Helping Men Get Proactive About Health: A Conversation with John La Puma, MD

It's no secret that women tend to seek medical attention earlier and more frequently than men. They're also more proactive about prevention, and more likely to seek nutrition and lifestyle-based modes of managing common disorders.

We're generalizing here, but the truth is many American men take the, "If it ain't broke, don't fix it," ethos to the extreme when it comes to their own health and wellbeing. They'll often ignore signs that things are breaking and wait until there's a serious problem before seeking care.

Though things are changing, the notion of "toughing it out" is deeply ingrained in many a man's psyche. Some pay far more attention to the wellbeing of their cars or their computers than their own physiological machinery.

John La Puma, MD, hopes to change this situation.

LaPumainKitchenDr. John La Puma, the "ChefMD," in the kitchenA professionally trained chef as well as a practicing internist, Dr. La Puma has been at the forefront of nutrition-based medicine for decades. At his ChefClinic in Santa Barbara, CA, on his award-winning ChefMD website, and through the best-selling RealAge Diet books he co-authored with Michael Roizen, Dr. La Puma has taught thousands of people not only what to eat for health, but how to prepare delicious, satisfying meals everyday.

In his forthcoming new book, Men Don't Diet, Men...Refuel, expected at the end of this year, Dr. La Puma details a comprehensive 24-day eating plan focused on helping men shed fat, increase testosterone and build stamina.

A featured speaker at HPC's upcoming Heal Thy Practice 2013 conference in October, Dr. La Puma says there are many unmet needs in preventive healthcare for men, and many opportunities for holistically-minded clinicians who want to help men restore and maintain their health as they age.

HPC caught up with Dr. La Puma for a lively exchange on how to get guys interested in taking care of themselves.

HPC: You've had considerable success engaging men in healthful living. How do you position your practice to draw male patients?

JLP: In two ways: by speaking with women about what and how to speak to men about their health; and by speaking to men about the things they care about-- looking and feeling better; better sexual function; and getting strong.

Women want to help men, and women make most of the health care, cooking, food shopping and health care decisions at home. But they lack the language to speak with men about their health. Men often take suggestions about their eating and fitness habits as unwanted intrusions. The women don't mean it as such.
Women are concerned with the quality of their relationships, the longevity of the relationships and health of the family, and the continued enjoyment of activities together. Without healthy men, their own lives suffer.

Truth is, most men like to be depended upon, and want to please women, but the language men and women use is important in getting men to take responsibility for their own health.

In the office, I ask men to do a pushup; a lunge; a squat; and a plank. Most of the men I see cannot do at least one of these. But because muscular strength responds so well to efficient, effective exercise, they see rapid improvement once they know how, and once they resolve to practice.

I also give very specific advice to men about what to eat, and what not to eat: it doesn't work to say, "Eat a high protein breakfast" or "Skip the sugary foods at dinner." It does work to say: "Have 3 scrambled eggs with two tomatoes" and "Put 23 almonds in 3 baggies and put one in your desk drawer, one in your glove compartment, and one on the counter, and eat the nuts for snacks, and chew each almond at least 5 times."

HPC: What, specifically, do you see as unmet needs in men's health?

JLP: The greatest unmet need is in helping men learn how their bodies work, and giving men back control. The best tools to do this are structured and emotionally meaningful. I think LaPumaRefuethey fall into 3 categories:

A) Offer empathy and don't judge: Men are not failing, the system is failing them. Plastics are lowering sperm counts, bad food is everywhere. Jobs are sedentary—sitting is the new smoking! And it's causing diabetes. Walk the talk by exercising regularly, having good food around the office and visible, and make smoking your practice's enemy #1.

B) Fight the conversion of testosterone to estrogen: Make the message to men about what they care about: sex, energy, strength, masculinity, their families. Putting it as simply as possible, a man's waist should be half his height.

C) Use language and laboratory tools precisely: Say, "The back pain is because of the spasm and nerve pressure," not, "You have back pain because your belly is too big." I think every man with a waist of 40 or greater should have his testosterone level checked, and should be told that you are concerned about testosterone conversion to estrogen. Every man should take my free testosterone estimation quiz: physicians can use my eating daybook to help patients track what they're eating.

HPC: Many men will not seek medical attention unless we have stabbing chest pain, serious injury, or some other major symptom. We're scared of admitting things don't work as well as they once did. How do you get guys to admit they need help?

JLP: The real difficulty is between men and women, and helping women to nudge men for health checks in the right way.

Broadly speaking, most men don't have any history with food or cooking. And it's interesting that 95% of weight loss research has been done with women, or primarily with women. Nearly all diet books are written for women, who have been raised in a culture which values women's knowledge of recipes, meal preparation, nutrition, and good health. Men have no such cultural expectations.

If they're already in the office, you're way ahead. The first thing to do is congratulate men on coming to see you. It takes courage, and men have exhibited that by showing up.

The second thing is to move away from using fear or guilt as motivators. Both work in the short term, but are exhausting and ineffective after weeks or months.

The third thing is to make men successful doing just one thing. Just deliberately walking for 30 minutes daily, or learning strength training in intervals for 5 minutes daily, or going to bed 30 minutes earlier twice a week, or not drinking for 17 consecutive days. This may seem slow, and it is, but it is the only way to help men create lasting change--by giving them something to do, a trigger for doing it, and a reward once they achieve it. I'm not talking about lowering LDL: I'm talking about the behavior that they practice, so it can become a habit.

Finally, I begin to teach men how their bodies see food, and how it works, and how quickly they can look and feel better.

Most men are surprised to learn that their belly fat converts the testosterone their testes make into estrogen. That does a lot of things that are not in their best interest. Most men don't know that erectile dysfunction is an early warning sign for heart disease. And most importantly, they do not know that they can reverse those problems, promptly.

HPC: Some men are extremely athletic and engaged in pursuit of health, but many others are not. Some have a strong aversion to "working out," or participating in sports. How do you get non-athletic guys to focus on health & well being?

JLP: In many ways, this is easier than working with guys who are already athletic: nearly all of health and well-being is related to diet, physical fitness, stress management and sleep; and you can be fit without having to be ripped.

In fact, extreme workout programs like P90X and Insanity are not relevant for most guys, and certainly most guys over 35. Nearly all of weight loss has to do with what you eat: you can out-eat almost any amount of exercise. So we focus on food choices, sleep quality, mindset, and productivity.

Guys who do not have any history of athletics are usually competitive in another way, and competition helps men: it raises the bar, it gives us something to shoot for, and it taps into a basic drive.

Then there are the guys who are already muscular but overweight: those guys know about fitness, like getting strong, but are unaware of the testosterone to estrogen conversion that is taking place in their visceral fat.

I sometimes use the RealAge test, and ask men--and women--to complete it. I wrote two books with Michael Roizen on RealAge, and it serves as a tailored, detailed report card on 149 factors that can make your biological age younger or older than your chronological age.

Many people find this motivating, and a great, structured, personalized way to identify what they can change first to make the biggest impact. The questionnaires are available free in our book, RealAge Diet, and now on RealAge.com, which is part of ShareCare.

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