Infertility in men is on the rise.

A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)
A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)

Not being able to conceive a child can be stressful. Male infertility refers to a male’s inability to cause pregnancy in a fertile female. Male infertility is commonly due to deficiencies in the semen.

In Canada, about 16 per cent of couples struggle with infertility – a figure that has doubled since the 1980s. Men are solely responsible for infertility in about 30 per cent of those cases, and contribute to half the cases overall, according to Health Canada.

A comprehensive study published this summer shows sperm counts of Western men dropped by more than 50 per cent in less than four decades. Sperm count is the best measure of male fertility.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperms. Illnesses, injuries, chronic health problems, lifestyle choices (drugs, alcohol, sexually transmitted diseases) and other factors can play a role in causing male infertility, says Mayo Clinic website.

How does fertilization occur?

During the fertile window, the female creates a sperm friendly fluid that enables sperm to swim up towards the egg.
Of the millions of sperms released upon ejaculation, only a handful make it to the fallopian tube where the egg is released. There, the sperm must survive long enough to meet and fertilize the egg. Isn’t that an amazing act of nature!

Besides the quality of sperms, sperm count matters. There needs to be enough sperms in the semen. A low sperm count is fewer than 15 million sperms per milliliter of semen or fewer than 39 million per ejaculate.

Likely causes for poor sperm count are: chronic smoking, obesity, diabetes, drugs, alcohol, emotional problems, stress, depression, hormonal problems and previous surgeries.

According to the British Medical Journal (BMJ October 4, 2018), around one in seven couples in the UK seek treatment for infertility when they are unable to conceive, despite regular unprotected intercourse. In about a third of patients, no cause can be identified.

Even though male partner may have suboptimal sperm parameters both partners need to be assessed for infertility, so the couple should ideally be seen together when investigating infertility.

Managing infertility is not always easy, as often exact cause is not identified. But help is there.

According to Mayo Clinic website treatments for male infertility include:

  1. Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperms are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
  2. Treating infections. May or may not help.
  3. Treatments for sexual intercourse problems. Medication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction.
  4. Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperms are then inserted into the female genital tract, or used to perform in vitro fertilization.

When treatment doesn’t work then one can consider using sperm from a donor or adopting a child. As somebody has said, “Parenthood requires love, not DNA.”

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Here are some reasons for eating the heart-healthy Mediterranean diet.

Kananaskis Country (Dr. Noorali Bharwani)
Kananaskis Country (Dr. Noorali Bharwani)

In a 2012 study, 52 per cent of Americans (that were polled) believed doing their taxes was easier than figuring out how to eat healthy.

When you are hungry it is so easy to find unhealthy fast junk food. Junk food easily satisfies your hunger and craving for sweet, salty and oily food. But junk food can cause lot of damage to your heart, liver, brain, bones and other vital organs.

Heart and Stroke Foundation of Canada encourages Canadians to eat a healthy diet, control salt intake, and be physically active to lower blood pressure. The latest result from the DASH study (Dietary Approaches to Stopping Hypertension) has confirmed these recommendations, providing more encouragement for people to choose a healthier diet.

My favourite is Mediterranean diet – a traditional cooking style of countries bordering the Mediterranean Sea. The Mediterranean diet incorporates the basics of healthy eating – plus a splash of flavorful olive oil and perhaps a glass of red wine.

Mediterranean and DASH diets are considered to be the most effective diets for good health.

In Mediterranean diet you are encouraged to eat fresh fruit and vegetables, wholegrain cereals, nuts, the odd glass of red wine, fish and dairy, and olive oil as the main source of fat. Mediterranean diet is well known as one of the world’s healthiest. DASH diet also recommends a higher level of vegetable and fruit intake.

The DASH diet had the greatest effect on blood pressure, lowering levels within two weeks of starting the plan. Not only was blood pressure reduced, but total cholesterol and low-density lipoprotein (LDL) or “bad cholesterol” was lower, too.

What is important to note is blood pressure was lower for everyone on the DASH diet. Less salt people consumed, the greater the decrease in blood pressure. People who already had high blood pressure had the largest decrease in blood pressure.

Five things to remember about Mediterranean diet:

  1. Eat fruits and vegetables, whole grains, legumes and nuts.
  2. Replace butter with healthy fats such as olive oil and canola oil.
  3. Use herbs and spices instead of salt to flavor foods.
  4. Limit red meat to no more than a few times a month.
  5. A glass of red wine per day – if you are confortable with that.

The health effects of alcohol have been debated for many years, and some doctors are reluctant to encourage alcohol consumption because of the health consequences of excessive drinking.

There are other benefits of Mediterranean diet. It is associated with a reduced incidence of cancer, and Parkinson’s and Alzheimer’s diseases. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer.

The focus of the Mediterranean diet isn’t on limiting total fat consumption, but rather to make wise choices about the types of fat you eat. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans fats), both of which contribute to heart disease.

In 1999, the Lyon Diet Heart Study compared the effects of a Mediterranean-style diet with one that the American Heart Association recommended for patients who had survived a first heart attack. The study found that within four years, the Mediterranean approach reduced the rates of heart disease recurrence and cardiac death by 50 to 70 percent when compared with the heart association diet. That is remarkable.

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Have you had a milky day today?

Valley of the Kings, on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)
Valley of the Kings, on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)

Is milk good for you?

The answer depends on who you talk to. If you have milk allergy then of course it is not good for you. If you have no allergy then why wouldn’t you drink milk?

“America’s iconic ‘Got Milk?’ campaign was pulled this year (2014) after a successful run of over 20 years. Graced by the likes of Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie sporting a milk moustache, the campaign garnered wide recognition. Yet milk was losing favour against a growing variety of breakfast and drink options,” says Dr. Anita Jain, India editor of the British Medical Journal (BMJ October 29, 2014).

Now the dairy industry is focused on promoting milk as rich in protein content. Protein is good for you. Milk has long been promoted as a source of protein and calcium essential for bone health. The evidence, though, on the health benefits of milk consumption is scant and divided, says the BMJ article.

Milk continues to be a controversial dietary recommendation. There are not just health risks and benefits to be considered, but often also the availability and feasibility of consuming milk against deriving necessary nutritional value from other foods.

With growing public interest in a vegan diet, the morality of consuming dairy products presents a new angle too, says Jain. A vegan diet is one that consists of only plant-derived foods. Vegans do not use or consume any animals or animal products including milk.

Many asthmatics perceive their asthma is worsened by drinking milk. There is no scientific evidence to confirm that.

There is no evidence that milk leads to excessive mucus secretion. It does not make saliva thick. These unscientific controversies make people forget that milk is an important source of calories, calcium and vitamins for children.

What is the difference between milk allergy and lactose intolerance?

Milk allergy usually shows up early in life. It’s one of the most common food allergies in children. Cow’s milk is the usual cause of milk allergy, but milk from sheep, goats, buffalo and other mammals also can cause a reaction. Milk allergy is a true food allergy caused by an allergic reaction to the protein in milk.

Lactose intolerance is caused by not having enough of the enzyme lactase, which is needed to break down lactose, the sugar found in milk and other dairy products.

Why is it important to drink milk?

Government of Canada food guide website says having milk or fortified soy beverages every day provides the nutrients that you need for healthy bones and optimal health. It recommends the following:

  1. Drink skim, one per cent or two per cent milk each day.
  2. Have 500 mL (2 cups) of milk every day for adequate vitamin D.
  3. Drink fortified soy beverages if you do not drink milk.
  4. Select lower fat milk alternatives.
  5. Compare the Nutrition Facts table on yogurts or cheeses to make wise choices.

Yes, milk is good for you. Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie cannot be wrong! Every day ask yourself: Have I had a milky day today?

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Food wastage is costing Canadians billions of dollars.

The Mike O'Callaghan–Pat Tillman Memorial Bridge, a key component of the Hoover Dam Bypass project. (Dr. Noorali Bharwani)
The Mike O'Callaghan–Pat Tillman Memorial Bridge, a key component of the Hoover Dam Bypass project. (Dr. Noorali Bharwani)

More than $31 billion worth of food is wasted every year in Canada. When energy, water and other resource costs are factored in the true cost could be up to three times that much (CBC News, Dec 11, 2014).

The Canadian Food Inspection Agency produces a Guide to Food Labeling and Advertising that sets out a “Durable Life Date”. The authority for producing the guide comes from the Food and Drugs Act. The guide sets out what items must be labeled and the format of the date.

It is expensive to throw away food. A family of four loses $1,500 each year on food it throws away. But the damage is global as well when you take into account how much water, energy, and labor it takes to grow, package, and transport the food that never gets eaten. What’s more, food that has been tossed is the biggest component of landfills, and as it decomposes, it produces the greenhouse gas methane.

What to do with food that has passed expiry date? The U.S. Food and Drug Administration (FDA) web site says expiry date matter. Do not ignore it.

According to Wikipedia, shelf life is defined as the length of time that a commodity may be stored without becoming unfit for use, consumption, or sale. Most expiration dates are used as guidelines based on normal and expected handling and exposure to temperature.

Consumer Reports (July 24, 2918) says, “Confusion over expiration dates leads Americans to throw out food when it might still be good.”

The report says there are several reasons why we throw away food that may be good to eat – picky kids, overstocked pantries, or even leftovers that sit in refrigerators too long.

But another major factor is the misconception about what all of those dates on food package labels – “sell by,” “use by,” and “best if used by” – really mean.

Statistics show 90 per cent of Americans misinterpret the dates on labels and throw out food that could still be consumed or frozen for later use, says Consumer Reports.

That raises the question: If expiration dates aren’t a reliable gauge of food spoilage, how does a consumer know what to keep and what to toss?

Consumer Reports gives the following guidelines:

  1. With the exception of baby formula, there are no federal regulations on date labeling.
  2. Often the “best if used by,” “sell by,” and “use by” designations are just manufacturers’ best guesses about how long their food will taste its freshest.
  3. Supermarkets may also use the dates as a guide when stocking shelves. But the dates have little to do with how safe the food is.

It is a tricky situation. How confident would you be to eat food that has passed “expiry date”?

Here is what Consumer Reports says: As a general rule of thumb, most canned foods (for example, canned tuna, soups, and vegetables) can be stored for two to five years, and high-acid foods (canned juices, tomatoes, pickles) can be stored for a year up to 18 months, according to the USDA. Watch out for dents and bulges in cans, though. That might be a sign it’s time to toss those products.

Important thing is to be safe. Follow good food handling and storage practices. This will prevent unnecessary spoilage and ensure food safety.

The U.S Congress is trying to define what dates on food labels mean. One Congressman said, “It’s time to settle that argument, end the confusion, and stop throwing away perfectly good food.” In the meantime be safe. Buy what you need so you don’t waste food.

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