Dietary, social habits significantly impact urologic health

Dietary and social habits can have a significant impact on urinary health, according to four new studies presented at the 2019 AUA annual meeting in Chicago. The studies highlighted the positive effects of heart-healthy diets on erectile function, the impact of marijuana smoking on urinary health, and the impact of restrictive diets on testosterone production.

These studies were presented during a news briefing moderated by Mayo Clinic urologist Tobias S. Kohler, MD, MPH, chair of the AUA Public Media Committee.

Low-fat diets have been shown to have a number of health benefits, but may have a negative impact on serum testosterone levels in men, one study found. Using data from the National Health and Nutrition Examination Survey (NHANES), the study examined the relationship between diets and serum testosterone levels. Among the 7,316 men identified for the study, 15.9% (1,160) were on a low-fat diet, 26.3% (1,924) were on a Mediterranean diet, and 67.2% (4,920) were on a non-restrictive diet.

Compared to men with non-restrictive diets, average testosterone was lower among men with low-fat and Mediterranean diets. Men adhering to a low-fat diet were more likely to have a testosterone level <300 ng/dL compared to those on non-restrictive diets.

Marijuana’s effect on sperm

In a study of 622 men, researchers explored the potential association between marijuana and tobacco use in testicular and sperm function, as well as male infertility and hypogonadism. Subjects were divided into four groups: marijuana users (74), tobacco users (144), infertile (125) and fertile (279).

Seminal reactive oxygen species levels were found to be higher in the marijuana group compared to tobacco and fertile groups. In addition, marijuana users had worse overall semen parameters (including sperm concentration, sperm count, motility and morphology) than tobacco users.

Risk factors for LUTS

Researchers identified several risk factors for lower urinary tract symptoms-depression, hypertension, metabolic syndrome, erectile dysfunction, and marijuana use-in a review of 20,548 patients on medical treatment for BPH/LUTS. This is the first time marijuana use has been implicated as a risk factor for problems with urination, researchers say.

The study found that marijuana use and erectile dysfunction were associated with an increased risk of being on a LUTS medication. On multivariate analysis, marijuana remained associated with this increased risk. Alcohol use was not associated with an increased risk of BPH/LUTS.

Heart-healthy diet and ED

Quitting smoking and weight loss are heart-healthy lifestyle changes that can also be considered for non-pharmacologic treatment of erectile dysfunction (ED), but it is not known whether heart-healthy diets have an association with ED.

In a prospective analysis of 26,246 men ages 40 to 75 in the Health Professionals Follow-Up Study, researchers assessed erectile function and dietary questionnaires (used to calculate Mediterranean Diet and Alternative Health Eating Index [AHEI] scores) to review whether dietary choices were related to risk of incident ED.

Among the findings: Mediteranean Diet and AHEI scores were associated with decreased risk of incident ED. The inverse association between Mediterranean Diet and AHEI scores was strongest in men under age 60. Researchers also found that higher intakes of legumes, fruit, vegetables, fish, and long-chain fats were associated with a decreased risk of ED, and red and processed meats and trans fats were positively association with ED risk.

"This is the first time we've seen a definitive connection between marijuana use and certain urologic conditions such as infertility and BPH/LUTS, and in the context of legalization of cannabis, more research is warranted," Dr. Kohler said. "Most importantly, these studies further underscore the need for healthy lifestyles and an understanding of how what we put in our bodies affects how they function."