Inflammatory Diet and Testosterone Deficiency in Men

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Eating a diet rich in pro-inflammatory foods , including foods containing refined carbohydrates and sugar, as well as polyunsaturated fats, may be associated with increased odds of developing testosterone deficiency among men, suggests a study in The  American Association of Urology’s The Journal of Urology. Urology (AUA). The magazine is published in the Lippincott portfolio by Wolters Kluwer.

The risk of testosterone deficiency is higher in men who are obese and consume a refined diet that scores high on the dietary inflammatory index (DII), according to new research by Qiu Shi, MD, Zhang Chichen, MD, and colleagues from Western China Hospital, Sichuan University, Chengdu, Sichuan Province, China. "While these findings do not prove causality, they do support previous research suggesting that a pro-inflammatory diet may contribute to testosterone deficiency, among other potentially debilitating health problems," said Drs. Qiu and Zhang how.

Does diet influence testosterone levels? New study discovers link

Testosterone is a male sex hormone that plays an important role in reproduction and sexual function. However, between 20 and 50 percent of American men have testosterone deficiency, defined as a testosterone level less than 300 ng/dL (nanograms per deciliter).

Symptoms of testosterone deficiency can include decreased libido, decreased energy, poor concentration, and depression. Testosterone deficiency is also associated with chronic diseases, including cardiovascular disease and obesity.

Studies in humans and animals have linked testosterone deficiency to increased levels of inflammation in the body.

Men with low testosterone have higher levels of proinflammatory cytokines : small proteins released by cells during injury, infection, or in response to inflammatory factors in the environment. The DII has emerged as a tool to assess the inflammatory potential of a person’s diet, particularly in relation to other health markers.

The researchers studied the association between DII and testosterone deficiency in 4,151 men from the National Health and Nutrition Examination Survey, all of whom completed a 24-hour dietary interview and underwent sex hormone testing. Each participant’s DII was calculated based on the dietary history interview.

The calculated DII scores ranged from? 5.05 (most anti-inflammatory) to +5.48 (most pro-inflammatory). The average total testosterone level was 410.42 ng/dL in men on the most pro-inflammatory diet versus 422.71 ng/dL in those on the most anti-inflammatory diet. Overall, about 26 percent of men were deficient in testosterone.

For men on the most pro-inflammatory diet, the odds of testosterone deficiency were about 30 percent higher compared to men on the most anti-inflammatory diet. The associations remained significant after adjustment for other characteristics, including body mass index and smoking.

In a fully adjusted analysis, the risk of testosterone deficiency was higher in men who were obese and had a higher DII. For this group, the odds of testosterone deficiency were almost 60 percent higher compared to men with obesity who had a lower DII.

Drs Qiu, Zhang and co-authors point out some important limitations of their study, including the fact that DII was calculated based on a limited number of anti- and pro-inflammatory dietary parameters.

"Our results suggest that men who consume a pro-inflammatory diet, particularly obese men , are more likely to be testosterone deficient," said Drs. Qiu and Zhang how. "Since men with obesity are likely to already experience chronic inflammation, doctors should be aware of contributing factors, such as diet, that could likely worsen this inflammation and contribute to the risk of other health conditions, such as diabetes and heart disease." .

Drs. Qiu and Zhang and their colleagues call for more studies to verify the causal relationship between DII and testosterone deficiency. They also suggest that consuming a more anti-inflammatory diet "could be a feasible method to reduce the accumulated inflammatory load, which [potentially] leads to an increase in testosterone level."

Discussion

In this study, we showed that for men, higher consumption of pro-inflammatory diet was associated with a higher risk of testosterone deficiency. This association remained significant even after adjustment for all potential confounders, with participants in tertile 3 (those who were most pro-inflammatory) having a significantly increased risk of TD (30% higher) compared to those in tertile 1.

To our knowledge, this is the first study to evaluate an association between the inflammatory potential of general dietary patterns and sex hormones. In the same NHANES participants, Kuchakulla et al previously reported no association between a plant-based dietary pattern (plant-based diet index) and serum testosterone levels. with the serum T level. 

On the other hand, Fantus et al used a 2-day dietary history to report that men on a low-fat diet had significantly lower serum T levels (57.2 ng/dl) than men on a non-restrictive diet; However, no association was observed between the different dietary patterns and TD.

Our results indicated that higher proinflammatory dietary intake was positively associated with testosterone deficiency (TD). When we limited participants to men with obesity , the risk of TD was also significant. Furthermore, the inflammatory diet (DII) was inversely associated with TT level among men with obesity and men with the most pro-inflammatory diet (tertile 3) had a TT level 26.75 ng/ml lower than men with an anti-inflammatory diet (tertile 1).

According to current research, men with obesity and impaired reproductive function have a higher intake of saturated fats and refined carbohydrates and a lower intake of fresh fruits and vegetables. Another study also showed that men consuming foods rich in MUFA and PUFA had significantly reduced serum T production after a 5-hour period, similar to the level in men with obesity.

Emerging evidence showed that a possible mechanism of our results could be the effect of diet on pro-inflammatory markers such as IL-1, IL-6, IL-17, and tumor necrosis factor. These markers alter T secretion by activating inflammation and the production of reactive oxygen species by interstitial macrophages residing adjacent to Leydig cells. Furthermore, some experimental studies also demonstrated that these proinflammatory cytokines, including IL-6, IL-1b and tumor necrosis factor-a, could modulate the hypothalamic-pituitary-gonadal axis to inhibit T secretion.

For men with obesity, excess visceral adipose tissue was a cause of chronic inflammation because fatty tissue was the main source of proinflammatory mediators.

Tissue under inflammatory conditions produced aromatase that converted T to E2, thus decreasing T levels. Additionally, the higher prevalence of leaky gut (low-grade inflammation induced by the passage of lipopolysaccharide derived from intestinal bacteria) in men with obesity and the Obesity itself was associated with metabolic endotoxemia which was associated with reduced T production.