Saturday 21 April 2018

Dr Ciara Kelly: 15 reasons why men die younger

Lifestyle choices play a huge part in determining how long you will live - you could be doing something right now which is knocking years off your life. Dr Ciara Kelly reveals what about your life is likely to be killing you, and what you can do about it

Ciara Kelly
Ciara Kelly

Ciara Kelly

Men are notoriously bad at looking after their health, often only attending the doctor having been sent there by their significant other. And often ignoring even quite pressing symptoms for a long time.

Irish men have a life expectancy of 78, a full five years less than Irish women. They have a higher risk of heart disease and stroke. They're more likely to commit suicide. And they have a greater risk of getting and dying from cancer. Yet they attend the doctor far less frequently than women and in the main don't engage with health services unless they have to.

So what is going on with our men and why are they dying younger?

It may be a cultural thing that men don't seek help readily around health issues - part of that whole 'Man up' and 'Boys don't cry' narrative that implies men shouldn't have needs or show emotions - they should be tougher than that. But it doesn't do them any favours as we can see from our statistics around young male suicide - which tells us if nothing else that men just as much - if not more than women, can become overwhelmed at times and need support and to be listened to.

So let's drill down and take a look at exactly why men don't live as long as women - and what they can do about it.

What's killing our men?

The number one killer of men and indeed women is still heart disease - killing one in six of all men. But it can start to affect men from their thirties and forties - as opposed to generally affecting women from their sixties - which is a big reason why men's life expectancy is shorter - so it is one of the main health risks men need to manage.

Cigarettes

The main risks of heart disease are family history and cigarette smoking.

You can do nothing about the former - but the latter is within your power. Almost one in five men still smoke in Ireland, half of whom will be killed by it - one in 10 men will die directly from cigarettes. That's a huge health risk right there.

So first up stop smoking. Right now. Today. Immediately.

That will slash your risk of heart disease, lung disease and most cancers straight off.

Vaping increases your risk of successfully quitting the fags hugely and is considered to be 95pc safer than cigarettes. So when you finish this article, put down the paper, throw your cigarettes in the bin, go to the shops and switch to ecigarettes. Yes, today. Ideally we want you off nicotine altogether but vaping is a good first step.

Cholesterol

There is a huge vogue currently for all sorts of diets skewed in various directions but having a diet high in saturated fats and trans fats will increase your risk of heart disease because we still think that a high 'LDL cholesterol' is bad for your heart. Eating a balanced diet that's low in these types of fats - that includes lots of salads, vegetables and fruit, but also one that includes oily fish, nuts, seeds, avocados and olives - which can help push up your good 'HDL cholesterol' is best for your heart. Throw in some healthy porridge and you are eating a good heart-friendly diet. If we are what we eat, then most of our men are pepperoni and extra cheese pizzas - and it's doing them no good.

Body weight

It's true that the BMI - or body mass index - measure of size, is hard on men. That's because muscle is denser than fat, so men - with their higher muscle mass, weigh heavier than women even if they are proportionally the same size. Still with me? Basically it means that because men are more muscular they can weigh heavier and appear to be overweight - according to their BMI - when they possibly aren't.

But the truth is most men have a higher BMI because they're fat. With Irish guys on average gaining a stone a decade. Around two thirds of Irish men are currently overweight or obese and most have that big beer belly, central obesity or 'apple shape'. Which in addition to having a thick layer of fat under the skin of the abdomen also means you've laid down visceral fat around your organs. So, to go along with your beer belly you've also got a heart that's encased in fat - making it harder for it to do its job of pumping blood and which puts you at increased risk of heart disease.

Maintaining a healthy body weight reduces the fat around your heart and takes some of the strain off it, reducing your blood pressure and its overall workload. And will go a long way to allowing you to live longer.

Physical activity

The funny thing is we have started to see a split in the male population. The majority live sedentary lives, sitting down for most of the day, watching their shirt buttons pop and learning to balance their dinner plate on their belly, as they put on weight round their midriff and take little or no exercise.

A significant minority are turning into MAMILS (Middle Aged Men In Lycra) tearing around the place on bikes or running along the highways and byways in luminous tops and trousers resembling tights - training for triathlons and Hell and Backs.

Sitting for long periods of the day and inadequate activity is closely linked to heart disease - so getting your 30 minutes a day of exercise is vitally important for heart health and longevity.

And when you think about it - it's still a good deal, when we're saying you can sit on your ass for 23-and-a-half hours a day and still be healthy!

Drink

Alcohol is the curse of the Irish man. With the average Irish man drinking more than almost anyone else in the world. This, because booze is high in sugar and calories, results in a huge amount of weight being put on from drinking. The average pint of beer has more than 200 calories - similar to the average bar of chocolate - so bear in mind when you go out drinking for the night that you may have had the equivalent of nine or 10 Mars Bars.

We should pause for a moment to just take a look back at how much advice so far is lifestyle related and so recognise just how much your health is within your own hands when it comes to ageing well or living longer

Cancer

The next biggest killer of men after heart disease is cancer - with prostate, lung, colorectal (bowel) and liver being the big ones.

Well the good news is that now that you've all agreed to give up smoking from earlier on in this column you've just slashed your risk of lung cancer.

So that's one thing to feel better about. But equally cutting your intake of alcohol - which is also a major carcinogen - something we do not hear mentioned nearly often enough, and also keeping your weight down, will slash your risk of dying from other cancers too. So simple lifestyle changes really do make a major difference.

Processed meats

Cutting down on your intake of processed meats like ham, sausages, bacon or salami will, in addition to keeping you trim, also cut your risk of colorectal cancer. You should also sign up to the national bowel screening programme to do a simple test from home which can indicate at an early stage if you need to go for a blood test or a colonoscopy.

Prostate

Prostate cancer is the commonest cancer among men with around one in two older men in their seventies and eighties falling victim to it - but it can affect younger men too and is often more aggressive in the younger group.

If you've any difficulty passing urine or find yourself getting up more frequently at night to pee - especially if you've a family history - you need to see a doctor for a blood test and an examination.

And again stop or preferably don't ever start to smoke as cigarettes are implicated in prostate cancer too.

Sex

The other thing you can do to reduce your risk of prostate cancer is increase your frequency of ejaculation. So an active sex life is protective.

If you're not lucky enough for that to be an option masturbation can be helpful. Men who ejaculate more than 21 times per month enjoy a 33pc less risk of prostate cancer is something you don't hear very often but considering it's the commonest cancer men suffer from we should probably be shouting about.

Unintentional injuries

The next big killer of men after heart attack and cancer is unintentional injuries. That's things like road deaths, accidents, fights, falls and overdoses. The risk of death from this is much higher, around double, for men than for women as men appear to be greater risk takers but also again alcohol plays a huge role here, and historically men drank far in excess of women - although that's now changing.

Young men are at particular risk of death from drunken accident, and with drink-driving again on the rise in this country, it's worth mentioning the significant risks to men's health that alcohol poses across a range of health problems. Approximately 12,000 years of life are lost every year to alcohol in the Republic by reasonable calculations.

Parents, tell your sons not to drink, not to fight, not to drink and drive and to generally think before they act if they don't want to live to regret it. And older men - you guys need to mind yourselves too on this score.

Stroke

Stroke is the next biggest killer of men. But if you're doing all the right things by your heart - you're generally reducing your risk of stroke too. Arrhythmias, or irregular heartbeats, are a big cause of stroke though, so if you are experiencing palpitations you should see a doctor. And also as alcohol can also be a major inducer of atrial fibrillation, one of the commonest forms of arrhythmia, you need to realistically watch that here too. Taking aspirin can reduce your risk of both heart attack and stroke so middle-aged men should discuss this with their doctors.

Diabetes

One in 20 men get Type 2 diabetes but that rises to one in eight in the over sixties. Type 2 diabetes is a leading cause of death in men and is almost exclusively a function of obesity. Maintaining a normal body mass and eating a low-sugar, low GI (glycemic index), moderate carb diet will reduce your risk of getting it or if you already have it, will help prevent complications arising from it so you can live well into your older years.

Influenza and pneumonia

We sometimes forget because so many people say they have the flu when they have no such thing and merely have a common cold that it is a major cause of significant illness and death. There have been more than 500 hospital admissions with the flu so far this year and as of last week 15 deaths. The best way to avoid succumbing to both these illnesses is through vaccination. But our vaccine rates remain worryingly low. It's cheap. It's safe and it might just - particularly if you are a man over 65 - save your life, as it's that age group who seem to be hit hardest with flu symptoms.

Chronic obstructive pulmonary disease

This is almost exclusively a function of smoking so now that you are non-smokers your risk is much reduced. Which is just as well as death from COPD is an unpleasant form of slow suffocation. I vividly remember it being described to us as medical students as similar to death by crucifixion.

Suicide

We know it's worryingly high among our young men but, sadly, older Irish men have a relatively high rate of suicide too and it's thought that many of the single car collisions that are written up as road deaths are in fact suicides too.

Mental health and suicide is a genuine crisis for Irish men that needs addressing urgently. Men are almost three times more likely to kill themselves than women, and suicide is now the number one cause of death in younger men. To me the elephant in the room is once again alcohol here - with it playing a role in half of suicides. And there is a proven association between excessive drinking and suicidal ideation and intent.

Our young men are drinking way too much, often not sleeping enough, and not opening up about their feelings. Many men see suicide as an acceptable solution to emotional crises. Imposing a permanent irreversible radical solution on what is a transient problem never helped anyone. We need to change that situation and indeed challenge the culture that prevents men from feeling OK about their emotions. And we need to create channels of communication so men can talk openly.

And men, you need to recognise when you're struggling and look for help. It is out there.

If you think there was a lot in this piece about alcohol, you're right. It's genuinely the scourge of Irish men's health and that coupled with smoking and a diet too great in volume and too high in bad fats, salt and sugar is causing a big reduction not only in our men's longevity but also means they don't live as well as they could, while they're alive.

Men need to wake up and start recognising they're not invincible and sometimes they need to reach out and seek help for both physical but also emotional and mental health issues. They also need to stop doing stupid, risky, impulsive things that might just get them killed.

A huge amount of the reasons men don't live as long as women are down to lifestyle choices and them not looking after themselves. A few simple tweaks and it could really be a man's world.

@ciarakellydoc

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