Archive for September, 2011

Prostate Cancer: Can Diet And Lifestyle Make A Difference?

September 30, 2011

September is National Prostate Cancer Awareness Month, so I thought that a discussion of prostate cancer and preventative measures would be an appropriate topic to write about as the month approaches its end.  As a urologist and a wellness advocate, this subject is very dear to my heart.

Prostate cancer is the second leading cause of cancer-related deaths among men in the USA.  The burden of this disease is felt not only by those men diagnosed with this disease, but also by their partners, relatives and friends who are key elements in their emotional support system.

Prostate cancer is the most common non-skin malignancy among men in most Western populations (240,000 estimated new cases in 2011 in the U.S.), and is the second leading cause of cancer death among U.S. men (34,000 estimated deaths in 2011). To put this in perspective, heart disease causes more than 800,000 deaths per year in American men and is the leading cause of death in men with prostate cancer.  Many more men die of heart disease than of prostate cancer, and even in the population of men with prostate cancer, many more men die with it than of it.

The three major risk factors for prostate cancer are age, race, and family history. The likelihood of developing prostate cancer increases with the aging process, thought to be on the basis of gradual accumulation of DNA mutations due to incremental oxidative damage (literally “rusting”) of prostate cells. With each decade of aging, the incidence of prostate cancer increases appreciably.

In terms of race, African-American men have the highest reported incidence of prostate cancer in the world, with an incidence of 1.6 times that of Caucasian men in the United States; additionally, mortality is 2.4 times higher for African American men. On a worldwide basis, the highest incidence is in North America and Scandinavia and the lowest incidence is in Asia.

Prostate cancer tends to run in families, so it is prudent for male children of those with prostate cancer to be checked on an annual basis starting at age 40 (with a PSA blood test and digital rectal exam). With respect to familial prostate cancer, risk increases according to the number of affected family members (the more affected, the higher the risk), their degree of relatedness (brother and/or father affected confer a higher risk than cousin and/or uncle), and the age at which they were diagnosed (relatives of patients diagnosed younger than 55 years old are at highest risk). Generally speaking, if you have a brother or a father with prostate cancer, your risk of developing it is doubled. If you have three family members with prostate cancer, or if the disease occurs in three generations in your family, or if two of your first-degree relatives have been diagnosed at an age younger than 55 years, then you have a good likelihood for hereditary prostate cancer, which confers a 50% risk of developing the disease.

My father, a retired urologist, was diagnosed with prostate cancer at age 65 and underwent curative surgery and is currently 80 years old and thriving. For this reason, I have been very diligent in seeing my internist annually for a prostate examination and a PSA blood test. Additionally, I have been proactive in taking a medication to decrease my risk of prostate cancer.

Prostate cancer is unique among solid tumors in that it exists in two forms: a latent form (evident on autopsy studies, but not causing an abnormal digital rectal exam or PSA), which is present in 60-70% of men older than 80; and a clinically evident form (causing an abnormal rectal exam or elevated PSA), which affects approximately 1 in 6 men in the United States. Overall, men have an approximately 17% chance of being diagnosed with prostate cancer and a 3% chance of dying from it. This high ratio of prostate cancer incidence to mortality suggests that a portion of the cancers are minimal or indolent, non life-threatening conditions.

Currently, most prostate cancers are detected on the basis of a PSA elevation ranging from 2.5-10 ng/ml. Widespread PSA testing has resulted in the increased diagnosis of prostate cancer and a downward stage migration to non-palpable, organ-confined cancer with a parallel reduction in deaths—as opposed to the pre-PSA era, when most cancers were detected on the basis of a palpably abnormal digital rectal exam and were at a more advanced stage at presentation.

It is very important to know that when detected early, prostate cancer is highly curable. In the USA, more than 90% of men diagnosed with prostate cancer survive at least 10 years after the diagnosis is made. Even when not discovered early, it is a very manageable condition. In general terms, prostate cancer is a relatively slow-growing process.   Although most prostate cancers diagnosed at an early stage often have an indolent course, local tumor progression and metastases may certainly develop in the long term; therefore, early treatment is an important consideration for men with a general life expectancy exceeding 10 years.

Localized prostate cancer typically causes no symptoms and is typically diagnosed by a biopsy done because of a PSA elevation, an accelerated increase in the PSA over time, or an abnormal digital rectal examination. Non-palpable cancers, i.e., those picked up by virtue of a PSA elevation or accelerated PSA velocity, now account for 75% of all newly diagnosed prostate cancers. Although screening for prostate cancer remains somewhat controversial because of a lack of studies demonstrating a decrease in mortality in screened populations, the observed trends in PSA-driven detection of prostate cancer at earlier stages and declining mortality where screening is common provide strong inferential evidence that screening is beneficial.

Wouldn’t it be wonderful if we could prevent the occurrence of prostate cancer? It certainly would make my job a whole lot easier. Unfortunately, we are not there yet—but we do know a thing or two about lifestyle measures that can be pursued to maintain health and wellness in general and to help mitigate the chances of developing prostate cancer.

When Asian men (the ethnic group that has the lowest incidence of prostate cancer) migrate to Western countries, their risk of prostate cancer increases substantially over time.  So it is clear that environment plays a strong role in the genesis of prostate cancer and it is not just a simple matter of genetics.

Unquestionably, a coronary artery-clogging Western diet high in animal fat and highly processed foods and low in fruits, vegetables, legumes and whole grains is associated with a higher incidence of many preventable chronic health problems including cancer.  A heart-healthy, colon-healthy diet is a prostate-healthy and life-healthy diet.  A healthy diet combined with a healthy lifestyle, will afford us our best opportunity at minimizing heart disease, diabetes, and a host of cancers. This means weight management; the avoidance of obesity; healthy eating with abundant fruits and vegetables (chock full of antioxidants, vitamins, minerals and fiber) and real food as opposed to processed foods; consumption of animal fats and dairy in moderation; avoidance of tobacco and excessive alcohol; and plenty of exercise. And if we do develop prostate cancer, we will be in stellar physical shape and will heal that much better from any intervention necessary to treat the prostate cancer. Good nutrition and exercise helps in part by inhibiting oxidation and inflammation, factors that contribute not only to prostate cancer but also to conditions such as heart disease and osteoarthritis.

Michael Pollan, a journalism professor at the University of California, Berkeley and author of The Omnivore’s Dilemma, summarized in a most succinct way the answer to the question of what humans should eat, in his seven words: “Eat food. Not too much. Mostly plants.” By food, he means a nutritional substance that your grandmother would recognize as food, not a food-like highly processed substitute. Not too much is pretty obvious. A mostly plants-based diet will result in the consumption of a moderate amount of calories and plenty of fiber and anti-oxidants.

In addition to recommending a regimen of healthy eating and regular participation in exercise, there are medications that can help prevent the occurrence of prostate cancer. The presence of precursor lesions such as high grade prostate intraepithelial neoplasia (HGPIN) many years before the onset of prostate cancer, coupled with the increasing prevalence of prostate cancer with the aging process, suggest that the process of developing cancer takes place over a protracted interval of time. In fact, it is estimated that it takes many years—often more than a decade—from the initiation of the initial mutation to the time when prostate cancer becomes clinically manifest with either a PSA elevation or an abnormal digital rectal examination. In theory, this provides the opportunity for intervention before the establishment of a cancer.

The Prostate Cancer Prevention Trial was a clinical trial that tested whether Finasteride, which induces a deficiency of the enzyme 5-alpha reductase, would prevent prostate cancer. This trial was based upon the fact that prostate cancer does not occur in the absence of testosterone and that men with a congenital absence of 5-alpha reductase (that functions to convert testosterone to the activated form, dihydro-testosterone) do not develop benign or malignant prostate growth. This 7-year study involved almost 20,000 men who were randomly assigned to Finasteride or placebo. The study was terminated 15 months early because a 25% risk reduction for prostate cancer was achieved on Finasteride. The other finding was that the prevalence of higher-grade cancers was slightly higher in the Finasteride group (6.4% vs. 5.1%); however, Finasteride is known to change the pathological appearance of the prostate in such a way as to make determination of an accurate grade difficult.

A number of years ago, I was given the disheartening news that I had sunburn on my crown!  A balding pate frankly did not appeal to my sense of vanity!   After topical Minoxidil (Rogaine) proved ineffective, I started taking Propecia (a.k.a. Finasteride) every morning. Lo and behold, my thinning crown filled in and ultimately I had a full re-growth of hair.  When the Prostate Cancer Prevention Trial report came out revealing a 25% risk reduction for prostate cancer associated with the use of Finasteride, this cinched it—particularly insofar as my father had been diagnosed with prostate cancer.  Finasteride is a drug that fixes my bald spot, shrinks my prostate, and helps prevent prostate cancer, for which I have a family history. It seemed like a win-win situation, a no-brainer!

Bottom line:  Prostate cancer is very prevalent in men, involving one in six men in the USA.   When picked up on a timely basis via screening with the digital rectal exam and blood PSA test, it is eminently treatable and has an excellent prognosis, with only 3% of deaths in the USA attributable to prostate cancer.  There are both genetic and environmental factors at work in the genesis of prostate cancer.  We are not in control of our genetics, but we are in command of our lifestyle.  Maintaining a healthy lifestyle—including rational food choices—can help mitigate our chances of developing prostate cancer.

Andrew Siegel, M.D.

September 30, 2011

For more information on prostate cancer:

American Cancer Society:

American Urological Association Foundation:

Cancer Care:

National Cancer Institute:

National Prostate Cancer Coalition:

Prostate Cancer Foundation:

Prostate Cancer Research and Education Foundation:

Us TOO Prostate Cancer Education and Support Network:


Psych 101 As It Relates To Eating

September 24, 2011

There are a number of psychologists whose works are relevant to our behaviors with respect to food and eating. I have selected few—Freud, Pavlov, Skinner, Csiksczentmihalyi, as well as the French author, Proust. My intent is to summarize their seminal contributions and discuss how viewing our eating behaviors through the prisms of their perspectives and philosophies can provide us with insight and understanding of not only why we eat for emotional reasons, but also to help us eliminate our inappropriate eating behaviors.

Why bother learning the philosophy of the aforementioned psychologists and authors? Many intelligent people I have spoken with tell me that they don’t really care about the psychological underpinnings of their eating behaviors, only about how they can achieve weight loss and keep it off. So how can this knowledge improve our ability to get to a healthy weight and stay there? The answer is because when we eat for the wrong reasons and emotions drive dysfunctional eating patterns, we must be cognizant of our behaviors and make every effort to understand them in order to change them. Freud’s divisions of the psyche, Pavlov’s classical conditioning, Skinner’s operant conditioning, Csiksczentmihalyi’s concept of flow, and Proust’s “Madeleine” each offer a unique framework to comprehend the basis of human behaviors, including eating. Even more importantly, these formative contributions offer insights into how to manage dysfunctional eating behaviors in order to achieve the endpoint of a healthier relationship with food, healthier eating patterns and a healthier weight.


The model of the human psyche established by Sigmund Freud divides our psyche into the ego, id and super-ego.  Our ego acts in accordance with the reality principle. The domain of the ego is conscious awareness, reason and common sense. Our ego is responsible for the delicate balance between primitive drives and reality, essentially mediating between the two poles of the id and super-ego. Our ego can be thought of as the adult within.  Our id operates in accordance with the pleasure principle. The domain of the id is instinctual impulses, drives and passions that demand immediate satisfaction. Our id can be thought of as the child within. Alternatively, our id can be understood in terms of the devil inside.  Our super-ego serves a role as our conscience. The super-ego aims for perfection and punishes misbehavior with guilt. Alternatively, the super-ego can be construed as the angel within us.

This framework of the psyche can be helpful in analyzing eating behaviors. Our eating can be id-driven in which we seek to achieve immediate pleasure and gratification with no thought of responsibility or of the long-term effects of that indulgence, a devil-may-care attitude. By the same token, super-ego-driven eating demands careful scrutiny and deliberation about any food item that is consumed, with great consideration given to mindful eating for the purpose of satisfying hunger and maintaining health. Any transgression from the super-ego’s tight rein and control over eating behavior would result in guilt, the avoidance of which motivates angelic eating patterns. Ego-driven eating is the compromise between these two polar extremes. This is human eating behavior practiced by many of the one-third of the population that maintain a healthy weight—generally sensible, but with occasional excursions into id domain and super- ego domain that allow us to tip over into over-indulgent eating and then right ourselves.

Although some of us display primarily ego-driven eating with forays into id-driven eating that are checked by our super-ego drives, many of us are id-predominant and a few of us are super-ego predominant. Those who do most of their eating based upon sheer instinct, with immediate-gratification-seeking consumption with no thought given to long-term consequences, are likely to be overweight or obese. Conversely, those whose eating style is tightly controlled and carefully measured, with the utmost of mindfulness applied to food choices and eating behavior, are unlikely to be overweight or obese. Super-ego driven eating is not necessarily a healthy behavior—it can be extreme just as id-driven eating is—and its obsessive nature can lead to problems such as anorexia.

Another name for id-driven eating is promiscuous eating. This wanton, impulsive and reckless eating behavior can cause or contribute to obesity. A realistic goal to counteract id-driven promiscuous eating is to employ a mindful eating strategy in order to achieve balance and moderation—not obsessive mindfulness, simply a judicious amount of attention and awareness applied to our eating. We do not need to be angels at all moments—we simply need to be mindful of when and why the devil is influencing our behavior—be aware of it, think about it, understand it—and then either avoid the behavior, intervene by stopping before it gets out of hand or, if we must succumb, substituting a healthy alternative for an unhealthy indulgence. In other words, when our eating is id-driven, we should strive to recognize what is going on through mindfulness, and then turn on the super-ego to get us back on track to ego-driven eating.


Ivan Pavlov was a Russian physician, physiologist and psychologist who won the Nobel Prize in medicine. He is best known for describing classical conditioning, summarized as follows: meat causes dogs to salivate, an instinctual reaction called an unconditioned response. Pavlov used a metronome to call his dogs to their meaty meal and, after a few cycles of repetition, the dogs began to salivate on the basis of just the sound of the metronome. The reaction to the metronome is called a conditioned response, since it is a learned behavior.

Human beings are not all that different from Pavlov’s dogs. Many foods literally elicit a “mouth watering” unconditioned response and certain specific contexts and environments can exact a conditioned response in the absence of the specific food item. This can certainly help explain the foraging for food that many of us pursue coincident with the television getting turned on. The same phenomenon happens in many movie theatres where accessory eating occurs as a result of the collusion of classical conditioning and opportunistic, temptation, and social forces. A similar situation happens to many of us as we enter our homes and head into the kitchen where all the food-associated context clues—the refrigerator, pantry, kitchen table, cookie jar, etc.—trigger our desire to eat via the classical conditioning pathway. The importance of classical conditioning vis-à-vis eating is that food-associated context cues can elicit a conditioned response that can trigger eating and drive overeating, weight gain and obesity.

A solution to eating driven by classical conditioning is to try to override it via mindfulness. When context is the initial drive to partake, the indulgence will not occur until the impulse becomes an action. When the television goes on and we get that strong urge to munch, in spite of not being hungry and perhaps just having finished a satisfying dinner, there are a number of solutions. We are intelligent and highly evolved cognitively, and we can and should be aware of the situation at hand. Before transforming the notion into an action, we can exercise a thought process to try to quell the conditioned response. That process might be musing about the folly of eating when not hungry, consideration of obesity, heart disease, clothes not fitting, flab around the waistline, etc. Our mindfulness and cognitive powers can override urges and reflexes—you might call this a mindful de-conditioning of a conditioned response.  Alternatively, we can succumb to the conditioned response, but eat only a small portion of the item we desire, or even better, swap our craving from its intended source to a healthy, colorful, crunchy, natural substitute such as fruit or veggies. Not only can we de-condition a conditioned response, but we also can actually re-condition ourselves to have a yearning for something healthy when we are exposed to context clues. Another possibility is to exchange the act of eating for an alternative activity such as exercising. An example of this is my post-work routine: after a day at the office, when I enter my house through the kitchen, I have conditioned myself to think of heading down to the basement to work out in lieu of staying in the kitchen and snacking.


As a behavioral psychologist, B.F. Skinner believed that behavior could be explained on the basis of external and observable causes, and not by internal motivations. Operant conditioning is a means of learning governed by rewards and punishments meted out for the performance of certain behaviors. Behavioral change or learning occurs as associations are made between a given behavior and a consequence for that behavior. In operant conditioning, the promise or possibility of reward causes an increase in the behavior and the imposition of punishment causes a decrease of the behavior.

How does this relate to eating issues? For many of us, food functions to placate our state of emotional un-wellness. Comfort food consumption soothes our souls and drives continued comfort food consumption. I’m really stressed and beaten up from a horrible day at work, so two large pieces of seven-layer chocolate cake are going to do the trick. I deserve it. The problem is that this consumption is a behavior that begs repeating the next time the negative emotion surfaces. So, as the behavior gets reinforced again and again, a behavioral pattern gets established and over time, it gets more and more difficult to break.  Additionally, food can serve as a reward for certain behaviors—I did this, so I deserve that kind of logic. I passed the exam, so I deserve a hot fudge ice cream sundae. So food serves a role in an entire range of emotional circumstances—to tranquilize and mollify a negative state, or, just as likely, to reward a positive state.

How do we combat the reward effect provided by the consumption of food to help calm our frazzled or heightened emotions? We must use Skinner’s behavioral schema and think about the reward in negative terms—by mindful consideration of the long-term negative consequences of the continued behavioral pattern (being overweight, obese, diabetic, etc.) vs. the short-term reward/gain. Instead of a re- ward (present), we need to think presence of mind. The seeming reward is, in fact, a punishment to our long-term physical and emotional well being and serves only as a short term palliation that also functions to further perpetuate the cycle. Remember, in operant conditioning the promise or possibility of reward causes an increase in the behavior and punishment causes a decrease of the behavior. So, we are applying mindfulness to Skinnerian logic to think of emotional eating in terms of punishment to cause a decrease in the behavior. If mindfulness and intellectualization are insufficient to stem the emotional or reward eating, alternatively, consumption of just a taste (portion control) of the comfort food or reward is one possibility, and another is swapping out the reward for a healthier substitute, like exercising.


Mihaly Csiksczentmihalyi is a psychologist who has written about the concept of flow—a zen-like, heightened state of intention, concentration and complete mental engagement. This condition of full immersion in the activity at hand puts us in the zone where there are no distractions, time seemingly is arrested, our performance is optimal and a sense of fulfillment is derived. Achieving this state of flow requires focused attention and awareness, and pursuits including yoga, meditation and martial arts can help direct us into the flow groove.

To what extent flow can be cultivated is uncertain, although engaging in the aforementioned activities can definitely improve our abilities to become more mindful, which is a solid step towards achieving flow. It would seem that achieving the state of flow is equivalent to the ultimate state of mindfulness, uber-mindfulness, if you will. Mindfulness, awareness and attempts to achieve flow are powerful weapons when brought to the food and eating arena. With laser-focused mindfulness, dysfunctional eating patterns become more obvious and solutions more readily employed.


Marcel Proust was a French author who is known for his novel Remembrance of Things Past, in which it is revealed how the act of eating a madeleine pastry enables the narrator to evoke powerful memories with astonishing clarity and richness. Mere words cannot do justice to the remarkably vivid memories elicited and rekindled by the sight, smell and taste of this pastry, so the reader is referred to Proust’s novel.

My personal “Proustian Madeleine” is a peach. When I grasp a fuzzy peach in my hand and draw it up to my face and breathe in deeply to take in the sweet aroma, I am immediately transported to the backyard of my grandparents’ house. I am about ten years old and it is the peak of summer, the sun is high in the sky on an intensely blue-skied, cloudless day and verdant grass and shrubs surround my grandmother and me. Their neighbors have a grand old peach tree whose branches hang over into my grandparents’ backyard. Many of the peaches are ripe and the air is redolent with the perfume of peaches ready to be eaten. I reach up and pick a big, perfectly round, pink and orange colored, downy, fragrant fruit. I bite into the succulent peach, close my eyes and the juice trickles down my face. When I open my eyes, my grandmother is smiling at my delight.

To this day, peaches evoke so many rich and vivid memories— times when there were no worries or responsibilities; my long since deceased, beloved grandmother; the warmth of summer; being out- doors on an idyllic day; nature; bliss. I am convinced that one of the reasons I love peaches, aside from the joy that they provide on face value, is their ability to allow me to revisit powerful memories and associations.  In essence, I have a deep-seated form of conditioned response to peaches. My conditioned response of sorts is also an operant reward—a positive memory—from the thought process stirred up. This cheerful and upbeat conditioned response and operant reward will certainly drive me to continue to seek out peaches in particular, certainly a healthy indulgence. And I suppose that if it were a madeleine, a doughnut, or cheesecake that was the food item that evoked such happy memories, then I would be driven to eat them as opposed to my healthier indulgence.

Perhaps on a subconscious level, we are driven to eat food items that evoke in us a Proustian madeleine-type response and this may help explain in some way our propensity towards certain foods, whether they be healthy or not. Possibly, this may be a factor in the over-indulgence of certain food items that contribute to the American overweight and obesity epidemic. The Proustian response is such a formidable and compelling force that, if the food item that elicits the response is unhealthy, I am not sure that there is any simple solution. And if our positive Proustian moments are associated with healthy foods, we are most fortunate indeed.

Excerpted from Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food.

Aging Young

September 17, 2011

With the occurrence of my birthday this past week and lots of birthdays of family members this month, I have been thinking about longevity, the aging process, and why—for so many of us—there is a glaring discrepancy between how old we are and how old we look.

Our collective longevity has improved dramatically over the past few centuries.  The 19th century was the Century of Hygiene (improved public health and sanitation saved more lives than any other cause), the 20th century was the Century of Medicine (vaccines, antibiotics, transfusions, chemotherapy, etc., helped contribute to longevity), and the 21st century will be the Century of Healthy Lifestyles—whereby longevity will be increased by reducing risky behaviors and making positive changes with regards to exercise and nutrition.

Aging is an inevitable occurrence, but how we age is within our control to a significant extent. We have it within our own power to maintain health, vitality, and quality longevity—to walk with a spring in our steps and to feel energized and content. Aging is, of course, a 100% fatal proposition, and the best recommendation to push the limit of it is to first do no harm by avoiding malignant behaviors. So the first general rule is active omission—avoid doing bad—do not eat excessively, stay away from harmful substances such as fast food, tobacco and drugs, be moderate when it comes to such things as alcohol and ultra-violet light exposure, minimize stress, etc. The second recommendation to push the limit of aging is active commission—do good—eat properly, exercise vigorously, get enough sleep, seek preventative maintenance, respect yourself, invest in yourself, engage in the fitness and health lifestyle, live well!

“You have to work on longevity…” “My ‘secret’ is that you have to plan for your life. You need to plant the seeds and cultivate them well. Then you can reap the bountiful harvest of health and longevity.” 

(Jack LaLanne, at age 92)

“The secret to aging well is simply living well.”

(A rabbi in his 80’s, who is a patient of mine)

Chronological age refers to how old you actually are (in years, months, days, etc.); physiological age refers to your functional age, the age at which your organ systems and other body parts are functioning.  There can be a great disconnect between chronological and functional ages—one can have a chronological age of 40 and a functional age of 30; or alternatively, someone may chronologically be age 40, yet have a functional age of 60. This disparity basically comes down to genetics and lifestyle. A desirable goal is to maintain a functional age that is as young as possible.

Through my interviews with many chronologically older adults who were physiologically much younger than their years of life would seemingly indicate, certain attributes of aging well and aging long became obvious:

  • An active, purposeful and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose
  • Ample exercise and physical activity
  • Mental engagement and commitment to interests and hobbies—reading, travel, games, art, music, crafts, pets
  • A healthy diet
  • Avoidance of self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun, excessive risks—an “everything in moderation” attitude
  • Close relationships with family and friends with sources of strength being a good social network and perhaps religious/spiritual pursuits; in particular, being in a good marriage seems to be a very important attribute of aging well
  • Optimistic and grateful attitude—cheery, happy and upbeat dispositions with a sense of hope about what the future will bring, a good sense of humor and the ability to deal positively with stress
  • The ability to adapt to loss or change
  • Good genes
  • The practice of preventative maintenance
  • Care about yourself, respect yourself and invest in yourself—live well

Andrew Siegel, M.D.

If interested in a free electronic download of Finding Your Own Fountain of Youth: The Essential Guide to Health, Wellness, Fitness & Longevity, go to the Promiscuous Eating site and click on “links.”

Wealth Is Health: Your Exercise Savings Account

September 10, 2011

Your Exercise Account: Building Sweat Equity

Sadly, many people seek and ultimately obtain financial wealth at the expense of their health, not realizing the fact stated so clearly by poet/author Ralph Waldo Emerson:“the first wealth is health.”  Without health, having financial wealth is absolutely meaningless!

We do our best to save for retirement, although with our current economic crisis—high unemployment, slow gain in wages for those fortunate to be employed, falling house prices, our national debt burden and the strong possibility of a double-dip recession—it has become much more of a struggle to do so.  We earmark money for Individual Retirement Accounts and 401K plans, annuities, and other similar retirement vehicles that allow us to sock away resources in investments for the future.  Some day, we will no longer be working and will need to tap our savings to live.  And hopefully, we will be living for many years after retirement.

Sweat equity is a business term used to describe the non-financial contribution of time and effort that is fundamental to the success of a business endeavor. I borrow this term and extend its use to the fitness and health arena.  As many of us hopefully have retirement savings accounts, I propose that we all have a Sweat Equity Account as wellbasically, a Fitness Account.   It consists of time and effort put into exercising and maintaining fitness.  The tenets of obtaining and maintaining a fitness account run parallel to the principles of obtaining and maintaining a retirement account and are as follows:

  • Have a plan.   Understand the need for and the importance of your fitness account.  If you invest wisely in this account, it will pay you back in spades. 
  • Pay yourself first.   Carve out the time for fitness and commit to it automatically—this guarantees that it is a priority to be tampered with only under the most unusual circumstances.  This will ensure regular deposits to build your personal fitness nest egg.
  • Slow and steady approach.   A moderate amount of exercise, deposited to the account on a diligent and regular basis, will ultimately allow for complete funding of your fitness account.
  • Start early.   The earlier you begin the fitness account, the more time available to work the magic of compounding, when the investment returns themselves earn further returns. You will earn returns in the form of “interest and dividends” (improved quality of life), and “capital gains” (augmented quantity of life).   If you missed the boat on starting early, don’t waste another minute…start today.  It is never too late.
  • Long-term perspective.  The greater the investment in terms of time invested, the larger the fitness nest egg builds.  The commitment to this plan needs to be a lifetime endeavor.  No gimmicky investments!    No shortcuts!  No tricks or instant rewards!  No nonsense!
  • Seek investment counseling.   Not everyone is capable of managing his or her own fitness account—if not, seek the services of a professional personal trainer or fitness instructor.  Their services will be well worth their cost.
  • Diversify.   Deposit into your account all different forms of fitness investments, including aerobic and endurance activities, weight training, core, flexibility exercises, etc…. include lots of variety in your portfolio.  Shake it up a bit.  I personally like cycling, tennis, golf (always walking the course, if possible), yoga, Pilates, P90x, etc.—by doing something different every day you don’t give yourself an opportunity to get bored and you get the benefit of working different areas of your body and different aspects of fitness.
  • Eliminate debt.   Pay down and eliminate debt, of which one component can be thought of as the fitness deficit that you owe yourself from past exercise omissions.  The other component should be thought of as your current debt in terms of excessive body weight and the burden of bad lifestyle choices.  You will reap the benefits of becoming debt free through exercise and healthy lifestyle and eating habits.

Your contributions to your Fitness Account will ultimately make you wealthy; that is, “healthy wealthy”…it just takes time and tenacity.  And some day, when sickness or disease will inevitably surface, you will be equipped to strike a noble fight because of your years of investment in yourself. 

“Living is a pain in the butt.  Dying is easy.  It’s like an athletic event.  You’ve got to train for it.  You’ve got to eat right.  You’ve got to exercise.  Your health account, your bank account, they’re the same thing.  The more you put in, the more you can take out.”

Exercise is king and nutrition is queen: together, you have a kingdom.”

Jack LaLanne (2006)

Andrew Siegel, M.D.

To view my brief video on the merits of exercise, visit:

Tempus Fugit (Time is flying)

September 3, 2011

Tempus Fugit

As another birthday rapidly approaches, I wax philosophical about the aging process. I will soon be 56, a not insignificant number of years now being well behind me.  The numbers do not lie, but the feeling is surreal in quality—how is this possible? I still look reasonable young (although the grays are coming in but good), and feel great, particularly invigorated at this particular moment after a two-hour bike ride with my wife on our tandem hybrid in preparation for the upcoming Bergen Bike Tour fundraiser.

The aging process is insidious. The years creep by, seemingly slowly at first; then, ever so gradually, the wheel of time starts to crank faster and faster with greater and greater momentum, until the weeks and months roll past at a dizzying and frightening warp speed. Before you know it, you are 50 years old and are at the summit of the mountain, looking down at the back face or, for you golfers out there, you’re on the back nine.

The older you get, the faster the perception of the passage of time gets. When I was a child, a single summer seemed to represent an eternity; now, in midlife, the summers blur by at a rate that challenges my sanity. Family events that are scheduled on the calendar for a few years from now seem to approach at an uncomfortably rapid pace and, suddenly, are here. Part of this may be explained on a strictly mathematical basis—for a five-year-old, one year represents 20% of his or her life, whereas for a 50- year-old, it represents a mere 2%.

The lightness of being is an additional factor facilitating the perception of the rapid passage of time—we float around the planet consumed by a variety of roles that we play, always in a hurry, constantly on the move, existing without giving a great deal of thought to actual existence—as a result, existence seems to lose its substance, weight, meaning, and time framework. We are so consumed by our numerous mundane daily destinations, working, traveling, living in our oftentimes insular circles, that we are remiss in attending to the real journey, the true process, life in its entirety. Our pursuit of a productive and busy career does not necessarily lend itself to the awareness of time: time consciousness, if you will. We are all ever increasingly focused on our day-to-day activities, too caught up in maintaining our routines to take notice of the hours, weeks, and years speeding by. It is a Zen precept that life is to be found in the present moment, and not the future. Lack of focus on the here and now with too much attention to the next moment can be a factor in the perception of time passing at warp speed.

The bottom line is that the future is approaching in a fast and furious fashion and most of us desire to maximize our time—one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to quote author/columnist Ben Stein paraphrasing Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To further quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”

Stop for just a second or two to fully understand the notion that our time is truly limited, that the clock is ticking away relentlessly. So what is one to do in the face of this seemingly harsh reality? The only thing you can do is try to appreciate every moment, put your best effort into every endeavor, and relish the journey because the inevitable destination for ALL of us is exactly the same. This is essentially an expansion of Tony Horton’s “BRING IT” concept (regarding exercise) to life in general.

“Life is a fatal adventure. It can only have one end. So why not make it as far ranging and free as possible.” Alexander Eliot (author/critic)

“We are living on borrowed time.”  Father Americo Salvi, my patient

Our Mojo is Ageless

 “Age isn’t how old you are, but how old you feel.” Gabriel Garcia Marquez, Memories of My Melancholy Whores

 Our driving force and passion—spirit and vitality, if you will, is something that we are born with and generally never changes with the aging process. No joke! I’m, at my essence, just a 55-year-old kid with the same mental attitude, energy, and life force that I have had since childhood. When my twelve-year-old daughter inquisitively seeks advice from me, I answer her questions as best I can, but secretly feel like I am party to a grand charade— I am really an imposter—a poseur—a child in a man’s body, and at any time my duplicity will be unmasked. I honestly do not feel any different than I did when I was eighteen. The flame of joie-de-vivre, or lack thereof, that we are imbued with does not die or change as we age. Too many of us harbor a misconception that physical aging is associated with aging of mind and attitude. WRONG!! Questioning my own ninety-year-old grandfather, a Russian immigrant who was employed as a Brooklyn “seltzer man,” about this confirmed my already sneaking suspicions about this stability of passion. He conveyed to me that our drive, enthusiasm, and spirit are truly independent of chronological age.

“Never abandon the spirited fire of spontaneous, determined inspiration that sparks dreams into majestic conclusions, marvelous deeds, and spectacular endings.” Bernard Ficarra, M.D.

“You are old when you lose the capacity to dream and be creative.” Shlomo Raz, M.D.

Bottom line:  Time races on, seemingly faster and faster.  So eat well, stay fit, take good care of yourself, live well, be well, treat yourself well and enjoy what life has to offer.  As the cliché states, this is not a dress rehearsal nor is there a second act so…carpe diem (seize the day).

Happy Labor Day weekend and may our United States employment stagnation rapidly correct itself.

Andrew Siegel, M.D.