Archive for September, 2012

The Zoo On You (Our Microbial Ecosystem)

September 29, 2012

Andrew Siegel, M.D.   Blog #77


There is an invisible “zoo” that lives on and in our skin, mouths, nasal passages, intestines, etc. We are literally teeming with this wildlife park of microscopic creatures —bacteria, viruses, fungi—that live on and in you and me. We are like coral reefs in the sense that other species take up harbor on or within us, although in this case, the tenants are microbial. This extensive menagerie of microorganisms consists of an incredible diversity of species with an estimated population of 100 trillion—collectively it is referred to as the microbiome.  Every one of us has a unique community of microbes, predicated on our genes, diet and environment.  This invisible ecosystem is dynamic and will change with variations in our diet and environment.

Many bacteria have been justifiably given a bad rap—methicillin-resistant Staph aureus (MRSA), E. Coli O157:H7, Clostridium difficile, etc.—as they are potentially very hostile creatures that can wreak havoc to our health and even kill us. However, not all bacteria and other microbes are our evil enemies; in fact, many are valuable, beneficial and are, in fact, vital for our health and existence, and that is the nature of our microbiome.

Our microbiome is primed at birth, when we depart the sterile environment of the womb.  Our initial exposure is to our mother’s vaginal flora or skin flora, depending upon whether the delivery is vaginal or via C-section.  This “jumpstarts” our immune system and provides us with our own micro-cosmos of creatures that will help us survive and thrive.  One of the key residents of a pregnant woman’s vagina is Lactobacillus.  This species usually resides in the gut, where it makes enzymes to help digest milk. During vaginal delivery, the baby is exposed to an abundance of these bacteria, theorized to prepare the baby to be able to digest breast milk.  Breast-feeding further charges up the microbiome, as breast milk contains hundreds of species of healthy bacteria.  In the first few years of life, our microbiome ecosystem gets increasingly complex as new microbes are added through contact with family members, our diet, and exposure to our environment including animals and other human beings.

There is a lot of truth in the following joke by George Carlin:

When I was a little boy in New York City in the 1940’s, we swam in the Hudson River. And it was filled with raw sewage! OK? We swam in raw sewage, you know, to cool off. And at that time the big fear was polio. Thousands of kids died from polio every year. But you know something? In my neighborhood no one ever got polio. No one! EVER! You know why? Cause WE SWAM IN RAW SEWAGE! It strengthened our immune system, the polio never had a prayer. We were tempered in raw shit!

Most of the invisible residents composing the microbiome are not harmful to humans and in fact, are vitally helpful to us in many ways.  This colony of aliens lives on our skin, in our nose, mouths, and gastro-intestinal and uro-genital tracts.  Our largest organ—the skin—is swarming with good bacteria, some of which break down the oily secretions of skin cells, creating a moisturizing film that provides suppleness and prevents cracks that could allow entry to those harmful microbes that can cause invasion and disease.

The greatest population of microbes resides in the gastro-intestinal tract.  This makes sense, since that’s where the most abundant food supply is.  Hey, why did Willie Sutton rob banks? …. Because that’s where the money is. We carry at minimum a few pounds of microbes in our intestines.  They confer many  advantages to us, including the following: they digest components of plant-based fiber that we cannot break down on our own; they synthesize vitamins, e.g, Bacteroides, which produces Vitamin K; they help release beneficial chemicals from food; they activate, train and maintain our immune systems; they suppress those microbes that can cause food poisoning, e.g., Lactobacillus salivarius in our mouths makes a toxin lethal to Listeria monocytogenes; and they guard against virulent (hostile) microbes by virtue of the magnitude of good bacteria present.

Our gut microbiome is very much influenced by our diet.  Interestingly, lean people seem to have very different intestinal microbes than obese people, and diabetics have very different intestinal microbes than non-diabetics.  Gut bacteria can digest fiber that we cannot on our own and are thus capable of allowing us to harvest additional energy.  The microbiome of obese people plays a role in regulating how cells use sugar for energy and in fat storage.  Certain bacteria in the gut can cause an inflammatory response that promotes fat storage and weight gain. It has been proposed that, like diet and exercise, gut microbes should be regarded as an additional factor affecting our overall energy balance.  Different gut microbiome composition can help explain why the absorption of nutrients and medications varies so much from person to person.

The fascinating story of Clostridium difficile (C. difficile)

This bacteria inhabits the intestine of about 8% of healthy people without causing harm or symptoms.  It remains non-hostile, as long as its population remains checked by the presence of a large population of healthy bacteria.  A C. difficile infection is commonly acquired under the circumstance of taking broad-spectrum antibiotics. These antibiotics not only kill the bacteria that they are intended to kill, but are also lethal to the “good” bacteria, allowing the C. difficile to flourish and predominate.  In the majority of people who don’t normally have C. dificile in their microbiome, it is acquired in hospitals or nursing homes, where it is spread by the fecal-oral route (not washing hands after bowel movements).  Toxins produced by the bacteria cause a horrible diarrhea with potential dire consequences.

In the United States, C. difficile causes more deaths per year than HIV infections.  The treatment of choice is to stop the broad-spectrum antibiotics that are responsible for killing off the good bacteria, and starting an antibiotic called Vancomycin, that is capable of killing C. difficile.  For refractory cases that do not respond to these means, fecal transplantation—transferring stool from a healthy donor to an ill patient to restore the normal balance of gut bacteria (i.e., the actual injection of healthy fecal matter into the colon via colonoscopy)—has proven highly effective.

How To Be On The Best Terms With Your “Zoo”:

  • Unless you have an immune deficiency, you do not need to live a life in quarantine—remember, in his joke, George Carlin made a very telling point.
  • Don’t use anti-bacterial soaps as they can kill off some of our good bacteria; good old plain soaps are just fine.
  • Don’t overdo it with hand sanitizers.
  • Don’t use antibiotic creams for every minor wound—clean with soap and water and cover with a band-aid.
  • Don’t beg your doctor for antibiotics.  More than 50% of antibiotic usage in the United States is both inappropriate and unnecessary.  Most common infections are viral—not bacterial—and the use of antibiotics is not only ineffective, but also a waste of resources and selects for a population of bacteria that are resistant to antibiotics.
  • Probiotics such as yogurt can help repopulate the microbiome if there is cause to believe it has been disturbed.  (This will be the subject of a blog in the very near future).

There’s no need to say “ewww” about your own personal “zoo”; rather, attempt to do everything to leave it undisturbed so that it can provide you with its natural health benefits.


Men’s Health, May 2012: The Dirty Little Secret Of Perfect Health by Jim Thornton

New York Times, March 20, 2012: Gut Infections Are Growing More Lethal by Denise Grady

Nutrition Action Newsletter, July/August 2012: Living In A Microbial World—Learning To Love Your Bacteria by David Shardt

New York Times, June 19, 2012: Attending The Bodies Microbial Garden by Carl Zimmer

ZOOBIQUITY: What Animals Can Teach Us About Health and the Science of Healing, Barbara Natterson-Horowitz, M.D. and Kathryn Bowers

Andrew Siegel, M.D.

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

Available in paperback or e-book on Amazon Kindle

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Anti-Oxidants 101

September 21, 2012

Blog #76   Andrew Siegel, M.D.

The image above depicts a meal teeming in anti-oxidants.  It is actually my lunch from today, which is very Mediterranean is style.  In the large bowl is a terrific salad with mixed greens, tomatoes, cucumbers, carrots, red cabbage, onions, red pepper, olives, falafel and feta cheese; on the side is whole wheat pita bread with hummus; ice water with fresh lemon as a drink; for dessert, non-fat yogurt with fresh blueberries, strawberries and figs.  

Oxidation is a chemical reaction that occurs in the presence of oxygen and water: given sufficient time for the oxidative reaction to occur, the process is capable of altering physical appearances—and, unfortunately, not for the better. Oxidation is the process responsible for changing the original copper-colored Statue of Liberty into the greenish color it now appears.  Oxidation is responsible for changing the appearance of the exposed inner portion of a cut apple from white to a brownish discoloration. Oxidation corrodes the exposed iron on a scratch on our cars, causing rust.

Oxidation can promote the aging of our cells, the rusting of our cellular structure, if you will.  Insofar as humans are an immense array of cells organized into tissues and organs, oxidation is one of the processes responsible for causing aged, “rusty” human beings.

The oxidative stress theory hypothesizes that over the course of many years, oxidative damage occurs via the accumulation of by-products of our metabolism, from environmental toxins to which we are all exposed, and from the general wear and tear of our bodies. What results are free radicals, unstable oxygen compounds that contribute to DNA damage. These reactive oxygen species engender inflammation, aging, diseases, and ultimately, death. These reactive oxygen species adversely affect normal cell functioning. For example, free radicals can attack collagen and elastin (responsible for skin elasticity and tone), resulting in aged-appearing, wrinkle-laden, saggy skin. Free radicals can also damage cells in the eye, causing age-related macular degeneration, a leading cause of blindness.

The great irony is that oxygen is an absolute necessity for life, but reactive oxygen species can shorten life. What to do? Anti-oxidants can slow the oxidative damage process. These are vitamins, minerals, enzymes and natural food pigments that act as “scavengers” that can mitigate the damage caused by the reactive oxygen species. The most common anti-oxidants are vitamins A, B-6, B-12, C, E, folic acid, lycopene and selenium. Many plants contain anti-oxidants—they are found in beans, fruits, vegetables, grain products and green tea. The bright colors of many fruits and vegetables are a good clue as to the presence of high levels of anti-oxidants—so  give some thought to adding a rainbow of colors to your diet including pinks, reds, oranges, yellows, greens, blues, and purples.  For a few examples, pinks include pink grapefruit; reds include pomegranate and tomatoes; oranges include squash, oranges, carrots, cantaloupe, papaya, apricots and sweet potatoes; yellows include butternut squash, bananas, mango and lemons; greens include broccoli, spinach, kale, kiwi, avocado, and asparagus; blues include blueberries and Belgian endive; and purples include plums, red grapes, cherries, purple cabbage and eggplant.

In addition to a bountiful intake of anti-oxidants, minimizing exposure to first-hand and second-hand cigarette smoke as well as excessive ultra-violet radiation from sunlight can help control harmful free radical accumulation. As beneficial as anti-oxidants are, they carry some potential negatives, specifically when it comes to their intake via vitamin supplementation.  For example, excessive beta-carotene (Vitamin A) supplementation has been linked in some studies to an increased risk of lung cancer in smokers. Mega amounts of Vitamin E in those with heart disease or diabetes have been associated with an increased risk of heart failure. It seems that no one truly knows all of the risks associated with high vitamin supplement doses, nor for that matter, all of the salutary effects of anti-oxidants on the aging process. Hopefully, ongoing scientific studies will further elucidate this matter. For the meantime, the best advice is to consume your vitamins by eating your fruits and vegetables, especially brightly colored ones. If your diet is inadequate in these terms, vitamin supplements in moderate doses can be an excellent source of anti-oxidants and may be considered a beneficial dietary measure until proven otherwise.

The ravages of aging, exposure to sunlight, tobacco, alcohol, environmental chemicals, etc., are constantly damaging our cells.  When a cell is damaged, on occasion this aberrant cell can replicate, multiply and ultimately develop a blood supply of its own—when this occurs, it is known as a cancer. Food and nutrition can act as a promoter or killer of aberrant cells.  Plants contain anti-cancer compounds,  so consuming a variety of fruits and vegetables, particularly vibrantly colored ones can be a boon to our health. The following are a list of some of the pigments in fruits and vegetables that can have profound salutary benefits: Indoles, found in cruciferous vegetables such as cauliflower, broccoli and brussel sprouts; lycopene, a red pigment found in tomatoes, watermelon and pink grapefruit; carotenoids, an orange/yellow pigment found in carrots, corn and cantaloupe; anthocyanins, a blue/purple pigment found in blueberries and raspberries.

Here, then, is the take home message:  Choose a diet rich in plant-based foods from the colors of the rainbow—these will help to maximize the efficiency and effectiveness of your cells in staving off disease processes as well as many of the signs/symptoms of aging.  They will provide you with all the vitamins and anti-oxidants you need to for optimal health and wellness.

Andrew Siegel, M.D.

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

Available on Amazon Kindle:

Fat: Location, Location, Location Matters

September 14, 2012

Andrew Siegel, M.D.     Blog #74


We all have body fat; even elite athletes have a body composition that is a svelte 5-10% fat—this translates into roughly 10-20 pounds of fat for a 180-pound athlete.  What is important is that all fat is not created equal—where the fat accumulates in our bodies dramatically effects how that fat behaves.  So, the very location where your fat takes up residence has a tremendous influence on your health.

Fat on our body surface is much less problematic than fat deep within our body. Humans have two basic types of fat: subcutaneous fat and visceral fat. Subcutaneous fat—also known as “love handles,” “spare tires,” “muffin tops,” or “middle-age spread”—is present between the skin and the abdominal wall. When present in normal amounts, it gives us nice contours and makes us look less bony and skeletal and more smooth and curvy. When present in excessive amounts, it makes us look plump, roly-poly and pear-shaped. A moderate amount of subcutaneous fat is of little danger to our health and, in fact, provides us numerous advantages including padding and insulation to conserve heat and help with temperature regulation, a means of storage of fat-soluble vitamins, and a ready source of energy. Visceral fat—also referred to as a “pot belly,” “beer belly,” or “Buddha belly”—is internal fat deep within the abdominal cavity that can make us apple-shaped.  It wraps around our internal organs including our liver, kidneys, and pancreas. Visceral fat is always unhealthy fat that can have dire metabolic consequences. In general, waist circumference is a reasonably good measure of visceral fat. (Of course, morbid obesity due to either type of fat can prove extremely  dangerous to one’s health.)

It’s kind of like real estate, the value of which is predicated on location, location, location. Think of visceral fat as prime, expensive beachfront property on the gold coast with a short walk to the ocean, the ocean of metabolic disasters.  Think of subcutaneous fat as less expensive, inland property, quite removed from this ocean of metabolic disasters.  Clearly, visceral fat is fat that behaves badly and fat that is strongly desirable to avoid.

In many ways, the distinction between subcutaneous and visceral fat parallels the distinction between good fats and bad fats in our diet.    The not unhealthy one or two inches of subcutaneous fat that you can pinch around your waistline can be thought of as a good fat such as the fat in olive oil, avocados, or nuts.   On the other hand, the unhealthy visceral fat that causes a man to have a big protuberant abdomen—creating an appearance not unlike a very pregnant female—can be thought of as bad fats such as the partially hydrogenated fats present in vegetable shortening that are commonly used in fast foods and other processed baked goods.

Visceral fat storage is not static but dynamic, meaning that there is continuous mobilization of our fat (as fatty acids) and storage (as triglycerides).  Lipolysis is the chemical reaction in which the fat is broken down into fatty acids that the body can use as energy. This can occur very readily in visceral fat. Likewise, accumulation of visceral fat can occur in a very rapid fashion. Excessive intake of calories will be rapidly stored as visceral fat, whereas under circumstances of a reduced calorie intake, the visceral fat is broken down to provide fuel for our bodies’ metabolic processes, particularly muscle contraction.

Visceral fat is not just a bland collection of fatty tissue sitting inertly within your belly causing an oversized appearance to your abdomen.  It is an extremely metabolically active endocrine organ with a life of its own.  Fat is the largest endocrine organ in our bodies and it releases a myriad of pro-inflammatory factors, hormones and immune cells that can affect metabolism and other bodily functions. Fat has an abundance of the hormone aromatase, which converts testosterone to the female hormone estrogen.  One consequence of too much fat in men is excessive conversion of testosterone to estrogen. Men with plentiful visceral fat often will bear the consequences of lower testosterone and higher estrogen levels, including sexual issues and breast development as well as numerous other negative consequences of insufficient levels of testosterone.

Visceral fat is intimately connected to the inflammatory process and can result in insulin resistance, metabolic syndrome, cardiovascular disease and an entire array of negative health ramifications, including chronic diseases such as arthritis and cancer.  This is in contradistinction to subcutaneous fat, which produces far less inflammatory chemicals. Since men have a tendency towards visceral fat collection whereas women have a tendency towards subcutaneous fat collection, this might explain why women are less susceptible to cardiovascular disease then men are.

Insulin is the principal regulator of fat metabolism. After a sugar and carbohydrate load, insulin is released to get the fuel into our cells. When we go without food, as happens when we sleep, insulin levels decrease and fat is released to be used as fuel.  Insulin levels are determined primarily in response to our carbohydrate intake in order to keep our blood sugar regulated. Insulin has much to do with the way our bodies store or burn fat. You can think of insulin as our fat hormone—when insulin levels are elevated, we accumulate fat; when levels are low, we burn fat for fuel.  So if you have a substantial collection of visceral fat, it becomes highly desirable to reduce sugar and refined carbohydrate intake to decrease insulin and burn away that bad, pro-inflammatory fat as fuel. The good news is that by losing abdominal fat, the potentially bad health repercussions can be reversed. The dangerous visceral fat submits relatively easily to diet and exercise whereas the less harmful subcutaneous fat at the waist is more stubborn and resistant to reversal measures.

How To Burn Fat:

  • Eat in accordance with nature’s design—meaning whole foods.  Avoid processed foods.  The best diet is an “anti-processed-atarian” diet.
  • Avoid “naked” calories (stripped of fiber), so restrict sugar, simple white carbohydrates, and liquid calories. Specifically avoidsugared drinks, white pasta, white rice, white bread, doughnuts, bagels, potatoes, etc.  Aggressively steer clear of high fructose corn syrup.
  •  Eat high-quality, whole-grain, high-fiber carbohydrates (whole grain pasta, brown rice, whole grain breads, legumes, whole fruits and vegetables), lean protein sources (easy on meat and dairy) and healthy fats (vegetable and seafood-origin).
  • Avoid giant meals in which the caloric load will be stored as fat; substitute with multiple smaller meals in which the calories will be used for immediate energy.
  • Limit after dinner snacking since unnecessary calories at a time of minimal physical activity will be stored as fat.
  • You must incorporate exercise into your lifestyle, achieving balance between aerobic, resistance and core workouts.  Aerobic exercise has great potential in burning fat for fuel and interval training seems to really rev up our fat-burning capabilities.
  • Portion control is the name of the game: in order to burn fat, energy intake must be less than energy output.  Even if you eat only the healthiest of foods, if calories in exceed calories out, you will not burn fat for fuel.
  • Minimize stress; if you can’t eliminate it, work to manage it.
  • Get adequate amounts of quality sleep.  See my previous blog entitled “Sleep To Slim” to find details:

The bottom line is that while body fat in any excessive amount is unhealthy and unattractive, it becomes a potentially life-threatening issue depending on its location in our bodies.  An enormously protuberant belly can lead to processes that result in disease—and even death.

Andrew Siegel, M.D.

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

Now available on Amazon Kindle


Emotional Eating: Podcast Interview Of Dr. Siegel

September 7, 2012

This week’s blog is a change of pace–it is a podcast of Morty Lefkoe interviewing Andrew Siegel on the subject matter of Dr. Siegel’s book.  The interview delves into maladaptive, emotional eating patterns and tactics and strategies that can be employed to develop healthier eating behaviors.  Click on the following link to access the interview :

Morty Lefkoe is president and founder of The Lefkoe Institute, and is the creator of The Lefkoe Method, a series of psychological processes that result in profound personal and organizational change, quickly and permanently. He is also the author of Re-create Your Life: Transforming Yourself and Your World.  Morty has written over 100 articles and columns for such publications as the Wall Street Journal and the New York Times. He has also appeared on over 100 radio and TV shows, including Today, Leeza, ABC World News Today, and Fox Cable News. He is a member of the American Counseling Association and has written articles describing the Lefkoe Method in The California Therapist, The Group Therapist Perspective, and the California Psychologist. In addition, Morty has spoken before groups such as the American Management Association, Vistage, American Psychotherapy Association, American College of Counselors, American Association of Integrative Medicine, National Wellness Coalition, Managed Health Care Congress, Association for Fitness in Business, and the American Psychological Association-National Institute for Occupational Safety and Health. He has conducted over 200 seminars for groups of CEOs on “A Proven Method for Successfully Instituting Change” and “Limiting Beliefs, Business and Personal: How to Identify and Eliminate Them.”

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

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Man-Oh-Pause: When Things Are Not So Good Under The Hood

September 1, 2012

Blog #73     Andrew Siegel, M.D.


“T”  (an abbreviation for testosterone) has become a very commonly used and in vogue term. Many of my patients come into the office specifically asking for their T levels to be checked.  The pharmaceutical industry has been responsible for direct-to-consumer advertising of testosterone replacement products, a practice that has promoted this recent grass-roots awareness of testosterone issues, a subject that was previously the domain of urologists and endocrinologists.

T is that all-important male hormone that goes way beyond male sexuality.  Testosterone has moved to the endocrine vanguard and is now regarded as a key factor in men’s health. Current evidence suggests that a man’s testosterone level might serve a function as a good indicator/marker of general male health.

Aside for contributing to libido, masculinity and sexual function, T is responsible for the physical changes that commence at the time of puberty, including pubic, axillary and facial hair, deepening voice, prominent Adam’s apple and increased bone and muscle mass.  Additionally, T contributes to our mood, bone and muscle strength, red blood cell count, energy, and general mojo.  Most testosterone is manufactured in the testicles, although a small percentage is made by the adrenal glands.

There is a gradual decline in T that occurs with the aging process—approximately a 1% decline each year after age 30.  This will occur in most men, but will not always be symptomatic.  40% of American men aged 45 or older have low or low range T.  Low T is associated with metabolic syndrome and diabetes, bone mineral loss, and altered sexual function.  Specifically, symptoms of low T may include one or more of the following:  fatigue; irritability; depression; decreased libido; erectile dysfunction; impaired orgasmic function; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; abnormal lipid profiles. Essentially, low T can accelerate the aging process.

Belly fat is literally the enemy of masculinity and a testosterone-choker that can push you in the direction of the female gender.  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 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—the “turtle effect.”  If your belly blocks your view of your penis, your pubic fat pad makes your penis difficult to locate, your breasts have filled out, and your libido and erections are sub-par, it may just really be time to rethink your lifestyle habits!

Abdominal obesity—an accumulation of fat in our midsections—not only is unattractive from a cosmetic standpoint, but can have dire metabolic consequences that can affect the quality and quantity of our lives. Obesity has a pivotal role in the process leading to low T and waist circumference is a reasonable proxy for low T. Fat is not just fat—it is a metabolically active endocrine organ that does way more than just protrude from our abdomens.  Fat has an abundance of the hormone aromatase, which functions to convert T to the female sex hormone estrogen (E).  The consequence of too much conversion of T to E is the potential for gynecomastia, aka man boobs.  Too much E slows T production, and with less T, more abdominal obesity occurs and even more E is made, a vicious cycle (literally a vicious circus) of male castration and emasculation.

Obesity can steal away your masculinity, male athletic form and body composition, mojo, strength, and also one of your most precious resources—the ability to obtain and maintain a good quality erection.  Remember the days when you could achieve a majestic, heaven-pointing erection simply by seeing an attractive woman or thinking some vague sexual thought?  Chances were that you were young, physically active, and had a svelte build with a hard abdomen. If those days are mere memories, it is probable that you are now carrying extra pounds, have a soft and protuberant belly, and are not physically active.  When you’re soft in the middle, the consequence is that you will probably be soft down below. The good news is that by losing the abdominal fat, the unfortunate consequences of low T can often be reversed.

How To Turn On Your Testosterone Boosters: 

  • A healthy lifestyle, including good eating habits, maintaining a healthy weight, engaging in exercise, obtaining adequate sleep, moderation with respect to alcohol intake, avoiding tobacco, and stress reduction are the initial approaches to treating low T engendered by abdominal obesity.  Insufficient sleep can lower T.  Excessive alcohol increases the conversion of T to E.  Maintaining an active sex life can help maintain T.
  • It is of paramount importance to lose the abdominal fat, with the caveat that a sufficient caloric intake of quality food and nutrients is necessary to prevent the body going into “starvation mode,” which can substantially decrease T production.
  • In terms of exercise, a healthy balance of aerobic, resistance, and core training is best, but in particular, vigorous resistance exercise is crucial.  This will help the flabby abdomen disappear and build lean muscle mass, which in turn will increase metabolic rate.

If lifestyle modification fails to improve the symptoms of low T and T remains measurably low via a simple blood test, a trial of T replacement under the supervision of your doctor can provide a meaningful improvement of your quality of life.

Andrew Siegel, M.D.

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

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