Patient-Focused Philosophy

The strength and history of innovation at Epoch Health stems from a patient-focused philosophy and a dedication to the most advanced technology.


September 2017

10 Ways For Men to Prevent Cancer Today

By: Epoch

Source: TIME

Sweat Daily

In a University of Vermont study, the fittest men were 68 percent less likely to develop lung cancer and 38 percent less likely to develop colorectal cancers than the least active men—and those who developed cancer had better outcomes if they exercised regularly. Cardio and resistance training help control inflammation and hormone levels—and they keep your immune system strong to fend off wayward cells. (Turn up your muscle gains outside the gym. These 18 Ways to Build Muscle All Day will help you shed fat, sculpt muscle, and accelerate recovery.)

Skip Anything Fried

Guys who eat french fries, fried chicken, fried fish, or fried doughnuts once or more a week have up to a 37 percent higher risk of prostate cancer, according to a new study from the Fred Hutchinson Cancer Research Center in Seattle. Oil that’s heated to high temperatures develops carcinogenic compounds in food. (You might not know you're missing vital nutrients, but here's how to get them by learning these 6 New Food Rules to Follow.)

Sip Pomegranate Juice

Researchers at the University of Wisconsin at Madison found that pomegranate juice may stunt lung cancer growth. Plus, previous studies also show it delays prostate cancer in mice and stabilizes PSA levels in men who’ve been treated for the cancer. Sip about 16 ounces of the juice per day, which is rich in polyphenols, isoflavones, and ellagic acid that may team up to fight cancer.

Get Screened

If there’s a screening for a type of cancer and you’re eligible for it, get it. The Center for Disease Control and Prevention estimates that if everyone over 50 had regular colon cancer screenings, 60 percent of deaths from the disease could be prevented. Talk to your doctor about screenings for colorectal, prostate, testicular, skin, and lung cancer. (Discover 8 stealth strategies to Cancer-Proof Your Body.)

Snack on Blueberries

The fruit is brimming with a compound called pterostilbene that may slash precancerous lesions in the gut that, left unchecked, could lead to colon cancer, Rutgers University researchers say. Aim for a cup and a half of blueberries per day—pour them over your cereal, snack on them fresh, or dump them into a daily smoothie.

Befriend Fiber

People on a high-fiber eating plan—about 17 grams per 1,000 calories—had a 19 percent decrease in kidney cancer risk compared with those who took in the least, a study in the journal Clinical Nutrition found. Fiber may block cancer-causing toxins from traveling from your intestines to your kidneys, the study reports. (Here are more foods with amazing—and scientifically proven—health benefits: Check out the 50 Foods with Superpowers.)

Get Help to Stop Snoring

People with severe sleep apnea—snoring is the main symptom—are almost five times as likely to die of cancer as those who snooze more soundly, according to researchers at the University of Wisconsin-Madison School of Medicine and Public Health. With sleep apnea, levels of oxygen in your blood dip. This can cause small existing tumors to grow new blood vessels, giving them fuel to develop faster and spread through your bloodstream more quickly.

Stand Up

More than 92,000 cases of cancer a year can be blamed on sitting too much, a study by the American Institute for Cancer Research suggests. Even if you exercise regularly, you’re still at risk. Set your cell phone alarm to remind you to stand for one to two minutes every hour. It’ll help reduce levels of molecules in your body that are linked with cancer risk.

Down the Sunshine Vitamin

People who supplemented their diets with 1,000 IU of vitamin D every day decreased their risk of cancer by as much as 77 percent over four years compared to those who popped a placebo, reports a study in the American Journal of Clinical Nutrition. Vitamin D is also available in salmon, sardines, and shiitake mushrooms.

Go Nuts

Eat three Brazil nuts every day, which deliver healthy selenium. A Harvard study found that this amount is associated with a 48 percent lower incidence of advanced prostate cancer.




September 2017

19 Ways To Keep Your Prostate Healthy

By: Epoch


All men, regardless of age, should be concerned about their prostate health. Although prostate disorders such as prostatitis, benign prostatic hyperplasia, and prostate cancer generally do not affect men until they are in their 40s or older, the time to help prevent prostate problems and support prostate health is now. However, whenever symptoms of prostate disease do occur, it is important to seek professional medical help with a diagnosis.

Here are some tips on how to maintain and promote prostate health. These tips are based on more than 200 studies conducted over 15 years.

  1. Maximize your intake of fruits and vegetables: Fruits and vegetables are excellent to good sources of anticancer and anti-inflammatory compounds such as antioxidants, polyphenols, vitamins, minerals, and fiber. These foods can help reduce the risk of developing prostate cancer.
  2. Focus on proper nutrition: Your food choices account for up to 90 percent of cancers of the prostate, breast, pancreas, and colon. Adjusting your diet can significantly lower your risk of getting prostate disease.
  3. Eat healthy fats: People who live in countries where high-fat diets are the norm (like the United States) are more likely to develop prostate cancer than people who live in countries where less fat is consumed.
  4. Choose plant protein over animal protein: Certain plants can provide all the protein you need for maximum overall and prostate health. The World Health Organization has also noted that “diets high in red meat, dairy products, and animal fat have frequently been implicated in the development of prostate cancer”.
  5. Eat whole and natural foods: Whole, natural foods are typically high in fiber, a component linked to two indicators for prostate health: lower levels of testosterone and lower PSA scores.
  6. Consume green tea: Green tea contains catechins, antioxidants that can slow the cancer cell growth, promote cancer cell death. Men who drink green tea can reduce the risk of developing prostate cancer by as much as 70 percent when compared with men who don’t drink green tea.
  7. Eat omega-3 rich foods: Found in certain fish, omega 3 fats fight inflammation, a process that destroys the body’s natural antioxidants and weakens the immune system, making the body more vulnerable to disease.
  8. Avoid foods and additives that harm the prostate: Some foods, supplements, and additives can harm the prostate, including but not limited to meat, calcium, chondroitin, and foods high in sugar.
  9. Choose safe supplements: Become an informed consumer of supplements. While many supplements can benefit the prostate, others can be harmful (such as calcium).
  10. Consume cancer-killing foods: Some foods and their components have anticancer abilities, including but not limited to lycopene, turmeric/curcumin, folic acid, and vitamin D.
  11. Hydrate daily: Drinking pure water is essential for prostate health.
  12. Maintain a healthy weight: Being overweight or obese is associated with a higher risk of prostate cancer, lower long-term survival rate, and more aggressive forms of the disease.
  13. Exercise regularly: Exercise can not only helps slow the spread of prostate cancer, but also has a preventive effect on prostatitis, BPH, and inflammation.
  14. Manage stress: Although stress may not directly cause cancer, long-term stress can weaken the immune system, alter your hormonal balance, and make you more susceptible to disease.
  15. Try natural therapies: Natural prevention and treatment approaches for prostate health include acupuncture, biofeedback, homeopathy, hormone restoration, massage, reflexology and stress management techniques.
  16. Follow a prostate friendly lifestyle: Smoking, inadequate sleep, some medications, and alcohol use can have a negative effect on prostate health.
  17. Maintain hormone balance: Hormone management and balancing play a major role in prostate health. The World Health Organization noted that “diet might influence prostate cancer risk by affecting hormone levels.”
  18. Maintain a healthy sex life: Sexual activity appears to be healthy for your prostate.
  19. Avoid exposure to toxins: Stay away from chemicals and other substances that can increase the risk of developing cancer.



August 2017

How to Maintain a Healthy Kidney & Liver Naturally

By: Epoch




The kidneys and liver are organs in your body that help to perform vital functions, such as filtration, storage of nutrients and digestion. When these organs are functioning at an optimal level, you are able to derive the most benefit from the foods you eat. Eating a diet of unhealthy, highly processed foods can impair the functioning of the liver and kidneys and cause symptoms, such as indigestion and bloating. Fortunately, both the liver and kidneys respond quickly to a natural approach that can maintain a healthy level of functioning.

Step 1

Emphasize high-quality proteins, in limited quantities. Protein is necessary for maintaining organ function and repairing damaged tissue. If you have compromised kidney or liver function, you should be aware that eating too much protein places a strain on these organs. Higher quality protein foods include meat, poultry, fish and eggs. Lower quality proteins are those found in vegetables and whole grains but both kinds of protein are important to maintain healthy kidney and liver function. Speak with your doctor or dietitian about how many grams of protein you need daily.

Step 2

Stay within your caloric range, which should be provided by your health care provider or dietitian. Anyone who has compromised kidney function should strive to maintain a health weight. Eating healthy foods throughout the day and staying within caloric guidelines can help you lose weight and prevent excess weight from putting a strain on both your kidneys and liver. Excess calories can impair the functioning of the liver and causes fat to be stored in the liver. Consume 15 calories for every pound you weigh as a baseline amount of daily intake.

Step 3

Limit your intake of sodium. Sodium or salt is an essential mineral that is also widely used to preserve foods. Consuming too much sodium can cause an imbalance of water in your body, placing a strain on the kidneys. In addition, salt causes water retention, especially in individuals with kidneys and a liver that aren't functioning properly. The excess water can place a strain on the cardiovascular system and increase your risk of a heart attack or stroke. Always read nutritional labels because sodium is often hidden in foods like frozen and canned vegetables. You should be able to get plenty of sodium naturally from the healthy foods you eat and not as an additive ingredient.

Step 4

Avoid drinking alcohol which can cause significant liver and kidney impairment and damage. Alcohol destroys liver cells and can disrupt the delicate electrolyte balance the body maintains to maintain biological stability. Drinking alcohol can also cause your body to retain water in an effort to restore electrolyte balance. Unfortunately, water retention causes more impairment of kidney and liver functioning and can lead to complete organ failure if left untreated.



June 2017

9 Tests Every Man Over 40 Should Take

By: Epoch

Source: The Huffington Post

The following are tests that every man over forty should have done, as they may help you detect silent killers such as high blood pressure, or catch or even reverse other diseases while they are still in their early, treatable stages. Get these done and don’t mess around.


The PSA test measures the level of prostate-specific antigen, an indicator of prostate health in your blood. A rising or high PSA may indicate prostate cancer, or it could point to another prostate condition that may need medical attention, or it may itself lead to cancer. Despite some controversy surrounding this test, it is still an important test for all men to consider as an early warning of reduced prostate health. I found out I had an abnormally high PSA about a decade ago after a PSA blood test. Since then, I have massively changed certain aspects of my diet and lifestyle to prevent any potential progression to prostate cancer—and today my PSA level is below normal for my age.


The digital rectal exam (DRE) is a simple procedure for the early detection and diagnosis of prostate cancer and other abnormalities of the prostate gland. The doctor inserts a lubricated gloved finger in the rectum to feel the prostate gland for lumps or enlargement. As such, it’s the test guys fear the most. But man up and have it done, because it could save your life.


Low T can cause several changes such as erectile dysfunction, fatigue, weight gain, loss of muscle, loss of body hair, sleep problems, trouble concentrating, bone loss, and personality changes. Your doctor can check your testosterone through a blood or saliva test. Before you jump on the T therapy wagon, though, I urge you to try the natural treatments listed here which I’ve used to increase my testosterone 38% in the last 5 years. Check out my book if you’re interested in exploring this in more detail.


Osteoporosis may be more common in women, but men get it too. Experts recommend that men over fifty who are in high-risk groups (low T, family history, sedentary lifestyle, smokers, etc.) get tested, and men of normal risk get tested at sixty. A bone density scan (DEXA) can measure how strong your bones are and help you determine the risk of a fracture.


There are different kinds of cholesterol circulating in your blood. When you get tested you should receive the following measures:

  1. total cholesterol;
  2. low-density lipoprotein (LDL) or your “bad” cholesterol;
  3. high-density lipoprotein (HDL) or your “good” cholesterol; and your 
triglycerides, which are another form of fat in the blood.

High cholesterol is one of the risk factors for heart disease. Most men can have their cholesterol tested as part of a routine blood test.


Blood pressure is a silent killer. There are no symptoms of high blood pressure, but it can harm your heart, lungs, brain, kidneys, and blood vessels. I keep a portable blood pressure monitor in my office. They’re not expensive, and you can get a pretty good idea of your own health before you visit a doctor for confirmation.


A blood sugar test measures the amount of glucose in your blood. The test is an important screening for diabetes or pre-diabetes and insulin resistance. Untreated diabetes will continue to get worse and cause problems with eyes, feet, heart, skin, mental health, nerves, kidneys, and more. Insulin resistance causes weight gain, high blood pressure, high cholesterol, bloating, and high blood sugar. When untreated, it can lead to diabetes. There’s also a higher risk of prostate and other cancers associated with high blood sugar.

It’s estimated that 34% of the US population is pre-diabetic. Although I’m not personally diabetic, I regularly take my blood sugar with a home blood sugar monitor so I can keep an eye on my glucose levels and make changes to my diet and lifestyle if it’s creeping up. 


Doctors recommend that people ages fifty to seventy-five get screened for colon cancer with any of three following tests: the sigmoidoscopy, colonoscopy, and the fecal occult blood test. 
The US Multi-Society Task Force on Colorectal Cancer has ranked the screening methods. They say that tests like fecal occult blood screens can detect early stage cancers, but the colonoscopy is considered the best test for prevention.

I have a history of colon cancer, as my mom died from the disease in her early seventies, so I started getting checked every three to four years starting when I was forty. So far, so good—and it’s worth the regular screening to know for sure.


You may be surprised to see HIV on the list, but about 15 percent of new infections each year are among people over age fifty, and people over fifty represent almost one-fourth of the HIV/AIDS cases in the United States. With birth control no longer a concern, many people over age fifty are having unprotected sex. Doctors don’t usually ask their older patients about sex, and educational programs that teach prevention neglect the patients in this age group—but HIV is certainly still a concern no matter how old you are.

These nine tests can help you stay healthy and improve your longevity. By giving you a warning that you have a condition that puts you at risk of a more serious disease, they can allow you to make changes in your diet, exercise, and other habits to reduce your risks. Because some of these conditions have no symptoms, you may have no idea that you have a problem if you do not get tested. It is easier and less expensive to prevent disease than to try to treat it after years of damage have set in.




June 2017

The Hits to Infertility All Add Up

By: Epoch

Source: The Turek Clinic By: Dr. Paul Turek


As a kid, how many times did your mother tell you to put a coat on before going outside in the winter so that you wouldn’t get sick? In my family, this was a cardinal sin… but then again we were pretty healthy kids.

The coat-in-the-winter-thing is all about susceptibility. You still need to be exposed to a virus to get sick but that’s beside the point. But, when it comes to male fertility, I believe that the susceptibility argument holds water.

Do the Math

When it comes to things that affect fertility, the math is 1+1+1= more than 3. Piling on insults to fertility is not simply additive but more likely synergistic. It’s the “the whole is greater than the sum of the parts” idea, just turned a little sideways.

The first time this occurred to me was when we analyzed our data on how semen quality among infertile men improved after discontinuing hot tubs and baths. The sperm counts in many men took off after cooling the jewels for 3 to 6 months. But the semen quality in other men did not respond at all. When we took a closer look at the nonresponders, we found that they were more likely to be smokers and have varicoceles, two other insults that hurt a man’s fertility. The more that holds a man down, the more likely he won’t get up.

The second time the susceptibility idea surfaced was during a flu season. Even with the flu shot, damn near everyone gets the flu over the winter. I noticed that, unlike men with normal sperm counts, guys with low sperm counts often became temporarily azoospermic (sterile!) when hit with the flu. Pretty scary to be helping a man improve his fertility only to see his sperm count tank with a couple of days of fevers and body aches. Whatever causes the low sperm counts in the first place may also make men less robust in the face of further insults.

Eliminate Variables

Add to these examples men with varicoceles using recreational drugs or taking medications like propecia and you can see how many iterations of insults are possible, all working to keep a good man down.

So, the little things really do matter when it comes to your fertility. Sperm production is an engine that wants to run hard and at high RPM; so don’t forget to change the oil, keep it tuned and put gas in the tank. Take great care of yourself, treat your body like a temple and consume things in moderation. And yes, listen to your mother and put on a coat in the winter.



June 2017

Diabetes and erectile dysfunction: What is the connection?

By: Epoch

Source: Medical News Today

Erectile dysfunction, also called impotence, is not being able to get and maintain an erection for long enough to have sexual intercourse.

There are many causes of erectile dysfunction (ED) which can be physical, psychological, or both. One of the most common causes of ED is diabetes.

Studies suggest that 35-75 percent of men with diabetes will go on to develop ED. They will also tend to develop ED some 10-15 years earlier than men without diabetes.

Why can diabetes cause erectile dysfunction?

Diabetes can cause ED because it can damage the blood supply to the penis and the nerves that control an erection.



When a man becomes sexually aroused, a chemical called nitric oxide is released into his bloodstream. This nitric oxide tells the arteries and the muscles in the penis to relax, which allows more blood to flow into the penis. This gives the man an erection.

Men with diabetes struggle with blood sugar level swings, especially if their condition isn't managed poorly.

When their blood sugar levels get too high, less nitric oxide is produced. This can mean that there is not enough blood flowing into the penis to get or keep an erection. Low levels of nitric oxide are often found in those with diabetes.

Other causes of erectile dysfunction

Listed below are some other reasons for ED:

  • obesity, high blood pressure, and high cholesterol
  • hormonal problems such as low testosterone
  • psychological problems including stress, anxiety, and depression
  • nervous system problems including damage to spinal cord or brain
  • smoking, drinking too much alcohol, and using some illegal drugs
  • some medications such as those taken for high blood pressure and depression

Pelvic injury or surgery on the prostate, bowel or bladder may cause damage to nerves connected to the penis. This nerve damage can also lead to ED.

Tests and diagnosis

A doctor will often perform some of the following tests to diagnose ED:

  • Blood tests to check for a raised blood sugar level, which may indicate diabetes.
  • Hormone tests to measure the levels of testosterone and other hormones.
  • Nervous system tests, such as blood pressure and sweat tests, which can rule out nerve damage to the heart, blood vessels, and sweat glands.
  • Urinalysis to test for sugar in urine, which might indicate diabetes.
  • Physical examination to assess the genitals and nerve reflexes in the legs and penis.
  • Patient history to help determine why someone is having problems with erections and under what circumstances.
  • Sexual health (SHIM) questionnaire to help diagnose the presence and severity of ED.
  • Injection of a drug into the penis to check that the blood supply to the penis is normal.

Lifestyle changes

Keeping diabetes under control is a good way to reduce the risk of erectile dysfunction.

Erectile dysfunction due to diabetes is much better understood now. Good control of diabetes can reduce the risk of ED.

Other preventive measures such as stopping smoking and reducing alcohol intake will help lower the risk of developing ED.

Other lifestyle changes that may help include:

  • Eating a healthy diet and taking exercise: Studies suggest that men who changed their diet to one low in saturated fat and high in fiber and did moderate physical activity each week were able to improve ED without prescription drugs.
  • Weight loss: Some studies show that even a small weight loss can improve erectile function and sexual desire in men with diabetes. Those who lost weight had increased testosterone levels and blood flow resulting in better erections.
  • Stress reduction: ED can cause stress and tension in a relationship. Counseling can be helpful even if the origins of sexual dysfunction are physical. People with ED should try to find time for relaxation and get enough sleep every night.

A new study also suggests that supplementation with amino acids called l-arginine and l-citrulline may also help to improve erectile function. These acids are known to increase the body's production of nitric oxide, which can increase blood flow to the penis. As stated previously, low levels of nitric oxide are often found in men with diabetes.


Treatment of ED will depend on the cause and there is a range of good treatment options. These are the same for men with diabetes and men who have ED from other causes.

Doctors can switch any prescription medications that may contribute to ED.

The most common treatment is with oral tablets. These have been shown to work well in many men with diabetes, restoring sexual function. Certain drugs called PDE-5 inhibitors are used to treat ED.

The four most commonly prescribed are:

  • sildenafil (Viagra)
  • vardenafil (Levitra)
  • tadalafil (Cialis)
  • avanafil (Spedra)

These drugs cause an erection by increasing blood flow to the penis. They require sexual stimulation to be effective. They should be taken 30-60 minutes before sexual intercourse.







June 2017

Infertility in men could point to more serious health problems later in life

By: Epoch

Source: The Conversation

Poor sperm quality affects about one in ten men and may lead to fertility problems. These men also have an increased risk of developing testicular cancer, which is the most common malignant disease of young males. And, even if they don’t develop testicular cancer, men with poor sperm quality tend to die younger than men who don’t have fertility problems.

Couples who can’t achieve pregnancy usually go to fertility clinics for treatment. At these clinics, emphasis is put on deciding whether the couple needs assisted reproduction or not, and, if so, to choose between different methods (such as IVF, IUI, or ICSI) for doing this. In most cases, these treatments lead to pregnancy and a live birth. So the problem seems to be solved. But if infertility is an early symptom of an underlying disease in the man, fertility clinics won’t pick it up.

Missed opportunity

Testicular cancer is easy to detect. In men seeking treatment for fertility problems, a simple ultrasound scan of the testes can reveal early cancer, so a life-threatening tumour can be prevented. If detected, 95% of all cases can be cured. But, unfortunately, testicular ultrasound scans are rarely performed at fertility clinics as the focus tends to be on sperm numbers and which method of assisted reproduction to use.

And testicular cancer is not the only threat to young infertile men’s health. Serious health problems, such as metabolic syndrome (high blood pressure, high blood sugar and obesity), type 2 diabetes and loss of bone mass are also much more common conditions among infertile men. These disorders are possible to prevent, but if left untreated often lead to premature death.

A possible culprit

At Lund University in Malmö, Sweden, we have – together with other research groups – made a number of studies focusing on the link between male fertility problems and subsequent risk of serious diseases. We cannot yet explain the causes, but testosterone deficiency is a strong candidate. My research team found that 30% of all men with impaired semen quality have low testosterone levels. And men totally lacking the hormone have early signs of diabetes and bone loss.

We recently conducted a study in which we investigated almost 4,000 men below the age of 50 and who had had their testosterone measured 25 years ago. We found that the risk of dying at a young age was doubled among those with low testosterone levels compared with men with normal levels of this hormone.

Although testosterone treatment may not necessarily be the best preventive measure, these findings makes it possible to identify men at high risk so that they can be advised about lifestyle changes, such as losing weight or quitting smoking – lifestyle changes that will help reduce the risk of developing type 2 diabetes, cardiovascular disease and osteoporosis.

A relatively high proportion of men get in touch with their doctor about infertility problems and, as they represent a high-risk group for some of the most common diseases occurring later in life, perhaps it is time to change the routines for managing them. With the knowledge we now have regarding these men’s health, the least we can demand from doctors is to identify those who are at risk of serious diseases after they have become fathers. This is cheap and only requires simple tests. It is no longer enough to just evaluate the number of sperm.



May 2017

Sex and Diabetes-What you should know

By: Epoch

Source: Diabetes Forecast

For an oversexed culture that isn't afraid to push boundaries on TV, in movies, on the radio, and in books and magazines, we're awfully shy about sex when it comes to our health. In fact, even though people with diabetes are at a higher risk for sexual problems, a 2010 study in the journal Diabetes Care found that only about half of all men with diabetes and 19 percent of women with diabetes have broached the topic with a doctor.

And, truth is, many doctors don't feel comfortable prodding patients for details on sexual function. It's why the newly diagnosed quickly learn about eye, nerve, kidney, and heart damage from uncontrolled diabetes, but hardly ever hear how diabetes affects sexual health. It is important for people to be open and honest with their doctors regarding all health concerns—even problems with sexual function. Problems with sexual performance and satisfaction can signal other health issues.

Many men with erectile dysfunction, for instance, later learn that they have diabetes. For people who already have diabetes, sexual problems can indicate nerve damage, blocked arteries, and even out-of-whack hormones. Though there's a lot yet to learn about sexual dysfunction in people with diabetes, researchers are certain of one thing: Chronic high blood glucose is behind many sexual problems people face, and the first line of action is to improve glucose control.

Honey, Not Tonight

Low libido, or sexual desire, is a real problem, one that affects people with diabetes more than those without. Men and women experience low libido as a result of poorly controlled diabetes. If your sex drive is stalled, first look to your diabetes control and take steps to lower your blood glucose levels. Then consider your medications. Certain drugs, such as antidepressants, can lower sexual desire, so talk to your doctor.

Researchers theorize that inflammation may also dampen desire. "Sexual desire is a brain-driven event," says Stacy Tessler Lindau, MD, MAPP, director of the Program in Integrative Sexual Medicine at the University of Chicago. "If inflammatory molecules cross the blood-brain barrier and circulate in the area where there is sexual desire, then it's plausible the desire for sex may be affected." Another possible culprit: low testosterone, which often affects men and women with diabetes.


Studies have shown that men with diabetes, especially those who have type 2 or are overweight, or both, have about twice the risk of low testosterone as their peers without the disease, which can affect a man's passion for sex. "The treatment is to give testosterone, and it's amazing how that can work in diabetes," says Irwin Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. When low testosterone is treated through losing weight and/or testosterone therapy, many men have a renewed desire for sex.


Treating women isn't quite as simple. (Get used to hearing that.) Some studies suggest that taking testosterone can increase sexual desire in women—a 2008 article in the New England Journal of Medicine found that post-menopausal women had a greater sexual appetite after taking testosterone for almost six months—but the treatment is still understudied, particularly its long-term effects on women's health. Not only that, but it's hard for researchers to determine whether a particular woman's low libido is a result of diabetes, emotional issues, or something else because low libido is common in women regardless of the presence of diabetes.

Let's Get It On—Or Not

Here's the difference between desire and arousal: First, sexual desire must occur; the body then responds, signaling arousal. That is, if everything's working properly. Both men and women with diabetes may feel desire but struggle with arousal problems, though the mechanisms behind this sexual dysfunction are better studied and understood in men. For both men and women, a good place to start looking for possible causes is your medicine cabinet. Some blood pressure–lowering medications, for instance, can contribute to erectile dysfunction. When meds aren't behind a person's hampered arousal, diabetes may be to blame. Poor diabetes control over time can damage the blood vessels and nerves—as it does in heart disease and neuropathy (nerve damage), other complications of the disease—that make arousal possible.


One of the main sexual problems men with diabetes face is the inability to have an erection. Damage to the vascular system can impair blood flow. If the blood vessels aren't functioning properly or if an artery is blocked, not enough blood will travel to the penis, making it difficult to get an erection.

Nerve function plays a role, too. If the brain isn't properly communicating with the nerves in the sexual organs, the body might not be able to shuttle blood there, impairing a man's ability to get an erection. The ability to keep an erection can also be affected, because the brain must communicate with the nerves to hold blood in the penis. (Keep in mind: A man's ability to get and hold an erection typically wanes with age.)

Fortunately, there are plenty of treatment options. Neither men nor their partners should accept male sexual dysfunction, says Janis Roszler, RD, CDE, LDN, a certified diabetes educator and author of the book Sex and Diabetes: For Him and for Her. "For men, there absolutely is a treatment that will work." Options include PDE5 inhibitors, such as Viagra and Cialis, which improve blood flow; testosterone injections or gels (if testosterone levels are low); injectable medications or suppositories; constriction rings that sit at the base of the penis; vacuum pumps that draw blood into the penis; support sleeves that hold the penis in place during sex; and penile implants.


Nerve damage may also cause vaginal dryness, which is twice as common in women with diabetes as it is in women without diabetes. It's also a result of aging. "Vaginal dryness is very common among women who are menopausal or post-menopausal," says Lindau. In those cases, a lack of estrogen is behind the dryness, and problems may be treated with prescription estrogen, available in pills, a patch, or a cream used in the vagina.

Because researchers don't understand exactly why women's bodies lose the ability to self-lubricate when menopause isn't the cause, treatment options are slim. Most experts recommend using store-bought lubricant.

Women with diabetes are also prone to the same blood-flow issues men face because of nerve or blood vessel damage. Diabetes complications may make it difficult for blood to move to the vagina and clitoris. "The question we have, as far as women go, is that there are women with excellent A1Cs who don't have any blood vessel issues," says Roszler. "They don't have any neuropathy. But they still have sexual problems."

Because studying female arousal problems is difficult for many reasons—women may have a hard time determining just how turned on they are, and there's less of a physical sign of arousal in women than there is in men—treatments are few. But Goldstein says research is promising.

A small study in the August issue of The Journal of Sexual Medicine found that women with type 1 diabetes who took 5 mg of tadalafil (Cialis) for 12 weeks reported an improved quality of life, greater arousal and orgasm, more enjoyment and satisfaction from sex, and more frequent sex. This doesn't mean you should start sneaking your partner's pills—please don't: The treatment is unapproved in women, dangerous in some people with heart problems, and generally unsafe until proved otherwise. But it does show promise for female treatments of the future. As for the present, Lindau says some women use clitoral pumps to aid blood flow but notes that the device isn't for everyone.

The Big O

An orgasm is a sought-after sexual reward, but for people with diabetes it can feel like an unattainable goal. And, yes, we're talking about women and men here. Both can struggle with the elusive O, and the first thing they and their doctors should check are the medications they take, such as antidepressants.


Though women in general report more difficulty having an orgasm than men, those with diabetes have even greater difficulty. Sure, a woman's inability to climax often has to do with her mental or emotional state (more on that later), but diabetes may be in play, too. According to a study published this August in the journal Obstetrics & Gynecology, middle-aged women whose diabetes requires insulin are 80 percent more likely to report trouble reaching an orgasm than women without diabetes.

"To the best of what we know now, the neurovascular system is necessary for arousal and orgasm," says Lindau. "If the small nerves are not working properly, then you can have sensation problems. In order for the clitoris to have the engorgement it needs to orgasm, it needs to have the blood flow and sensation."

A hormone imbalance may be to blame, Roszler says. Some scientists studying women's ovulation cycles hypothesize that off-balance hormones, and not just testosterone, may be behind women's decreased arousal and orgasm, but the research is in its infancy.


Having an orgasm is usually pretty easy for men, which is why it can be so frustrating if a man's unable to finish. Like women, men suffering from neurovascular damage—and the lack of blood flow and/or sensation it creates—can have a hard time reaching an orgasm. Men can get around erectile dysfunction with a variety of treatments, ranging from medications to vacuum pumps, but these treatments will not fix neuropathy.

Putting On The Brakes

Sex is supposed to bring you and your partner pleasure, so pain is an indication that something isn't right. Even if you're shy, it's important to discuss issues of painful sex with a doctor. "See a doctor who is familiar with taking care of sexual problems because we can rectify problems in [most] patients, especially people with diabetes," Goldstein says.


Men with diabetes are at an increased risk for developing Peyronie's disease, a condition in which scar tissue inside the penis causes a curved and painful erection. Before you worry, take heart: Penises all vary in shape, and a little curve isn't a big deal. With Peyronie's disease, the curve or bend is significant and can make having sex and getting or keeping an erection difficult and painful. A doctor can advise whether you should wait it out, take medication, or have surgery.


Having sex with too little lubrication can make a woman scream—and not in a good way. Vaginal dryness is one of the main reasons women with diabetes have pain during sex, and better lubrication is the answer. Whether that comes in the form of estrogen therapy for women whose dryness is a side effect of menopause or over-the-counter lubricants, the goal is to be well lubricated before sex.

Women with diabetes are also at a greater risk for urinary tract infections (UTIs) and vaginal yeast infections, which in turn may lead to painful sex. (Rest assured, though, that people with diabetes are at no greater risk of sexually transmitted diseases than those without the disease.) Lower your chances of getting a UTI or yeast infection by keeping your blood glucose under good control, and head to the doctor at the first sign of discomfort.

Sexual Healing

So maybe your sex life isn't where it should be. If you can admit that to your health care provider, you've already fought half of the battle. Depending on the extent of your sexual dysfunction, you may be able to see improvement by getting your blood glucose in control. Even if the complications are too severe to reverse with better diabetes control alone, keeping your blood glucose levels in line can help to prevent further damage. Another tip: Quit smoking. It's linked to sexual problems, and it's all-around bad news for the rest of your body.

There are several approaches that both men and women benefit from, including seeing a doctor who specializes in sexual medicine and talking with a mental health professional. The latter is an important step because relationship problems, body issues, stress, and a host of other emotional baggage can affect all aspects of your sex life. You may be too self-conscious to get in the mood or get aroused, or maybe you're too stressed to have an orgasm.

A counselor can also help you and your partner work out any strain your sexual dysfunction may have caused. "It creates such emotional tension in a relationship that it permeates the entire relationship, not just in the bedroom," Roszler says. So talk it out and find a way to work around your sexual problems.

Finally, consider making lifestyle changes. Managing your diabetes well, including eating healthfully, exercising regularly, and reducing stress, will benefit your entire body, not just your nether regions. "I think it's very likely that a good sex life leads to better health," says Lindau. "And better health leads to good sex."



May 2017

12 Diabetes Health Tips

By: Epoch

Source: AARP

Over 29 million Americans have diabetes. Another 86 million have prediabetes. The resulting circulatory, heart and eye problems make life more difficult and, sadly, shorter. Here are 12 ways to prevent or manage the disease.

1. Seek Greek

We know you've heard this before, but the staples of a Mediterranean diet — vegetables, fruits, legumes, whole grains, fish and red wine — are a good idea anytime. And supplementing that diet with extra-virgin olive oil can reduce your risk for type 2 diabetes by 30 percen

2. Don't just sit there

An extra two hours a day spent watching television increases your risk of developing type 2 diabetes by 14 percent, according to a report published in the Journal of the American Medical Association. Our suggestion: Exercise while watching, or run around the block between episodes.

3. Have a cuppa

Numerous studies show that drinking more than two cups of coffee (16 ounces) a day is associated with a 25 percent lower risk of developing type 2 diabetes. The FDA maintains that up to 400 milligrams per day of caffeine (about four cups) is safe for healthy adults.

4. Stress less

Chronic worry and stress not only contribute to insulin resistance but also make it harder for your pancreas to move glucose out of your bloodstream. Techniques proven to help you relax and reduce stressinclude biofeedback, meditation and deep breathing.

5. Squeeze some citrus

Eating oranges, grapefruit, lemons and other citrus fruits can slow glucose uptake, helping keep your blood sugar levels under control, a study in the journal Preventive Medicine concludes.

6. Sprinkle with cinnamon

Studies find that people with type 2 diabetes who eat one gram (just a pinch or light sprinkle) of this tasty spice every day may experience a drop in blood sugar. Try cinnamon on your morning cereal, in your coffee or dusted on yogurt.

7. Fix it with food

These foods eaten daily can help you manage your blood sugar:

  • Beans, peas and lentils: One cup of these protein-rich legumes can lower your blood sugar levels significantly.
  • Dark chocolate: It contains nutrients called flavonoids, which can both drop insulin levels and limit your cravings for sweet and salty foods.
  • Oatmeal: The magnesium in it helps your body secrete insulin properly.

8. Flex your muscles

A 2012 study in the Archives of Internal Medicine showed that men who lifted weights for at least 2 1/2 hours every week lowered their risk of diabetes by 34 percent.

9. Mind your meds

If you're already on medication for diabetes, it's important to take it as prescribed. Plus, free apps such as Mango Health and Pocket Pharmacist can alert you to possible side effects from other prescription and nonprescription drugs you might be taking. Plenty of medications can interfere with your blood glucose levels.

10. Limit red meat

An analysis of the diets of almost 150,000 people found that eating an extra half serving a day of red meat increases the risk of developing type 2 diabetes by 50 percent

11. Keep your naps short

If you routinely doze for more than 60 minutes during the day, consider this a wake-up call. A 2016 study by Japanese researchers who looked at the data of more than 21 studies showed that snoozing longer than an hour a day could increase your risk of developing type 2 diabetes by 45 percent.

12. Opt for an App

Researchers at Cardiff University School of Medicine, UK, found that type 2 diabetes patients who used apps to monitor their condition had lower blood glucose levels when compared to the control group. More good news: There are plenty of iOS and Android diabetes apps to choose from: BG Monitor, Blue Loop and Diabetes in Check are a few of the most popular.



May 2017

Fresh food that can help manage diabetes

By: Epoch


The advice to eat a healthy diet is not new. Back around 400 B.C., Hippocrates, the Greek doctor, had this missive: Let food be thy medicine.

But as a society, we've got a long way to go. About 1 out of every 2 deaths from heart disease, stroke and Type 2 diabetes in the U.S. is linked to a poor diet. That's about 1,000 deaths a day.

There are lots of places to lay the blame. Calories are cheap, and indulgent foods full of salt, sugar and fat are usually within our reach 24/7.

So, how best to turn this around? Consider Tom Shicowich's story. It begins with a toe. His left pinky toe.

"One day I looked down and it was a different color ... kind of blue," Shicowich says. And he began to feel sick. "I thought I was coming down with the flu."

The next day he was on the operating table. A surgeon amputated his toe, and it took two weeks of intravenous antibiotics to fend off the infection.

All told, he spent a month in the hospital and a rehab facility. "Oh, I tell you, it was a bad year," Shicowich recalls.

Fresh Food Pharmacy," intoned Sam Balukoff, the master of ceremonies at Geisinger Health System's recent debut of a new food pharmacy located on the grounds of a hospital in central Pennsylvania.

At this event, Shicowich was one of the stars of the show. Over the past year, he and about 180 patients with Type 2 diabetes have been participating in a pilot program aimed at getting them to change their diets and lose weight. They receive free groceries of healthy foods every week.

Shicowich has lost about 45 pounds, and he is now much more active.

Each week, Shicowich and the other participants come to the food pharmacy. In its new incarnation, it looks more like a grocery, with neatly stocked shelves filled with healthy staples such as whole grain pasta and beans. The refrigerators are full of fresh produce, greens, low-fat dairy, lean meats and fish.

The participants meet one-on-one with a registered dietitian. They're given recipes and hands-on instruction on how to prepare healthy meals. Then, they go home with a very different kind of prescription: five days' worth of free, fresh food.

Shicowich says it's a huge change from his old habit. "I would stop at a Burger King or a McDonald's or buy a frozen Hungry-Man dinner, basic bachelor food — you know, heat and eat."

But those days are over. Now, he and his girlfriend cook meals at home. He says now it's much easier to climb a flight of stairs or take a walk with his girlfriend.

"It's life-changing"

Shicowich's health has improved. His blood sugar and blood pressure have dropped so much that if he keeps on track, his doctors say they will reduce his medications.

"It's life-changing," David Feinberg, the president and CEO of Geisinger Health System, says of the results Geisinger has seen.

He says, so far, all the patients in the pilot program have made similar improvements. "It's mind-blowing," he says. And he says the range of support patients are offered — everything from dietary counseling to wellness classes and workshops — can help them succeed.

Take, for instance, the significant declines in patients' hemoglobin A1C levels. This is a blood test used to track how well patients with diabetes are controlling their blood sugar.

A year ago, Shicowich's A1C was close to 11. Now it's down in the high-6 range. Anything under 6.5 is considered below the threshold of Type 2 diabetes, according to the Mayo Clinic. Feinberg says this means that Shicowich — and other participants in the program — have a much better chance of avoiding many complications of Type 2 diabetes if they can maintain their A1C levels down in this range.

"[They] won't go blind; [they] won't have kidney disease, amputations," Feinberg says. "The list goes on and on."

Cheaper than paying for complications

When this program started, some questioned the premise of giving away free, fresh food to patients with diabetes. But keep in mind, the costs associated with diabetes in the U.S. now exceed $240 billion a year.

Once you consider that price tag, Geisinger's program can look like a bargain. Over the course of a year, the company will spend about $1,000 on each Fresh Food Pharmacy patient. All of the participants in the program are low-income, so the gift of the food eliminated a key obstacle to eating well.

But would this lead to a reduction in health care costs?

Feinberg says as his team tracks hemoglobin A1C levels in the pilot participants, it is also assessing the number of medical visits and sicknesses along with the overall cost of caring for these patients.

It's still early days, and the team plans to fully analyze its first year of data. But here's what it estimates so far: "A decrease in hemoglobin A1C of 1 point saves us [about] $8,000," Feinberg says.

And many of the participants have seen a decline in hemoglobin A1C of about 3 points. "So that's [about] $24,000 we're saving in health care costs," Feinberg says. "It's a really good value." Geisinger is now in the process of expanding the program to new locations within Pennsylvania.

Is prevention medicine the future?

This program is an example of the booming interest in prevention-oriented medicine.

The current health care system in the U.S. is often more aptly described as a disease-care system. "It's reactive," says Mitesh Patel, a physician and assistant professor of health care management at The Wharton School at the University of Pennsylvania. "We wait until people get sick and then spend lot of resources helping them get better."

But Patel says there are signs this is beginning to change. "I think the paradigm shift has already begun," he told us. Patel's take on Geisinger's new Fresh Food Pharmacy program: It includes the kind of financial and social incentives that can help motivate people to make changes.

For instance, the Fresh Food Pharmacy gives free, fresh food not just to the patients enrolled but to everyone in their household as well.

"The way we behave is really influenced by others around us," says Patel. So promoting a group effort could "make the program a lot more sticky and more likely to succeed."

It's always a challenge to get people to maintain lifestyle changes over the long term. But, Patel says, "If you get the entire family to change the way they eat, you're much more likely to improve health."

The evidence that lifestyle-modification programs can reduce health care costs is starting to accumulate.

Earlier this year, researchers published findings in the journal Health Affairs that evaluated the medical expenses of Medicare patients with prediabetes. The patients had completed a one-year diabetes prevention program focused on healthy eating and increased physical activity. The researchers found, overall, the average health care savings was about $300 per person, per quarter — compared with patients who hadn't been through the program.