Excerpt from - Dying To Be Men

Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys

By Dr. Will Courtenay

Excerpts About
DIABETES & MEN

More men than women have diabetes, which is the sixth leading cause of death in the United States; the death rate is nearly 1.5 times higher for men than for women. Men are 32% more likely than women to be hospitalized for long-term complications of diabetes; they are also more than twice as likely as women to have a leg or foot amputated as a result of complications related to the disease. In addition, the risk for cardiovascular death is 2 to 4 times higher for people with diabetes. During a 12-year period, people with diabetes are 3 times more likely to suffer an incident of cardiovascular disease than people without diabetes and who have normal blood pressure. As noted in Chapter 1, heart disease kills 1.5 times more men than women. Diabetes is also a risk factor for sudden cardiac death, which strikes 3 times more men than women. People with diabetes are at 2 to 6 times more risk for death from stroke. Recent research also suggests a link between diabetes and cancer.

There are also important differences between men of various ethnic groups based on their age. Among men aged 65 years or older, diabetes is the fourth leading killer in all ethnic groups except for European American men, for whom diabetes is not even among the five leading killers.

The risk for diabetes could be reduced by half through changes in behavior . . . The fact that men see doctors less often helps to explain why, according to the American Heart Association, twice as many men as women have diabetes that remains undiagnosed.

Similarly, there is strong evidence to support the value of regular screening to detect diabetes, particularly for men; the prevalence of undiagnosed diabetes is significantly higher in men than in women.

There is also sufficient evidence to recommend regular screening for prediabetes. (Before people develop type 2 diabetes, they almost always have prediabetes—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.) Screening for prediabetes is especially important because most people with this condition experience no symptoms. According to one large prospective study, prediabetes (specifically defined as impaired fasting glucose levels) increases the 5-year risk for death from heart disease by 250%. Based on the National Health and Nutrition Examination Survey, which examines biological samples of respondents, 26% of adults in the United States aged 20 years or older have prediabetes, and the prevalence is higher among men. The prevalence of prediabetes is also higher among boys than girls, and it is increasing for adolescents of both sexes 12 to 19 years old. Between the 1999–2000 and 2005–2006 survey years, impaired fasting glucose levels increased from 7% to 13% for this age group. In 2009, the prevalence of prediabetes for this age group was 16%, and it was nearly 2.5 times greater for boys than for girls.

Men are less likely than women to have had their cholesterol levels checked or checked recently, which significantly increases men's risk for cardiovascular disease and diabetes.

Getting sufficient sleep is another form of self-care. People who sleep fewer than 6 hours per night, in particular, are at increased risk for disease and death. Only 71% of men compared with 80% of women believe that getting a good night's sleep is absolutely necessary for good health. Not surprisingly, men get significantly less sleep than women. Far more women (35%) than men (26%) report getting more than 8 hours of sleep on workdays and on the weekends (54 and 51%, respectively). On the other hand, more men than women report sleeping 6 hours or less per night. Even among a national sample of 11,000 health-conscious respondents, the men reported sleeping 6 hours to the women's 8 hours. Furthermore, although both men and women get less sleep than they report, women are more accurate in their reporting than men, who significantly overestimate the time they sleep. People who sleep fewer than 6 hours per night significantly increase their risk for hypertension, and cardiovascular disease or death from any cause . . . Sleep influences health in a variety of ways . . . Insufficient sleep or chronic partial sleep loss can increase the risk for obesity and diabetes by causing changes in appetite and other physiological changes. Sleep also influences health behavior. Compared with people who are well rested, people who get insufficient sleep are far less likely to exercise (28% vs. 8%), eat healthy foods (23% vs. 7%), or engage in leisure activities (30% vs. 7%); they are also more likely to smoke cigarettes or use other forms of tobacco (18% vs. 10%).

Eating a healthy diet significantly reduces the risk for death from any cause, including heart disease and cancer; it appears to even help prevent cancer in people whose diet was poor in the past. A decreased risk for a variety of chronic diseases and causes of death is associated with dietary patterns that emphasize whole-grain foods, legumes, vegetables, and fruits and that limit red meat, full-fat dairy products, and foods and beverages high in added sugars. A healthy diet can improve several of the known risk factors for heart disease, and—in conjunction with physical activity—can reduce the risk for diabetes even more effectively than medication. An estimated one third of all cancer deaths are attributable to diet, regardless of body weight or level of physical activity. The diets and dietary habits of women differ considerably from those of men. Research consistently suggests that women attach greater importance to healthy eating and to choosing foods that are high in nutrients. Only 74% of men believe that eating well is absolutely necessary for good health, compared with 86% of women, and women are more likely to read food labels or be aware of which foods are healthy. It is not surprising, then, that men's diets are consistently found to be less healthy and less nutritious than women's diets. Men are significantly less likely than women to eat fruit and vegetables, or to eat foods that are high in fiber and low in fat or sodium. Only one in five men (20%), compared with nearly one in three women (29%), eats fruits and vegetables five or more times a day. Research also consistently shows that men eat much more red meat than women and are less likely than women to limit red meat in their diets. National data indicate that this difference amounts to 74 grams a day, or nearly 1.5 times more servings of meat a day than women eat. In addition, 70% more men than women get their dietary calories from alcohol rather than food. Based on extensive research linking poor health with poor diet—including high red meat consumption and low fruit and vegetable intake—gender differences in diet and dietary habits are clearly a major contributor to men's disproportionately high risk for heart disease and cancer, the leading killers in the United States; these factors are also a major contributor to men's risk for the precursor to heart disease: metabolic syndrome. This syndrome consists of a cluster of risk factors linked to heart disease, including high glucose levels, abnormal cholesterol levels, excess weight, and hypertension. Among adults in the United States, where differences in the prevalence of metabolic syndrome exist, men are at greater risk. This gender disparity in risk is seen as early as adolescence. As a result of their poorer diet (along with their lack of sufficient exercise), metabolic syndrome is 2.5 to 3 times more common among 12- to 19-year-old males than among females of the same age. Poor dietary habits also contribute significantly to men's and boys' increased risk for being overweight. Compared with nonoverweight youth, overweight adolescent boys consume a greater proportion of their daily energy (nearly 10%) from soft drinks. (I discuss obesity and overweight at greater length in the Weight section of this chapter.) Among high school students nationally, 10% more males (39%) than females (29%) drink a can, bottle, or glass of soda at least once a day. Adolescents who do not drink soft drinks consume fewer overall calories per day than those who drink more than 26 ounces of soft drinks per day. A recent large study provides preliminary findings of a link between the consumption of two or more soft drinks per week and a nearly doubled risk for pancreatic cancer—which, as noted previously, kills 30% more men than women. The American Heart Association recommends limiting the consumption of beverages with added sugars to help reduce the risk for heart disease. Indeed, a recent study has linked a high intake of fructose—which is found in soft drinks—with higher levels of blood pressure.

Limiting dietary fat is considered a primary means to improve health, reduce weight, and prevent these diseases, as well as stroke and diabetes . . . Most saturated fat comes from animal sources—especially from meat . . . As noted previously, men eat more meat that women do. They are also less likely than women to limit fat in their diets, and more likely than women to eat meals away from home or in restaurants, and to eat convenience foods, which are all high in fat. Consequently, males of all ages consume more saturated fat than females do, even when sex differences are adjusted for body size. Total fat intake in grams is 1.5 times higher for males than females of all ages.

The primary sources of dietary cholesterol are eggs, dairy, and meat . . . Whereas the dietary cholesterol intake of girls and women of all ages is generally within the recommended range, the cholesterol intake of boys and men is much higher. As a result, national surveys have consistently found that men and boys have lower high-density lipoprotein (HDL or "good") cholesterol levels than women and girls, even when gender differences are adjusted for body size. At the same time, significantly more men than women have higher levels of LDL [low-density lipoprotein (LDL or "bad")] cholesterol . . . Research, including large prospective studies, consistently shows that high blood cholesterol significantly increases the risk for diabetes.

Overweight and obesity have increased, especially among men. National data consistently indicate that more men (67%) than women (50%) are overweight. Men are also more likely to be obese, and the percentage of men who are obese continues to increase.

Overweight and obesity are associated with a variety of chronic conditions—including heart disease, diabetes, dyslipidemia, hypertension, stroke, arthritis, high serum cholesterol, and erectile dysfunction—as well as with premature death.

The finding of greater [health risks] among overweight men [compared to overweight women] is not uncommon. For example, overweight men, but not overweight women, are at increased risk for stroke; similarly, the risk for diabetes is greater for overweight men. This finding regarding diabetes is especially relevant for adolescent boys. As noted previously, the risk for prediabetes is nearly 2.5 times greater for adolescent boys than it is for adolescent girls, and it is nearly double for adolescents who are overweight. Prediabetes is reversible through lifestyle changes related to weight, physical activity, and diet, as well as pharmacological intervention.

One line of research suggests that certain diseases, including asthma and diabetes, are linked with gender-based susceptibilities caused by the interplay of sex steroid hormones or sex chromosomes with environmental risk factors at particular developmental windows, which would explain why these diseases are more common among males

Smoking is considered the single most preventable cause of illness and death in the United States, even after controlling for potentially confounding factors, such as other health practices and health status at the time of survey National data from the late 1990s showed that significantly more men than women smoked—26% compared with 21% . . . Although the number of smokers decreased slightly during the 1990s and the first decade of this century, the significantly higher rate of smoking among men persists; 23% compared with 18% for women. It is not surprising, then, that at least twice as many male as female deaths are attributed to smoking . . . The risk for diabetes is also up to 4 times higher for heavy smokers than it is for nonsmokers.

Research consistently reveals greater problem drinking and heavy drinking among men, and a higher prevalence of alcohol abuse and dependence . . . Heavy drinking increases the risk for diabetes by up to 400%.

Will Courtenay, PhD, LCSW, "The Men's Doc"
Helping Men & Boys Live Happier, Healthier, More Fulfilling Lives
McLean Hospital, Harvard Medical School
Author of Dying to Be Men
Consultant, Researcher, Speaker & Psychotherapist
5835 College Avenue, Suite D
Oakland, CA 94618
415-346-6719
TheMensDoc.com