Archive for August, 2012

Minor Choices…Major Differences (In Waistline)

August 25, 2012

 Andrew Siegel, M.D.  Blog # 72


Many of us are literally bombarded with food exposure at work where opportunity and temptation can undermine healthy eating patterns.  For example, in my office we have pharmaceutical and device representatives who bring lunch in for our staff at least a few times weekly. It’s really a very nice perk, but it can be too much of a good thing.  Although some of the lunches are healthy, many are not—and it takes a bit of wisdom to avoid poor choices and over-consumption, both of which can leave one feeling acutely bloated, with an expanding waistline and a ticket to poor future health and chronic disease. I have found that minor, smart  and prudent choices applied diligently can keep the waistline stable and maintain health, wellness and vitality.

For example, a “rep” brought in Cassie’s wood-burning pizza and a big tray of chicken Caesar salad for yesterday’s office lunch.  The following is a deconstruction of my decision process and the choices made—choices that occur in reflex, subconscious, automatic fashion because they have become ingrained habits that help me swiftly navigate the complex world of eating.

Decision #1: I will eat a maximum of two slices pizza; one serving of salad—(portion control; no need to be a pig and down three or four pieces; no desire to feel stuffed, bloated and sluggish all afternoon.)

Decision #2: Pizza with the veggies on top, not the pepperoni—(I love veggies and never eat fat-oozing, coronary-clogging, mystery meat products: what’s in there anyway?)

Decision #3: Avoid the croutons in the salad—(They are tasteless, salty, white bread remnants that are just soggy refined carbs.)

Decision #4: Drizzle just a touch of salad dressing on—(No need for ruining a healthy salad with a big glob of fattening creamy Caesar dressing.)

Decision #5: Avoid the soda and the diet soda and instead grab a large glass of spring water—(Who needs “naked” calories, a load of high fructose corn syrup and artificial colors or calorie-free sugar substitutes?)

Bottom line: There is a great deal of leverage to be had by minor, consistently applied sensible eating choices. 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

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What’s This Metabolic Syndrome I’ve Been Hearing So Much About?

August 18, 2012

Andrew Siegel, M.D.    Blog #71


The “metabolic syndrome” is a cluster of risk factors that are dangerous to your health.  These include visceral obesity as defined by waist circumference, elevated blood glucose level, high blood pressure, elevated triglycerides, and low HDL cholesterol (the good cholesterol).  Visceral obesity is a collection of fat within the abdomen as opposed to under the skin (subcutaneous fat).

When a patient walks into the office and the first thing observed is a protuberant and bulging belly, a siren goes off screaming “metabolic syndrome, metabolic syndrome, metabolic syndrome.”

If you have at least three of the following five risk factors, you have metabolic syndrome.  Those who have metabolic syndrome often develop cardiovascular disease and/or type-2 diabetes.

 Features of Metabolic Syndrome:


  • Elevated waist circumference: men > 40 inches; women > 35 inches
  • Elevated triglycerides: > 150 mg/dL
  • Reduced HDL (“good”) cholesterol: men < 40 mg/dL; women

< 50 mg/dL

  • Elevated blood pressure: > 130/85 mm Hg
  • Elevated fasting glucose (sugar): >100 mg/dL

One of every four Americans has metabolic syndrome. This syndrome is caused by insulin resistance—the body’s inability to properly process nutrients including sugars and fats because the pancreatic hormone insulin no longer works in an efficient manner to get nutrients into our cells.  The root cause of insulin resistance is too much waist and not enough movement.  Essentially, our well-engineered systems are “flooded” by taking in excessive calories.  Our bodies simply were not designed for chronic caloric overload, and the only people who can handle this caloric flooding are endurance athletes who burn the calories, such as Michael Phelps.

Triglycerides are the main fat in food and the bloodstream.  One in three adults have a fasting triglyceride level higher than 150; optimally, triglycerides should be under 100.  Even a non-fasting triglyceride level should not be that high, because no healthy person should ever develop an extremely high level even in response to a fatty meal.  Diets high in sugar are the major underlying cause of elevated triglycerides.

The good news is that lifestyle modification has a very positive impact on triglyceride level—it is very possible for triglycerides to decline as much as 30% based upon a diet with less calories, sugar, saturated fat and alcohol.  EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are marine-derived omega fats that are capable of lowering triglycerides.  Fish contain these two omega-3 fats because they consume algae that are rich in them.   Exercise is an equally important component of lowering triglycerides, since it activates lipoprotein lipase, which breaks down triglycerides.

Ways To Avoid Metabolic Syndrome:

  • Lose excess weight to improve each of the five features of metabolic syndrome
  • Eat a diet with abundant fruit, vegetables, and fiber
  • Minimize saturated fats and refined carbohydrates
  • Minimize sugar: the American Heart Association recommends a maximum of 6 teaspoons daily for women and 9 for men, including the sugar in processed foods
  • Eat fatty fish high in EPA and DHA including salmon, herring, sardines, halibut and trout; if you don’t eat fish, take fish oil capsules
  • Exercise will facilitate weight loss and will improve every feature of metabolic syndrome

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Now available on Amazon Kindle


Eat It Raw

August 11, 2012

Blog # 70   Andrew Siegel, M.D.


There are numerous health advantages to eating raw produce.  As a general premise, the less our food is processed, the healthier it is—and cooking is certainly a form of processing.  There is often some degree of nutrient loss as a vegetable or fruit is cooked.   If weight loss is a concern, raw is particularly good because one expends more calories just to break down raw food as opposed to cooked food, which is essentially “pre-digested.”   Also, since raw foods are less calorie-dense because of increased water content, they not only are more filling, but also require more energy to heat the increased water content to body temperature.  The need to use additional calories to burn calories is called the thermogenic effect.  For example, eating raw broccoli has a strong thermogenic effect; drinking soda has very little thermogenic effect.

Clearly, raw food is less digestible and more bulky and filling than its cooked brethren. Raw foods require more chewing and thus more exercise of our masseter muscles of the jaw—hence more calories burned. This increased requirement for chewing—think raw carrots vs. cooked—forces us to eat more slowly and increases our satiety.  The high fiber content of raw fruit and vegetables slows digestion and minimizes glucose fluctuations, modulating insulin spikes and thus helping to prevent fat deposition and weight gain, in addition to its beneficial effect on bowel regularity.

Forget about all of the potential benefits for health and vitality for a moment.  On a more primal level, there is nothing like the delight derived from a piece of ripe, juicy, aromatic summer fruit bursting with sweetness and intense flavor. The vibrant color appeals to our vision, the sweet scent is alluring, the feel in our hands and mouth is pleasing, in addition to being downright delicious and a reminder of the beauty of the simple and natural things that life has to offer.

By no means am I recommending a totally raw produce diet, but it is reasonable to shake it up and consume some vegetables and fruits in their natural state.  Most people eat some raw vegetables in the form of salads, and raw fruit is often the norm for most of us.   But many of us would be well served to increase the amount and variety of raw veggies in our diet.   Think of a nice crudité platter as opposed to mushy cooked vegetables. Keep in mind a beautiful red delicious apple vs. a baked apple or applesauce.

Advice of the day: Eat a salad with crunchy vegetables before a meal to help decrease caloric consumption during the meal.  Throw in some strong flavored veggies like radicchio, scallions, radishes or arugula because their intensity is so stimulating that they can induce satiety, allowing us to eat less. Alternatively, a piece of fruit before a meal will achieve the same endpoint.  Experiment with how you use raw fruits and vegetables—the results can be a delightful change for your palate, and a slimmer waistline.

Andrew L. Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Available on Amazon Kindle

Tapping Into Our Pharmacy Within

August 4, 2012

Blog # 69    Andrew Siegel, M.D.

We all have the capacity to tap into a powerful pharmacy housed within our physical beings.  Our bodies are incredibly engineered “machines” with an array of organs, tissues and cells that produce a cocktail of powerful natural chemicals and hormones that can dramatically influence and affect our mood, energy, focus, drive, etc.

I am capable of tapping my pharmacy within through vigorous exercise. It probably accounts for my “addiction” to exercise and my suffering from withdrawal symptoms if I miss a day or two.  Exercise is certainly not the means for everyone—we all need to try to discover own method for exploiting this robust pharmacy that does not demand a prescription, expense or medicine cabinet. Walking doesn’t cut it for me—I need to sweat, huff and puff and feel my heart pounding.

Most days, I do not get the opportunity to exercise until after work, at 5PM or so.  On rare occasions, I will have a gap between early morning procedures and afternoon office hours, an interlude that affords me the opportunity to actually go home, exercise, shower and have lunch before returning to the office.  Recently, I had one such lovely day.   I started the day with a 6:30AM procedure at the surgery center and because of the sheer efficiency of the facility, I was finished by 9AM, not having to return to the office until noon.  I went home, changed, headed to the basement and pulled out one of my P90x DVDs, specifically the back and biceps workout.  I exercised for an hour or so, and even though this particular workout was primarily resistance, I still worked up a good sweat and got my heart pumping and lungs heaving.  After a hot shower and a healthy lunch, I headed to the office, refreshed, renewed, restored and invigorated.

My office is hectic and office hours are often stressful.  However, on days in which I get to exercise midday, no one and nothing can “hurt” me.  I find myself super-alert, focused, energetic and immune from the many frustrations and irritations that typically chip away at my good spirits.  I am unequivocally convinced that vigorous exercise releases dopamine, endogenous opiates and a cocktail of internal chemicals that are responsible for my heightened state of mind, vigor, stamina, equanimity under pressure and resistance to the usual stressors that typically leave me fatigued, depleted and emotionally and physically spent.

I vow that I must schedule exercise into my midday routine—for the benefit of myself as well as my patients— but I never do, the rare occasion it occurs is due to happenstance.

“Exercise is medicine, and every man needs a daily dose.”

Jordan Metzl, M.D.

Andrew L. Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Available on Amazon Kindle