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It is now more than 69 weeks since I first successfully started using kimchi to treat the chronic sinusitis that had plagued me (and my family) for so many years. I originally reported on the Sinusitis Treatment on Dec. 6, 2013 (the method is described there) and followed up on Feb. 21, 2014.

Based on the sinus microbiome research of N. Abreu et al (from Sept. 2012 in Sci.Transl.Med.) that discussed Lactobacillus sakei as a sinusitis treatment, I had looked for a natural source of L.sakei and found it in kimchi. Since dabbing the kimchi juice in our nostrils as needed, all 4 of us are still free of chronic sinusitis and off all antibiotics at close to a year and a half (I'm optimistic). So how is year two shaping up?

Well, it is different and even better than year one. Much of the first year seemed to be about needing to build up our beneficial bacteria sinus community (sinus microbiome) through kimchi treatments, eating fermented foods (such as kimchi, kefir, yogurt), whole grains, vegetables, and fruits. And of course not having to take antibiotics helped our sinus microbial community.

But now in year two we notice that we absolutely don't need or want frequent kimchi treatments - even when sick. Daily kimchi treatments, even during acute sinusitis (after a cold), actually seems to be too much and makes us feel worse (for ex., the throat becomes so dry, almost like a sore throat). But one treatment every 2 or 3 days while sick is good. In fact, this year we have done so few treatments, that even when ill, each time the sick person stopped doing kimchi treatments before he/she was fully recovered, and any sinusitis symptoms kept improving on their own until full recovery! Amazing!

To us, this is a sign that all of us have much improved sinus microbiomes from a year ago. And interestingly, we are getting fewer colds/viruses than ever.  Our guiding principle this year is: "Less is more." In other words, at this point only do a kimchi sinus treatment when absolutely needed, and then only do it sparingly. Looking back, we think we should have adopted the "less is more" last year after the first 6 months of kimchi treatments.

The other thing we've done is cut back on daily saline nasal irrigation, especially when ill and doing kimchi treatments. We've started thinking that the saline irrigation also flushes out beneficial bacteria.

The conclusion is: YES, a person's microbiome can improve, even after years or decades of chronic sinusitis. It is truly amazing and wonderful to not struggle with it, and to feel normal.

(UPDATE: See Sinusitis Treatment Summary page and The Best Probiotic For Sinus Infections for more information, more products one can use, and more L. sakei treatment information. We are using the high quality refrigerated product Lacto Sinus these days.)

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SUMMARY OF TREATMENT METHOD USING KIMCHI

The following is a quick summary of the method we use (see Sinusitis Treatment Summary page).We use live (fermented and not pasteurized) vegan (no seafood added) kimchi. Choosing vegan (no seafood added) kimchi is a personal preference. Lactobacillus sakei is found in meat, seafood, and some vegetables.

Treatment Method: 1) Wash hands, and then use a clean teaspoon to put a little juice from the kimchi jar into a small clean bowl. 2) Dip finger in the kimchi juice and dab it or smear it along the insides of one nostril (about 1/2" into the nostril). 3) Dip finger in kimchi juice again and repeat in other nostril. 4) Do this several times. If I needed to blow my nose at this point I would, and afterwards I would put more kimchi juice up each nostril (again repeating the procedure) and then not blow my nose for at least an hour (or more). 5) Afterwards, any unused kimchi in the little bowl was thrown out and not replaced in the main kimchi jar. (Note: Put the main kimchi jar back in the refrigerator. Also, once opened, take kimchi juice from it for no more than 6 days.)

My rationale was that I was inhaling the bacteria this way and that it would travel up the nasal passages on their own to my sinuses. I did this regimen once or twice a day initially until I started feeling better, then started doing it less frequently, and eventually only as needed.

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I spent time this past week searching the medical literature (US National Library of Medicine - Medline/PubMed) for the latest in sinusitis research. I wish I could tell you that amazing research has been happening recently, especially with the sinus microbiome (which could mean treating sinusitis with microbes), but I was disappointed. Really disappointed.

I did four searches: one for "sinusitis" (looked at 600+ studies dating back to summer 2013), then "chronic sinusitis" (going back to fall 2012), then "sinusitis, probiotics", and finally "sinusitis, microbiome". The "sinusitis, probiotics" search turned up 10 studies dating back to 2002. The "sinusitis, microbiome" search turned up a grand total of 13 studies, with the oldest dating back to 2004. Of course the sinus microbiome research by Abreu et al from September 2012  discussing Lactobacillus sakei and which I based my personal (and successful) kimchi sinusitis treatment was on the list (see my Dec. 5 post for a discussion of their research). But none of the other studies looked at Lactobacillus sakei (which is in kimchi).

Some of the findings among the many chronic sinusitis studies: microbial diversity is lower in antibiotic treated chronic sinusitis sufferers (than in healthy controls) and the microbial communities more uneven (meaning some microbes dominated over others), and greater Staphylococcus aureus populations among those with chronic sinusitis. After antibiotic treatment patients typically became colonized by microbes that are less susceptible to the prescribed antibiotics. One study found that Staphylococcus epidermidis (SE) may have some effectiveness against Staphylococcus aureus (SA) in the sinusitis microbiome in mice. Lactobacillus rhamnosus was not found to be effective against sinusitis. A number of studies reported biofilms in the sinuses which are highly resistant to medicines. Some studies found that smoking or exposure to second-hand smoke is linked to chronic sinusitis. (June 2016 UPDATE: I should have said that Lactobacillus rhamnosus (R0011 strain) was not effective against sinusitis when taken orally (a tablet) twice a day for 4 weeks in the study. There have been no further studies since then looking at L. rhamnosus for sinusitis treatment. It is unknown whether spraying or smearing/dabbing L. rhamnosus directly into the nostrils would have a positive effect)

Everyone agreed that state of the art genetic analyses found many more microbial species than older methods (the least effective was the traditional culture method). Several studies suggested that perhaps chronic sinusitis is due to immunological defects and one suggested that it was due to "immune hyperresponsiveness" to organisms in the sinuses. Surprisingly, some studies reported that there are more microbes or microbial species in chronic sinusitis patients than in control patients and that Staphylococcus aureus may be dominant (NOTE: These results may be due to not having been done with state of the art genetic analyses which would have picked up more microbial diversity. Another issue is where in the respiratory tract the samples were taken from, because it seems that the different areas have different microbial communities).

There was frequent mention that chronic sinusitis affects millions of people each year in the US, that little is known about its exact cause, and that there is controversy over appropriate treatment. Originally doctors thought that healthy sinuses were sterile, and it has taken a while to realize that is untrue. It is clear that researchers are only now trying to discover what microbial communities live in healthy individuals compared to those with chronic sinusitis.

But it appeared to me that the majority of the studies from the last 2 years indicated that treatment of chronic sinusitis is still: first try antibiotics, then antibiotics plus inhaled corticosteroids and perhaps nasal saline irrigation, then followed by endoscopic sinus surgery (or sometimes balloon dilation), then perhaps steroid drip implants (steroid-eluting sinus implants), and then there may be revision surgeries.

So I'm sticking with my easy-to-do, inexpensive, and fantastically successful kimchi (Lactobacillus sakei) sinusitis treatment. Of course! (see my Dec. 6, 2013 and Feb. 21, 2014 posts or click on the Sinusitis Treatment link for further information).

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Another article stating that the future is feces in treating a number of diseases. From Pacific Standard:

Medicine’s Dirty Secret: Fecal Transplants Are the Next Big Thing in Health Care

POO IS A DECIDEDLY IMPERFECT delivery vehicle for a medical therapy. It’s messy. It stinks. It’s inconsistent, not to mention a regulatory nightmare. But it can be incredibly potent. A classic study of nine healthy British volunteers found that bacteria accounted for more than half of the mass of their fecal solids. That astonishing concentration of microorganisms, both living and dead, makes sense when you consider that the microbial colonists inhabiting our gastrointestinal tract outnumber our own cells roughly three to one, on recent estimates.

In the ideal conditions of the human gut, a thriving ecosystem of 1,000 or more bacterial species that rivals the complexity of a rainforest has co-evolved with us. This microscopic jungle is constantly adapting in response to our diet, antibiotic use and other environmental influences. As the science has progressed, researchers are now comparing the entire collection of microbial inhabitants of the human gut, our microbiome, to a “hidden metabolic organ.” Scientists have linked disruptions to this organ, a condition known as dysbiosis, to everything from inflammatory bowel disease and high blood pressure to diabetes and obesity.

Viewed in this light, a fecal microbiota transplant is nothing more than an attempt to reseed an intestinal tract, often after antibiotics have killed off the native flora that might have kept invasive species at bay. No other medical therapy can claim such a high cure rate for the infection widely known as C. diff.

Some doctors have likened the recoveries of desperately ill patients to those seen with anti-HIV protease inhibitors in the mid-1990s. After the Mayo Clinic in Scottsdale, Arizona, performed its first fecal microbiota transplant in 2011, a patient who had been bed-ridden for weeks left the hospital 24 hours later. And in 2013, researchers in the Netherlands halted a landmark C. diff. clinical trial early for ethical reasons when they saw that the overall cure rate of 94 percent with donor feces had far outpaced the 31 percent cured with the antibiotic vancomycin.

Yet few other interventions elicit such disgust, revulsion, and ridicule. Chronicling a potential advance by a team of Canadian scientists, one newspaper account warned readers: “Hold your nose and don’t spit out your coffee.” In 2013, the founder of a patient advocacy blog called The Power of Poop wrote an open letter to 13 gastroenterology associations detailing the story of a Kentucky man who contracted an acute case of C. diff. Despite his family’s pleas, his doctor dismissed the idea of a fecal transplant as “quackery.” The man died the next day.

Although most providers haven’t published their overall success rates, their self-reported results are surprisingly similar, and consistent with what published reports there are. Khoruts says he has achieved a success rate of about 90 percent after one infusion, 99 percent after two. “In medicine, it’s pretty startling to have therapy that’s that effective for the most refractory patients with that condition,” he says. Colleen Kelly, a gastroenterologist with the Women’s Medicine Collaborative in Providence, Rhode Island, has performed the procedure on 130 patients with recurrent C. diff., with a success rate of about 95 percent. Most of the transplants have taken after just one attempt.

For a relatively simple bacterial infection, Petrof says, the potential remedy may be fairly straightforward. “With recurrent C. diff. what you’ve done is you’ve basically torched the forest,” she says. Nearly everything has been killed off by the antibiotics, leaving very low bacterial diversity. “So the C. diff. can just take root and grow.” Adding back almost any other flora—the equivalent of planting seedlings in the dirt—could help the ecosystem keep interloping pathogens at bay.

For more complicated conditions, though, a simple fecal transplant may not be enough, at least with donors from the Western world. One hypothesis suggests that people in lower-income countries might harbor more diverse bacterial populations in their guts than those who have grown up in a more sterile, antibiotic-rich environment. And in fact, a 2012 study found that residents of Venezuela’s Amazonas state and rural Malawi had markedly more diverse gut microbiomes than people living in three U.S. metropolitan areas. Scientists have already raised the idea that a rise in allergies and autoimmunity in industrialized nations may derive from a kind of collective defect of reduced microbial diversity.

“We cannot find people who’ve never been on antibiotics,” Khoruts says of his donors. For complex autoimmune diseases such as ulcerative colitis, fecal transplants may offer only a partial solution. And with some data suggesting that susceptibility may be linked in part to past antibiotic exposure, perhaps no Western donor can provide the microbes needed to fully reseed the gut.

What then? Khoruts says it may be necessary to seek out ancestral microbial communities—the ones all humans hosted before the advent of the antibiotic era—within people in Africa or the Amazon. “It’s just a disappearing resource,” he says.

By the beginning of April 2014, nearly 30 fecal transplant clinical trials were underway around the world. Roughly half were aimed at C. diff., including two testing the therapy in combination with vancomycin, and another multi-center trial evaluating the effectiveness of fresh versus frozen donor poo.

As the therapy becomes more widely established, via something akin to a “poop pill” or “crapsule,” perhaps the infectious pool of C. diff. patients may start to dwindle. More clinicians, then, might feel emboldened to explore how our bowel flora may affect not only the gastrointestinal system but also the immune and neurological systems. At least a dozen trials are now investigating whether fecal transplants can help treat some form of inflammatory bowel disease, be it Crohn’s disease or ulcerative colitis. Another is looking into Type 2 diabetes, and one is even using lean donors to test fecal transplants on patients with metabolic syndrome. Researchers say it won’t be along before they’re joined by studies investigating whether the therapy might aid diseases like multiple sclerosis and autism.

For those who want to know more, another article form The Pacific Standard:

6 Ways to Transplant Fecal Matter, at Home or at the Hospital

And the following two groups:  The Fecal Transplant Foundation

The Power of Poop

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Two studies that look at the role of diet, weight, and obesity in breast cancer. From Science News:

Fighting cancer with dietary changes 

Calorie restriction during treatment for breast cancer changes cellular programming in a way that lowers the chance of metastases in mice. Breast cancer patients are often treated with hormonal therapy to block tumor growth, and steroids to counteract the side effects of chemotherapy. However, both treatments can cause a patient to have altered metabolism which can lead to weight gain. In fact, women gain an average of 10 pounds in their first year of treatment. Recent studies have shown that too much weight makes standard treatments for breast cancer less effective, and those who gain weight during treatment have worse cancer outcomes.

From Medical Daily:

Breast Cancer Patients Suffering From Obesity Face Higher Death Risk Than Healthy-Weight Women

Obesity increases the risk of another cancer, which adds to the long list of life-threatening health hazards that accompany obesity. A new study reveals more evidence that obesity is a risk factor for cancer prognosis and its development, which will be presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago on May 30.

Researchers found that out of the 80,000 women in the study who had early stage breast cancer, obesity increased the risk of death by 34 percent for women who were pre-menopausal and were susceptible to higher levels of the hormone estrogen.

"No matter how we look at it, obesity is slated to replace tobacco as the leading modifiable risk for cancer," Dr. Clifford Hudis, ASCO president and chief of Memorial Sloan Kettering Cancer Center's Breast Cancer Medicine Service in New York, announced at a news conference.

Fat tissue produces an excess amount of estrogen, and those with increased levels have been associated with the risk of breast cancer. Obese women unquestionably have more fat tissue, which is why their estrogen levels are naturally higher. This leads to a more rapid growth of estrogen-responsive breast tumors. Obese patients also have increased level of insulin and insulin-like growth factor-1, which has been known to promote the development of tumor tissue.

They did find, as they had expected, there was no link between obesity and breast cancer death risk among women who were postmenopausal and either had an estrogen receptor positive or estrogen receptor negative breast cancer. This meant the tumors did not rely on estrogen to grow at a time in a woman’s life when her estrogen levels are fairly low.

Obesity has been linked to an increased risk of many other common cancers as well, which include colon, pancreas, esophagus, kidney, thyroid, gallbladder, and endometrium. Endometrial cancer is found within the lining of the uterus, and those who are obese increase risk by up to 40 percent.

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Of course we should expect to find bacteria in a healthy placenta. It only makes sense. But this is interesting stuff - the possibility that the placental biome being out of whack playing a role in preterm birth. From Medical Xpress:

Bacteria live even in healthy placentas, study finds

Surprising new research shows a small but diverse community of bacteria lives in the placentas of healthy pregnant women, overturning the belief that fetuses grow in a pretty sterile environment. These are mostly varieties of "good germs" that live in everybody. But the study also hints that the make-up of this microbial colony plays a role in premature birth.

We share our bodies with trillions of microbes—on the skin, in the gut, in the mouth. These communities are called our microbiome, and many bacteria play critical roles in keeping us healthy, especially those in the intestinal tract. Healthy newborns pick up some from their mother during birth, different bugs depending on whether they were delivered vaginally or by C-section. What about before birth?

Aagard's team earlier had studied the microbiome of the vagina, and learned that its composition changes when a woman becomes pregnant. The puzzle: The most common vaginal microbes weren't the same as the earliest gut bacteria that scientists were finding in newborns. What else, Aagaard wondered, could be "seeding" the infants' intestinal tract?

With colleagues from Baylor and Texas Children's Hospital, Aagaard analyzed 320 donated placentas, using technology that teases out bacterial DNA to evaluate the type and abundance of different microbes. The placenta isn't teeming with microbes—it harbors a low level, Aagaard stressed. Among them are kinds of E. coli that live in the intestines of most healthy people. But to Aagaard's surprise, the placental microbiome most resembled bacteria frequently found in the mouth, she reported in the journal Science Translational Medicine. The theory: Oral microbes slip into the mother's bloodstream and make their way to the placenta.

Why does the body allow them to stay? Aagaard said there appears to be a role for different microbes. Some metabolize nutrients. Some are toxic to yeast and parasites. Some act a bit like natural versions of medications used to stop preterm contractions, she said. In fact, among the 89 placentas that were collected after preterm births, levels of some of the apparently helpful bacteria were markedly lower, she said.

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Most of us are infected with human papilloma viruses. But the really interesting part is that the researchers found that the various HPV strains tend to interact, coexist, and offset symptoms in a balancing act - a HPV viral biome. From Medical Xpress:

More than two-thirds of healthy Americans are infected with human papilloma viruses

In what is believed to be the largest and most detailed genetic analysis of its kind, researchers at NYU Langone Medical Center and elsewhere have concluded that 69 percent of healthy American adults are infected with one or more of 109 strains of human papillomavirus (HPV). Only four of the 103 men and women whose tissue DNA was publicly available through a government database had either of the two HPV types known to cause most cases of cervical cancer, some throat cancers, and genital warts.

Researchers say that while most of the viral strains so far appear to be harmless and can remain dormant for years, their overwhelming presence suggests a delicate balancing act for HPV infection in the body, in which many viral strains keep each other in check, preventing other strains from spreading out of control. Although infection is increasingly known to happen through skin-to-skin contact, HPV remains the most common sexually transmitted infection in the United States. 

"Our study offers initial and broad evidence of a seemingly 'normal' HPV viral biome in people that does not necessarily cause disease and that could very well mimic the highly varied bacterial environment in the body, or microbiome, which is key to maintaining good health," says senior study investigator and NYU Langone pathologist Zhiheng Pei, MD, PhD. 

Lead study investigator and NYU Langone research scientist Yingfei Ma, PhD, says "the HPV 'community' in healthy people is surprisingly more vast and complex than previously thought, and much further monitoring and research is needed to determine how the various non-cancer-causing HPV genotypes interact with the cancer-causing strains, such as genotypes 16 and 18, and what causes these strains to trigger cancer."

Among the study's other key findings: - Some 109 of 148 known HPV types were detected in study participants. - Most study participants had HPV infections in the skin (61 percent); then vagina (41 percent), mouth (30 percent), and gut (17 percent). - Skin samples contained the most varied HPV strains (80 types of HPV, including 40 that were found only in the skin). Vaginal tissue had the second most numerous strains (43 types of HPV, with 20  exclusive to the organ), followed by mouth tissue (33 types, of which five were exclusively oral in origin), and gut tissue (six types, all of which were found in other organs).

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There has been much discussion lately on declining male sperm counts and what it means. From Medical Xpress:

No link found between low sperm count, birth defects

Having a low sperm count doesn't seem to determine whether a man's children will be born with birth defects, a new study indicates.

With infertile couples, men are partially or fully responsible for the inability to conceive about 40 percent of the time. Assisted reproductive technologies such as in vitro fertilization can help couples have children, but research has suggested a possible link between these approaches—when used to treat infertility problems in the male partner—and a higher risk of birth defects.

In the new study, researchers examined a Baylor College of Medicine database in search of possible connections between birth defects and low sperm count. The researchers didn't find any links.

But the following finding is a cause for concern. From Science Daily:

Male infertility linked to mortality, study shows

Men who are infertile because of defects in their semen appear to be at increased risk of dying sooner than men with normal semen, according to a study. Men with two or more abnormalities in their semen were more than twice as likely to die over a roughly eight-year period as men who had normal semen, the study found.

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Several interesting bacteria studies. Who knew that dental caries (tooth decay that causes cavities) is contagious? From Science Daily:

Bacteria can linger on airplane surfaces for days

Disease-causing bacteria can linger on surfaces commonly found in airplane cabins for days, even up to a week, according to research. In order for disease-causing bacteria to be transmitted from a cabin surface to a person, it must survive the environmental conditions in the airplane. In this study, MRSA lasted longest (168 hours) on material from the seat-back pocket while E. coli O157:H7 survived longest (96 hours) on the material from the armrest.

From Science Daily: Cavities are contagious, research shows

Dental caries, commonly known as tooth decay, is the single most common chronic childhood disease. In fact, it is an infectious disease, new research demonstrates. Mothers with cavities can transmit caries-producing oral bacteria to their babies when they clean pacifiers by sticking them in their own mouths or by sharing spoons. Parents should make their own oral health care a priority in order to help their children stay healthy.

From Science Daily: Physicians' stethoscopes more contaminated than palms of their hands

Although healthcare workers' hands are the main source of bacterial transmission in hospitals, physicians' stethoscopes appear to play a role. To explore this question, investigators assessed the level of bacterial contamination on physicians' hands and stethoscopes following a single physical examination. Two parts of the stethoscope (the tube and diaphragm) and four regions of the physician's hands (back, fingertips, and thenar and hypothenar eminences) were measured for the total number of bacteria present in a new study. The stethoscope's diaphragm was more contaminated than all regions of the physician's hand except the fingertips. Further, the tube of the stethoscope was more heavily contaminated than the back of the physician's hand.

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An exciting research study which finds that it is normal for bacteria to live in the bladders of healthy women, and that urine is not sterile. After further studies on the microbial communities in the bladder, perhaps bacterial treatments for various urinary problems? From Science Daily:

Study debunks common myth that urine is sterile: Bacterial differences found in urine of healthy women and women with overactive bladder

Bacteria live in the bladders of healthy women, discrediting the common belief that normal urine is sterile. This study also revealed that bladder bacteria in healthy women differ from the bladder bacteria in women affected by overactive bladder (OAB), which causes a sudden need to urinate.

Approximately 15 percent of women suffer from OAB and yet an estimated 40 -- 50 percent do not respond to conventional treatments. One possible explanation for the lack of response to medication may be the bacteria present in these women.

"If we can determine that certain bacteria cause OAB symptoms, we may be able to better identify those at risk for this condition and more effectively treat them," said Alan Wolfe, PhD, co-investigator and professor of Microbiology and Immunology, SSOM.

This study evaluated urine specimens of 90 women with and without OAB symptoms. Urine samples were collected through a catheter and analyzed using an expanded quantitative urine culture (EQUC) technique. This EQUC technique was able to find bacteria that are not identified by the standard urine culture techniques typically used to diagnose urinary tract syndromes.

Loyola researchers now plan to determine which bacteria in the bladder are helpful and which are harmful. They also will look at how these bacteria interact with each other and with their host, and how we can use this information to help patients. 

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Moderate levels of exercise seems to have tremendous benefits for everyone, but there are downsides to being an extreme exerciser.  From Science Daily:

Elderly men with high blood pressure lower death risk with moderate fitness

Elderly men with high blood pressure can lower their risk of death with even moderate levels of fitness. "This level of fitness is achievable by most elderly individuals engaging in a brisk walk of 20 to 40 minutes, most days of the week," said Charles Faselis, M.D., lead author of the study.

For the study, researchers assessed the fitness status of 2,153 men, aged 70 years and older with high blood pressure by a standard treadmill exercise test. Researchers applied the international units used to measure fitness, called metabolic equivalents (METs), to determine the men's peak fitness levels. After an average follow-up of nine years, researchers found that the risk of death was 11 percent lower for every one-MET increase in exercise capacity.

"For every 100 people who died in the least-fit category, 82 died in the low-fit, 64 in the moderate-fit and 52 in the high-fit categories," Kokkinos said. "The death rate is cut in half for those in the highest fitness category."

Too much exercise also has negatives for men. From Medical Xpress:

Too much prolonged high-intensity exercise risks heart health

Overdosing on high intensity exercise may actually increase the risk of death from a heart attack or stroke in those with existing heart disease, suggests German research published online in the journal Heart.

Similarly, a second Swedish study in the journal suggests that young men undertaking endurance exercise for more than five hours a week may increase their risk of developing an irregular heart rhythm in later life.

Both sets of findings indicate a J-shaped curve for the health benefits of exercise... And they describe "a similar U-shaped or reverse J-shaped pattern for the dose-response effect of exercise: maximum cardiovascular benefits are obtained if performed at moderate doses, while these benefits are lost with (very high) intensity and prolonged efforts."