abnormal food consumption habits and beliefs or fears about body image. Though common percep- tion is that eating disorders are women’s problems (women outnumber men 10 to 1 among those who seek treatment for eating disorders), health experts believe it is likely that as many men as women have eating disorders. Eating disorders in men tend to manifest as efforts to maintain PHYSI- CAL FITNESS through inappropriately intense exer- cise (exercising all the time or focusing obsessively on specific parts of the body) more so than as obsession with food.
The health consequences of eating disorders can be significant and range from hair loss and dry skin to GALLBLADDER DISEASE, intestinal dysfunction, PANCREATITIS, stomach ulcers, serious irregularities in the heartbeat, and permanent changes in the heart muscle that affect its ability to pump blood efficiently. Diagnosing eating disorders in men can be especially challenging because neither men nor doctors are particularly oriented to look for them but instead focus on overt symptoms. Though it is important to treat the health conditions that these symptoms may represent, effective treatment for the eating disorder must target identifying and resolving the underlying factors, which often have to do with emotional and body image issues.
At any given time 25 percent of men in the United States are actively trying to lose weight, gen- erally through dieting that restricts food consump- tion. Some are overweight and need to lose weight to improve health; about 40 percent of American men are overweight. Others are of healthy weight and are dieting for reasons that, beneath the sur- face, have nothing to do with physical health. Emo- tional factors are significant in eating disorders,
though men commonly ignore, deny, or resist such correlations. Men also have significant concerns regarding body image.
Body weight is an important factor in many sports. Sports such as wrestling and boxing encour- age men to maintain body weight that is just below a particular weight-class cutoff point. Other sports do not have formal weight classes, though body weight is an important competitive factor. Some sports emphasize low body weight; among them are bicycling, gymnastics, swimming, diving, row- ing, and track events. Other sports emphasize body mass and high body weight; among them are foot- ball, weightlifting, and field events such as discus and shotput. Striving to maintain body weight appropriate for a particular sport is not itself a sign of an eating disorder; the risk is that many men resort to inappropriate behaviors regarding food consumption that are common in eating disorders and that are ultimately harmful to health. Even men who do not participate in sports may feel the need to adopt the body image of the sports (or the athletes) they admire, and similarly to adopt the behaviors to obtain and maintain that image.
Compulsive overeating and binge eating are the most common forms of eating disorders in men. There is a component of social acceptability to the outward behaviors—excessive indulgence— inherent in these forms, though the behaviors themselves generally are beyond the man’s con- scious control. A man with such an eating disorder may feel guilty about the amount of food he con- sumes and then go on an intensely restrictive diet or engage in a frenzy of intense physical exercise. It is important to recognize that these behaviors are ultimately counterproductive as well as poten- tially harmful to health.
120 echinacea
See also NUTRITION AND DIET; OBESITY; WEIGHT
MANAGEMENT.
echinacea An herb taken to boost IMMUNE SYS-
TEMfunction and prevent or shorten the course of viral infections such as COLD SORESand COLDS AND FLU. Researchers believe echinacea activates cer- tain white blood cells that are part of the immune system, hastening and intensifying both the pro- tection and the attack components of the immune system: fewer invading pathogens such as viruses and bacteria are able to penetrate the body’s defenses, and those that do get through are more quickly surrounded and neutralized. Some evi- dence suggests that echinacea also enhances inter- feron production; interferon is another important component of the immune system’s response to viral infections. Though there is speculation that echinacea’s effects on the immune system help to prevent certain kinds of cancer, as yet there are no clinical studies to support this premise. Echinacea does seem to improve immune function in people receiving CHEMOTHERAPY and RADIATION THERAPY
for CANCERtreatment, however.
Most practitioners who recommend echinacea believe the herb is most effective when taken at the onset of common viral infections to minimize symptoms and possibly shorten the infection’s course. Some men who are prone to yeast (fungal) infections such as athlete’s foot take echinacea to improve their resistance to these infections. Once a yeast infection is present, treatments that target the infection generally are necessary to resolve it. Bacterial infections also may benefit from echi- nacea, though they may require treatment with
ANTIBIOTIC MEDICATIONS. There is debate as to
whether echinacea is appropriate or helpful for men who have HIV/AIDS. Many men who are HIV- positive, though not taking any medications, take echinacea. As echinacea can interact with numer- ous medications, men taking medications for HIV/AIDS should check with their doctors before adding echinacea to the mix. Because echinacea stimulates the immune system, it is generally not recommended for people who have AUTOIMMUNE
DISORDERS.
In the United States echinacea is sold as a nutri- tional supplement and comes in liquid (drops) and
capsule forms, often in combination with other immune-boosting herbs such as goldenseal and astragalus. Specialty herbalists may provide dried or ground plant parts and tea; most men prefer the capsules because they are easy to take. Echinacea drops and tea are bitter, which many people find unpleasant. Echinacea’s effect on the immune sys- tem diminishes after six to eight weeks. Herbalists recommend taking echinacea in a rotating pattern with other immunosupportive herbs or no longer than eight weeks, followed by a two- to three- week break, when taking echinacea alone.
See also HERBAL REMEDIES. eczema See DERMATITIS.
edema An abnormal collection of fluid in the body tissues. Local edema can occur after an injury, such as the swelling of a sprained ankle, and goes away as the injury heals. Local edema related to injury is part of the body’s healing response, part of the purpose of which is to immobilize the area to reduce further injury. Injured muscles release pro- teins that draw water from the blood, allowing the swelling to take place rapidly. Icing an injury reduces blood flow to the area, minimizing the release of proteins and consequently of swelling. Bruising sometimes accompanies local edema, either as a result of the injury or from damage to the tiny blood vessels in the tissue that may rupture under the pressure of the extra fluid in the tissues. General edema suggests a number of health conditions such as disease and failure of the kid- neys, liver, and heart, and can be peripheral (involving the limbs) or central (involving the trunk). Peripheral edema generally is apparent as swelling, often involving the lower legs and feet and the lower arms and hands. Both sides tend to be equally affected; when just one side is edema- tous, it suggests a blocked blood vessel or other localized cause rather than general edema. Severe and persistent peripheral edema can traumatize the surrounding tissues enough to produce bruis- ing, though bruising does not typically accompany peripheral swelling. Lack of circulation can even- tually lead to ulcerations of the swollen areas, par- ticularly around the ankle and foot. Peripheral edema generally worsens as the day progresses,
particularly in men who stand or sit much of the time. Elevating the feet to the level of the chest, when possible, reduces the gravity resistance that challenges the return of blood flow to the heart and minimizes edema of the lower extremities. Often the only perceptions of peripheral edema might be the feeling that shoes or a watchband or ring feel too tight.
Central edema may not be noticeable except by otherwise unexplained weight gain and symptoms of lung or heart congestion such as shortness of breath. Regular weighing is one means doctors suggest for assessing the level of central edema present with conditions such as heart failure. Ascites is a form of edema in which fluid collects in the abdominal cavity, usually as a consequence of
LIVER DISEASE. Central edema puts pressure on
organ systems, which can intensify the health problems of the organ system already in failure, such as the heart or kidneys, or strain other organ systems that are struggling to maintain normal function in an abnormal environment. The degree of edema present functions as a “ballpark” measure of how well medications may be controlling condi- tions such as HYPERTENSIONand heart failure.
Treatment for general edema targets removing excess fluid from the body and correcting the underlying health circumstances causing the edema. Doctors often prescribe diuretic medications (water pills) to help the kidneys extract additional water from the blood, and may prescribe additional medications to treat underlying conditions such as heart failure or liver disease. The doctor may rec- ommend dietary sodium (salt) restrictions and occasionally fluid restrictions, depending on the condition responsible for the edema. Support hose, sometimes called edema socks, reduce edema of the lower extremities. These are available in styles that look like regular socks except that they go to just below the knee. Regular socks can be worn over support hose as well.
Two rare though very dangerous forms of edema pose risks for men who do high-altitude mountain climbing: HAPE (high-altitude pul- monary edema), which affects the lungs, and HACE (high-altitude cerebral edema), which affects the brain. These conditions result from pro- longed exposure to “thin” air—breathing air with
low oxygen content. This causes imbalances to develop in the blood that result in massive amounts of fluid flowing into the surrounding tis- sues. Treatment is administration of pressurized oxygen and rapid removal to lower altitude.
See also HEART DISEASE; KIDNEY DISEASE; LIVER
DISEASE.
Edex See ALPROSTADIL.
ejaculation The process through which SEMEN
leaves a man’s body. Ejaculation occurs as a result of sexual stimulation that initiates rhythmic con- tractions of the muscles in the perineal area. These contractions, which culminate in ORGASM, propel
semen (a mix of SPERMand fluids from the seminal vesicles and PROSTATE GLAND, also called ejaculatory fluid) through the urethra and out the tip of the penis. Sexual activities such as ORAL SEX, sexual
intercourse, and MASTURBATION all can result in ejaculation.
Premature ejaculation is one of the most common
sexual problems among men. Ejaculation may occur before or shortly after penetration or other stimulation of the penis, ending the sexual encounter often before either the man or his part- ner desire. Most often premature ejaculation results from anxiety about sexual performance. The man and his partner can learn techniques to help the man control his level of arousal and the timing of his ejaculation.
Retrograde ejaculation occurs when the semen
goes into the urinary bladder instead of out of the body. The urethra serves as the passageway for both urine and semen to leave the man’s body. A small valve at the urethral opening into the blad- der normally closes when ejaculation is imminent. When the valve fails to close, the flow of semen takes the path of least resistance and enters the bladder instead of traveling the rest of the length of the urethra. Nerve damage causes the valve to malfunction; this damage can arise as a conse- quence of neurological disorders such as multiple sclerosis, lost nerve function following surgery, side effects of medications, and changes in the nerves and blood vessels as a consequence of DIA-
BETESor HYPERTENSION(high blood pressure). Once
the nerve damage takes place, there is little that ejaculation 121
doctors can do to restore the valve’s function. Though retrograde ejaculation affects fertility, it does not harm health.
See also REPRODUCTIVE SYSTEM SEXUAL HEALTH. electrolytes Ionized chemicals in the blood that carry electrical charges, often referred to as salts (a reference to their chemical structures). The most common electrolytes in the body are bicarbonate,
CALCIUM, chloride, magnesium, phosphate, potas-
sium, and SODIUM. Electrolytes typically enter the body in combinations that balance their negative and positive charges, such as sodium chloride (table salt) and sodium bicarbonate (baking soda). Chemical actions in the body break them into their respective ions, which then function to facilitate the electrical impulses of nerve signals to and from all cells in the body. Each ion conducts certain kinds of nerve impulses; calcium and sodium are particularly important for maintaining the heart’s rhythm. Nearly all foods contain electrolytes.
The kidneys are primarily responsible for regu- lating the body’s electrolyte balance. The kidney’s filtration process increases or decreases the elec- trolytes the kidney extracts from the blood. This process is highly efficient and can keep pace with the body’s electrolyte losses during activity and exercise. Circumstances that cause heavy sweating, such as intense heat or extremely vigorous EXER-
CISE, can deplete the body’s electrolyte stores. Heavy contractions of the skeletal muscles further draw on electrolytes. These demands can exceed the ability of the kidneys to replace lost elec- trolytes.
As well, heavy sweating results in substantial fluid loss; dehydration can tip the electrolyte bal- ance to the other extreme and allow high levels to accumulate in the blood. Drinking plenty of water during exercise and in the heat helps to restore hydration. Supplementing water with liquids such as sports drinks that contain added electrolytes can more quickly replenish lost electrolytes, though these drinks should not be the sole source of fluid replacement as they typically also contain high lev- els of carbohydrates (sugars) that can further alter the electrolyte balance. Other circumstances that can disturb electrolyte balance include prolonged vomiting and diarrhea (which can rapidly diminish
electrolyte levels) and certain medications such as
DIURETIC MEDICATIONS commonly taken for HYPER-
TENSION(high blood pressure).
See also NUTRITION AND DIET.
electron beam computed tomography (EBCT) scan A specialized imaging procedure, also called an ultrafast computed tomography (CT) scan, that determines the amount of CALCIUM (called a cal- cium score) in atherosclerotic deposits within the coronary arteries. Calcium is present in the arteries only when such deposits (accumulations of fatty acids along the inner walls of the arteries) are pres- ent. When the deposits accumulate to the extent that they obstruct or block the flow of blood through the coronary arteries, ANGINA and HEART
ATTACKcan result. Some studies suggest there is a
high degree of correlation between the amount of calcification and the likelihood of heart attack.
At present, doctors request EBCT when there are symptoms of early CORONARY ARTERY DISEASE
(CAD), and use the findings to help determine the risk of heart attack in assessing treatment options. As over half of men who have heart attacks have no indications of CAD beforehand, researchers are exploring the value of EBCT as a screening tool for early CAD in men under age 60 who do not have symptoms of heart disease. Twice as many men as women have calcification before there are other indications of CAD; identifying it allows for inter- vention approaches that can slow or stop the pro- gression of CAD and avert heart attack.
The procedure of EBCT requires no preparation and takes only a few minutes to complete. Some- times a medication is given to slow the heart for better visibility of the blood flow. Electron beam X- ray takes very rapid sequential images, which a computer then assembles into a dimensional rep- resentation of the coronary arteries. The computer also assesses the presence of calcium and calculates its depth, which indicates the extent of ATHERO-
SCLEROSISpresent in the artery.
See also LIFESTYLE AND HEALTH.
endocrine system The network of glands and structures within the body that produce HOR-
MONES. The functions of the endocrine system are
closely integrated with each other as well as with 122 electrolytes
the functions of other systems throughout the body. Endocrine structures release their hormones directly into the bloodstream. In addition to the eight endocrine glands (some single, some paired), other tissues in the body that have endocrine func- tions include the brain, intestines, and kidneys, all of which produce hormones. The endocrine sys- tem regulates the development of secondary sex- ual characteristics, FERTILITY, and sexual function.
Adrenal Glands
There are two adrenal glands, one above each kid- ney. Each adrenal gland has two parts, each with different functions. The adrenal medulla is the inner portion; it produces epinephrine and norep- inephrine, chemicals that function as hormones as well as neurotransmitters. These hormones regu- late vital body functions such as heart rate, blood pressure, and breathing rate. The adrenal medulla responds to signals from the nervous system (which regulates cardiovascular and pulmonary functions) and from the pituitary gland.
The outer portion of the adrenal gland is the adrenal cortex. It responds to hormones the pitu- itary gland releases to produce three hormones: • Aldosterone, which regulates kidney functions
related to sodium balance as part of the body’s mechanisms for maintaining blood pressure • Cortisol, which regulates metabolism and the
body’s inflammatory response as part of the immune system’s function
• DEHYDROEPIANDROSTERONE (DHEA), an ANDRO-
GENprecursor
The adrenal glands form the body’s stress response center; its hormones are often referred to as the stress hormones, or “fight or flight” hor- mones. Extended exposure to stress causes imbal- ances in these hormones, which can result in health conditions such as hypertension and
ARRHYTHMIAS (irregular heartbeat). Deficiencies of
cortisol cause ADDISON’S DISEASE, a potentially life- threatening disorder that requires treatment with cortisol supplements. Over production of cortisol causes CUSHING’S SYNDROME, another dangerous health condition.
Brain
The brain produces numerous hormones known collectively as neuropeptides. The best known of these are the endorphins and enkephalins, hor- mones that influence mood and euphoria (“run- ner’s high”). They also appear to act as natural painkillers, binding with opiate receptors in the brain. Opiate receptors are areas on nerve cells that receive pain signals; opiate medications (narcotics) can bind with opiate receptors to block out pain signals. Other neuropeptides have various func- tions in the brain, most of which remain poorly understood.
Hypothalamus
Located deep in the center of the brain, the hypo- thalamus controls the functions of the endocrine system. Also part of the nervous system, the hypo- thalamus regulates body functions essential for survival. It produces these hormones:
• Antidiuretic hormone (ADH), which regulates the passage of fluid from the kidneys