Man Up!

I’m asked about men’s health a lot, but not necessarily for the reasons you might think. I’ve got credentials—but so does half the world. Credentials aren’t the main reason men talk to me.

No, the main reason people talk to me is because 40 years ago, I was an overweight, heroin- and cocaine-addicted, alcoholic smoker headed down a path that wasn’t likely to end well. Now, I’m the healthiest and happiest I’ve ever been. I’ve maintained the same body weight and fat percentage since 1989. I play competitive tennis in a USTA league, and I play tennis or hike almost every day. I travel all over the country, have written a book a year for the past 15 years, and I have an almost-embarrassing amount of energy. And I’ve been passionately in love with the same partner for over 10 years—and my desire for her grows every year.

On my next birthday, I’ll be 74. That’s why people ask me about men’s health. And it’s an important topic, because while we may consider ourselves the stronger sex, the fact is that men are losing the longevity battle. In 1900, the average female lived to about 48 compared to 46 for the average man—a gender gap of about 2 years. As of 2017, the gender gap had grown to 5 years, with women living to an average of 81 years compared to 76 years for men. More than half of all women over age 65 in America are widows, and they outnumber widowers 3:1. Among centenarians, there are four women for every man.

So women clearly live longer than men. And apparently, they stay healthier as well. Although heart disease is an equal opportunity killer, men typically get their first heart attack at age 65, while women get theirs at 72.

There are many reasons for the sorry state of men’s health in America. Some you can’t do anything about—like your sex, your age, and your genes. But there are five areas of health in which you can make changes that will transform your life and change the outcome.

So, for what it’s worth, here are the five most important lessons I’ve personally learned on my 40-year journey to discovering what really matters when it comes to getting healthy. And it’s so delightfully simple that you’ll smile at how obvious some of the “rules” are.

1. Nutrition

As a practicing functional nutritionist, I’m biased: I think health begins with food. Obviously there are tons of other things in addition to food that influence how healthy you are, but it’s awfully hard to compensate for a chronically bad diet. And it’s hard to find a diet worse for you than the typical American diet of fast and processed foods: high in carbs, low in fat, and bursting with toxic protein like factory-farmed meat.

There’s really only one rule when it comes to diet, and it’s so simple you may be inclined to dismiss it. But it actually makes all the difference. Are you ready? Eat real food.

Now if you’re not sure what a “real food” is, it’s food that, if you showed it to your great-grandmother, she’d know exactly what it is. It’s food that would spoil if you left it outdoors. It’s food—for the most part—that doesn’t come packaged or boxed (though there are exceptions).

Since there are tons of food products out there that might be hard to classify as “real” or “unreal”—kale chips and vegan pizza, I’m talking to you—here’s one simple guideline: If you’re not sure if it’s “real,” it’s probably not.

I want to be clear here. The single most important thing you can do, the single most important dietary rule you can follow, is to eat unprocessed food 99 percent of the time. That trumps percent of protein, absence of meat, absence of carbs, counting calories, or any other dietary fad. Just. Eat. Real. Food.

After 30 years in the trenches teaching, experimenting, and testing diets, that is the single most important life-saving advice about food that I’ve got. And it works every time.

Related: Natural Solutions for Common Men’s Health Issues

2. Movement

The first thing you have to understand before we go any further is the difference between movement and exercise. Exercise is great. I’ve been doing it all my life. But exercise is a specific kind of movement—running, swimming, weightlifting, playing tennis. What I’m talking about when I say “movement” is much bigger and more inclusive.

See, exercise sessions take up a small part of the day. The kind and amount of movement you do the rest of the time—the other 15½ hours you’re awake—probably matters more to your overall health than the 30 minutes a day you spend on a Peloton.

So the rule, again, is simplicity itself: Move. As much as possible, wherever possible. Walk around the room every hour or so. Take the stairs even if you don’t need to. Get a standing desk—or sit on a stability ball. Park farther from the entrance to the grocery store. Take stretch breaks. Walk the mall. Stroll around the block after dinner. Do some random squats at your chair. Walk while you talk on the phone (I never take a business call at my desk). All that daily “non-exercise” movement is what really matters for the long game.

There’s even a technical name for this kind of movement—it’s called NEAT (non-exercise activity thermogenesis). NEAT refers to the calories you burn doing just about everything that isn’t technically “exercise”—from working in the yard to walking to work, from typing to fidgeting. It all counts!

If you want to exercise, fine. I’m all for it. But studies show that even daily exercise doesn’t erase the metabolic effects of sitting for 8 hours a day. What does? Moving around.

So here’s the rule in the movement department: Move. A lot. Your paleo ancestors roamed an average of 11 miles per day, and they never “exercised.” You don’t need a gym, a treadmill, or a tennis court to get the benefits
of daily movement.

3. Stress Management

We could easily spend this entire article talking about the destructive effects of chronic stress, especially in the age of coronavirus! Stress shrinks a portion of the brain involved with memory and thinking called the hippocampus. Chronic stress—through a long chain of metabolic processes involving the stress hormone cortisol—actually forces the body to create belly fat. Stress depresses immunity. It can bring on outbreaks of certain conditions (such as herpes, for example), make recovery from sickness longer and more difficult, and it can even make you vulnerable to a heart attack.

There are lots of ways to reduce stress—all of them good. Take baths. Take walks. Do some deep breathing exercises. Meditate. Or spend a few minutes a day writing down what you’re grateful for.

This last tip has enormous health benefits. The state of gratitude is incompatible with the state of anger. Thinking about what you’re grateful for calms your psyche, soothes your soul, lowers your blood sugar, and even changes your brain waves. The lowest-hanging fruit on the tree of stress management is to simply write down three things you’re grateful for every single day.

And don’t resist this because you think it’s too Kumbaya. It’s a profoundly beneficial exercise that will likely produce immediate results. So just do it, men!

4. Sleep

The twin sister of stress management is sleep hygiene. Under-sleeping, or sleeping fitfully and restlessly, is a major stressor to the body and raises the same stress hormone—cortisol—that’s raised when you’re late for an appointment and caught in traffic. All the same negative health effects we talked about in the section on stress apply here.

In addition, studies have shown that even under-sleeping for a few hours can produce metabolic changes of the kind associated with pre-diabetes. Insulin resistance—a condition that frequently goes with metabolic disorders from obesity to heart disease—is increased with lack of sleep.

Here are some ways to upgrade your sleep. And once again, the rules are simple and few.

• Go to bed a half hour earlier than normal and keep doing that every week until you are sleeping a full 7–9 hours a night.

• Turn the temperature in the bedroom down to 68–69 degrees.

• Turn off the television and all electronic media ½ hour before bed (especially the news!).

• Keep the bedroom dark (and that includes removing glowing electronic devices).

Related: Guys, Get Your Sleep

5. Relationships

This is a big bucket, and it’s impossible to overstate its importance. By “relationships,” I mean marriages, friendships, and romances, sure, but also groups (church, school, community, AA, Weight Watchers, mastermind groups, birdwatching club). Under this heading, I’m also including what could loosely be called contribution (more on that in a moment).

Wondering what relationships could possibly have to do with health? Only everything. When Dan Buettner of National Geographic studied the areas around the globe called “The Blue Zones”—five places that have the highest concentration of healthy, active centenarians in the world—one of his findings stood out. Even though people in the Blue Zones did not eat the same diet or do the same kind of exercise, there was one thing every single one of the five cultures studied had in common: community.

They had strong ties to other people. They had big family suppers together, shared chores, took care of their sick, gardened together. They shared a sense of community and purpose, both of which have been shown to be characteristics of healthy, long-lived men (and women).

This really shouldn’t be surprising. Let’s not forget that when we celebrate the enormous health benefits of the Mediterranean Diet, we’re really talking about the Mediterranean lifestyle, which includes men bonding over long lunches, hanging out in the park, taking long walks, and, yes, talking about their feelings to other men. Many have argued that the real benefits of the Mediterranean “Diet” don’t just come from the olive oil and nuts—they come from relationships, friendships, and a strong social fabric.

Hand in hand with relationships goes the concept of community and contribution, both outgrowths of strong relationships. Don’t think for a second that these aren’t important modulators of physical as well as mental health. The mere fact of taking care of something or someone—as Harvard psychologist Ellen Langer has demonstrated—confers health benefits. Langer gave half the people in a nursing home population a snake plant to care for and found that the caretakers had better medical reports and fewer doctor visits.

And that’s a snake plant, which, if you don’t remember, is the plant your grandmother had in her basement that’s practically impossible to kill. Yet just the fact of being responsible for something—even though it didn’t involve much work—improved the participants’ overall health.

Partnership—with individuals, churches, schools, community, clubs, teams, charities—is as health-giving as a hefty dose of vitamin C. No wonder married men live longer and have healthier lives than single men!

So here’s the rule with relationships: Cultivate them. Nurture them. Take them seriously. Make new ones. Rekindle old ones. I can tell you that I have had about eight friends that I’ve been close with for 30–40 years. Those relationships have nurtured, sustained, and supported me, and you better believe they’re a big reason I’m as healthy—and happy—as I am at 74.

An expanded notion of relationships has to include contribution (or, for some men, legacy. Or both.) A personal opinion: It’s no accident that Jimmy Carter, now in his late 90s, still devotes much of his time to his favorite charity, Habitat For Humanity. I don’t know Jimmy Carter personally. But I’d bet anything that if you asked him to make a list of the things most responsible for his long
life and health, his work for Habitat for Humanity—along with Rosalyn and Amy and his faith—would be among the top five items.

That’s the power of contribution. Whatever contribution looks like to you—whatever form it takes—participate. Contribution creates at least as much value for you as it does for the person or group you’re contributing to.

The Bottom Line

So there you have it. If someone asked me to put all my “wisdom” about health into six sentences, this is what I’d say: Eat real food—which usually means cutting out most sugar and starch. Move around as much as possible. Get some good restful sleep in a cool room every night. Find a method of reducing stress on a daily basis. And finally, cultivate love, joy, warmth, compassion, and connection in your relationships. And while you’re at it, spend some time focused on others.

Follow those basic guidelines, and even if you hit the bull’s eye only 80 percent of the time, you’ll undoubtedly be healthier. And—I’m willing to bet—a lot happier as well.

What About Hormones?

In the interest of full transparency, I’ve been on hormone replacement therapy—medically supervised by the oldest and largest age-management medical practice in the country—since 1999. I know that very few health “gurus” or “personalities” like to talk about hormone replacement therapy (or plastic surgery for that matter). But many of us do one or the other or both. I don’t normally mention it because it’s not available to everyone, can be very expensive, and because there are a lot of fly-by-night discount hormone replacement clinics—I wouldn’t want anyone to rush out and try one of them because I spoke highly of HRT.

That said, there’s good reason to do it. Men go through a period analogous, though not identical to, menopause, called the andropause. During andropause—which can last for years—we have steadily declining levels of testosterone. Testosterone is not only linked to a healthy sex drive and a leaner body, but it’s also associated with a lower risk of many diseases, including heart disease. Just as estrogen helps protect the bones of women after menopause, testosterone helps protect the hearts—as well as the energy, libido, and lean muscle mass—of men.

Hormone replacement does not take the place of any of the other things we talked about. You can optimize your hormones all you like, but if you’re still eating crap and spending most of your time on the couch, it’s not going to make much difference.

And let’s be clear—you can transform your health by taking the steps suggested in this article. Men don’t need hormone replacement for health and well-being. But it can sometimes be a very nice addition.