Optimal men’s health diet recommendation 1

There should be a focus on probability-based changes before focusing on diet, which means that men should know their fasting lipid profile, blood pressure, and other cardiovascular markers as well as they know any other health numerical values, for example prostate-specific antigen (PSA).

The lack of general health knowledge shown by some patients despite an impressive and obsessive need-to-know position concerning prostate, erectile dysfunction (ED), or other health issues is concerning. For example, surveys of the general population indicate that most men do not know their cholesterol values or have little understanding of what they represent in terms of potential health outcomes, and this finding is consistent regardless of age, race, and even gender. When the dual concern of CVD and overall men’s health risks is emphasized and promoted, men tend to become familiar with all of their clinical values, numbers, and overall risks. For example, it is more relevant to conduct a cholesterol/blood pressure screening and ED or prostate screening on the same day at any institution. Men should also be educated regularly on the normal values of a cholesterol panel and blood pressure test, because these values have recently been updated on 2 different occasions by the Expert Panel from the National Cholesterol Education Program (NCEP). A man attending a free PSA screening is at risk of ending up with a myopic health and disease perspective. Preliminary empirical evidence of this concern lies in recent data from Surveillance, Epidemiology and End Results (SEER) tumor registry, which suggests that men diagnosed or treated for prostate cancer need to focus as much on cardiovascular prevention because of the observed competing causes of mortality. At our institution, we have attempted to change our previous paradigm by currently abandoning PSA screening day and organizing, at the least, an annual general health lecture for men. Men need other resources, apart from overburdened primary care doctors, to emphasize and review basic optimal lipid and general health values. Table 1 is a modified, quick review for men and urologic health professionals.

The NCEP suggests a first cholesterol screen at an age of 20 years, which is approximately 20 to 30 years before a suggested PSA test, but few if any men have had a lipid test at this early age. Perhaps clinicians can greatly assist men in adhering to this early screening age. For example, when men with a family history of prostate cancer or ED, or an early diagnosis of most diseases, inquire about what their children should do first to prevent this condition from happening to them, a common suggestion for children or adolescents to just have an initial cholesterol screen seems most appropriate. In my experience, this tends to surprise and simplify patient concerns because most did not previously consider this thought or option for their children. The time is appropriate for this approach because of the recent concern in abnormal lipid levels among adolescents screened in the United States, which is approximately 20% to 43% based on a variety of factors, especially weight status (normal, overweight, or obese).

CVD risk is affected by lifestyle risk factors such as obesity, physical inactivity, and a high-caloric and overall unhealthy diet. These and other emerging risk factors or risk markers should ideally be discussed, because, despite the cholesterol test being a good marker for predicting future cardiovascular problems, it is not a perfect test. Other novel cardiovascular markers such as high-sensitivity C-reactive protein (hs-CRP), or traditional markers such as impaired fasting glucose or hemoglobin A1c, and evidence of subclinical atherosclerotic disease should also be discussed with the patient. Even a referral to a cardiologist may be appropriate for some men because some of these markers may also be related to overall mortality as well as CVD risk and some specific men’s health conditions.

Additional tangible advantages may occur for a man and his clinician that continue to follow these overall cardiovascular markers. For example, cholesterol levels are an outstanding indicator of how well a patient may be adopting lifestyle changes or even medication compliance following a PSA test, ED diagnosis, or after some definitive therapy. If these numbers improve, it may be more likely that the patient is following a men’s health lifestyle program. High-density lipoprotein (HDL) provides a good indicator of the commitment to exercise by the patient. HDL tends to increase, and at times substantially, with a greater amount of aerobic physical activity, and a higher HDL may be correlated with a lower risk of abnormal prostate conditions. Triglycerides are an indicator of changes in belly (visceral) fat, because this compound is generally stored in this anatomic location with increasing blood levels. However, in a minority of patients who follow a healthy lifestyle, a less-than-optimal change in lipid values may occur, but these men can be referred to a specialist for potential drug intervention and more aggressive lifestyle therapy.

Blood pressure monitoring should be emphasized as much as any other values. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure altered the criteria for what defines a healthy blood pressure. Men and their partners should be informed that normal blood pressure is less than 120/80 mm Hg and individuals with a systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg are considered to be prehypertensive, and lifestyle changes should be advocated in these individuals ( Table 2 ).

Blood pressure can be reduced with a healthier lifestyle, and again is a good indicator of lifestyle compliance, and a healthy blood pressure may also lower the risk of ED. Again, a minority of patients may not reduce their blood pressure with lifestyle changes, but these men can be referred to a specialist. Men who adopt healthy lifestyle and behavioral changes that do not result in CVD risk improvements should still be given encouragement to continue these changes because of the other potentially profound impacts these behaviors may have on overall and mental health. Patients seem more motivated to continue healthy lifestyle changes when there is some tangible healthy outcome with the behavioral change, and this becomes more probable when all numbers are used in the consult, including cholesterol and blood pressure, for example, as opposed to just other single and disease-specific (eg, PSA) values.

Optimal men’s health diet recommendation 2

The body mass index (BMI), but more importantly the waist/hip ratio (WHR) or waist circumference (WC) measurement and pant size should also become a standard part of a clinical record before initiating dietary changes.

The negative impact of being overweight or obese on overall morbidity and mortality is well known. BMI is moderately reliable as an isolated measurement, but it is a rapid method to determine who may be overweight or obese. BMI is defined as the weight (in kilograms) divided by the square of the height in meters (kilograms per square meter). Another method to calculate the BMI is to take weight in pounds and divide it by the height in inches squared and to multiply this number by 704 (pounds/inches ² × 704). A BMI of less than 25 kg/m ² is considered normal by the Word Health Organization (WHO), whereas 25 to 29 kg/m ² is overweight, 30 kg/m ² or more is defined as obese, and 35 kg/m ² or more is considered morbidly obese. Several of the largest and most recent preventive medicine randomized trials of men or women have shown that most individuals in these studies are overweight at baseline, and this includes trials to prevent specific men’s health abnormalities with prescriptions, supplements, or just dietary change. Thus, it has become so common to be overweight or obese that only a minority of men in current and past clinical trials have a BMI in the healthy range.

WHR may be another rapid measurement to determine obesity. An individual must stand during the measurement of WHR. WHR more precisely measures abdominal adipose circumference or tissue and fat distribution. The waist is defined as the abdominal circumference midway between the costal margin and the iliac crest. The hip is defined as the largest circumference just below the iliac crest. For men, a WHR greater than 0.90 is a moderate indicator of an increased risk for obesity-related conditions independent of BMI.

WC is perhaps the easiest and fastest method to currently assess obesity, and is my preference, together with pant size (waist size) in men because belly fat (visceral adipose tissue) seems to have one of the best predictive values of CVD and potential all-cause mortality risk among all the other weight measurements from some of the largest prospective studies in the world. However, the combination of WC with a BMI measurement may have added predictability. WC is also one of the best predictors of a future cardiovascular event, regardless of the ethnic group studied. WC is also one of the 5 specific criteria of the metabolic syndrome. WC has a tangible advantage compared with BMI, which can be appreciated after an individual commits to resistance exercise. An increase in muscle mass from resistance activities such as weight lifting can cause an increase in BMI, which could be frustrating to the patient and clinician. However, this does not occur when using the WHR or WC measurement. Informing patients of their official WC and asking pant size allows these parameters to not only be documented in the chart but allows for the patient to identify a goal of maintaining or reducing these numbers by the time of the subsequent clinical visit, thereby reducing the emphasis on the weight scale or trying to compete with a national standard. A patient with a BMI of 35 kg/m ² and a WC of 102 cm may be considered alarming, but a lack of aerobic fitness and caloric restriction, or not being able to reduce the value slightly over time, is more of an issue. A summary of the basic interpretation of the BMI and WC value is presented in Table 3 .

Kidney stones and renal cell carcinoma (RCC) may have a strong relationship with obesity. Obesity is also associated with lower testosterone levels, higher estrogen levels, and a higher risk of CVD, which could partially explain the preliminary finding that obese men have a higher risk of ED, but recent novel clinical research suggests that an improvement in these parameters occurs rapidly with just a 10% weight loss from dietary changes alone.

Clinicians should begin to carry and use tape measures that can measure WC, and I often argue that this is as critical as the stethoscope to the individual working in men’s health. Clinicians should also refer patients on a consistent basis to ancillary diverse services such as nutritionists, therapists, social workers, a variety of professional and even surgical weight-loss programs if needed, and recent weight-loss consumer publications. Simply becoming familiar with local weight-loss resources is an initial step in the appropriate direction for the patient and clinician.

Optimal men’s health diet recommendation 2

The body mass index (BMI), but more importantly the waist/hip ratio (WHR) or waist circumference (WC) measurement and pant size should also become a standard part of a clinical record before initiating dietary changes.

The negative impact of being overweight or obese on overall morbidity and mortality is well known. BMI is moderately reliable as an isolated measurement, but it is a rapid method to determine who may be overweight or obese. BMI is defined as the weight (in kilograms) divided by the square of the height in meters (kilograms per square meter). Another method to calculate the BMI is to take weight in pounds and divide it by the height in inches squared and to multiply this number by 704 (pounds/inches ² × 704). A BMI of less than 25 kg/m ² is considered normal by the Word Health Organization (WHO), whereas 25 to 29 kg/m ² is overweight, 30 kg/m ² or more is defined as obese, and 35 kg/m ² or more is considered morbidly obese. Several of the largest and most recent preventive medicine randomized trials of men or women have shown that most individuals in these studies are overweight at baseline, and this includes trials to prevent specific men’s health abnormalities with prescriptions, supplements, or just dietary change. Thus, it has become so common to be overweight or obese that only a minority of men in current and past clinical trials have a BMI in the healthy range.

WHR may be another rapid measurement to determine obesity. An individual must stand during the measurement of WHR. WHR more precisely measures abdominal adipose circumference or tissue and fat distribution. The waist is defined as the abdominal circumference midway between the costal margin and the iliac crest. The hip is defined as the largest circumference just below the iliac crest. For men, a WHR greater than 0.90 is a moderate indicator of an increased risk for obesity-related conditions independent of BMI.

WC is perhaps the easiest and fastest method to currently assess obesity, and is my preference, together with pant size (waist size) in men because belly fat (visceral adipose tissue) seems to have one of the best predictive values of CVD and potential all-cause mortality risk among all the other weight measurements from some of the largest prospective studies in the world. However, the combination of WC with a BMI measurement may have added predictability. WC is also one of the best predictors of a future cardiovascular event, regardless of the ethnic group studied. WC is also one of the 5 specific criteria of the metabolic syndrome. WC has a tangible advantage compared with BMI, which can be appreciated after an individual commits to resistance exercise. An increase in muscle mass from resistance activities such as weight lifting can cause an increase in BMI, which could be frustrating to the patient and clinician. However, this does not occur when using the WHR or WC measurement. Informing patients of their official WC and asking pant size allows these parameters to not only be documented in the chart but allows for the patient to identify a goal of maintaining or reducing these numbers by the time of the subsequent clinical visit, thereby reducing the emphasis on the weight scale or trying to compete with a national standard. A patient with a BMI of 35 kg/m ² and a WC of 102 cm may be considered alarming, but a lack of aerobic fitness and caloric restriction, or not being able to reduce the value slightly over time, is more of an issue. A summary of the basic interpretation of the BMI and WC value is presented in Table 3 .

Kidney stones and renal cell carcinoma (RCC) may have a strong relationship with obesity. Obesity is also associated with lower testosterone levels, higher estrogen levels, and a higher risk of CVD, which could partially explain the preliminary finding that obese men have a higher risk of ED, but recent novel clinical research suggests that an improvement in these parameters occurs rapidly with just a 10% weight loss from dietary changes alone.

Clinicians should begin to carry and use tape measures that can measure WC, and I often argue that this is as critical as the stethoscope to the individual working in men’s health. Clinicians should also refer patients on a consistent basis to ancillary diverse services such as nutritionists, therapists, social workers, a variety of professional and even surgical weight-loss programs if needed, and recent weight-loss consumer publications. Simply becoming familiar with local weight-loss resources is an initial step in the appropriate direction for the patient and clinician.

Optimal men’s health diet recommendation 3

Fitness and overall health should receive more attention. Approximately 30 to 60 minutes or more of physical activity a day on average should be the goal, which should include lifting weights or performing resistance exercises several times a week. Equal emphasis should be placed on aerobic and resistance exercise; one is not more important than the other for men’s health.

Physical activity, defined as at least 3 hours of vigorous exercise weekly, was associated with an approximate 70% lower risk of aggressive prostate cancer, advanced disease, and a potential for improved survival in the Health Professionals Follow-up Study. More than 47,000 men were included in this cohort, with a mean follow-up period of 14 years. The investigators appropriately concluded their publication by recommending 30 minutes a day of physical activity for all individuals because of the overall health benefits of this intervention.

Morbidity and mortality from CVD are affected by exercise, but weight lifting also seems to provide additional benefits. For example, additional data were derived from the Health Professionals’ Follow-up Study, which prospectively followed more than 44,000 men for 12 years. Men who jogged for 1 hour or more per week had a 42% reduction ( P <.001 for trend) in the risk of coronary heart disease (CHD), and those who just walked for 30 minutes or more per day or who were involved in other physical activities also experienced a risk reduction in CHD versus those who did not engage in these activities. Men performing regular resistance exercise (weight lifting) for just 30 minutes or more per week experienced a 23% risk reduction ( P = .03 for trend) in CHD. This observation was novel because previous prospective studies had not adequately addressed this subject. Weight training can increase fat-free mass and lean body weight, reduce sarcopenia, increase resting metabolic rate, and potentially reduce the risk of abdominal adipose deposition. Weight training or resistance training also seems to improve glucose parameters, including insulin sensitivity, and may slightly improve lipid levels, and reduce hypertension, which are all potential risk factors for ED and other men’s health conditions. Physical activity may also greatly reduce the impact of sympathetic overload that may be one of the many causes of benign prostatic hyperplasia (BPH). These studies emphasize the need to engage in aerobic and resistance activity together because of the documented synergism.

The mental health improvements with increased physical activity seem to be as profound as the physical health benefits. For example, a landmark trial was published more than a decade ago that included 156 adult volunteers with major depressive disorder (MDD) randomly assigned a 4-month course of aerobic exercise (30 minutes 3 times/wk), sertraline therapy, or a combination of exercise and sertraline. After 4 months, patients in all 3 groups showed significant mental health improvements; however, after 10 months, individuals in the exercise group had significantly lower recurrence rates compared with individuals in the medication arm of the study. Exercising during the follow-up period was associated with a 51% reduction in the risk of a diagnosis of depression at the end of the investigation. Men need to be instructed that regular physical activity and resistance training have adequate physical and mental health benefits such that not performing these activities reduces the potential for improved overall health. It is important to explain to male patients that, if the overall results from exercise studies were viewed similarly to a specific pharmacologic intervention, it probably would have already garnered attention worthy of a Nobel prize in, arguably, multiple categories of medicine, including male health breakthroughs.

Optimal men’s health diet recommendation 4

Men should reduce unhealthy dietary fat intake and increase the consumption of healthy fats, which should lower overall caloric intake. Saturated, trans-fat and even dietary cholesterol should be reduced and replaced by more healthy types of monounsaturated or polyunsaturated fat (eg, ω-3 fatty acids).

Saturated fat reduces low-density lipoprotein (LDL) receptor expression and increases LDL serum levels. LDL increases by 2% for every 1% increase in total calories from saturated fat. The NCEP recommends that saturated fat be reduced to less than 7% of total calories to reduce the risk of CVD. Some nonlean meats, high-fat dairy products (whole milk, butter, cheese, ice cream, and cream), tropical oils (palm oil, coconut oil, and palm kernel oil), baked products and mixed dishes with dairy fats, and shortenings are some of the larger contributors of saturated fat to the food supply. Many foods that contain high levels of saturated fat also contain the highest levels of trans-fat (partially hydrogenated fat), cholesterol, and, more importantly, total calories in many cases. For example, there are almost twice as many calories in 237 mL of whole milk (5 g of saturated fat) compared with skim, or even almond milk or soymilk (0 g of saturated fat each). Thus, identifying 2 similar products, such as milk, meats, dairy, or chips, and choosing the item lower in saturated fat can allow for a profound reduction in total caloric intake, which is critical to helping maintain or reach an appropriate weight or waist size.

However, simply reducing all saturated fat in an individual’s diet is not necessarily a practical and healthy dietary lifestyle change. The current cardiovascular goal of obtaining less than 7% of calories from saturated fat seems ideal from past studies, because getting minimal to no calories from saturated fat not only is excessive, it seems to reduce levels of HDL (good cholesterol) from past CVD and men’s health clinical trials. Reducing almost all saturated fat consumption also suggests that this type of fat, in itself, is heart unhealthy, which is not accurate from the largest recent meta-analysis of prospective studies. In some countries where overall caloric intake is low compared with the United States, saturated fat may have tangible cardiovascular benefits, but this also needs to be placed in perspective. Regions of the world (for example Japan) where healthy men have the largest intakes of saturated fat would still be in the lowest saturated fat consumption category in the United States. Regardless, a potential impact of reducing saturated fat is that it may reduce overall caloric intake and reduce weight and waist gains. Another benefit of reducing saturated fat is that it allows for the opportunity to reduce dietary cholesterol intake and increase the consumption of other monounsaturated and polyunsaturated fats that have shown a greater reduction in CVD from past clinical trials. A summary of the different types of dietary fat, food sources, and impacts on specific lipids is found in Table 4 .

Optimal men’s health diet recommendation 5

Men should consume a diversity of low-cost fruits, and especially vegetables, and not focus on high-caloric, high-cost, and high-antioxidant exotic juices. Dietary supplements that claim to substitute for fruit and vegetable consumption are also concerning.

Lycopene seemed synonymous with men’s health in a variety of media and commercial sources. Few topics in men’s health disease prevention enjoyed such excessive attention as lycopene, tomato products, and their potential benefits. For example, an often-cited analysis of more than 80 epidemiologic studies on tomatoes and health seemed to be used by many commercial companies. Approximately half of the studies in this analysis supported the consumption of tomato products at least once a day to reduce the risk of a variety of cancers, including prostate cancer, but a large number of studies in this same analysis failed to detect a correlation. The overall recommendation of the author of the meta-analysis was to increase the consumption of a diversity of fruits and vegetables and not just tomato products, which was the most critical finding of the analysis that never garnered any commercial attention.

Perception does not seem to reflect reality in this area of nutritional medicine. For example, tomatoes were never the only, or even the primary, source of lycopene. A variety of other healthy products contain this compound, such as apricots, guava, and pink grapefruit. Watermelon is also an adequate source of lycopene, and is the largest source per gram compared with any other source, including tomato products.

Fruits, and especially vegetables in general, have been associated with a reduced risk of some male urologic conditions. For example, the Brassica vegetable group is diverse and includes broccoli, Brussels sprouts, cabbage, cauliflower, kale, and watercress, and may slightly reduce the risk of urologic disease, and it is interesting that these products are low in overall calories. The Allium vegetables have also been associated with a reduced risk, and this group includes chives, garlic, leeks, onions, and scallions. Fruits and vegetables have unique and shared anticancer and anti–heart disease compounds that may contribute to improved overall health. The sum of the epidemiologic data continues to support the increased consumption of a diversity of fruits and vegetables to potentially and favorably affect men’s health, but the overall data currently support a slightly greater potential reduction in CVD risk and mortality, perhaps through assisting in weight loss. Clinicians should recommend fruit and vegetable consumption for better overall health, but not for cancer prevention where the recent large-scale data seems to be less impressive.

Media attention seems to shift from one fruit or vegetable to another with each passing year. Clinicians need to be objective and explain to patients that these media reports do not necessarily represent any major breakthrough, but support the ongoing and past research that consuming a diversity of low-cost fruits and vegetables is just 1 practical and logical approach to improving men’s health. A recent example of this controversy is the recent research into pomegranate juice. The first attention-gathering study did not include a placebo group or another group of men that consumed another type of healthy juice product. This should not be construed as a lack of efficacy and some of these companies should be lauded for at least investing in research, but an objective overview of the preliminary research and the caloric contribution of these and other juices is necessary. Many brands of pomegranate and other novel juices contain at least 140 calories per 237-mL serving, which translates into more, or at least similar, calories than most commercial regular soft drinks and alcoholic drinks (approximately 100–150 calories). Many of these juices are expensive in comparison with cheaper nutritious and lower-calorie products, and it is concerning that low-income patients may find it difficult to afford them. In addition, drug and juice interactions are still being researched, which is important because grapefruit juice studies have provided a paradigm of medication interactions, but novel juices such as pomegranate may also cause some legitimate concerns with medications metabolized by CYP3A4.

In partial defense of some of these companies, it is also laudable that some lower-caloric exotic juice options now are appearing on some store shelves.

The competitive nature of the food and beverage industry, like any commercial business, translates into millions of dollars spent yearly on advertising, which usually affects how patients eat and drink. Clinicians need to be advocates for general evidence-based advice instead of encouraging hype on a specific compound or product that does not have at least a moderate amount of evidence in an area of medical need. When a patient begins to depend on a pill alone instead of on a lifestyle change, the potential for seeking other nonlifestyle changes via pills increases. This pendulum of health swings in a bidirectional fashion so, when a patient begins to exercise, there is an increased potential to seek other healthy behavioral changes such as eating better or quitting smoking or consuming less alcohol and not depending on pills. Thus, if a pill count can be kept to a minimum or nonexistent it is rewarding to watch patients depend on lifestyle change as the initial method to correct or prevent a condition. The next recommendation for men in this article would be difficult to achieve with any pill that claims to substitute for a fruit or vegetable; one healthy change improves the likelihood of another healthy lifestyle change.

Optimal men’s health diet recommendation 6

Consume more total (soluble and insoluble) dietary fiber (20–30 g/d) from food for overall health advantages, especially soluble and insoluble fiber, which can easily be found in higher quantities in low-cost options and not just from overcommercialized pills and powders.

General and numerous health benefits from consuming dietary fiber have been well documented and especially include a reduction in CHD risk. A pooled analysis of past cohort studies of dietary fiber for the reduction of CHD included research from 10 international studies, which included the United States. In a period of 6 to 10 years of follow-up, and after multivariate adjustment for demographics, BMI, and behavioral changes, each 10 g/d increase of calorie-adjusted total dietary fiber was correlated with a 14% reduction in the risk of total coronary events and a 27% reduction in risk of coronary death. These findings were similar for both genders, and the inverse associations occurred for both soluble (viscous) and insoluble fiber. Past studies have not observed a consistent benefit with one class of fiber rather than the other.

Small additions of fiber can affect medication dosages in a positive manner. Only 15 g of psyllium husk supplementation daily with a 10 mg statin (simvastatin) was shown to be as effective as 20 mg of this statin by itself in reducing cholesterol in a preliminary placebo-controlled study of 68 patients over 12 weeks Other cardiovascular benefits have also been consistently found. A meta-analysis of 24 randomized placebo-controlled trials of fiber supplementation found a consistent impact on blood pressure reduction. Supplementation with a mean dose of only 11.5 g/d of fiber reduced systolic blood pressure by 1.13 mm Hg and diastolic pressure by 1.26 mm Hg. The reductions were greater in individuals older than 40 years of age and in hypertensive individuals compared with younger and normotensive participants. Daily intakes of fiber in the United States and many other Western countries is approximately 10 to 15 g/d, which is approximately half of the total amount consistently recommended by the American Heart Association (AHA) and American Dietetic Association (25–30 g/d) for adequate overall health.

Dietary fiber from food is easily achieved from low-cost sources of soluble and insoluble fiber. For example, I often tell patients to have just a third of a cup of a bran cereal, which is only the size of 2 liquor shot glasses, with flaxseed and some fruit, and before they leave home in the morning approximately 20 g of fiber will have already been ingested toward the goal of 25 to 30 g. Low-cost fiber sources such as flaxseed can potentially provide numerous heart-healthy and general men’s health benefits and outcomes. Flaxseed is also one of the richest plant sources of heart-healthy ω-3 fatty acids, and chia seed is arguably the richest plant source of fiber and ω-3, and both of these additions to the male health diet would be ideal.

However, fiber seems to have become commercialized, and some men are turning primarily toward powders and pills to solve their fiber deficit; this is not only costly, but it also provides primarily small amounts of mostly soluble fiber that make it difficult to reach their total fiber goal using only these sources. For example, I often ask students how many fiber capsules/pills are needed to be consumed daily to obtain just 20 g of fiber, and the answer always seems to provide adequate surprise value (the answer is 30–40 pills a day, depending on the commercial source). Again, research continues to support the overall and heart-healthy benefits of fiber, especially when it is primarily derived from food sources. Arguably, fiber should be advertised to male patients as the ideal internal antiaging product because it lowers blood cholesterol, blood pressure, and reduces the risk of constipation, diverticulitis, hemorrhoids, reflux, and weight gain, which are all conditions associated with aging.