Imagine the Revolution!

Are you sick and tired of a medical industry that's influenced by drug reps trained in communication skills, sales, and profit margins; and with research funded and designed to benefit pharmaceutical companies?

Are you fed up with a health care system, including dietitians and nurse educators who encourage diabetics to eat dangerously or serve pizza, fried chicken, and beef 'n noodles to severely ill patients?

Are you disappointed that our educational system puts no value in instructing students in optimal health and longevity?  How fulfilling and productive is a career intermingled with food addiction, hangovers, and disease?  What enjoyment and satisfaction is there in a beautiful home and nice car mixed with alcoholism, eating disorders, heart disease, pain meds, chemo treatments, diabetes, and broken relationships?

Are you saddened by a culture that models, by example, and promotes gluttonous pleasures and indulgences?  What will happen to a society in which eating for disease has run rampant? 

Are you disturbed by the fact that a quarter of a million dollars can be spent on a heart surgery that would have been easy to avoid with a proper diet-style?  Are you equally disturbed that $110 can be spent on a small vial of insulin for type 2 diabetes, when eating healthfully would've resolved it ~ while entire families go to bed hungry?  Is it even ethical to squander such financial resources?   Do we need more medical care or more health education?

  • Imagine the revolution.

  • Imagine medical care and treatments that get people well based on scientific nutritional research instead of unsuccessfully managing diseases based on financial gains and losses.

  • Imagine an education system that values instruction in optimal health and longevity as a top priority for all students; no child left behind.

  • Imagine an entire society that has eradicated food addiction and nearly 80% of its diseases.

  • Imagine the financial and emotional burdens lifted as a result of no more heart bypass surgeries, cancers, dementia, chemical restraints, and vials of insulin.

The change of one is a transformation.

The change of many is a revolution.

Change begins with you and me.

Let’s all be that change.

It's time for the revolution!

 

NutritionalResearch.org

 

Painting credit: “Washington Crossing the Delaware” by Emanuel Leutze; 1851; oil on canvas; Metropolitan Museum of Art

Photography credit:  (c) by Emily Boller

 

Study implicates omega-3 fatty acids in prostate cancer - Is this reliable information?

I have reported on the inconsistent studies on omega-3 fatty acids and prostate cancer risk. More recently, a study has added to the confusion; the media has picked it up and scared men away from omega-3 supplements, meanwhile some experts have criticized the authors’ methodology and conclusions.

This study used data from a clinical trial on vitamin E and selenium supplementation for cancer prevention, and added on a blood test for omega-3 to determine whether there was an association between plasma levels of omega-3 fatty acids and incidence of prostate cancer.  The authors found a statistically significant difference in the average total long-chain omega-3 blood level between men who did or did not develop prostate cancer throughout the study.1

I have serious concerns about the potential risks of taking lots of fish oil capsules.  So much fish oil can have paradoxical effects, reducing immune function in later life.  Plus eating lots of fish exposes you to risky amounts of chemical pollutants, and raises IGF-1, a hormone that is causative in prostate cancer, so it is not that this relationship has no potential to be true.  However, this study does not tell us if these are valid concerns or not and we can’t make any meaningful conclusions from this new study.  This study does NOT indicate that omega-3 supplementation or eating fish are a contributory factor in the prostate cancer equation for numerous reasons.

1.       Plasma vs. erythrocyte fatty acid measurement, done only once

Although measuring omega-3 levels in the blood seems like it would be an objective and accurate indicator of fish oil intake compared to using the subjects’ reported dietary intake, this test does not  accurately reflect long-term dietary intake. There are two methods for measuring blood fatty acids; in plasma or in erythrocyte (red blood cell) membranes.  Erythrocyte omega-3 measurement has been reported to be a more accurate reflection of long-term blood levels, and to correlate more closely with dietary intake compared to plasma measurement.2   Regardless of which test was used, one blood test does not reflect one’s fish oil intake or fish exposure over a lifetime or even over a twenty year period.  Cancer is caused by what you do for many, many years, not what you do for a few weeks or months.   You would have to do multiple blood tests over many years to assure the results were indicative of a dietary pattern.  Also, since there was only one blood test at baseline in this study (and they used plasma levels), it only reflects what they consumed a few days before the test was drawn. This is very important, since cancer takes many years to develop. Some men that did have higher levels may have started taking fish oils supplements only recently, and some may have simply eaten a large piece of fish the night before the blood test.

2.       The tiny difference in blood omega-3s between the cases and controls.

The authors found a statistically significant difference in the average total omega-3 blood level between men who did or did not develop prostate cancer throughout the study. But is this a meaningful difference out in the real world?  In men diagnosed with prostate cancer, the average was 4.66% of total fatty acids; in men without cancer, the average was 4.48%. This is a very small difference, and likely reflects an insignificant difference in omega-3 intake.   

3.       No information on fish, fish oil, or other omega-3 supplement intake of subjects.

Where did the slight difference in omega-3 blood levels come from? Were the men who were diagnosed with cancer more likely to be taking fish oil capsules? Were they eating more fish overall?  More breaded and fried fish? More large, predator fish? The type of fish and how it is prepared would impact the level of environmental contaminants and dietary carcinogens.  Could the early development of prostate cancer increase blood omega-3s, rather than vice versa? 3 These unanswered questions make it very difficult to extract any useful information from this study’s results.  For it to have substantive impact they would have had to track dietary fish consumption, fish oil consumption and have confirm that was a true recall, with confirmatory blood tests taken episodically. 

4.       Rancid fish oil?

Industry experts have pointed to the potential role of rancid fish oil in the inconsistent results among omega-3 studies. Animal studies have shown that rancid fish oil could promote inflammation and even cancer, and the majority of fish oil capsules are indeed rancid. Omega-3s are highly unstable fats, very susceptible to oxidation, forming lipid peroxides and starting a chain of oxidation reactions leading to rancidity.  Exposure of EPA and DHA to light, heat and oxygen increase the likelihood of oxidation.4

(Fresh, non-rancid fish oil does not have an unpleasant taste or smell. If you take omega-3 capsules, open one up and taste the oil to test whether it has gone rancid.)  

5.       Research on omega-3s and prostate cancer remains inconsistent.

The authors state, “It is unclear why high levels of long-chain omega-3 PUFA would increase prostate cancer risk, and further study will be needed…” As discussed in my previous article, the literature on omega-3 fatty acids and prostate cancer is indeed inconsistent.

A 2010 meta-analysis of 31 studies on fish consumption and prostate cancer risk found no significant effect overall, and noted the inconsistency between studies: the risks of prostate cancer diagnosis calculated for high fish consumption ranged from a 61% decrease to a 77% increase.5  A 2013 meta-analysis of studies on blood omega-3 levels and prostate cancer also found no effect overall on prostate cancer risk, and noted significant heterogeneity (inconsistency in results) between studies. Only after removing one study from their analysis did they see an increased risk of high-grade prostate cancer.6  Interestingly, Asian populations, such as in Japan, that consume high levels of fish tend to have lower rates of prostate cancer.7-9 The 2010 meta-analysis also found a 63% decrease in risk of death from prostate cancer with high fish consumption.5  Many studies have shown that DHA and EPA decrease proliferation and increase cell death in prostate cancer cells, and that omega-3-enriched diets slow prostate tumor growth in animals.10-20  A clinical trial published in 2011 gave patients about to undergo prostatectomy either a low-fat (15% of calories) diet plus fish oil supplementation or a Western diet with no supplements for 4-5 weeks prior to surgery. The fish oil supplemented group showed a 32.2% decrease in malignant cell proliferation when prostate tissue was analyzed after surgery.21  Though many people with biases want to jump on the results of one of these studies to claim fish or fish oil are good or bad, we simply cannot do so with scientific integrity.   There are many different studies on this topic with widely varying results.

Omega-3 supplementation: the big picture

For optimal health (including cancer protection), we require the complete composition of the nutrient-dense (Nutritarian) diet that supplies us with optimal amounts of all valuable nutrients and phytochemicals.  Avoiding deficiencies is critical, but it is important to avoid excesses too.  Omega-3 fatty acids are essential nutrients that we must get from our diets because our bodies cannot make them; they are crucial for early brain development, and there is much evidence that they promote cardiovascular health and cognitive function.22,23  Note also, that higher omega-3 blood levels have been associated with reduced risk of death from all causes.24  Avoiding supplemental omega-3s is not the appropriate response to this new study.  This is especially critical because we all convert short chain omega-3 (ALA) into long chain omega-3 (DHA) differently, and if you are one of those poor converters, the lack of DHA in your diet can turn out to be devastating to you in later life.  Many vegans are gambling with their future cognitive health to uphold a philosophical viewpoint, because once you develop a neurological or cognitive deficit in later life, it will be too late to try to fix a deficiency that could have caused it. 

Of course, too much of any potentially good thing turns it bad.  For any needed nutrient, especially fat soluble nutrients, too much can be problematic.  Since all fish oil capsules give a pretty high dose of EPA and DHA, and most of them are rancid too, they could be part of the problem. Plus, fish is an unfavorable omega-3 source, since animal protein and environmental contaminants are packaged with the DHA and EPA.   I advise most people take a low dose of algae-derived EPA-DHA, or follow your omega-3 levels episodically to assure no deficiency exists.  Maintaining adequate, but not excessively high DHA and EPA levels is the safest and most conservative and responsible strategy. 

 

References:

1. Brasky TM, Darke AK, Song X, et al: Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial. J Natl Cancer Inst 2013.
2. Sun Q, Ma J, Campos H, et al: Comparison between plasma and erythrocyte fatty acid content as biomarkers of fatty acid intake in US women. Am J Clin Nutr 2007;86:74-81.
3. Liu Y: Fatty acid oxidation is a dominant bioenergetic pathway in prostate cancer. Prostate Cancer Prostatic Dis 2006;9:230-234.
4. Albert BB, Cameron-Smith D, Hofman PL, et al: Oxidation of marine omega-3 supplements and human health. Biomed Res Int 2013;2013:464921.
5. Szymanski KM, Wheeler DC, Mucci LA: Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr 2010;92:1223-1233.
6. Sorongon-Legaspi MK, Chua M, Sio MC, et al: Blood level omega-3 Fatty acids as risk determinant molecular biomarker for prostate cancer. Prostate Cancer 2013;2013:875615.
7. Dewailly E, Mulvad G, Sloth Pedersen H, et al: Inuit are protected against prostate cancer. Cancer Epidemiol Biomarkers Prev 2003;12:926-927.
8. Kobayashi M, Sasaki S, Hamada GS, et al: Serum n-3 fatty acids, fish consumption and cancer mortality in six Japanese populations in Japan and Brazil. Jpn J Cancer Res 1999;90:914-921.
9. Hebert JR, Hurley TG, Olendzki BC, et al: Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study. J Natl Cancer Inst 1998;90:1637-1647.
10. Cavazos DA, Price RS, Apte SS, et al: Docosahexaenoic acid selectively induces human prostate cancer cell sensitivity to oxidative stress through modulation of NF-kappaB. Prostate 2011.
11. Hu Y, Sun H, Owens RT, et al: Syndecan-1-dependent suppression of PDK1/Akt/bad signaling by docosahexaenoic acid induces apoptosis in prostate cancer. Neoplasia 2010;12:826-836.
12. Chung BH, Mitchell SH, Zhang JS, et al: Effects of docosahexaenoic acid and eicosapentaenoic acid on androgen-mediated cell growth and gene expression in LNCaP prostate cancer cells. Carcinogenesis 2001;22:1201-1206.
13. Rose DP, Connolly JM: Effects of fatty acids and eicosanoid synthesis inhibitors on the growth of two human prostate cancer cell lines. Prostate 1991;18:243-254.
14. Bureyko T, Hurdle H, Metcalfe JB, et al: Reduced growth and integrin expression of prostate cells cultured with lycopene, vitamin E and fish oil in vitro. Br J Nutr 2009;101:990-997.
15. Istfan NW, Person KS, Holick MF, et al: 1alpha,25-Dihydroxyvitamin D and fish oil synergistically inhibit G1/S-phase transition in prostate cancer cells. J Steroid Biochem Mol Biol 2007;103:726-730.
16. Yi L, Zhang QY, Mi MT: [Role of Rho GTPase in inhibiting metastatic ability of human prostate cancer cell line PC-3 by omega-3 polyunsaturated fatty acid]. Ai Zheng 2007;26:1281-1286.
17. Nakajima T, Kubota N, Tsutsumi T, et al: Eicosapentaenoic acid inhibits voltage-gated sodium channels and invasiveness in prostate cancer cells. Br J Pharmacol 2009;156:420-431.
18. Aronson WJ, Barnard RJ, Freedland SJ, et al: Growth inhibitory effect of low fat diet on prostate cancer cells: results of a prospective, randomized dietary intervention trial in men with prostate cancer. J Urol 2010;183:345-350.
19. Berquin IM, Min Y, Wu R, et al: Modulation of prostate cancer genetic risk by omega-3 and omega-6 fatty acids. J Clin Invest 2007;117:1866-1875.
20. Kelavkar UP, Hutzley J, Dhir R, et al: Prostate tumor growth and recurrence can be modulated by the omega-6:omega-3 ratio in diet: athymic mouse xenograft model simulating radical prostatectomy. Neoplasia 2006;8:112-124.
21. Aronson WJ, Kobayashi N, Barnard RJ, et al: Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy. Cancer Prev Res (Phila) 2011;4:2062-2071.
22. Simopoulos AP: The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood) 2008;233:674-688.
23. Simopoulos AP: Evolutionary aspects of diet: the omega-6/omega-3 ratio and the brain. Mol Neurobiol 2011;44:203-215.
24. Mozaffarian D, Lemaitre RN, King IB, et al: Plasma Phospholipid Long-Chain omega-3 Fatty Acids and Total and Cause-Specific Mortality in Older Adults: A Cohort Study. Ann Intern Med 2013;158:515-525.


Debunking the anti-soy myths

Despite the abundance of scientific evidence demonstrating the benefits of whole soy foods, many people have been scared off from healthful foods like edamame by the anti-soy propaganda (lacking responsible scientific integrity) that continues to float around the internet.

Edamame. Flickr: cl_03

It is true that the nutrient-depleted isolated soy in protein powders and processed foods is likely problematic. And of course, I recommend steering clear of genetically modified soy, as its safety, phytochemical value, and environmental impact remain questionable.

However, research has shown overwhelmingly that whole and minimally processed soy foods (like edamame, tofu and tempeh) provide meaningful health benefits. The presence of isoflavones, a class of phytoestrogen, has sparked much of the controversy around soy. There were concerns that these plant estrogens could potentially promote hormonal cancers, such as breast and prostate cancers; however, those fears were unfounded. I have previously discussed the large body of evidence that convincingly suggests that whole and minimally processed soy foods protect against breast cancer. In addition, a 2009 meta-analysis of studies on soy and prostate cancer found that higher soy intake was associated with a 26% reduction in risk.1 In addition, it appears that isoflavones have a number of anti-cancer effects that are unrelated to their ability to bind the estrogen receptor. Accordingly, soy foods are not only associated with decreased risk of hormonal cancers, but also lung, stomach, and colorectal cancers.2-4 (For further discussion of soy foods and health, see the May 2012 member teleconference.)

An article posted by John Robbins seeks to finally put the soy misinformation to rest. He provides a balanced review of the available information, addressing all the common concerns about soy, from cancer and osteoporosis risk to protein digestibility and mineral absorption.

Soy is not a magic pill or a poison; it is simply a bean.

One can’t argue with the data – the associations between minimally processed soy intake and reduced risk of cancers has been reported over and over again. There is no real controversy here.  However, one still should not eat lots of soy products, to the exclusion of other valuable foods. Variety is crucial for obtaining diversity in protective phytochemicals, and a variety of beans are health promoting, along with many other foods.  So use good judgment, avoid processed foods, GMO foods and eat a variety of whole natural plant foods including beans such as black beans, chickpeas, lentils and enjoy some edamame, tofu and tempeh as well.

 John Robbins: The truth about soy

 

Image credit - Flickr: cl_03

References:

1. Hwang YW, Kim SY, Jee SH, et al: Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies. Nutr Cancer 2009;61:598-606.
2. Yang WS, Va P, Wong MY, et al: Soy intake is associated with lower lung cancer risk: results from a meta-analysis of epidemiologic studies. Am J Clin Nutr 2011;94:1575-1583.
3. Kim J, Kang M, Lee JS, et al: Fermented and non-fermented soy food consumption and gastric cancer in Japanese and Korean populations: a meta-analysis of observational studies. Cancer Sci 2011;102:231-244.
4. Yan L, Spitznagel EL, Bosland MC: Soy consumption and colorectal cancer risk in humans: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2010;19:148-158.

Congratulations Julie ~ Winner of this Year's Holiday Challenge Contest!

On June 26th over 250 guests convened at the beautiful and luxurious Loew’s Coronado Bay Resort near San Diego, California for Dr. Fuhrman’s 7th Annual Health Getaway. It was a week set aside for renewal from the hectic pace of life; combined with informative and life-changing lectures by Dr. Fuhrman; delicious nutritarian foods prepared by world class chefs; and fun activities such as zumba, yoga, power walks, exercise classes led by Dr. Fuhrman, country line dancing, a patriotic dinner with live music, beach fun and games, and a highly entertaining talent show.

For Julie and her husband, Kip, it was the ultimate health getaway. They were this year’s recipients of the all-expense paid trip for two as a result of Julie winning the 2012 Holiday Challenge contest. One evening I asked Julie about her newfound health and was excited to learn about her journey. Welcome to Onlyourhealth, Julie!

 

How did you discover Dr. Fuhrman? 

One day I was sick and lying on the couch and decided to watch a movie that was on Netflix titled, “Fat, Sick, and Nearly Dead”. (Because that described how I was feeling that day!). The movie inspired me, but I instinctively knew that juice fasting wasn’t a lifestyle that I could sustain long term. Since Dr. Fuhrman was in the movie as a supervising physician, I researched him and discovered his book, Eat to Live. I bought the book that day, because his food pyramid looked logical to me. 

 

How did you feel then?

At 215 lbs I felt miserable. I suffered from polycystic ovary syndrome (PCOS), chronic sinusitis, debilitating migraine headaches, asthma, allergies, chronic bronchitis, sleep apnea, pneumonia, endometriosis, and loss of energy. Everything combined cause me to be a non-functioning wife and mother many days of the year.

 

How do you feel now?  

I’ve lost 65 lbs., and all symptoms of my past illnesses are completely gone. I’m able to be a full-time mother, and my children are proud of me now. I’ve also influenced them to eat for health, as well as my husband, parents, and friends, because they’ve all witnessed my health improvements. 

                  

What are your success tips?

  • Keep it simple. Stick to the basics of the program. If necessary, buy bags of lettuce and cut-up vegetables for quick meals.
  • Ignore the critics. Ignore those who aren’t informed but criticize what you are doing anyway ~ realize they just don’t know any better. 
  • Join Dr. Fuhrman’s Member Center. Ask questions, interact, and get support from veteran, successful Nutritarians; ask the doctors questions in Ask the Doctor; listen to the library of teleconference calls, and download favorite recipes from the Recipe Guide.  

 

Congratulations Julie for winning this year’s Holiday Challenge contest! If anyone is interested in the opportunity to win next year’s contest, stay tuned to the Holiday Challenge kick-off coming up again in November.  It's an exciting adventure you won't want to miss! 

 

 

Walnuts may promote male fertility

Infertility affects 10-15% of couples trying to conceive, and it is estimated infertility is at least in part due to the male in at least one-third, and up to 60% of these cases.1,2  Several dietary factors affecting fertility have been identified in women. Can men also improve their diet to improve their fertility?

 Walnuts

Certain micronutrients are thought to contribute to male reproductive fitness. Oxidative stress can damage sperm, and accordingly higher blood antioxidant capacity, carotenoids, and vitamins C and E have been associated with higher sperm count and motility. Infertile men have been shown to have lower circulating levels of these antioxidant nutrients compared to fertile men.3,4 Adequate folate, abundant in green vegetables, may also promote fertility by preventing DNA damage in sperm.5 In contrast, higher saturated fat consumption, and cheese specifically, have been linked to lower semen quality.2,6,7

Omega-3 fatty acids may also contribute to semen quality. Previous observational studies had shown that higher omega-3 fatty acid intake associated with higher rate of favorable sperm morphology (shape), and that fertile men tend to have higher blood omega-3 levels than infertile men.2,8 Deficiency in the omega-3 fatty acid DHA was shown to produce infertility in male mice, adversely affecting sperm count, morphology and motility. DHA supplementation restored these parameters to normal.9 Similarly, in a study of infertile men, DHA+EPA supplementation improved sperm counts compared to placebo.10

A latter study built on this previous omega-3 data by testing the effects of regular walnut consumption on semen quality in healthy young adult men (21-35 years old). Walnuts are rich in ALA, an essential omega-3 fatty acid and the precursor to DHA and EPA. However, there are many anti-inflammatory and beneficial compounds in walnuts that could be collectively responsible for the health benefits found in walnuts.  They contain more than a dozen phenolic acids, numerous tannins (especially ellagitannins), and a wide variety of flavonoids. The control group maintained their usual diet and was instructed to avoid eating nuts. The intervention group added about 3 ounces (75 grams) of walnuts to their usual diets each day for 12 weeks. Blood omega-3 ALA concentrations increased in the walnut group. Sperm vitality, motility and number of normal-morphology sperm were enhanced compared to baseline in the walnut group, whereas there were no changes in the control group.11 This study suggests that ALA (found in walnuts and flax, chia and hemp seeds) in conjunction with other beneficial nutrients in walnuts makes them a valuable food for  male fertility.

Couples who plan on becoming pregnant should follow a healthful, high-nutrient diet (including plenty of ALA-rich nuts and seeds), not only to better their chances of conceiving, but also to protect the future health of their children. Children’s health is influenced by their parents’ diets even before conception.12

In addition to focusing on whole plant foods, maintaining a healthy weight and minimizing exposure to agricultural pesticides (by eating organic produce when possible and minimizing animal foods) and endocrine disrupting chemicals (such as BPA and phthalates) are additional factors that can help to maintain favorable semen quality.13-19

 

References:

1. FamilyDoctor.org: Male Infertility [http://familydoctor.org/familydoctor/en/diseases-conditions/male-infertility.html]
2. Attaman JA, Toth TL, Furtado J, et al: Dietary fat and semen quality among men attending a fertility clinic. Hum Reprod 2012;27:1466-1474.
3. Benedetti S, Tagliamonte MC, Catalani S, et al: Differences in blood and semen oxidative status in fertile and infertile men, and their relationship with sperm quality. Reprod Biomed Online 2012;25:300-306.
4. Minguez-Alarcon L, Mendiola J, Lopez-Espin JJ, et al: Dietary intake of antioxidant nutrients is associated with semen quality in young university students. Hum Reprod 2012;27:2807-2814.
5. Boxmeer JC, Smit M, Utomo E, et al: Low folate in seminal plasma is associated with increased sperm DNA damage. Fertil Steril 2009;92:548-556.
6. Afeiche M, Williams PL, Mendiola J, et al: Dairy food intake in relation to semen quality and reproductive hormone levels among physically active young men. Hum Reprod 2013.
7. Jensen TK, Heitmann BL, Jensen MB, et al: High dietary intake of saturated fat is associated with reduced semen quality among 701 young Danish men from the general population. Am J Clin Nutr 2013;97:411-418.
8. Safarinejad MR, Hosseini SY, Dadkhah F, et al: Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr 2010;29:100-105.
9. Roqueta-Rivera M, Stroud CK, Haschek WM, et al: Docosahexaenoic acid supplementation fully restores fertility and spermatogenesis in male delta-6 desaturase-null mice. J Lipid Res 2010;51:360-367.
10. Safarinejad MR: Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic anti-oxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomised study. Andrologia 2011;43:38-47.
11. Robbins WA, Xun L, FitzGerald LZ, et al: Walnuts improve semen quality in men consuming a Western-style diet: randomized control dietary intervention trial. Biol Reprod 2012;87:101.
12. Ng SF, Lin RC, Laybutt DR, et al: Chronic high-fat diet in fathers programs beta-cell dysfunction in female rat offspring. Nature 2010;467:963-966.
13. Juhler RK, Larsen SB, Meyer O, et al: Human semen quality in relation to dietary pesticide exposure and organic diet. Arch Environ Contam Toxicol 1999;37:415-423.
14. Swan SH: Semen quality in fertile US men in relation to geographical area and pesticide exposure. Int J Androl 2006;29:62-68; discussion 105-108.
15. Bonde JP: Male reproductive organs are at risk from environmental hazards. Asian J Androl 2010;12:152-156.
16. Nordkap L, Joensen UN, Blomberg Jensen M, et al: Regional differences and temporal trends in male reproductive health disorders: semen quality may be a sensitive marker of environmental exposures. Mol Cell Endocrinol 2012;355:221-230.
17. Pflieger-Bruss S, Schuppe HC, Schill WB: The male reproductive system and its susceptibility to endocrine disrupting chemicals. Andrologia 2004;36:337-345.
18. Mocarelli P, Gerthoux PM, Needham LL, et al: Perinatal exposure to low doses of dioxin can permanently impair human semen quality. Environ Health Perspect 2011;119:713-718.
19. Jensen TK, Andersson AM, Jorgensen N, et al: Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 2004;82:863-870.