Archive for June, 2011

Hydration for Health

June 25, 2011

Drinking an adequate volume of fluid, primarily water, is vital to our health and wellness.  Water accounts for 60% of our total body weight and insufficient water intake or excessive water loss can wreak havoc with our health.  Dehydration—the state of depletion of total body water—tends to occur more commonly in the hotter summer months of the Northern Hemisphere.  Our bodies are remarkably well engineered and are designed to give us the proper feedback to maintain our health—whether it is fatigue begging for sleep, hunger demanding food or thirst calling for water.  So it is quite important for us to listen carefully to what our bodies are telling us, and respond appropriately.  When we become thirsty, it is usually a sign of mild dehydration, although excessive salt intake can also drive thirst.

Proper hydration is fundamental to maintain blood volume, blood pressure, temperature control as well as all of our metabolic processes.  Dehydration can occur under a number of circumstances, including excessive exposure to high temperatures, sweating from athletic pursuits, or that which results from vomiting, diarrhea, a bowel preparation for colonoscopy or simply not enough water consumption.

Body water is lost through obvious sources such as urination, bowel movements and sweating, but there are also insensible losses including vapor lost with breathing and evaporation of water from our skin in the absence of overt sweating.

If we are adequately hydrated, we will not be thirsty and our urine will appear dilute, similar to the color of light American beer.  Dehydration is marked by thirst, decreased urine output, and urine that is darker in color, similar to the color of a  amber, rich German beer.  Inadequate hydration can cause a host of symptoms, including fatigue, headache, lightheadedness and dizziness.  It can lead to confusion and impaired judgment, and if progressive, can ultimately cause heat stroke, a medical condition that demands emergent management and fluid resuscitation.  Children and the elderly are most at risk for the occurrence of dehydration.

Dehydration is one of the primary risk factors for kidney stones, that tend to occur when the urine gets very concentrated under which circumstances the calcium salts that are normally dissolved tend to precipitate out and form particles that can become stones.

In terms of weight management, thirst can often be confused or mistaken for hunger, and eating is a poor and inefficient means of rehydrating.  What we want and need when we are dehydrated is water and not calories.  Staying well hydrated can fill us up and suppress our hunger and help with the weight loss process, and as such, is an important component of many weight loss programs.

Our precise water requirement varies depending on our weight, the ambient temperature and our level of physical activity, so blanket generalizations such as 8 glasses per day–what I refer to as Cosmopolitan magazine dogma--are meaningless for an individual.  Adequate hydration is usually characterized by feeling well, lack of thirst, and adequate urine output that is clear or light yellow in color.  The bottom line is to be mindful of the external environment and mindful of the way our body feels, our thirst and our urine color—and to respond with increased water intake if circumstances dictate.  If it is a particularly hot day, or if we are going to be participating in vigorous athletic pursuits, it is best to pre-hydrate and to ensure that we have an adequate water supply in our possession.

Since we all tend to drink bottled water, for an interesting, eye-opening and astonishing report on the quality of the particular bottled water that you drink, consult the following website:


100 “pearls” excerpted from Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food

June 18, 2011

1. Clichéd but true and relevant regarding the path to achieving our desired weight: long and arduous journeys start with small steps—it is not a race, sprint, jog or marathon, but a lifetime walk at a comfortable pace

2. Don’t worry about a little fall or stumble off the journey—compensate with improved eating and exercise

3. Make an effort to eat only when physically hungry, not emotionally hungry

4. Exercise portion control

5. Food journals tell it like it is

6. Be calorie-conscious, but not calorie-obsessed

7. Understand that the goal of eating is satiety, not fullness

8. Try not to skip meals

9. Grazing is good

10. Minimize nocturnal noshing

11. Get plenty of sleep to help keep the pounds off

12. Keeping busy and productive is a great alternative to boredom eating

13. Eat nutritious snacks

14. Indulge with a small taste of temptation foods but try to avoid trigger foods

15. Keep healthy foods accessible, junk food poorly accessible

16. Read nutritional labels carefully—as if you were reading the back of a bottle of medicine before administering it to your child; be attentive to the size of a “serving” as delineated on nutritional labels

17. Try to eat the highest quality foods possible—better to spend it on good food than on avoidable medical care

18. Try to eat as many whole grain products as possible: wheat, brown rice, quinoa, couscous, barley, buckwheat, oats, spelt, etc.

19. The closer to nature the better it is: fresh, unshelled peanuts trump processed peanuts, which trump peanut butter; oranges are superior to orange juice, which is superior to orange drink

20. Fiber is fabulous—soluble fiber slows down absorption rate of food and regulates glucose and cholesterol levels; insoluble fiber slows transit time and lessens risk for colon cancer as the fibrous materials “brush” their way through

21. Fruit is better than fruit juice, since fruit has less calories and more fiber (both soluble and insoluble) and phyto-nutrients (plant-based healthy components)

22. Unshelled nuts and seeds—unlike bottled, canned and packaged—they are unprocessed without added salt and oil and are difficult to over-consume because of labor-intensity of shelling; the act of shelling keeps us busy and occupied

23. Beware of energy-dense foods like dried fruit as it is much easier to overdo caloric consumption: raisins vs. grapes, etc.

24. Limit fast food and junk food

25. Limit processed and highly refined foods: beware of high fructose corn syrup, partially hydrogenated vegetable oils, enriched wheat flour and trans fats

26. Limit fats that are solid at room temperature

27. Limit tropical oils (coconut, palm kernel and palm)

28. Beware of consuming any chemicals in foods that are also products in moisturizers and cosmetics!

29. Sugar and salt in moderation

30. Avoid soda (liquid candy), with its empty calories and high fructose corn syrup

31. As a soda alternative, try flavored seltzers or squeeze a piece of citrus fruit into regular water or sparkling water

32. Avoid products that contain unfamiliar, unpronounceable, or numerous ingredients

33. Avoid food products that make health claims, since real foods do not have to make claims as their wholesomeness is self-evident

34. “Organic” does not imply healthy, low-calorie or low-fat

35. Avoid “mystery” meats

36. Avoid doughnuts and their ilk—the only healthy part of a doughnut is the hole (and I don’t mean Dunkin Donuts “holes”—aka “munchkins”)

37. Avoid preservatives in our food

38. Avoid hormones in our food

39. Avoid antibiotics in our food

40. Avoid pesticides in our food

41. Avoid bacteria in our food

42. Animal fats in moderation

43. Eat red meat in moderation, trying to eat the leanest cuts possible

44. Lean turkey meat as beef alternative for hamburgers, meatballs, chili, etc.

45. Try to substitute vegetable protein for some of animal protein in diet, particularly legumes—peas, soybeans and lentils

46. Try to eat wild vs. commercially farmed foods (salmon, poultry, pork, beef, etc.)

47. Good fats are healthy and filling—mono-unsaturated and polyunsaturated—olive oil, canola oil, safflower oil, avocados, nuts, fish, and legumes

48. Consider olive oil as main source of fat

49. Soy: high in protein and healthy fat—edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), or soy milk

50. Skin poultry, because much of the fat adheres to the underside of the skin

51. Eat some fish, particularly those containing omega 3-essential fatty acids, such as salmon, herring, mackerel, anchovies and sardines

52. Use low-fat or non-fat dairy products

53. Use soy, rice or almond milk as dairy alternative

54. Baked, broiled, sautéed, steamed, poached or grilled are preferable to fried, breaded, gooey

55. Baked chips as opposed to fried

56. Drink plenty of water as thirst can be confused with hunger—jazz water up with ice, lemon or lime

57. Light beer instead of regular will save some calories

58. Alcohol-free beer and wine will save some calories

59. Cook healthy meals as opposed to dining out

60. Easy on creamy dressings and sauces

61. Order dressing on the side with salad, so it is not drowned in needless calories

62. Incorporate Mediterranean-style diet and other healthy ethnic foods—Japanese, Italian (careful, not too much pasta!), Greek, etc.—as Western diet alternatives

63. Shake it up by eating a wide variety of different foods as diversification will enhance proper nutrition and please the palate

64. Shop the periphery of the supermarket since this is where the fresh foods are located

65. Farmer’s market as alternative to supermarket

66. Eat local—good for us and our environment

67. Eat mostly plants, especially leaves, as they are a great source of antioxidants, phyto-chemicals, fiber and omega 3-essential fatty acids.

68. Anything that grows on a tree or in the soil is generally healthy and nutritious

69. Anything that is naturally colorful is good

70. Artificial colors and dyes are best suited on palettes and canvasses, not in our bodies

71. Try to eat foods fertilized by organic fertilizers

72. Try to eat meals with your family or friends at a table in the kitchen or dining room, not in the car, while reading or while watching TV

73. Eat slowly, deliberately and mindfully

74. To slow yourself down, use a fork and knife to eat foods that you would normally pick up with your fingers—sandwiches, pizza, etc.

75. Very hot and very cold foods will slow you down

76. Use small plates and bowls to create illusion of having “more” on your plate

77. Use small utensils, such as lobster fork or child-sized spoon to help eat slowly and deliberately

78. Use chopsticks to really put on the eating brakes

79. Serve pasta prepared “seriously” al dente: I discovered this when my then 10-year-old daughter made pasta that was way undercooked and thus was very hard and chewy—pleasurably so—each bowtie requiring a great deal of chomping, slowing me down considerably and resulting in less consumption

80. Close the shop: brush your teeth after meals—this will help minimize mindless, between-meal snacking

81. Breath mints, chewing gum or sucking candy as substitute for eating

82. Eat as if you were dining with your cardiologist and dentist (or if you don’t have a cardiologist, this is someone who you just might need if you eat indiscriminately)

83. Use a good quality bread knife to slice a bagel into four slices instead of two and eat just two

84. Bialy as a bagel alternative—absolutely delicious and so many less calories

85. Coffee is A-OK—tastes great, keeps us alert and focused, antioxidant; with a tiny bit of sugar, will curb our craving for sweets

86. Great snack: microwave popcorn, but not that processed junk—brown paper lunch bag with bottom sprayed with flash of oil mist and layered with corn kernels—fold bag and microwave for 4 minutes or so until popping ceases and throw on a dash of salt

87. Squash fries—great alternative to French fries and in my humble opinion are better: Take a peeled and deseeded butternut squash and cut with crinkle cutter, spray oil mist on baking sheet, sprinkle with kosher salt and bake for 40 minutes or so (Credit to Lisa Lillien, Hungry Girl)

88. Apple pie alternative: Cut apple into many slices (I like to use apple corer), put in Ziploc bag with a little cinnamon, shake and voilà—apple coated in cinnamon that tastes like apple pie (Credit to Lisa Lillien, Hungry Girl)

89. Carbonated cranberry cubes: instead of eating while watching TV, try cranberry juice diluted with seltzer, frozen in an ice cube tray; fill up glass with these cubes and enjoy (Credit to my patient)

90. Frozen banana: wrap peeled banana in plastic wrap and freeze—thaw and enjoy this frozen banana treat that tastes like banana ice cream and cannot be scarfed down because it is too hard and cold!

91. Greek yogurt is the best—tastes great and is really thick and creamy without watery whey, loaded with protein—Chobani is my favorite brand—6 ozs, 140 calories, 14g protein, 22 g carbs, no fat, no preservatives

92. Sour cream sub: use plain Greek yogurt on baked potatoes instead of sour cream; also instead of mayonnaise in salad dressings and dips

93. Great snack: celery, baby carrots, cherry tomatoes, peppers, cauliflower, etc.—dipped in hummus

94. Great snack: fruit shakes—in blender: skim or soy milk, frozen fruit of your choice, yogurt (I usually use a banana as a “base” fruit and add additional fruit/s)

95. Great Australian crackers even though they contain refined wheat flour: Waterwheel Fine Wafer Crackers—super light, non-greasy, crunchy, delicious and 10 crackers have less than 70 calories

96. If you need calcium supplementation and want a delicious means of getting it, try Citrical Creamy Bites that come in chocolate fudge, lemon cream and caramel flavor—they are low in calories and taste better than candy! For a real treat, freeze them. I confess to looting my wife’s chocolate fudge Citricals, even though I am not on calcium replacement!

97. Eat muffin tops if you want to get a “muffin top”—Dunkin Donuts coffee cake muffin: 580 calories, 19 grams fat, 78 grams carbs

98. Eat doughy foods if you want a doughy abdomen

99. Perishable foods with limited shelf lives are much healthier than non-perishable items that last indefinitely, as many processed items do

100. Happy ending—let the last thing you eat before sleep be healthy, natural and wholesome, like a nice piece of fruit—you’ll feel good about yourself when you get into bed, and even better in the morning

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is:  It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.  It is also available on Amazon Kindle.

“Elective” Male Sexual Dysfunction: How We Are Eating Ourselves Limp

June 11, 2011

“It is like a firstborn son—you spend your life working
for him, sacrificing everything for him, and at the
moment of truth, he does just as he pleases.”

Gabriel Garcia Marquez, Love In The Time Of Cholera


Two weeks ago, my blog dealt with the relationship between overeating/obesity and urinary incontinence/pelvic organ prolapse in females. In fairness to the male gender, today’s essay will be how overeating/obesity affects our manhood and vitality. What we eat—or don’t eat—can directly affect our sex lives! While the achievement of good sexual function is predicated upon many factors, it must be recognized that the particular diet we choose plays a definite role in its attainment.

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure. Healthy sexual function involves a satisfactory libido, the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. Although not a necessity for a healthy life, the loss or diminution of sexual function can result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us, it is vital that we maintain our sexual health.
On a functional level, sexuality is a very complex event dependent upon a number of systems, including the endocrine system (which produces sex hormones); the central and peripheral nervous systems (which provide nerve control); and the vascular system (which conducts blood flow). A healthy sexual response is, at its physical essence, largely about adequate blood flow to the genital and pelvic area. Increased blood flow to the genitals from sexual stimulation is responsible for the penis going from a flaccid to an erect state. Blood flow to the penis is analogous to air pressure in a tire: if there is not enough air, thereby causing the tire to be improperly inflated, the tire works less optimally and may even suffer a flat!
The penis is a rather amazing, multifunctional organ that has a role as a urinary organ allowing directed urination that permits men to stand to urinate, and a sexual and reproductive organ that when erect, allows the rigid penis the ability to penetrate the vagina and function as a conduit for release of semen into the vagina. No other organ in the body demonstrates such a great versatility in terms of the physical changes between its “inactive” versus “active” states! The penis has an abundant supply of vascular smooth muscle, and like every other muscle in the body, “use it or lose it” is relevant when it comes to the sexual domain. Disuse atrophy can occur if the penis is not used the way it was designed to be, and this often results in patients complaining of penile shrinkage.
Erectile dysfunction is a common problem, occurring in millions of American men. About one-third of the male population over age 60 is unable to achieve an erection suitable for intercourse. However, erectile dysfunction is NOT an inevitable consequence of the aging process as there are many elderly men who have intact sexual function.
Diminished blood flow occurs most commonly on the basis of an accumulation of fatty plaque deposits within the walls of blood vessels. As we age, physiological and lifestyle factors combine to increase this plaque build-up, causing a significant narrowing of many of the body’s blood vessels. The resultant decrease in blood flow to our organs negatively affects the functioning of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of vital oxygen and nutrients and removal of metabolic waste products. Pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the arteries that bring blood to the penis, will compromise blood flow to the genitals and incite sexual dysfunction.
The presence of erectile dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels). In other words, the quality of erections can serve as a barometer of cardiovascular health and those who can get hard attacks are unlikely to get heart attacks. The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults in the USA are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our poor dietary choices and sedentary lifestyle. Civilization Syndrome can lead to obesity, high blood pressure, elevated cholesterol, and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death. The diabetic situation in our nation—often referred to as “diabesity” has become outrageous and it probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.
Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the pudendal artery, which supplies blood to the penis. Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. The fatty tissue present in our obese abdomens contains abundant amounts of the enzyme aromatase—functioning to convert testosterone to estrogen—literally emasculating us! High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less blood flow through the pudendal arteries. Thus blood pressure medications, although very helpful to prevent the negative affects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction. High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction. Tobacco constricts blood vessels and impairs blood flow through our arteries. Smoking is really not very sexy at all! Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function. Hence, the physiologic explanation for the common occurrence of performance anxiety. Interestingly, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical to bring down the erection.
Obesity is stealing away one of our most precious resources—the ability to obtain and maintain good quality erections. Remember the days when you could achieve a rock-hard erection—majestically pointing towards the sky—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and perhaps had an abdomen that somewhat resembled a six-pack. The loss in function is often so gradual and insidious that it barely gets noticed. Maybe it takes a great deal of physical stimulation to achieve an erection barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need “daddy’s little helper”—a little blue pill (Viagra), or yellow pill (Cialis), or orange pill (Levitra), to get the blood flowing.

If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft down below. A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body. Perhaps when you are standing naked in the shower and you gaze down towards your feet, all you see is the protuberant roundness of your large midriff, obscuring the glorious sight of your manhood. Perhaps you’re wondering where your penis is hiding. In most cases, the abundant pubic fat pad that occurs coincident with weight gain obscures the penis, what I like to refer to as the “turtle effect.” If your pubic fat pad makes your penis difficult to find, your man-boobs are competitive with your wife’s breasts, and your libido and erections are just not performing up to par, it may be just time to rethink your lifestyle habits!
So, where does this leave us? It leaves us with what should by now be obvious: a healthy lifestyle is of paramount importance towards the endpoint of achieving an optimal quality and quantity of life. Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases caused by poor health decisions. Sexual dysfunction is in the category of a medical problem that is brought on by unwise lifestyle choices. It should come as no surprise that the initial approach to managing it is to improve lifestyle choices. By simply improving one’s daily habits, Civilization Syndrome can be ameliorated or even prevented, and the various medical problems that often follow, including sexual dysfunction, can be mitigated.
In terms of maintaining good cardiovascular health—and thus healthy sexual function—eating properly is incredibly important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome and natural foods will help prevent the build-up of harmful plaque deposits within blood vessels that can lead to compromised blood flow to the penis as well as every other organ. Poor dietary choices with a meal plan replete with calorie-laden, nutritionally-empty selections (e.g., fast food or processed or refined anything), puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!
If you want a “sexier” lifestyle, first start with a “sexier” style of eating that will help you feel better, look better and optimize your sexual, emotional and psychological well-being. Smart nutritional choices are a key component of sexual fitness. Exercise is a fundamentally important component of maintaining good sexual health and partners well with healthy eating. At times, even with the achievement of a very healthy lifestyle, erectile dysfunction can still persist. Under these circumstances, there are numerous excellent treatment modalities available, and the reader is referred to the following links below for more information.



I have done a number of educational videos on the subject of erectile dysfunction. These are intended for mature adults only as they contain language and images of a graphic and sexual nature and viewer discretion is advised.

Introduction to erectile dysfunction:


Penis size:

Causes of erectile dysfunction:

Treatment part 1:

Treatment part 2:

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living. It is also available on Amazon Kindle.

Andrew L. Siegel, M.D.

A Synopsis of Gary Taubes’ “Why We Get Fat And What To Do About it”

June 5, 2011

I just finished reading Gary Taubes’ book Why We Get Fat and What To Do About It and have summarized it for the benefit of those who have not had an opportunity to read this treatise of nutritional and metabolic intriguing and contrarian thoughts and ideas. The book is well worth your time and effort, but if you do not have the inclination to read it, my synopsis will give you the essential points.

A 1998 National Institute of Health report provided an excellent definition of obesity: a complex, multi-factorial chronic disease that develops from an interaction of genotype and the environment, involving the integration of social, behavioral, cultural, physiologic, metabolic and genetic factors. Taubes expands upon the NIH definition and not only rethinks and debunks conventional wisdom about weight gain and obesity, but literally decimates dogma into dirt, dust and debris. Be prepared to throw by the wayside much of what you understand as nutritional and metabolic givens! I will boldface his iconoclastic statements to make it easier for the reader.

Taubes’ premise is that obesity—the most prevalent form of “malnutrition,” is not a caloric imbalance (more calories in than out), but a hormonal imbalance, with a strong genetic component. If we happen to be born with a fat regulatory system that is efficient at turning calories into fat as opposed to burning them as fuel, and we stoke the genetic edict with a diet high in carbohydrates, then we are likely to get fat. Carbohydrates—particularly refined carbs, starchy vegetables and sugar/high fructose corn syrup—promote insulin release and hence fat storage, largely driving this pathway. Major culprits are carbs in liquid form including sodas, juices and beer as well as any refined, fiber-poor, easily digestible source of carbs.

He posits that it is not gluttony, sloth nor excessive caloric intake that are responsible for the majority of us being overweight or obese, but the way we process energy. Based upon genetic decree, some of us have a propensity to store calories as fat and at the other extreme there are the energy consumers, those who easily burn calories. So, energy regulation is responsible for gluttony and sloth—we are not fat because we overeat, but overeat because we get fat. Those with a predilection for storing calories as fat have fewer calories left to run the body. The more calories fat cells sequester, the more eating there must be in order to compensate—the body figures a way to get calories by increasing appetite or decreasing expenditure or both, promoting gluttony and sloth.

Taubes’ intriguing theory is that moderate eating and maintaining a physically active lifestyle are the metabolic benefits of a body that is programmed to remain lean, not evidence of moral rectitude. If our fat tissue is regulated so that it will not store significant calories as fat or our muscle tissue is regulated to take up plenty of calories to use for fuel, then we’ll either eat less, be more physically active, or both. This implies that elite athletes like marathoners and cyclists are not lean because they train vigorously and burn calories readily; rather, they are driven to expend calories because they are wired to burn calories and be lean. Analogous to greyhound dogs as opposed to basset hounds, genetics dictate how fuel gets partitioned to lean tissue or fat, and drives a propensity to exercise or not.

A central theme of the book is that our body fat (fuel) is carefully regulated, and hormones play a key role in this regulation—think how women fatten differently then men. Local factors also are relevant as some parts of our body are fat-free and others have a propensity for fat storage—think our hands vs. our abdomens. The importance of genetic factors has been discussed above. Essentially, genes regulate lipophilia (an affinity for stockpiling fat) to cause obesity. Fat tissue in obese individuals can be thought of in a similar way to malignant tumors, both of which have own agendas and grow regardless of food intake or exercise. If we can accept that our body fat is carefully regulated, obesity can be explained by a regulatory defect so small that it would be undetectable by any technique we know. If a laboratory animal that is genetically programmed for fat storage is put on a restricted diet from the get go, it responds by compromising its organs and muscles to satisfy its genetic drive to grow fat

Our fat stores are not static, but are dynamic with continuous mobilization (as fatty acids) and deposition (as triglycerides). Our pancreatic hormone insulin is the principal regulator of fat metabolism. Insulin controls how fuel is “partitioned” in our body—if we are “storers” of energy or “burners” of energy.
After a meal, insulin is released to get energy into our cells and when we go without food, as happens when we are asleep, insulin levels decrease and fat is released to be used as fuel. Insulin levels are determined primarily in response to carbohydrate intake in order to keep our blood sugar regulated. Everything insulin does promotes fat storage and decreases fat burning—this is why diabetics on insulin therapy get fat.

Insulin resistance occurs in response to chronic carbohydrate overload—the more insulin secreted, the more likely that the cells and tissues will become resistant to that insulin (as cells already have enough fuel within). As we age, our muscles get relatively insulin-resistant yet our fat cells always remain more sensitive than muscle. Insulin-resistant muscles partition more energy into fat, leaving less available for muscles and organs to use as fuel, so our cells adapt and use less energy. In Taubes’ mode of thinking, we don’t get fat because our metabolism slows, but our metabolism slows because we’re getting fat.

Taubes opines that energy consumption and energy expenditure are not independent but are dependent variables—cells burn less energy because they have less energy to burn. He believes that diets do not work because they result in us becoming hungry, cranky, depressed and lethargic and are therefore not sustainable. One of the most remarkable things about humans is our ability to adapt and compensate to changes in our environments. When we “starve” ourselves, we go into energy-conservation mode that essentially slows our metabolism. Ultimately, our bodies compensate for eating less and exercising more. Exercise makes us hungry and causes us to reduce our energy expenditure when we’re not exercising.

Excessive insulin secretion and insulin resistance causes metabolic syndrome. Metabolic syndrome is a spectrum of risk factors that increase the risk for diabetes, heart disease and stroke. It is defined as having three or more of the following:
• Blood pressure equal to or higher than 130/85
• Fasting blood sugar equal to or higher than 100
• Large waist circumference:
o Men – 40 inches or more
o Women – 35 inches or more
• Low HDL cholesterol:
o Men – under 40
o Women – under 50
• Triglycerides equal to or higher than 150

Insulin causes fat accumulation and stimulates fat cells to release inflammatory cells called cytokines. Insulin works in the liver to convert carbs to fat; this fat is sent off on particles that become small, dense LDL cholesterol, the dangerous kind that promote plaque formation in our arteries. Insulin causes our kidneys to resorb sodium, promoting hypertension; insulin impairs secretion of uric acid and stiffens our arterial walls. Chronically elevated blood sugars engender oxidative stress with accumulation of advanced glycation end products and provoke premature aging.

Now a bit of nutritional anthropology: For 99.5% of human existence (the Paleolithic era): mankind were hunter-gatherers subsisting on a diet in which 2/3 of calories were of animal origin and 1/3 of plant origin—a high protein, high fat, low carb diet that was of low glycemic index foods (carbs that are rather slowly absorbed), high fiber, slowly-digesting plants including seeds, nuts, roots, tubers and bulbs. For only 0.5% of our existence (the last 12,000 years), we have been in the agriculture era—so carbohydrate-rich foods are relatively new to our diet and in Taube’s opinion, it just might be that insufficient time has passed to allow us to evolve to be able to handle this carb-rich diet appropriately.
Studies on ethnic groups such as the Inuits and Maasai who are meat and fish eaters with no vegetable or fruit intake have interestingly shown that they have not suffered with diseases of Western civilization. We know that there are essential amino acids (building blocks of proteins) and fatty acids (building blocks of fats), but no such thing as an essential carbohydrate. All of the aforementioned suggest that a diet that primarily consists of protein and fat with limited carbohydrates, as has been the norm for many years, is a healthy diet that can help avoid the ravages of Western diseases. Taubes reports that wild animals maintain a stable weight no matter how abundant their food supply. Carnivorous animals never get fat, but herbivores (on a carb diet) can get fat, for example, the hippopotamus.

Dietary fats do not elevate our trigylceride levels and make us fat, but carbohydrates do. In the world according to Taubes, the predisposition for obesity is beyond our control, but is set off by the carbs we consume. The higher glycemic index foods—carbs that break down rapidly during digestion and release glucose swiftly into our blood, also typically the cheapest foods—promote fat deposition more so than lower glycemic index foods.

If we want to get leaner, we must lower our insulin levels and to do so requires carbohydrate restriction. Even if we don’t reduce our quantity of carb intake, we can improve the quality of our carb intake by eating healthier carbs—whole grains, fruits, vegetables, etc. There are numerous health benefits that accrue from a low carb diet. If we replace a high carb diet with a diet high in protein and fat and low in carbs, we end up with weight loss, higher HDL cholesterol , lower triglycerides, lower blood pressure, stable total cholesterol, higher LDL cholesterol and overall a decreased risk of heart disease.


This is the kind of information you will find in my book: Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is:   It provides information, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on wellness and healthy living.  Promiscuous Eating is now available on Amazon Kindle.

Andrew Siegel