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No one can explain it, but in the past decade well-to-do middle-aged men have begun falling victim to a previously rare form of cancer. This has happened particularly to white men. There has been no change in the incidence of this cancer among Asian and black men or among women.

It’s a cancer thought to be directly related to reflux – the surging up of stomach acid into the food pipe. The tragedy of this adenocarcinoma of the oesophagus or gullet is that it is lethal. Only 10 per cent of sufferers survive for more than 5 years.

Mysteriously, the incidence among white men living in Western societies is increasing at a rate of 10 per cent a year. In the past, a different kind of gullet cancer was predominant. About 20 years ago people tended to get squamous-cell carcinoma of the oesophagus, which was strongly related to smoking and the ingestion of alcohol. Now, as squamous-cell carcinoma levels have plateaued and even fallen off in men, the incidence of adenocarcinoma in men has begun increasing at a frightening pace. It is now occurring in three Australian men in every 100 000, and is particularly prevalent among the well-nourished and well-to-do.

The gullet is lined with a kind of skin, so it is understandable that squamous-cell carcinoma, which is a skin-like cancer, can grow there. It is more difficult to understand how adenocarcinoma, which is a gland-like cancer, can develop there.

Adenocarcinoma has a glandular cell structure and usually grows in glands such as those in the stomach, the pancreas and the bowel. It is abnormal to find it in the gullet. A healthy man would have no glandular tissue in his oesophagus.

It is thought that long-standing severe reflux starts the process that ultimately leads to this cancer. Of course, most men with reflux never develop it, but all those who do have it have a history of reflux.

Reflux occurs when the contents of the stomach get washed back up the gullet because the valve between the gullet and the stomach is not efficient enough to keep the acid and food in the stomach. It is thought that over the years the acid burns the skin lining off the lower end of the gullet and is gradually replaced by a different kind of lining, which is more resistant to acid.

This new lining is made up of gastric-type cells, which behave as if they were in the stomach. It looks like the gastric cells have broken out of the stomach and begun growing up the gullet. When this happens, a man is said to have a condition known as Barrett’s oesophagus. There are thousands of men out there with reflux, and it is not known why some develop a Barrett’s lining and others don’t.

Barrett’s is a precursor to this cancer, and it is not understood why some people with Barrett’s develop the cancer and others do not. When adenocarcinoma grows in the Barrett’s lining, it looks and acts like gastric cancer.

It is thought that a Barrett’s lining takes decades to develop.

When, for example, it is found in a 50-year-old man, there is characteristically at least a 20-year history of reflux.

One difficulty with Barrett’s is that men are unaware of it. It does not show up with a barium meal and X-ray and can only be found through an endoscopic examination. Because the lining has changed, it copes much better when acid is washed past, and the man may feel less pain or discomfort. With a Barrett’s oesophagus, reflux may effectively become a silent condition.

If, after a long time, a man notices a change in his reflux pattern, it could be a sign of Barrett’s. If he has had persistent reflux for 20 years and then, in the absence of new medication or a changed diet, his reflux seems to fade, he should be checked for the condition.

Tests show that men with Barrett’s have more acid in their gullet but that it does not seem to hurt as much. They also show that the valve between their gullet and stomach operates at a much lower pressure, which makes it less efficient. Usually, these men also have a hiatus hernia, which occurs when a portion of the stomach protrudes upwards through the diaphragm. This is a major factor in the valve losing pressure. Men commonly develop this hernia as they age.

At any one time, about one-third of the male population will have abnormal reflux. About 10 per cent of this third will develop Barrett’s. Of them, 10 per cent may develop adenocarcinoma of the oesophagus.

In New South Wales, about 250 people die from this cancer every year, and the vast majority of them are men. Some specialists say an effective preventive measure against Barrett’s and reflux is a hiatus hernia repair. The theory is that the hernia leads to valve weakening, which leads to reflux, which leads to Barrett’s, which leads to the cancer.

With keyhole surgery, the hernia can be repaired in an operation requiring just 2 days in hospital. Surgery for adenocarcinoma of the oesophagus is more drastic than open-heart surgery and involves removing part of the lower oesophagus and part of the upper stomach, then using the remaining stomach to form a tube to reconstitute the plumbing. During this operation, appropriate lymph nodes are also removed. Surgery certainly appears to improve men’s chances of surviving for a number of years.

Affluent men should be alert to a change in their digestion patterns. If food starts to stick or the man has difficulty swallowing or needs to drink water to get food down, he should see his doctor.

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If you are an older man thinking of a new family, it’s wise to give your sperm their best chance of success, as the following tale indicates:

The couple sitting across the desk seemed quite ordinary. The woman was in her early 20s and her husband was about 40. They were baffled. Why was she having repeated miscarriages?

They had come to a clinic that specialised in natural methods for fertility management, reproductive health and preconception care, and the young woman was distressed. She had always been healthy and had never had any reason to suspect her fertility had been compromised. Her husband had children from an earlier marriage and had no reason to suspect his fertility had been compromised either. In fact, he was convinced the problem resided with her.

While taking their histories, the clinician was alerted by the mans occupation. He was a builder who made a living renovating old inner-city houses. Often, he spent hours scraping or burning off old paint. Paint manufactured before the sixties contains lead, and with his kind of work it seemed possible that he had been exposed to high levels of the metal, not only from the paint but from the lead-laden dust that accumulates in these houses over decades.

But this man had come to the clinic essentially to support his wife and was not prepared to accept the possibility that the miscarriages could be due to him.

It is difficult for men to relinquish the notion that their sperm are invincible. The myth that sperm are resilient and divinely protected is very strong. Even men who are patently unhealthy assume that somehow their sperm remain healthy.

Men who abuse their bodies with alcohol, cigarettes or other toxins also assume these will have no effect on their sperm. So why should this man, who was fit and well and had already proved his fertility, entertain the possibility that his sperm were imperfect?

Reluctant to be investigated for infertility, the man did agree to have a hair analysis. This test can give an accurate indication of toxic metal contamination in the body. (Blood tests for lead are not reliable, as lead is passed quickly into other tissues, especially bones.)

Once the hair analysis showed very high levels of lead, he agreed to further tests, which confirmed that he had the classic sperm problems associated with lead toxicity. He had a low count with a high proportion of misshapen and less motile sperm. He was treated for this toxicity with nutritional supplements and herbal remedies, and about 10 months after their first visit, his wife conceived again. This time the pregnancy held and she produced a healthy baby.

What a man does before conception is just as important as what a woman does. His lifestyle and environment prior to conception can have a direct and profound bearing on his reproductive health and on the health of the baby.

Although one would expect the woman to have to behave more responsibly because she provides the egg and the nurturing environment, recent research challenges this. Sperm are more vulnerable than eggs because they are constantly being produced and are very much smaller. They are far more sensitive to factors such as toxicity, pollution, chemicals and radiation.

The clinic’s files were full of the records of men who had been exposed to occupational toxins that affected their fertility. Motor mechanics, for example, breathe in lead fumes all day, handle heavy metal like nuts and bolts covered in cadmium and use lots of chemical solvents.

As long as sperm are not visually defective, people think they are probably okay. But another view is that if 60 per cent are visually defective, those that remain have probably been adversely affected too. Sperm are made from nutrients, and there is no reason to assume some sperm will absorb more toxins than others.

The role played by zinc is an interesting example of how sperm are affected by a man’s general health. The tails of sperm are packet! with zinc, and if a man’s body is deficient in zinc, his sperm don’t get enough zinc either. Without sufficient zinc, sperm can’t waggle their tails, which means, in turn, that they can’t move. When an overall correction is made, a huge increase in fertility results.

Pre-conception care is an old idea that has been resurrected. Many tribal societies arc known traditionally to have fed special diets to young men and women of childbearing age.

Pre-conception care is starting to be considered an important component in the prevention of reproductive problems and the improvement of children’s health. Proper pre-conception care can make a huge contribution to the health of our population, not just by helping us produce normal-looking children but also by helping us produce children who have strong immune systems and are not affected by chronic or degenerative diseases. There is a growing recognition that this type of care is as important as, if not more important than, good antenatal care.

Clinicians point out that people who breed racehorses, champion dogs and cattle know that the best outcome is achieved when the health and vigour of both prospective parents are optimal at the time of conception. So why should the whole thing be left to chance when breeding humans?

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Teeth betray age. A well-preserved man of indeterminate years might cut a youthful figure at a glance, but as soon as he opens his mouth, his age is apparent.

While decades of red wine, cigarettes and coffee leave their mark on ageing enamel, odd bits and pieces of dental work, inattention to oral hygiene and receding gums remove all illusion of youth.

With care, however, it is possible to keep the average mouth youthful, in both appearance and function.

The first thing to take care of is saliva. For the maintenance of oral health, saliva is magic. Healthy people can’t get too much of its protective and restorative qualities. Saliva bathes the teeth and gums in a rich mixture of fluoride, phosphorus, calcium, enzymes and antibodies. It keeps the mouth fresh, hygienic and free from many undesirable bugs. It works constantly. When, for example, a high-acid diet leaches calcium and phosphorus from the outer layer of teeth, making them vulnerable to decay and wear, saliva is there to restore the balance. The same thing happens when athletes sip popular sports drinks that are high in acid and sugar.

Saliva also contains an epithelial growth factor that makes skin grow more rapidly. It is thought that this is the reason animals lick their wounds and why wounds in the mouth heal so quickly.

On average, people produce about 0.7 ml of saliva a minute, but once stimulated by chewing, production increases to between 1.5 ml and 2 ml a minute. Mouths are comfortable because oral mucosa like to be wet, there is sufficient saliva to lubricate food and swallowing is effortless.

People with perpetually dry mouths complain of a furry tongue that sticks to the roof of their mouth and teeth that have become sensitive to hot and cold because of erosion.

But not everyone is aware they have a dry mouth. Some reach for a lolly, thinking it is the sugar they are after when what they are actually doing is stimulating saliva production by sucking. Numerous dentists recommend sugarless gum to increase saliva flow.

Several factors contribute to a dry mouth. Stress and emotional upset can cause it, as can blocked or inflamed salivary glands, but two major culprits are medically prescribed drugs and dehydration.

Some drugs have anti-cholinergic side effects and reduce saliva production. If used only for short periods, however, drugs with these side effects, such as antihistamines, are not problematic. But some drugs prescribed for chronic conditions such as depression, high blood pressure and Parkinson’s can lead to long-term dryness, mouth ulcers and taste disturbances.

Radiation treatment or chemotherapy can result in saliva problems that may become so bad that patients may need to resort to artificial saliva.

Daily changes to diet can improve salivary flow and help to keep a mouth youthful. Unknowingly, many people live in a state of semi-dehydration – nothing that litres of water a day wouldn’t cure.

Fresh crunchy foods (fruit, vegetables, grains, nuts) stimulate saliva and keep mastication muscles in good shape. Chewing also stimulates ligaments around the roots of the teeth and this in turn stimulates bone growth. Bone anchors teeth, and if the bone is healthy there is less risk of teeth becoming wobbly.

Receding gums are a sure sign of age. Regular visits to the dentist can help keep insidious gum disease at bay, while proper brushing and flossing can control gum damage. In the morning, a 3-minute brush before or after breakfast is sufficient. The aim of this brush is to get plaque rather than food off the teeth. Before sleep at night, metabolism slows and salivary flow usually drops to a minimum. For this reason night brushing and flossing is crucial. The aim should be to get all bacteria off the teeth.

Brushing can conclude with a fluoride rinse recommended by a dentist. The rinse will coat the teeth for the night, prevent more bacteria settling on them and help to compensate for the reduction in saliva.

By taking care, it is quite possible to reach the age of 90 without ever becoming long in the tooth.

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Following vigorous intercourse, men may be alarmed to find translucent, worm-like masses encircling their penis. These are usually nothing to worry about and will disappear if left alone. During intercourse small lymph vessels have probably ruptured, causing a blockage that is disrupting lymph drainage. The men are advised to refrain from further intercourse until the whitish weals, known as sclerosing lymphangitis, have subsided.

Genital warts are common and arise in a variety of shapes and sizes. They may be single small finger-like projections or big cauliflower-like bunches, are often moist and may be itchy. Of the 65 different types of human papilloma virus that cause genital warts, only two (type 16 and type 18) are said to be pre-malignant. The others are benign.

Warty lumps are usually found on the shaft but can also occur just inside the urethra. While they can be highly visible, they can also exist subclinically and be invisible to the naked eye. Studies have shown 10 per cent of men have subclinical wart disease. Warts can be treated with chemicals, freezing, burning, surgery or lasers.

Other benign bumps include hemangiomas, which are little malformations of blood vessels, and sebaceous cysts, which form small nodules.

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Desire discrepancy is an inevitability of marriage. In all long-term relationships there comes a period when one partner’s desire is greater than the other’s – when one partner wants more intercourse than the other is willing to participate in.

Most couples find a way of coping with this discrepancy, but for some it is an unbridgeable gap that gives rise to tremendous hurt and misunderstanding. It can lead to fury and family breakup or to plummeting self-esteem and pathological behaviour.

Sex therapists see more clients suffering from desire difficulties than almost any other type of sexual disorder. There are clients who worry that their libido has waned inexplicably, those who complain of their spouse’s lack of desire and those who feel burdened with an oversexed partner.

Increasingly, it is men who have low desire. The old stereotype of men being eager and women making excuses no longer applies. More and more often, women are expressing frustration about unmet needs.

In the mid-seventies, men accounted for about 30 per cent of low-desire cases treated at sex therapy clinics. By (he eighties they were accounting for more than 50 per cent of cases.

By the nineties, the great majority of complaints that one partner had fizzled out sexually were coming from women.

Women were no longer lying back and making shopping lists or thinking of England. They had become willing partners.

The sexual revolution of the sixties and early seventies promised women new enjoyment. Masters and Johnson freed them from the quest for vaginal orgasms, the pill freed them from fear of pregnancy and the inconveniences of other birth-control methods, and the women’s movement encouraged them to take charge of their sexuality.

But after all that, men began to lag behind and respond less and less frequently to women’s overtures. Women find it upsetting and humiliating to fail to rouse their partner’s libido. While not being touched and noticed affects women severely, men frequently don’t even want to think about the implications of not being interested in sex.

Mrs S.F. was sexually rejected throughout an 8-year marriage. Although she and her husband managed to produce two children, the sex they had was extremely infrequent, always on his terms and mechanical. Painfully she recounted her predicament:

While at home with my two young children I would watch soap operas during the day and cry when there was a romantic kissing scene. I wept because I could not remember what it felt like to be kissed. At the time I really believed that if he would just kiss me now and again, then 1 could cope. I had given up all hope of ever having a normal sex life.

Out of loyalty to him, and to protect myself, I told no-one. I did not feel like a women. I felt devoid of gender. Although 1 was considered attractive, I thought there must be something repulsive about my appearance or behaviour to cause his rejection. I stopped caring about how I looked, gained weight, started wearing baggy jeans, long cardigans and desert boots.

Therapists told Mrs S.F. that her husband was not abnormal. His sex drive was not absent initially but it was low (he wanted sex every 6 weeks). As a result of his upbringing, his history or perhaps his physiology, he had little drive. This is not bad or wrong.

The pain in their relationship came not so much from the differences in their desire but from their inability to negotiate sexual compromises. One therapist put it thus: not only were their sex drives mismatched, they also had mismatched sexual expectations and attitudes. She interpreted his low desire as rejecting and controlling. But it wasn’t. He was not withholding; he just didn’t want frequent intercourse with her or anyone else. She took it personally, and eventually they found themselves in a vicious cycle in which any desire he might have had originally would have evaporated.

What typically happens in such marriages is that sex becomes a highly charged issue, and this has a paradoxical effect. It enhances the sexual readiness of the partner with the high sex drive and inhibits desire in the partner with the low sex drive.

People with a high sex drive often use sex to express and experience love. They have a strong need to be desired, and if they are not, they feel rejected. People with a low sex drive find fulfilment in nonsexual ways, through closeness and communication with their partners. This man would not have understood how painful it was for his wife when he said no to sex.

Desire discrepancy is bread and butter for sex therapists. A mismatch in sex drives is a relationship inevitability, not a dysfunction, and there are ways of dealing with it.

Perfect sexual synchronicity exists only in the movies.

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‘Fresh air’ is a frequently misunderstood term. Unless a room is completely sealed up, enough air comes in around doors and windows to provide oxygen for breathing. Whether more air should be circulated through the room is a matter of choice.

A few generations ago, air in itself was considered dangerous, especially night air, which was supposed to carry disease-laden vapours —called miasmas—and draughts, which doctors blamed for any number of illnesses. The result was that many of our ancestors accustomed themselves to wearing several layers of underclothing in all seasons, and to sleeping with their windows tightly closed. Newborn babies were wrapped up like mummies.

With such discoveries as the fact that malaria was caused by mosquitoes and not by night air, the pendulum began to swing in the opposite direction. One of the results of this change was the fresh-air fiend who went around flinging windows open, to the discomfort of his associates. A former patient of mine, a middle-aged woman from a well-to-do family, told me that her parents were so sold on the virtues of fresh air that they insisted on her being out of doors regardless of the temperature. As she was not a very active child, she was cold most of the time, even suffering from frostbitten fingers and toes. Each person needs to find the conditions in which he is most comfortable.

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I love to sit in the sauna or steam room at my gym, although 5 minutes is about all I can handle. All that heat and moisture certainly feel great after a workout. But don’t fool yourself into thinking that they’re effective weight-loss tools. Yes, you may sweat out some water, but any weight loss that occurs is very temporary. In fact, if you lose more than a tiny bit of weight in a sauna, you’re risking severe loss of body fluid and dehydration.

I don’t recommend a sauna or steam bath if you have high blood pressure. The heat is vasodilating, which means that it causes blood vessels to open up. This can alter your circulation and lower your blood pressure, which in turn can cause transient ischemic heart attacks and strokes in certain people.

Starch blockers-Products that interfere with the body’s ability to absorb starch were especially popular in the late 1970s and early 1980s. In 1982 alone, you could choose from among some 100 different starch blockers, and over 1 million starch-blocking pills were popped daily.

The theory behind the starch blocker is simple: If you absorb

fewer carbohydrates (starches), you’ll lose weight. But in real life the theory just doesn’t pan out.¹⁴ Besides, carbohydrates should make up about 70 percent of our daily diets. It’s the fat we want to reduce, not the carbohydrates. By all means use Chitosan, the Fat Blocker. Block the right thing!

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This 1985 diet was wildly popular for years, and the book that describes the diet still sells well. The program, devised by
Harvey and Marilyn Diamond, is based on the principles of Natural Hygiene, including the theory that the “body is always striving for health and that it achieves this by continuously cleansing itself of deleterious waste material.”⁶ They say the body has specific cycles during the day: From noon to 8 p.m. the body is appropriating (digesting: g the food you’ve eaten), from 8 p.m. until 4 a.m. the body is assimilating (absorbing and using nutrients), and from 4 a.m. to noon it is eliminating debris from the food and bodily wastes. According to the Diamonds, we should synchronize our eating t*o these cycles, eating the appropriate amounts of certain types of foods at each meal. This will ensure that our bodies will rid themselves of dangerous wastes and remain slim.

The Diamonds encourage dieters to combine foods in specific ways that will make sure that northing is left to “rot” in the stomach. They preach the importance of having no more than one concentrated food in the stomach at a time, eating only a.m. foods in the morning and p.m. foods later in the day, and many other unusual rules. With their plan, what you wind up eating is not a bad diet, but the theories behind this regimen were questioned long ago. Rather than adhering to a so-so diet based on incorrect principles, you’re much better off blocking fat with Chitosan and a scientifically based, patient-tested, safe, and effective healthy eating regimen.

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Just by forgetting to cut the extra fat off a cut of meat or leaving the skin on chicken, or by pouring a little extra oil in the frying pan, you can inadvertently add many grams of fat and therefore calories to a meal. So, if you use fat in cooking, always measure it carefully. And use a cooking spray, such as Pam, in preference to oil or butter when you fry. It adds only a tiny amount of fat, and the food cooks and tastes just the same. Also, considering sauteeing in water instead of oil. It doesn’t work for everything. But a few drops of water is just as good (and, to my taste, even better) than the same amount of fat when you are sauteeing mushrooms or onions. Try experimenting; you’ll be pleasantly surprised. The Fat Blocker Program encourages

trimming excess fat from meats, discarding the skin, eating lean meats only, using low-fat or nonfat versions of margarine for cooking and nonfat salad dressing, milk (unless you hate it), and yogurt. Once again, if you decide to add fat to a meal because otherwise it’s just not good enough to satisfy you, add as little as possible—and take Chitosan in advance to take care of the rest.

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Walking, wogging, jogging, running, swimming, or cycling aren’t the only kinds of aerobic exercise. Any physical activity that gets and keeps your heart rate up and your breath coming faster qualifies as aerobic. Doing heavy yard work, mowing the lawn, washing the car, vacuuming energetically, or chasing your kids around can provide you with aerobic exercise just as surely as running a mile does. And there is absolutely no need to do the same thing every time. After all, you don’t eat the same things every day (except, of course, for Chitosan), so why should you do the same exercise? In fact, varying what you do has two major advantages: It converts exercising from chore to fun so you never get bored, and it ensures that all your muscles get a workout. The only important consideration is to do some form of aerobic activity for at least 30 consecutive minutes at least 4 to 5 times a week. The closer you get to that goal, the better you’ll feel.

When you do start exercising (gently at first, remember), make a real effort to find stimulating activities. For instance, many people enjoy the stimulation and encouragement they find in an aerobics class with inspiring instructors. The energy in these classes can be contagious, while the friendships that spring up make going to class even more fun. The exercises are usually done to the beat of high-energy music, and low-impact formats offer protection against joint wear and tear.

Other activities that can provide aerobic benefits and overall physical fitness include cross country skiing, rowing, tennis, circuit-weight training (without long breaks between weights), and just about any sport that involves steady, continuous moving. Once again, let me remind you: It doesn’t matter which aerobic exercise you do as long as you do it, you do it regularly, and it keeps your heart beating in the target zone for the required amount of time.

For the more aesthetically inclined, jazz dance or ballet classes may be just the thing, and many dance studios cater to adults who are just beginning to learn to dance. Dancing brings strength, flexibility, and balance that can put a willing participant on the road to physical fitness, weight loss, and a new appreciation of the human form. Again, the advantage of being part of a group should not be underestimated. It is a lot more encouraging to hear your friends say, “We missed you,” than to listen to your spouse nagging you because you missed going to your class again.