation current population reports.
www. Census.gov/prod/2014pubs/p25-1140.pdf. 2014
• 2. Selvin E. Burnett AL, Platz EA. Prevalence and risk factors for erectile
dysfunction in the US. Am J Med. 2007;120: 151-157
• 3. Glycemicindex.com
• 4. Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses
Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698.
• 5. Sugar and Cardiovascular Disease: A Statement for Healthcare Professionals
From the Committee on Nutrition of the Council on Nutrition, Physical Activity,
and Metabolism of the American Heart Association. Circulation.2002; 106: 523-527.
• 6. Gearhardt, Ashley, et. Al. Can Food be Addictive? Public Health and Policy
Implications. Addiction. 2011 Jul; 106(7): 1208–1212.

52. References
• 7. Rosalind Chia-Yu Chen, Meei-Shyuan Lee, et. Al. Cooking frequency may
enhance survival in Taiwanese elderly.
• 8. Public Health Nutrition/ Volume 15/ issue 07/ July 2012, pp 1142-1149
• *American Urological Association (AUA) 2013 Annual Scientific Meeting.
Abstract 422. Presented May 5, 2013.
• 9. Lustig, Robet. http://www.uctv.tv/
• 10. **Mulligan, T. et. Al. Prevalence of hypogonadism in males aged at least 45
years: the HIM study. Int J Clin Pract. 2006 Jul 1; 60(7); 762-769

53. Suggested
Reading/Viewing
• Books
• The Calorie Myth. Jonathan Bailor
• Wheat Belly. William Davis
• Fat Chance. Robert Lustig
• Cholesterol Clarity. Jimmy Moore
• Eat Bacon, Don’t Jog. Grant Petersen
• YouTube videos:
• Sugar: The bitter Truth. Robert Lustig
• Fat Chance. Robert Lustig.