Men’s Body Click Diet part 4

Benign Prostatic Hypertrophy and Prostate Cancer

Benign prostatic hypertrophy is an enlargement of the prostate that's called benign because it is not due to cancer cells. Still, the enlargement can be far from benign if it results in a lack of control over functions that we all take for granted, including urinating when you want to urinate and only then. A single urinary accident in front of your classmates in the fir_st grade can constitute a major, unforgettable scar in one's childhood_; a repeat performance, like that of my sixty-year-old patient while standin_g i_n line at the check-in counter at O'Hare Airport, is no joke either. Nor is `benign' the right word to describe the condition that underlies such loss of control. BPH may also involve getting up frequently at night to urinate, with the intense urgency to do so unfortunately combined with a disconcerting hesitancy of performance and a lack of reward in the volume of urine produced.

Although the symptoms of BPH can be severe, it is ironic that men with prostate cancer often have no symptoms. As they age, most men, on biopsy, show signs of prostate cancer. In fact, by the time they are in their eighties, nearly all men have prostate cancer, as defined by the typical cancerous appearance of cells under the microscope. Yet, because this particular cancer grows slowly and spreads infrequently, only a small percentage of men actually become sick or die from the disease. (A man's lifetime risk of dying from prostate cancer is a little less than three per cent.)`'

Given the low odds of illness or death from prostate cancer, it's confusing from a medical standpoint when a 60-, 70- or 80-year-old man has a prostate biopsy and is found to have cancer cells. Because the question of the actual malignancy of the condition — how likely it is that the cancer will grow quickly enough to cause problems — is difficult to resolve, it encourages a more aggressive approach to therapy than might otherwise be warranted. Since aggressive therapy frequently involves either removing testicles or taking female hormones, which can produce dramatic changes in a man's body, this is not a trivial question.

Natural therapies for treating or, more important, preventing illness are not usually studied in the same way as pharmaceuticals, because no one can patent a naturally occurring substance like flaxseed powder and make enough money to justify the enormous expense of carefully conducted, controlled and double-blinded studies. Still, the studies show that consuming soy protein and other isoflavone and lignan-containing foods reduces the risk of prostate cancer. And the cancer data suggest strongly — and there is abundant anecdotal evidence to support it — that the same hormonal environment that leads to the high incidence of cancer in older men inour culture, but not in Chinese and Finnish men, is also associated with the risk for prostatic enlargement.⁵

The simple strategy for preventing the range and frequency of prostate problems is to consume more soy protein, flaxseed powder and rye fiber. If you happen to be a regular bacon, ham or sausage and eggs kind of guy, I urge you to substitute the shake, with its soy protein and flaxseed powder, at least four days a week. It's good that you're eating protein at your morning meal and getting the lift you need at the beginning of the day, but what you're eating will not protect your health like soy protein and flaxseed. (If you don't have time for breakfast, see the section for travelers in the appendix, where you'll find a quick shortcut that will help you get your soy protein and flaxseed every day.

The Body Clock Diet and Heart Disease: It's not Just the Cholesterol

Coronary heart disease (CHD) is the number one killer of both men and women in the United States. Each year, more than five hundred thousand Americans die of heart attacks caused by CHD. Soy intake has been shown to lower cholesterol and decrease cardiovascular disease associated with high cholesterol. There is growing scientific evidence to support this; for example, one recent study showed that a diet high in soy protein reduced cholesterol by as much as 20 per cent. ⁶ Other research has demonstrated that soy protein lowers triglycerides and reduces the oxidation of LDL or 'bad' cholesterol, which contributes to blood vessel problems linked to cardiovascular disease? And flaxseed has also been shown to lower both total and LDL cholestero1. The Body Clock Diet, which includes daily intake of soy protein and flaxseed powder, ensures that you get this important protection.

But cholesterol is not the exclusive evil agent in heart disease. Some people, especially those with complicating conditions of diabetes, tobacco smoking and a strong family history of heart disease and obesity, carry cholesterol-related risks. But most people who have heart attacks and other complications of 'hardening of the arteries' have fairly normal cholesterol levels.

The tide of medical thinking is changing when it comes to heart disease. It looks as if issues related to carbohydrate excess, insulin resistan_ce and homocysteine and its control by folic acid will take center stage away from cholesterol. ⁹ The benefits of substances like flaxseed and soy are not due solely to lowering cholesterol. Soy and flaxseed do indeed lower serum cholesterol, but they also modify carbohydrate and fat metabolism, further decreasing your cardiovascular risk. You don't have to be taki_ngaim at your cholesterol to get benefits from soy, flaxseed and the Body Clock Diet.

Like many men, you may have a tendency not to think about your health, shrugging off warnings from your mother, spouse, doctor and children as well as newspapers and television programs that try to scare or educate you about activities that are dangerous to your well-being. Nor do you want to listen to me when I say that failure to adhere to basic circadian principles may eventually show up as something noticeably wrong with your health. But my advice is simple: there are some painless things you can do to reap what are potentially major rewards for your long-term health.

Men’s Body Click Diet part 1

In the summer the men had to cope with constant daylight, so they were missing the normal cues to go to bed. 'When it's daylight, even though it's midnight or one o'clock in the morning, you don't think of it as being the time to go to sleep,' says Dave. 'Your mind just says, hey, there's work to be done. I may be tired but I'm not recognizing the need for sleep because it's daylight.'

Already lacking the strong time-giving effects of light, the men could not set their body clocks by what they were eating, either. 'We had four meals a day. Two of them occurred at noon and midnight, the other two at six in the morning and six in the evening,' continues Dave. 'One of the difficulties in telling what time it was, was that the 6:00 a.m. and 6:00 p.m. meals were powdered scrambled eggs and the other two meals were stew. So if you woke up at six o'clock and went into the galley for a meal and you had powdered scrambled eggs, you didn't know whethe_r y_ou were having breakfast or dinner.'

Despite losing the signals that are normally provided by the cycle of light and dark, the timing of activity, intake of food, reasonable work shifts or even simple obedience to the clock, most of the men managed t_oget through without becoming acutely sick or injured. But some of them developed a condition they called Big Eye, in which they became stuck in a sleepless state. Almost everyone had duties that required exhausting physical labor, but even so, the men with Big Eye failed to sleep for days.

The men with Big Eye demonstrated that the body's flexibility is a double-edged sword. The loss of essential time givers easily disrupted their circadian rhythms, probably setting them up for health problems if they continued down that path. On the other hand, proper application of some fairly simple rules for circadian health could have rescued them. And the same rules can rescue you from a potentially perilous state of disorganization.

The Body Clock Prescription reinforces strong circadian rhythms; produces better sleep, enhanced moods, alertness and energy; and reduces the risk for reproductive cancers for everyone. In addition to these overall improvements in health and well-being, there are specific aspects of the diet that have a favorable impact on prostate health, a subject that provokes anxiety for many men.

Prostate Ailments: The 'Male Problem'

There is certainly cause for concern. Prostate ailments are an almost universal threat to men in Europe and North America. Among men in the United States, prostate cancer is the most common cancer; it is also the second leading cause of cancer death.' In addition, countless men suffer from other prostate problems. This phenomenon represents a kind of `male problem' corresponding roughly to what used to be called 'female problems', a much less specific collection of gynecological woes that were lumped under this heading in the mid-1900s. The notion of female problems embraced excessive menstruation, infertility, irregular periods,cramps, vaginal discharge and other kinds of medical mischief that women endure.

The male problem is more localized in the prostate gland, the part of the male reproductive system that secretes fluids that help transport sperm. Nevertheless, it is a fairly complicated picture, which includes inflammations of the prostate, a common condition known as benign prostatic hypertrophy (BPH) and prostate cancer.

What's more, prostate problems may lead you to needing a cystoscopy, where a narrow flashlight is inserted into the hole from which you pee until it arrives in your bladder. On the way, it passes through your prostate gland. Cystoscopy is a procedure that causes 'big eyes' in the bravest of men.

Besides cystoscopy, the other method often used to examine men with prostate complaints is digital rectal examination, in which the examiner can feel the profile of your prostate gland. (Digital refers to the doctor's finger, not his computer.) Both give much less information than you would expect to get from such relatively invasive procedures. Opening your mouth and saying Ah' discloses much more about your teeth, gums, tongue and throat than any rectal exam reveals about your prostate, unless you have a huge lump. Ultrasound, magnetic resonance imaging (MRIs) and computerized axial tomography (CAT) scans are necessary to get a good picture of what's happening to this gland, whose actual location on the floor of your pelvis seems mysterious to anyone who has not studied anatomy.

Diet and Prostate Health

If you look around you, especially as you get older and start hearing stories from men who have prostate trouble, you may wonder if there's something simple you can do to avoid it. I'm not talking about early detection, which is mentioned frequently these days. (Of course, most men's idea of early detection is that early next year or the year after would be just fine.) Nor am I saying that a good history, physical exam, measurements of prostate-specific antigen (PSA), a common blood test used to screen for prostate cancer and other indicators of your underlying health, prostate or otherwise, are not a good idea.

But you're misplacing your priorities if you go through those procedures without making some modest changes in your diet now to prevent troubles in the future. Most men who have a reasonably healthy personal and family medical history and who don't abuse themselves with excesses of drugs, tobacco and alcohol, other risky activities or excessive inactivity can probably remain free of obvious symptoms even if they don't implement all the points of the Body Clock Prescription. Some of these point_sare aimed at people who are trying to get out of serious medical trouble or who have risk factors that call on them to follow the diet very strictly.

Naturally, the more closely you follow the Body Clock Prescriptio_nthe better, but if you do nothing else, I urge you to consume soy protein and flaxseed powder daily to prevent prostate problems. By making these simple dietary changes and keeping your mind open to the possibility that fungal infection, intestinal overgrowth or allergy might have a hand in any prostate inflammation that is not otherwise easily diagnosed by a physician, you can go a long way toward avoiding the possibility of getting prostate cancer, as well as the other problems that frequently lead men to undergo cystoscopy.

But do men need to be taller? continue...

Baldness occurs in white men more than in any other racial or sexual group. Genes for baldness are carried on the chromosomes of both men and women but require the male sex hormones for activation and for baldness to occur. Whilst white women may show a gradual thinning of their hair, by the time men have reached their early twenties some will show a receding hair line or bald spot, and by the age of 50 up to 60 per cent of men will have lost some hair.

It has been argued that balding is a sign for possible female mates that the balding male is beyond his prime and no longer fit to reproduce. However, this argument seems to be contrary to the rest of male reproductive behaviour and physiology which permits men to reproduce for almost as often and as long as desired. The absence of any obvious biological association between male sexuality and balding has not prevented hair from being central to many men's body image and hair loss being a serious fear.

So where does this fear come from? Why isn't balding simply accepted as a natural response to age or to the influence of hormones?

How many actors can you think of who are balding? How many television personalities accept their thinning hair without resorting to toupees or the 'sweeping syndrome'? The media present masculinity and hair thickness as being inseparable. The only exceptions to this rule are actors (two spring to mind) who are completely bald, suggesting that they have chosen to shave their heads and that if they wanted to they could easily grow it back.

How do men respond to this pressure?

Unlike for height, society offers men several ways to challenge the problem of hair loss. It offers them a way out. Men can wear toupees, sweep their hair across, living in constant fear of high winds, or they can have hair transplants. And some of them do. Some men are severely traumatised when their hair starts to fall out, some see it as the end of their youth and others as the end of their attractiveness.

I interviewed several men, and asked them how important their hair was and whether they were frightened of going bald. I received many responses, all of which indicated that balding was certainly not something to look forward to. Words such as 'horrible' and 'upsetting' were used and 'I'd look stupid' was a common remark.

However, one man did say that he was quite looking forward to going bald. He felt that it was 'cool' and distinguished, although he did add that the chances of his going bald were very slim.

Yet, as with male concerns with weight and height, these problems with balding do not seem to have such a profound effect on body image as weight does with women. This is not to trivialise men's body dissatisfaction or to dismiss their self-criticism, but to put it into perspective compared with the multitude of women who spend their lives preoccupied with weight.

I asked several men if they thought there was a difference between men and women as far as their looks were concerned. Surprisingly many men seemed to be aware of a difference and felt that they were lucky.

One man said: 'Women aren't attracted to men by their looks, they find their personalities attractive, but I am initially attracted to women by their looks, but then everything else becomes more important.'

Another said: 'If you are a man, being fat can give you status and suggests that you are rich and successful enough to eat nice food and drink good wine. If you are a woman, fatness means that you cannot command as much respect, and that you have a problem with food.'

He also said: 'Men's attractiveness is to do with character and personality. Women's attractiveness is far more to do with their physical appearance.'

Another man said: 'Men may not think of themselves as being attractive, or even worry about how attractive they are, but they put their energy into examining how attractive women are. Men's attractiveness can be determined by how attractive their female partner is.'

But are things changing?

Women assume that men get off lightly. However, over the last few years there has been an increase in the number of men used in advertising and an increase in magazines designed specifically for the male reader. Stereotypically good-looking men now advertise milk, cars, food and a multitude of consumables. Men's magazines are full of tall, dark, handsome men modelling clothes and even the male perfume market has taken off. Are we heading for a future of image-obsessed men?

I was interested to find in a recent copy of Cosmopolitan an article called 'Cosmo man' which was introduced by the question 'Is he worried stiff about his penis, his stomach, his mother?' Men also seemed to be getting the treatment. The article outlined men's 'touchiest topics' from penis size to balding and described each fear and neurosis in detail. It was sympathetic but subtly ridiculed each male preoccupation. The fears were treated as genuine but not as all that important. The article was interspersed with adverts for clothes modelled by tall men with lots of hair. The jokey article and the adverts presented the perfect combination of messages to develop and perpetuate any male neuroses.

Maybe the advertising world has saturated its use of women. Maybe it has discovered the new world of men's desire to conform to an ideal image. Whatever the reason, men are appearing more and more in the marketing world. And maybe in a few years' time we will start to see the damaging results.

But do men need to be taller?

Biologists argue that women stop growing at an earlier stage so that they can get on with what they are supposed to do: reproduce. It is argued that girls cannot waste energy on growing when this energy is needed to produce children, and that growing and reproducing at the same time would place too many demands on the body's reserves. Montagu has pointed out that, for the first few years after the start of menstruation, girls are rarely fertile, even though they may appear so, and it is at this time that the remainder of their growth occurs. This suggests that we are responding to a history of shorter life expectancy, and that we should reproduce as often and as early as possible. For men, this pressure does not exist and so they can grow for a longer period of time. In addition, anthropologists argue that men need to be taller in order to compete for female partners.

As a result of these biological differences men do tend to be taller than women. In America the average male is five inches taller than the average female. However, improvements in diet and living conditions in the western world have meant that not only are western women frequently taller than men from other areas of the world, but there is also a greater overlap in male and female heights within the same community. Ten per cent of women are taller than 10 per cent of men and 5 per cent of women are taller than the average male.

So tallness means maleness. Even though women can be tall and men can be short, tall things are masculine and short things are dainty and feminine.

This association comes from a biological difference but is also used and perpetuated by social expectations and media images. The media, with phrases such as 'man-size tissues' and 'man-size portions' and images such as 'large cars are for men', promote this association. It is also obvious in our traditional behaviours such as 'a man holds the umbrella over the woman' and 'a man puts his arm around the woman's shoulders'. Princess Di is only half an inch shorter than Prince Charles if she wears flat shoes, yet in the postage stamp commemorating their wedding she has shrunk to such a degree that she looks up into his eyes. Either she was crouching or he was standing on a box!

And as women we promote this idea. Being five foot ten myself I am well aware of the traumas of having shorter boyfriends. I have spent many an evening slouching, walking in the gutter and working out which way the pavement slopes so that I can make myself that little bit shorter. I also know the embarrassment of having a boyfriend put his arm around me, resulting in his left shoulder being wrenched nearly out of its socket. As women, we expect men to be taller, and men perceive this expectation.

At the extreme end of this preoccupation with height, Erving Goffman in his book Stigma examined the effects of height on

men who are well below average height. He discusses how such men are either excluded from enjoying normal lives or can play the traditional role of short men as 'jesters' or 'favourites of well-to-do ladies'. It has been observed that if short men marry short women the 'mating sequence' is often accelerated, with the dating, engagement and marriage taking less time than usual. Goffman concludes that short people marry short people because they have found an opportunity at last, and because they are expected to do so.

Men worry about their height. It is a weakness in some ways comparable to that of women and their weight, but does it have the same damaging effect on their self-image?

There are certain props available to the man who wants to be taller, such as built-up shoes and tall hats, yet these tend to be regarded as slightly ridiculous. They appear desperate. Unlike weight, which it is possible at least to attempt to change, changing your height is not a physical possibility. Perhaps, because of the absence of feasible alternatives, men simply have to get on with their lives and cope with this disagreeable area of their physical appearance. If the medical profession were to develop a means of adding extra inches or perhaps to suggest that a certain combination of foods would solve the height problem, then maybe men would become more preoccupied with their height, which would develop a more central role in their self- image. The absence of possible change reduces the importance of the problem.

Are there other physical characteristics which are specifically important to men?

A study in 1973 asked a group of men to rank a list of physical characteristics in the order that they felt they were important in determining their physical attractiveness. From a list consisting of characteristics such as chest, body build and face, the men rated hair texture second only, to facial complexion. Facial complexion appears to be of significance to men in their teens and early twenties, with the fear of acne and concern about degree of facial hair. However, hair texture and the fear of baldness appear to play a central role in determining body-image.

Men and dieting part 1

A couple of years ago I was explaining my area of research at a job interview. After I had given what I considered a clear and full account of my work, the only man in the room said 'There is an obvious logical error in your work'. I was totally taken aback and meekly asked what it was. 'What about men?' he said. I had never really considered men in relation to dieting before. My interest in the area stems from being a woman myself, and I always felt that it was nice to work on something that men hadn't managed to monopolise yet. This post is a concession to that male interviewer, and to the many other men who have told me 'it's just as bad for men'.

Men also have role models and heroes. Over the centuries, literature has been full of ever changing images of the ideal man. In 1813 Jane Austen wrote in Pride and Prejudice:

Mr Darcy soon drew the attention of the room by his fine, tall person, handsome features, noble mien; and the report which was in general circulation within five minutes after his entrance, of his having ten thousand a year.

Attractive men were tall, straight and rich.

In the 1950s Charles Atlas used to be the ideal man. Men were sold work-out kits and body-building equipment. They had to be large, powerful and strong. They were men of few words and lots of muscles. But what is the message now? Do men have an image that they have to conform to?

It is often assumed that the media focus only on women's bodies in their attempts to sell a wide variety of products. Most adverts still have women modelling anything from clothes to cars

to cleaning fluid. I asked several men if they felt there were pressures on men to look a certain way.

One 25-year-old NHS manager immediately replied: 'Definitely' and proceeded to provide a detailed description of the ideal man:

You have to be tall, in a sharp suit (casual but smart), exuding money. The ideal body is well built, wide shoulders, a v-shaped back tapering to a firm bottom with dimples and a flat stomach.

He felt that men used to be proud of their beer guts but now they were ashamed and hid them.

Another 25-year-old man said that the ideal man was summed up by the actor Richard Gere: 'Not over-muscular, fit and at fighting weight. So that you don't really notice his body, but it is capable of doing what it's supposed to do without impairing itself' He felt that the ideal body was to do with fitness and health. He felt that the ideal body was one that was not noticeable because it was 'how a man's body should be'. Another felt that the ideal man was 'lithe, fit, stubbly and dark haired'.

I also asked several men what these images meant to them. The most common answer was that being tall, thin and fit meant that you were in control, and control was central to the 1990s' image of the ideal man. It also meant that you were healthy and confident and therefore capable of being a success in all other areas of life.

With the rise of the 1980s' work ethic, men in the media have become leaner; they look hard working and healthy. The ideal man does not self-indulge, he is in control and in command of his life. Hedonism seems to be becoming a thing of the past and this is illustrated by the contemporary ideal man.

So where do these images come from? These pressures seem to come from three sources: other men, women and the media.

One man said: 'Other men joke about putting on weight. They say "you're letting yourself go a bit" or suggest that you should take up squash at lunchtime.'

Another said, 'You overhear women talking about firm bottoms and flat stomachs and you realise that that's what they expect.' He also said: 'You know that women find certain film stars attractive. You also realise that they know nothing about them apart from how they look and what their bodies are like, so you realise that it is their bodies that make them attractive.'

The pressure also comes from the media. Over recent years there has been an increase in men used in advertising, all of whom are thin and stereotypically attractive. Media men have become less hedonistic and increasingly in control and reserved. In a recent television advert, a young man is used to advertise healthy pre-cooked meals. He is thin, healthy and represents clean living and self-control. He looks sensible. Male heroes of the 1960s and 1970s had an air of excess and debauchery about them. Now men are tame and controlled. The only media man that any of the men I interviewed could think of who was outside this image was Jack Nicholson who personifies total hedonism, self- indulgence and pleasure. Perhaps his attractiveness comes from his obvious rejection of social norms, and his ability not to conform, not to use tricks and not to be influenced by what other people expect.

Women tend to assume that men can get away with a greater variety of looks, sizes and shapes than women. It is believed that the male personality can compensate for many (but not all) physical characteristics. Woody Allen is a sex symbol; the female equivalent would never have even made it through the studio door. However, the media do seem to present an image of the ideal man of the 1980s and 1990s. How do men respond to these images? Do men feel dissatisfied with their bodies?

In 1968 Diabiase and Hjelle carried out a study to evaluate men's idea of the ideal body size. Groups of fat, average and thin men were shown silhouettes of male bodies which were also fat, thin and of average weight. The men were then asked to say which size they preferred and why. All the male subjects regardless of their own size preferred the average weight. They felt that both the thin and fat bodies represented qualities such as being shy, dependent and withdrawn, whereas the average-size body represented being active, energetic and dominant.

The men in the study showed a preference for a particular size. But was this reflected in a dissatisfaction with their own size?

Men and women were asked to rate their ideal size and their actual size. All the women subjects showed a large discrepancy between how they felt they looked and how they wanted to look, but the young men in the study did not. Regardless of their actual size, they felt satisfied with their weight.

Although men may report an ideal size and a preference for a particular body size this does not seem to be reflected in a dissatisfaction with their own size. It would seem that men are not directly affected with worries about their weight.

Indifference - the biggest enemy? continue...

Colon cancer update

Some recent findings to do with the prevention of colon cancer (one of the most common cancers) are heartening. Studies on human beings have shown that including less fat and more fibre in one's dietprobably lessens the presence of `mutagens' (substances which can promote the development of cancer) in the bowel contents.

A recent four-year study in the USA also produced interesting results. The subjects of the research were a series of patients with 'familial adenomatous polyposis'. This refers to a segment of the population with bowel polyps which are particularly prone to become cancerous. (Polyps are growths with a pedicle or stem which usually develop on mucous membranes.) These patients were put on a high fibre diet (about 22g of fibre daily compared with the usual daily intake of about 12g), the extra fibre being provided by commercial bran cereal. In all the patients, a regression or shrinking of the polyps resulted - an outcome which was regarded as very promising by the US National Cancer Institute.

Also interesting is the fact that elderly blacks examined in the Department of Gastroenterology at Baragwanath Hospital, Soweto, showed no evidence of polyps; indeed their bowels had the appearance and elasticity of that of white teenagers! Among old rural blacks, colon cancer is extremely rare and even among urban dwellers, its occurrence is only a tenth of that found in elderly whites. The significance seems to be that the diets of these people are generallymuch higher in fibre and lower in fat than those of their white counterparts.

Eating to combat cancer - a day's sample menu**

* Breakfast: Cereals (such as All-Bran flakes or Weet-Bix), or oatmeal porridge, with milk and sugar

* Orange juice, a poached egg on brown (preferably wholewheat) toast and a couple of slices of tomato

Tea or coffee

* Lunch: 2 or 3 slices of brown or wholewheat bread with margarine,cottage cheese, salad (eg lettuce, celery, raw carrot), an apple or a banana

Tea or coffee

Dinner: Fish or chicken (not fried), brown rice, baked or newpotatoes, a green vegetable, baked beans, gem squash and a brown roll

Stewed or canned fruit (eg pineapple) and yoghurt

**This suggested menu provides about 30% of energy from fat and about 20-25g dietary fibre.

The alcohol/cancer link

Too much alcohol is a risk factor for the development of several cancers, especially of the liver, oesophagus, lung, pancreas and rectum. But here again, little notice has been taken of calls to cut down and levels of consumption are still rising, not only in many Western populations but in all Third World urban populations as well.

What is a reasonable or safe alcohol intake? For the majority of consumers there is no health problem, since it is considered that the majority of people who drink do so moderately and never experience any harmful effects. The crucial question is: What is a sensible limit? The liver burns up one standard drink (a half pint of beer, a glass ofwine, a measure of whisky) in an hour. With this in mind, the following safe allowances have been put forward:

For men, four to six standard drinks, two or three times a week. Or, at most, from 18 to 20 standard drinks weekly. For women, two or three standard drinks, two or three times a week or, at most, 9 to 13 standard drinks weekly.

These recommendations (endorsed by World Health 1985) were set out by the London Health Education Council in a booklet titled 'That's the Limit: a Guide to Sensible Drinking'. The reason why the limits for women are lower than for men is twofold: firstly, in men, water makes up 55-65°/o of body weight and in women, 45-55%, therefore alcohol is more diluted in men than in women; secondly, alcohol is potentially more noxious in women than in men.

Smoking and cancer

Smoking is believed to be responsible, directly or indirectly, for about a third of total cancers. It increases the risk of certain diet-related cancers such as breast cancer, but appears to have little influence with others, such as cancer of the prostate. In many Western populations there has been a major decrease in cigarette smoking among men, although far less so among women. In the USA, current frequencies are 32% for men, but 26% for women. Nowadays more young women than young men smoke, and today's female smoker is a heavier onethan yesterday's!

In Third World countries, tobacco use is rapidly increasing - in African populations, consumption has doubled in the last 10 years. So the dismal view is that all tobacco-related cancers, especially lung cancer, will almost certainly increase in the years to come.