Two studies show diet can affect mobility of sperm, quality of semen

MONDAY, Oct. 17 (HealthDay News) — For years, nutritionists have rallied around the notion that “you are what you eat.”

Now, new research suggests this adage might even extend to the strength and quantity of sperm.

The observation stems from a pair of studies slated for presentation Monday at the American Society for Reproductive Medicine annual meeting in Orlando, Fla., both of which highlight an apparent linkage between nutrition and semen quality.

The upshot: Diets rich in red meat and processed grains seem to impair the ability of sperm to move about, while diets high in trans fats appear to lower the amount of sperm found in semen.

“The main overall finding of our work is that a healthy diet seems to be beneficial for semen quality,” said Audrey J. Gaskins, lead author of the first study. Currently a doctoral candidate in Harvard School of Public Health’s department of nutrition in Boston, Gaskins’ colleagues included researchers from both the University of Rochester and the University of Murcia in Spain.

“Specifically, a healthy diet composed of a higher intake of fish, fresh fruit, whole grains, legumes and vegetables seems to improve sperm motility,” Gaskins explained, “which means a higher number of sperm actually move around, rather than sit still.”

Gaskin’s conclusions are based on work with 188 men between the ages of 18 and 22, who were recruited in Rochester. Food questionnaires were completed, and participant diets were categorized as being either “Western” in content (including red meat, refined carbs, sweets and energy drinks) or so-called “Prudent” (composed of fish, fruit, vegetables, legumes and whole grains).

Semen tests were then conducted to assess sperm movement, concentration and shape.

Although diet seemed to have no impact on either sperm shape or number, motility was impacted, with “Western” diets linked to reduced movement, even after accounting for factors such as race, smoking history and body-mass index (BMI).

Gaskins stressed, however, that more work is needed to better understand exactly how nutrition can affect sperm.

“This was a small study, and we don’t know if there’s something else about the men that causes them to have worse motility,” she noted. “We don’t know if nutrition actually causes the change. So, for now all we can say is that there’s an association between nutrition and sperm quality.”

On a similar front, a second study led by Dr. Jorge Chavarro, an assistant professor of nutrition and epidemiology at the Harvard School of Public Health, revealed that men who eat diets that contain a relatively high amount of trans fat had lower sperm concentration levels. What’s more, the amount of trans fat found in their sperm and semen went up.

The conclusion was drawn from work with nearly 100 men, all of whom underwent a nutritional and semen quality analysis.

Even after adjusting for a wide array of factors such as age, drinking and smoking histories, BMI, caffeine intake and total calories consumed, the authors found that although trans-fat intake appeared to have no impact on sperm movement of shape, the more trans fatty acids consumed the lower an individual’s sperm concentration.

Dr. Edward Kim, from the University of Tennessee’s graduate school of medicine in Knoxville, reacted to both studies with enthusiasm and caution.

“I think that this research is certainly very suggestive that dietary factors may have an impact on male infertility,” said Kim, who also serves as president of the Society for Male Reproduction and Urology.

“And the studies point us in a direction that suggest that a healthy lifestyle may correlate with better quality sperm,” he added. “But clearly further research in this area is needed to come up with definitive conclusions.”

Because both studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

In June 2011, senior military medical leadership met with The Bravewell Collaborative and renowned scientists and physicians to discuss improving pain management for warriors and veterans through the use of integrative medicine. This meeting, held at the Pentagon, was part of the Army’s effort to provide “a standardized DoD and VHA vision and approach to pain management to optimize the care for warriors and their families.”

The 2009 Army Pain Management Task Force (PMTF) report called for building best practices for the continuum of acute and chronic care based on a “holistic, multidisciplinary, integrative approach to care.”  The Army Comprehensive Pain Management Campaign Plan Symposium is an important step in implementing the PMTF recommendations. 

“This is a unique, historic moment to capitalize on what we know works to effectively treat pain,” said Army Surgeon General Lt. Gen. Eric B. Schoomaker, MD, PhD.  “It marks the beginning of a cultural shift in how health care is practiced in the military.”

Symposium participants reviewed the latest science in pain management and how integrative interventions can not only help improve pain management but also advance the overall health and “mission readiness” of the DoD and VHA, which is vital to the safety of our nation.

“We have an extraordinary generation in the military right now,” Schoomaker noted.  “Today’s wounded warriors do not want to be defined by their injuries.” They want to live fully and in some cases, they want to return to active duty.

Brig. Gen. Richard Thomas, the assistant Surgeon General (Force Projection), noted that many medical advances have come through wartime medicine, such as the development of the yellow fever vaccine by Walter Reed and the discovery by Dr. R. Adams Cowley of the golden hour in emergency medicine, the time period following traumatic injury during which if proper treatment is administered, lives can be saved.  “Many innovations in military medicine have changed American health care,” said Col. Kevin Galloway, Chief of Staff for the Army Pain Management Task Force, “…and we are approaching the tremendous need for improvement in pain management with this same spirit.”

It is estimated that millions of our nation’s warriors and veterans live with chronic pain and research shows that pain reduces quality of life, work and relationships.  Integrative strategies, such as those presented by leadership from the Allina Health System in Minnesota and the Scripps Center for Integrative Medicine in California, have been shown in clinical research to reduce pain scores by as much as fifty percent.

  “The nine integrative medicine centers in the Bravewell Clinical Network have been developing successful models of integrative care for the past nine years and we are pleased to be able to share these with the military and the VHA,” explained Christy Mack, President of The Bravewell Collaborative. 

  For more information about the Army Pain Management Task Force, please visit:

http://www.armymedicine.army.mil/prr/pain_management.html.

Montori and Amit Sood are not the only voices of support for alternative approaches at the Mayo Clinic, a medical center renowned not only for the excellence of its medical care, and for the relatively low cost of that care, but also for a culture that is fanatical about doing whatever is best for each patient over all other considerations. With its soaring, graceful buildings and an almost pious, midwestern earnestness about patient care, the Mayo Clinic feels a bit like the mother church for modern medicine. I met with a range of prominent physicians there to discuss their views on the growing presence of integrative medicine in mainstream medical care, including at the Mayo Clinic itself, which houses what it calls the Complementary and Integrative Medicine program.

One of them was Morie Gertz, a hematologist, who chairs the Mayo Clinic’s internal-medicine department. “Most of the doctors here were top of their medical-school class, top of their residency, blah, blah, blah,” he told me. “That’s technical mastery. That doesn’t make them effective healers. Over the past 30 years, I’ve seen hundreds of patients who clearly feel they’ve benefited from alternative therapies. It’s not my job to tell them they shouldn’t feel better. And I wouldn’t tell patients they shouldn’t try alternative medicine if they want to—we need to follow the clues patients give us about what might help them. If a patient chooses to walk away from the therapy I’ve prescribed and go to an alternative therapist instead, that’s not the fault of alternative medicine; it’s because I’ve failed as a doctor to do a good job of making my case in terms that are important to the patient.”

Gertz is among the many physicians who dismiss the lack of supportive randomized-trial data as a reason to write off alternative medicine. “The randomized trial is a very high bar,” he says. “Eighty percent of what I do here isn’t based on randomized-trial data.” Physicians routinely write “off-label” prescriptions, Gertz says—that is, prescriptions that call for drugs to treat conditions for which those drugs have not been officially approved. It’s a perfectly legal and ethical practice, and even one that physicians consider essential, accounting for about a fifth of all U.S. prescriptions. “It’s off-label not because it doesn’t work, but because there’s no good randomized-trial data on it. In the same way, we may not have great evidence that alternative medicine works, but that’s very different from saying it doesn’t work.”

This notion that alternative medicine is a legitimate response to mainstream medicine’s real shortcomings is one I heard, in variations, from everyone I spoke with at the Mayo Clinic. Keith Lindor, a liver specialist, even went a bit further. “I see how often there’s little we can do with specific therapies to help patients,” he told me. “One of the most common complaints we see from patients is chronic abdominal pain, and we only figure out what’s wrong 10 percent of the time. These people deserve a chance to be helped by someone who takes a different approach.”

His own positive view of alternative practitioners was shaped early in his career, when he spent time working alongside a Native American medicine man at a reservation clinic. “I had been trained to aggressively treat patients with drugs that often only made them even more ill,” he says. “But he could often do much better with just a press of his hand.” When Lindor himself developed severe neck pain from long hours doing procedures, a doctor suggested drug injections into the base of his skull, but he ultimately found relief from several sessions of massage. The beneficial effects of alternative therapies on Mayo Clinic patients, he says, have been observable in shorter hospital stays, in lower levels of self-administered painkillers, and in reduced tissue inflammation, which is a general indicator that the immune system is better holding its own.

Lindor’s opinion is perhaps of special significance, because he is also the dean of the Mayo Clinic’s medical school. Ultimately, what today’s medical students think about alternative medicine will be more important to the future of medicine than what anyone else thinks of it. Mayo Medical School has woven alternative medicine into its curriculum. And its students seem eager to learn more. Among the dozen or so “interest groups” the student body has set up to arrange further discussion and education outside the normal curriculum is one focused on alternative medicine, attracting about a third of the students, on par with the other groups. “I’m probably not interested in being an alternative practitioner, but I want to learn more about it so I can have a better conversation with patients,” says Lauren Jansons, the ebullient second-year student who heads the group. “As physicians, we learn to identify disease and treat it. What we’re not always taught is to identify with patients, to understand what they’re thinking and feeling, even though that’s important to human nature. It’s an approach that motivates people to be more active in their treatment and healing, and we can channel that.”

In fact, a more open-minded consideration of alternative-medicine practices has become par for the course at medical schools. In recent years, the American Medical Student Association has co-sponsored an annual International Integrative Medicine Day, which, according to this year’s press release, “will increase awareness and availability of integrative medicine, promote inter-professional collaboration, encourage self-care, foster cultural awareness and enhance patient-physician communication” (an “infiltration of quackademic medicine,” blogged David Gorski, a surgical oncologist at Wayne State University and one of the more prickly anti-alternative-medicine warriors, in despair).

Before leaving the Mayo Clinic, I stopped in to watch a small mountain of muscle named Ryan Berry receive massage therapy, through the integrative-medicine program, to address the discomfort he was experiencing two days after extensive thoracic surgery. When I came in, Ryan, who is 34, was stiff with pain, and seemed sewn to the chair in which he had been propped up. He clutched the arms of the chair, grimacing with each shallow breath. Over soothing music, the therapist spent several minutes talking with Ryan, getting him to discuss, through clenched teeth, the details of his pain. When she finally started the treatment, she seemed to barely brush her hands against the top of his back. But within a minute, his hands started to release their death grip, his teeth unclenched, and he was slumping a bit. Within three minutes, he was breathing deeply and slowly, his hands were open and limp, he was sunk down in the chair, and his grimace had been replaced with a hint of a smile. Personally, I doubt it mattered much where exactly the therapist placed her hands and how she moved them, which means a randomized trial would have found the treatment to be no better than sham massage. But it was as compelling a picture of suffering relieved as I have ever seen.

Scenes like that one, witnessed by more and more doctors in clinical settings, make it obvious why the front lines of medicine are pushing toward a less rigid stance on alternative medicine, if slowly, and in pockets. Open-mindedness can strike in even the most unexpected of places. Steven Salzberg happened to mention to me in passing that he didn’t consider hypnosis to be an alternative practice. I asked him why he left it off his long list of shams and frauds, and he seemed surprised, as if he had never considered the possibility that it might not be a legitimate therapy. “I don’t know,” he said. “I guess it’s because my father was an academic clinical psychologist, and he used it in his work.” Had he looked at studies on the effectiveness of hypnosis? “Not very closely,” he said. “But I believe it works.”

David H. Freedman is the author of Wrong: Why Experts Keep Failing Us—And How to Know When Not to Trust Them. He has been an Atlantic contributor since 1998.

“La medicina complementaria y alternativa es un conjunto diverso de sistemas, prácticas y productos médicos de atención de salud que no se considera actualmente parte de la medicina convencional”, define el Centro Nacional de Medicina Alternativa y Complementaria (NCCAM) del gobierno de Estados Unidos y agrega; “La medicina integrativa combina tratamientos de medicina convencional y de la medicina complementaria y alternativa para los cuáles existen datos cientifícos de alta calidad sobre su seguridad y eficacia. También se conoce como medicina integrada”.

Enfoque de la medicina complementaria y alternativa

La medicina complementaria y alternativa se enfoca a la persona como un todo, considera los síntomas físicos, el estado mental, emocional y espiritual de la persona. Aborda el estudio de “terapias naturales que utilizan elementos no invasivos y libres de química para la conservación de la salud y tratamiento de las enfermedades”, como lo comenta Francisco Javier Zarzosa Diez en su artículo de Suite101.net del 9 de Marzo del 2010.

Dentro de estas terapias se encuentran: la acupuntura, el reiki, el masaje terapéutico, terapias del biocampo y bioelectromagnéticas que provienen de sistemas integrales de salud utilizados en Oriente y algunas otras que se consideraron prácticas de medicina complementaria y alternativa se han formalizado en Occidente como: grupos de apoyo a pacientes, terapia cognitiva y conductual. En Occidente también se han desarrollado sistemas médicos integrales como la homeopatía y la naturopatía.

La medicina del siglo XXI: investigación

La Universidad de Duke realiza educación e investigación para entender la efectividad de los modelos de medicina integrativa, la cual considera es la práctica de la medicina del siglo 21.El NCCAM en Estados Unidos tiene como parte de su misión proporcionar fondos para la investigación científica de la medicina alternativa y complementaria para validar la efectividad de las terapias.

El departamento de Medicina Integrativa de la Universidad de Michigan define: “Es la práctica de la medicina que reafirma la importancia de la relación entre el profesional de salud y el paciente, enfocado a la persona como un todo, utilizando la evidencia y enfoques terapéuticos , para alcanzar el estado óptimo de bienestar de la persona”

La Universidad de Georgetown creó en 2003 la maestría en ciencias para el estudio de las terapias alternativas y complementarias que se enfoca en preparar profesionales que conozcan y evaluén la seguridad y efectividad de estas terapias e introduzcan el rigor cientifíco necesario para su validación.

Terapias alternativas: su uso va en aumento

El uso de las terapias alternativas se ha incrementado en los últimos años en Estados Unidos, “en el año 2002 el 36% de los adultos utilizaron algún tipo de terapia alternativa, en 2007 se incrementó al 38% de los adultos (4 en 10) y el 11.5% de los niños (1 en 9) , entre los adultos es mayor el porcentaje de mujeres y personas con alto nivel educativo que las utilizan” de acuerdo con los datos proporcionados por el NCCAM en Diciembre de 2008 y agrega: “de las terapias más utilizadas se encuentran: la respiración profunda (12.7%), meditación (9.4%), masaje (8.3%) y yoga (6.1%)”.

El grado de efectividad en la aplicación de las terapìas alternativas varía de terapia a terapia y de paciente a paciente, en las investigaciones recientes, normalmente se concluye que aún y cuando algunas terapias tienen efecto positivo en el bienestar general de la persona, se requiere más investigación.

Los datos y hechos muestran que ante una demanda en aumento de soluciones integrales de salud, que tomen en cuenta el estilo de vida y la persona como un todo, las instituciones gubernamentales y educativas están patrocinando investigación que profundice en la aplicación y alcances de las terapias alternativas o complementarias a la medicina tradicional.

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