Archive for April, 2013

Happiness Deconstructed

April 27, 2013


Andrew Siegel, MD   Blog #104


What causes us to experience the emotion of happiness? Certainly, under the right set of circumstances, our bodies release a “cocktail” of “happy” chemicals including serotonin, dopamine, endorphins and numerous other elusive mediators of the mysterious mind-body connection.  But what is the root source of this reaction—what sets this biochemical cascade of happiness into motion? 

There have been several recent articles on the subject of happiness in the New York Times—Gary Gutting and Elizabeth Weil have both opined on the determinants of happiness.  Reading them has provoked me to wax philosophical on the topic

I begin with a quote from Martha Washington that I believe to be factual: “The greater part of our happiness or misery depends upon our dispositions and not our circumstances.” Every human has a happiness set point that is probably largely genetic in basis.  When “favorable” events occur and the “threshold” is surpassed, our happiness sense is triggered; with “unfavorable” occurrences, the threshold is not achieved and not only is happiness not triggered, but unhappiness may be prompted.

We bring that set point (disposition) into any and every situation that we face.  For example, when I recently found out that my daughter (who is completing her junior year in college) was accepted into a paid summer internship program in the field in which she desires to work (marketing/fashion), I was elated, both from the practical standpoint of her obtaining a solid position aligned with her career desires, but also from the vantage point of my being happy for no other reason than because of her being happy.  The Yiddish term “naches”—meaning happiness at another’s success—was brought into play here. On the other hand, when earlier this week I received a letter from a lawyer about a copyright infringement based upon two Google images that I used for my educational videos and blogs, I became quite distraught and unhappy, and felt a sullen heaviness of my jaw line, blunting any possibility of a smile.

As Gary Gutting articulated in his New York Times article, there are a number of factors that determine our happiness or lack thereof, and I will highlight them in boldface.  Happiness typically demands that we are sufficiently free of physical and emotional suffering.  I deem this to be largely true, with rare exceptions, as some remarkable people even in the most dire of circumstances—such as being confined to a concentration camp or being severely physically compromised—are able to maintain happiness and meaning in their lives. There is much wisdom in the words of Nietzsche: He who has a ‘why’ to live for can bear almost any ‘how.’

Luck certainly plays a prominent role in determining our happiness—the good fortune to be healthy and to be born into a family of reasonable means that can provide basic necessities. Although money cannot buy happiness, it can buy food, shelter, medications and security, all of which can help us to be rendered free of suffering. As my father’s friend Stuart Goldsmith stated so succinctly with regard to money: “It’s not so good with as it’s bad without.”  In other words, as desirable as it is to have means, it is even more desirable to avoid not having means.

Pursuing meaningful and fulfilling work that is satisfying to both the individual and society at large is an important determinant of happiness.  Unfortunately, there are many meaningful and fulfilling sources of work that do not provide a sufficient means of earning an adequate living, many of these occupations being in the creative arts. On the other hand, there are many sources of work that provide sufficient means to earn an adequate living, but are unfulfilling—what comes to mind are the many unhappy lawyers I know of who have left the profession for more satisfying work. The challenge is to find work that provides both meaning and sufficient means.  Although much of my work can be routine, repetitive and even monotonous at times, my profession certainly brings me moments of great human connection where I have been able to truly help someone in terms of his or her quality and quantity of life, and making such a difference brings with it a heady sense of happiness and satisfaction.

I’m not sure of the source from which I co-opted the following lines, but I appreciated it enough to have it framed and displayed in my office.   It is a parable about one’s personal sense of the meaning of their work experience.   Three stonecutters building a cathedral in the 14th century were interviewed regarding their work.  The first stonecutter replied with bitterness that he is cutting stones into blocks, a foot by foot by three quarters of a foot. With frustration, he describes a life in which this is done over and over, and will continue to do it until he dies. The second stonecutter is also cutting stones into blocks, a foot by foot by three quarters of a foot, but he replies in a somewhat different way. With warmth, he tells the interviewer that he is earning a living for his beloved family; through this work his children have clothes and food to grow strong, and he and his family have a home, which they have filled with love.  But it is the third man whose response gives us pause. In a joyous voice, he tells us of the privilege of participating in the building of this great cathedral, so strong that it will stand as a holy lighthouse for a thousand years.  Clearly, one’s perspective and disposition can affect one’s sense of happiness.

Human connection and love is a sine qua none for happiness: our spouse, our children, other family members, and friends.  It is in the company of others that we are often most happy, although we need to be reasonably intrinsically happy in order to be happy in others’ presence.

Pleasure—defined as immediate gratification of one or more of the five physical senses (but also aesthetic feelings directed towards art, beauty and nature)—is an obvious determinant of happiness.  In my opinion, pleasure is not so much derived from things and possessions as it is from activities and experiences. In the words of Graham Hill: “Intuitively, we know the best stuff in life is not stuff at all, and that relationships, experiences and meaningful work are staples of a happy life.”   

The “little things” that pique my senses (sensual happiness) provide more “happiness fuel” than possessions such as a fancy car or jewelry including, for example, the following: a bike ride on a beautiful and sunny afternoon with birds chirping and the fragrance of honeysuckle; walking on the beach seeing and hearing the waves crash at your feet while inhaling the scent of the sea and hearing the gulls; rolling on the carpet frolicking with my English Springer Spaniel; a great massage; reading an engaging book; laughing; watching a movie lying on the couch in comfortable well-broken in jeans and a cozy old sweatshirt with my leg intertwined with my wife’s; a very early weekend morning on a gray and sullen, Seattle kind of winter day, clacking away on my computer keyboard, articulating my thoughts into the written word while my family sleeps safely and peacefully upstairs; drinking a St. Pauli Girl beer from a frosty mug when I’m so thirsty that my mouth is parched; listening to beautiful music; watching my youngest daughter sing and perform; hitting a perfect, soft approach shot on the green; crafting a delicate drop shot on the tennis court; etc.

What can make many of us happiest is when we can overcome an issue or circumstance that previously made us very unhappy. I digress with a short anecdote to illustrate this point.  I am a recreational doubles tennis player who participates in a U.S.T.A. league.  Several years ago, my team won first place in the men’s 4.0 league in Bergen County and had to compete against the first place team in Essex County in order to determine who would go to the regional play-offs in Syracuse.  When I arrived at the outdoor courts in Essex County, I was introduced to our two opponents.  One player had been on the doubles team that had beaten my doubles team 6-0, 6-0 the previous year.  The other opponent was an aggressive, incredibly unpleasant plaintiff’s attorney who had represented a party that had sued me in a medical malpractice case that went to trial on two occasions; I had prevailed in both of them but, nonetheless, they had proven a source of great frustration, anger and annoyance for me. I didn’t recognize him at first, but it soon became readily apparent who he was.  So, my opponents were a player who embarrassingly “double-bageled” us on a previous occasion and a vicious, relentless plaintiff’s attorney who had caused me indescribable angst.  The match became much more than a match, and in a grueling victory of 6-4, 6-4, our win became the deciding match in propelling our team to the regional matches.  I was hyper-focused and single-minded, as the need for that win became of exaggerated, all-consuming importance and the victory never tasted sweeter or brought me a greater sense of happiness and justified retribution and redemption for all that had gone before.  It was with the greatest of delight that evening when I sent off an email to the attorney, informing him that it was an absolute pleasure having prevailed in both the court of law as well as the tennis court…yes, I am perhaps guilty of a little schadenfreude.

I end this composition with a quote from Viktor Frankl that nicely sums up some of the salient features of happiness: “Happiness cannot be pursued; it must ensue, and it only does so as the unintended side effect of one’s personal dedication to a cause greater than oneself or as the by-product of one’s surrender to a person other than oneself.  Happiness must happen: you have to let it happen by not caring about it.”

And yes, you may have gleaned something about my general feelings about lawyers!

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

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Wise Choices: Eating Clean

April 20, 2013

Andrew Siegel, MD   Blog #103



Justin, age 35, when interviewed for Promiscuous Eating stated the following: I eat meal to meal—I don’t think ‘big picture’—I try to make good choices versus poor choices, without planning ahead.”


Justin has the right mindset with respect to healthy eating.  And to quote the wise words from Bootcamp Goldcoast (an Australian reader of this blog): Obviously both of these elements (exercise and healthy eating) are critical for losing weight (and keeping it off) but personally… I don’t think either are the most important.For me, mindset is by far the most important tool for losing weight. A good strong mindset is the thing that will bring exercise and diet together, it will give you the focus and belief to become what you’re capable of.


It’s not difficult, nor complicated nor long-term, although a series and succession of short-term wise choices will translate into long-term success.  It’s a very practical, here-and-now means of approaching food choices that many of us face on a daily basis, and when employed, will help keep us trim and svelte, as well as healthy.  Wise choices involve the consumption of “clean” fuels—the polar opposite of wise choices is “promiscuous” eating. 


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 (e.g., three times this past week). It gives the reps some quality time with the doctors and staff to brief and update us on drugs that we prescribe.  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—in the manner of Justin and the mindset of Bootcamp above—that minor, smart and prudent choices applied diligently can keep the waistline trim and maintain health, wellness and vitality.


So, for example, on Monday a lunch was hosted that included the following foods:  salad; corn chips; broiled veggies; soft tortillas; boneless chicken; sliced steak; rice; cheese; refried beans; guacamole; soda; and water.  There was an abundance of choices of varying levels of  “healthiness.”   I abided by the “Justin” and “Bootcamp” principles in an effort to make a series of wise decisions. The following is a deconstruction of my decision process and the choices made—choices that occur in reflexive, subconscious, automatic fashion because they have become deeply ingrained in order to help navigate the complex world of eating and the surprises that one may encounter at any given time.


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


Grab a large plate of salad—(Crunchy, healthy, colorful, full of anti-oxidants and low in calories and fat.)


Minimize the croutons in the salad—(Salty white bread remnants that are just soggy refined carbs.)


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


Boneless white meat chicken vs. steak—(Chicken wins, hands down—less calories and saturated fat.)  Throw a few pieces of chicken in one soft tortilla (one is enough for lunch); place a little guacamole on top (guacamole trumps the cheese, avocado vegetable fat being healthier than the animal fat in the cheese.) Add some of the broiled veggies—broccoli, mushrooms, peppers, and zucchini—to round it out. (Better to fill up with veggies than more meat.)


Skip the rice and refried beans—(I’ll be quite satisfied with the chicken and veggie tortilla I made, supplemented by the salad…and who needs to be bloated at lunch with white carbs (rice) and heavy, greasy, gas-producing beans—after all, I need to work in the afternoon and don’t have the leisure of being able to nap…or keep running to the bathroom!)


Bottom line: There is a great deal of leverage to be had by making minor, consistently applied, sensible eating choices. A smart mindset and eating meal-to-meal without planning ahead will serve you well.

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Time Out

April 11, 2013


Andrew Siegel, MD  Blog #102


I am now just a few short years away from 60 (how is that possible?), inciting me to wax philosophical about the aging process.  The numbers are concrete and I view and interpret them through a surreal prism of disbelief and astonishment, still appearing reasonably young and internally feeling no different than 20 or 25 or 30. Factually, the average life expectancy for a male in the USA is 75.5 years.  So the truth of the matter is that if I am fortunate enough to achieve average longevity, I have already lived 75% of my life. And generally speaking, the last 25% of one’s life are not the best years in terms of one’s health, as I can attest to as a physician.

Somehow and some way, humans are imbued with a powerful mechanism of denial that allows us to isolate realities such as these and store them on some imaginary shelf, bottled in some imaginary can to be sequestered and quarantined and not to be contended with.  If we did not have this ability, the psychic pain would be unbearable and thanks to this artifice, we manage to endure emotional burdens. This allows me to proceed under the delusion that I am still “young” and have my whole life in front of me and I remain hopefully optimistic about what the future will bring, and my optimism is self-fulfilling.

I completed my fellowship at UCLA and continue to receive mailings and updates from this superb medical institution.  I just received their publication “Vital Signs,” which has a section for my demographic advertising their “Fifty Plus” program, which offers educational lectures, a walking program, information on community and health resources, membership amenities, a free community flu shot clinic, and special events. In the Spring 2013 edition, the following classes were offered: Senior

Scholars; Memory Training Course; Brain Boot Camp; Vision Problems in Older Adults; Health Maintenance and Disease Prevention; Tai Chi Workshop; Introduction to Dementia; Senior Health Fair; Vaginal and Bladder Mesh Surgery; and Dizziness. Oy Veh…woe is me!

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 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 one gets, the faster one’s perception of the passage of time. 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 initially 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%. Another factor in the perception of time racing faster and faster is our pursuit of a career—being productive and busy does not necessarily lend itself to the awareness of time: time consciousness, if you will. Many of us are 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.

The lightness of being is an additional factor contributing to 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. 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 hopefully desire to maximize our time—irrefutably one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to paraphrase Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”

As my former golf instructor-cum-philosopher Hank related to me, every opportunity we have to swing a golf club at a ball is a unique moment in space and time—a different day, a different course, a different ball, a different lie, a different mood, a different weather forecast—a moment that will happen once and only once and then will be gone forever. So, since you have one and only one chance at making the most of this unique slice (pardon the pun) of eternity, why not give it your all

and make it count to the best of your abilities. This concept is a useful metaphor when extended to life in general.

So what is one to do in the face of this seemingly harsh reality? The answer is 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 overall.

“We see life through a screen of thoughts and concepts, and we mistake those for reality.  We get so caught up in this endless thought-stream that reality flies by unnoticed.  We spend our time engrossed in activity, caught up in an eternal pursuit of pleasure and gratification and eternal flight from pain and unpleasantness.  We spend all of our energies trying to make ourselves feel better, trying to bury our fears, endlessly seeking security.”

Bhante Henepola Gunaratana

“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

“Do stuff. Be clenched, curious.  Not waiting for inspiration’s shove or society’s kiss on your forehead.  Pay attention.  It’s all about paying attention.  Attention is vitality.  It connects you with others.  It makes you eager.  Stay eager.”

Susan Sontag

“Don’t betray time with false urgencies.” 

Jack Kerouac

“For of all sad words of tongue or pen, the saddest are these—it might have been.”

John Whittier

“The miracle is not to walk on water.  The miracle is to walk on the green earth, dwelling deeply in the present moment and feeling truly alive.”

Thich Nhat Hanh

“Life moves pretty fast.  You don’t stop and look around once in a while,

you could miss it.”

Ferris Bueller

“Learn as if you were to live forever. Live as if you were to die tomorrow.”



“….Time is passing faster and faster every day.  Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose.  And I’m starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life’s sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time.  It is dreadful.  But since it’s my own choices that’ll lock me in, it seems unavoidable—if I want to be any kind of grownup, I have to make choices and regret foreclosures and try to live with them.”
David Foster Wallace

“The first half of life is orderly, a miracle of detailed harmonious unfolding” beginning with the embryo.  What comes after our reproductive years is “more like the random crumpling of what had been neatly folded origami, or the erosion of stone.  The withering of the roses in the bowl is as drunken and disorderly as their blossoming was regular and precise.”

Jonathon Weiner


“What surprises me most about humanity is man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

The Dalai Lama, when asked what surprised him most about humanity.

“Maybe it’s not metaphysics. Maybe it’s existential. I’m talking of the individual US citizen’s deep fear, the same basic fear that you and I have and that everybody has except nobody ever talks about except existentialists in convoluted French prose. Or Pascal. Our smallness, our insignificance and mortality, yours and mine, the thing that we all spend all our time not thinking about directly, that we are tiny and at the mercy of large forces and that time is always and that every day we’ve lost one more day that will never come back and our childhoods are over and our adolescence and the vigor of youth and soon our adulthood, that everything we see around us all the time is decaying and passing, it’s all passing away, and so are we, so am I, and given how fast the first forty two years have shot by it’s not going to be long before I too pass away, whoever imagined that there was a more truthful way to put it than “die,’ “pass away”, the very sound of it makes me feel the way I feel at dusk on a wintry Sunday—’

And not only that, but everybody who knows me or even knows I exist will die, and then everybody who knows those people, and might even conceivably have even heard of me will die, and so on, and the gravestones and monuments we spend money to have put in to make it sure we are remembered, these’ll last what—a hundred years? two hundred? – and they’ll crumble, and the grass and insects my decomposition will go to feed will die, and their offspring, or if I am cremated the trees that are nourished by my windblown ash will die or get cut down and decay, and my urn will decay, and before maybe three or four generations it will be like I never existed, not only will I have passed away but it will be like I was never here.

That everything is on fire, slow fire, and we’re all less than a million breaths away from an oblivion more total than we can even bring ourselves to even try to imagine, in fact probably that’s why the manic US obsession with production, produce, produce, impact the world, contribute, shape things, to help distract us from how little and totally insignificant and temporary we are.”

David Foster Wallace, from “The Pale King”

“Life is tough.  It takes a lot of your time, all your weekends, and what do you get at the end of it?  Death, a great reward.  I think that the life cycle is all backwards.  You should die first, get it out of the way.  Then you live twenty years in an old-age home.  You are kicked out when you are too young.  You get a gold watch, you go to work.  You work forty years until you’re young enough to enjoy your retirement.  You go to college, you party until you’re ready for high school.  You become a little kid, you play, you have no responsibilities, you become a little boy or girl, you go back into the womb,  you spend your last nine months floating.

 And you finish off as a gleam in someone’s eye.”

Jack Kornfeld
“Reverse Living”

Bottom Line: The reality is that the “end of the line” comes far too quickly. So, enjoy and protect in every way possible what you have today. Carpe Diem!


Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Obesity and Urology

April 5, 2013

Andrew Siegel, M.D.  Blog #101

A whopping two-thirds of adults in the USA are either overweight or obese.   In 1960 the obesity rate was 13%; currently it is 36%. Our physical activities have diminished, our stress levels and our portion sizes have increased, and our derrières have expanded accordingly.  There are an increasing abundance of readily available, unhealthy, processed, cheap foods.  These factors in sum have contributed to our weight gain and to a very negative impact on our overall health.  In addition to the more obvious increased risk for high cholesterol, high blood pressure, heart disease, stroke, and diabetes, weight gain and obesity are also associated with an increased incidence of gallstones, arthritis and other joint problems, sleep apnea and other breathing problems, as well as certain cancers. There are many other less obvious effects that obesity has, negatively impacting every system in our body.

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.  It is important to understand that fat is not merely the presence of excessive padding and insulation that signifies excessive intake of energy—but a metabolically active endocrine “organ” that does way more than just protrude from our abdomens, producing hormones and other chemical mediators that can have many detrimental effects on all systems of our body.  So, fat is not just fat. Today’s blog will focus on the harmful ramifications of weight gain and obesity on urological health. As a urologist, on a daily basis I sadly bear witness to the adverse effects and ill consequences of America’s bulging waistline.

Overactive bladder (OAB) is a common condition that causes urinary urgency, frequency, the need to run to the bathroom in a hurry, and at times urinary leakage before arrival at the bathroom. There is a clear-cut association between weight gain and the presence of OAB.   Similar to the way obesity taxes the joints, particularly the knees, so it burdens and puts pressure on pelvic organs including the urinary bladder.

Stress urinary incontinence (SUI) is a frequent ailment in adult women in which there is leakage of urine associated with a sudden increase in abdominal pressure, such as with sneezing, coughing, lifting, laughing, jumping, and any kind of strenuous exercise. Although the major risk factor is pregnancy, labor, and delivery, weight gain is clearly associated with exacerbating the problem.

Pelvic organ prolapse (POP) is a prevalent issue in adult women in which one or more of the pelvic organs—including the bladder, uterus, or rectum—drop down into the space of the vagina and possibly outside the vagina.  Similar in respect to stress urinary incontinence in that the major risk factor is pregnancy, labor and delivery, it is most certainly associated with weight gain and obesity, which have a negative effect on tissue strength and integrity.

Kidney stones are a major source of pain and disability and are very much associated with weight gain, obesity, and dietary indiscretion. Excessive protein and salt intake are unequivocal risk factors for the occurrence of kidney stones.   Uric acid stones, in particular, occur more commonly in overweight and obese people.  Beyond a certain weight limitation, “larger” patients cannot be treated with the standard, non-invasive shock wave lithotripsy to break up a kidney stone and urologists must, therefore, resort to more antiquated, more invasive, more risky measures.

Hypogonadism, a condition in which there are insufficient levels of the male sex hormone testosterone, is an increasingly prevalent condition that is associated with a host of negative effects. Obesity has a pivotal role in the process leading to low testosterone. One’s waist circumference is a reasonable proxy for low testosterone. Fat has an abundance of the hormone aromatase, which functions to convert testosterone to the female sex hormone estrogen.  The consequence of too much conversion of testosterone to estrogen is the potential for gynecomastia, a.k.a. “man boobs.”  Too much estrogen slows testosterone production and with less testosterone more abdominal obesity occurs and even more estrogen is made, a vicious cycle of emasculation and loss of libido.

Erectile dysfunction is a very prevalent condition associated with aging and numerous other risk factors. Weight gain and obesity are major contributors to poor quality rigidity and durability of erections.   This goes way beyond simply low testosterone levels.  Erections in essence are all about sufficient blood flow to the penis. Obesity contributes to problems with penile blood flow that can interfere in a major way with sexual function.   Additionally, as the abdominal fat pad grows, the penis seemingly shrinks and it is estimated that for every 35 pounds of weight gain, there is a 1-inch loss in apparent penile length. In fact, penile shrinkage is a very common complaint among my obese patients.

Prostate cancer is the most common cancer in men.  Like all cancers, prostate cancer is caused by mutations that occur during the process of cellular division.   Prostate cancer has a multifactorial basis, with both genetic and environmental factors at play. There is a clear association between a Western diet and the occurrence of prostate cancer.   This has been witnessed in Asian men, who have a relatively low incidence of prostate cancer in Asia, but after migrating to the USA and assuming a Western diet and lifestyle, have an incidence of prostate cancer that approaches that of Caucasians.

The obese patient presents a real challenge to the urological surgeon in terms of care both during and after an operation.  Surgery on overweight patients is more complex and takes longer as it is much more difficult to achieve proper exposure of the anatomical site being operated upon.  Surgery on obese patients has a higher complication rate with increased respiratory and wound problems. Anesthesiologists have more difficulty placing the breathing tube through a thick, obese neck, and greater difficulty with regional anesthesia as well, because of fatty tissue obscuring the landmarks to place the needle access for spinal anesthesia.

Bottom Line: Fat puts one at risk…for many very unfortunate potentialities.  Maintaining a healthy weight is an important priority for overall health, as well as our urological health.  The good news is that a lifestyle “remake” is typically the first line of treatment for many of the problems that I have just delved into and has the capacity of mitigating, if not reversing, some of them.  This involves the adoption of healthy eating habits, weight loss to achieve a healthy weight, and exercising on a regular basis.   

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.