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Nu trition Continued from cover Some Fat Recommended in Daily Diet drive, erectile dysfunction, reduced muscle mass and strength (including increased risk of osteoporosis), lower energy levels and mood disorders such as depression. Studies have shown that for men with low levels of testosterone, prescribing the drug not only has the potential to improve these symptoms, it can also improve longevity compared with low-testosterone men who aren’t on the therapy. Testosterone levels begin to decline in middle age, and at least one-in-four men 75 years of age and older have below-normal testosterone levels. Testosterone deficiency has also been found to be common in men with both type 1 and type 2 diabetes. The U.S. Food and Drug Administration is reassessing the safety of FDA-approved testosterone products after two studies suggested an increased risk of cardiovascular problems among men on the therapy. However, the FDA has not concluded that the treatment increases the risk of stroke, heart attack or death, and patients are advised not to stop taking prescription testosterone without consulting with their healthcare provider. the level of bad LDL cholesterol and increase the risk of cardiovascular disease. “If you see on the back of a package that a product contains saturated or trans-fats, it is best to limit consumption or just stay away,” says Dr. Lee. Dietary choices should include the mono- and polyunsaturated fats, which are associated with lower levels of LDL and higher levels of good HDL cholesterol, along with reduced risk of cardiovascular disease. Sources for these healthy fats include vegetable oils, nuts, fish and certain fruits such as olives and avocados. “The best first step is to eliminate the unhealthy fats from the diet by sticking with whole fruits and vegetables and lean proteins,” Dr. Lee says. A healthy diet — including sufficient protein consumption — is essential for maintaining muscle mass and overall fitness, explains Zhaoping Li, MD, PhD, a physician nutrition specialist with the UCLA Center for Human Nutrition. “Body weight is commonly used to indicate overweight or obesity, but what really matters is body composition — in particular, how much of your weight is from fat vs. muscle and organs,” Dr. Li says. She notes that for some individuals, including many postmenopausal women, body weight can remain stable even as body-fat percent rises and muscle mass declines, increasing the risk for diabetes and cardiovascular disease, among other concerns. Signs to look for include increased waistline, inability to walk briskly and a reduction in overall strength. A key factor in building and maintaining muscle mass, particularly for older persons, is monitoring protein consumption — 25-30 grams per meal on average for healthy seniors, spread evenly throughout the day. The ideal sources are lean proteins, Dr. Li says, including seafood, chicken and turkey breast, egg whites, whey and soy. To view a video about nutrition and healthy shopping, go to: goodfats Although there can be benefits, the therapy has also been over-promoted and in some cases over-prescribed, Dr. Rajfer says. “It should be given only after testosterone levels are measured in a blood test, and to address a specific symptom associated with low testosterone,” he explains. If the drug doesn’t improve symptoms, “that means the low testosterone wasn’t the cause of the symptom and the patient shouldn’t be on it anymore.” “It’s important to remember that with any drug, there are potential side effects,” Dr. Rajfer adds. “Before starting testosterone therapy, patients should have a discussion with their doctor about why they are doing it.” Vital Signs Fall 2014 Vol. 64 7