Posts Tagged ‘cardiovascular disease’

All Fat Is Not Created Equal

September 29, 2018

Andrew Siegel MD  9/29/2018

www.maxpixel.net-Obesity-Weight-Obese-Fat-Heavy-Overweight-3313923

Thank you, Max Pixel for image above

My next few entries concern weight and diet. Clearly, obesity is unhealthy on many levels and I do not encourage anyone to carry excess pounds. However, fat can be advantageous under certain circumstances: see below 12 Benefits to Being Overweight (to be taken tongue in cheek).  Next week’s entry (to be taken seriously) will discuss a healthy eating style that  effectively can improve your shape and shred excess pounds that I am excited to share with you.

Some fat is good, but not too much

Having some fat on our bodies is actually a good thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and is used in the manufacture of certain hormones.

All fat is not created equal

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat.  Visceral fat–also referred to as a “pot belly” or “beer belly”– is  fat deep within the abdominal cavity that surrounds the internal organs.  Subcutaneous fat–also known as “love handles,” “spare tires” or “muffin top”– is present between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more of a health hazard than is subcutaneous fat since its presence increases the risk of heart disease, diabetes and metabolic disturbances.  This is as opposed to subcutaneous fat, which is inactive and relatively harmless and generally does not contribute to health problems.

 

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Thank you Pixabay, for above image of visceral obesity (“beer belly”)–NOT GOOD FOR ONE’S HEALTH

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Image above, subcutaneous fat (“muffin top”), Attribution: Colin Rose from Montreal, Canada–MIGHT NOT BE THAT ATTRACTIVE, BUT GENERALLY NOT A HEALTH ISSUE

 

A beer belly is called a beer belly for good reason. One of the real culprits in the formation of visceral fat is drinking liquid carbs, whether sweetened beverages including sodas, iced tea, lemonade, sports drinks, etc., fruit juices such as orange, grapefruit, cranberry, etc., and alcoholic beverages.  Liquid carbs have no fiber and are essentially pre-digested, stimulating a massive insulin surge and rapid storage as fat. It is much healthier to eat the real fruit rather than drink the juice, since the product in its original form is loaded with fiber that fills you up and slows the absorption process and also contains abundant phytonutrients.  You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat is a metabolically active endocrine “organ” that does way more than just create an unsightly appearance. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body.  So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, etc.). This name should convey the dangerous nature of this “gland.”  I suggest “die-roid” gland because of its dire metabolic consequences, including risk of metabolic syndrome, diabetes, heart disease and premature death.

The good news about visceral fat is that it is metabolically active so that with the appropriate lifestyle modifications it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be extremely difficult to lose.

12 benefits to being overweight

  1. Less prominent crow’s feet, wrinkles and nasal-labial folds
  2. More comfort in the cold winter months because of more insulation
  3. More likely to survive hypothermia if your ship should sink in icy waters or your plane goes down on a snow-laden mountaintop
  4. Better buoyancy in the water
  5. Better survival when stranded on a desert island because of the fat (stored energy) that will keep you sustained and alive long after the thin people have perished
  6. Less osteoporosis (bone thinning) because of the weight-bearing that keeps bones mineralized
  7. Strength because of all that weight-bearing—think NFL offensive linemen
  8. Built-in airbag for better survival of traumatic motor vehicle crashes and other forms of trauma
  9. More comfortable when sitting on tailbone or lying on vertebra because of better padding
  10. More stable footing under conditions of gale-force winds
  11. Curvier, more voluptuous bodies
  12. Cuddlier, like a teddy bear!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

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These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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Man’s Motivation for Medical Ministration: His Penis

October 18, 2014

Andrew Siegel MD

 

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You—as a man—are a master of denial, who, through a combination of nature and nurture, often play the stoic, tough guy, independent, cool as a cucumber, stubborn, non-demonstrative, too-proud-to-ask-directions act. You typically serve the role of provider, protector, hunter, and warrior as opposed to your nurturing and more emotional female gender mate. Furthermore, you are literally “tainted” by testosterone levels that can biochemically impair your ability to think rationally. Truth is that deep inside, most men are actually weak-kneed milquetoasts who are put to shame by women when it comes to true bravado. Regarding seeking help in the form of medical care, men are much more reluctant to do so than women, particularly preventive health care, and medical care is often not sought until after a problem develops, establishes itself and worsens.

Men’s Health: Facts

  • Men live 6 years less than women on average
  • 36% of men seek medical care only when they become really ill
  • 30% of men defer seeking medical help as long as they can
  • 90 million men have a usual place of medical care, as opposed to 106 million women
  • 30 million men reported no office visits with a physician in the past year, as opposed to 16 million women
  • Men have higher rates of inactivity, poor nutrition, and excessive alcohol consumption than women
  • More than 50% of premature death in men in the USA are result of chronic, but preventable medical conditions

One of the challenges of being a physician is to persuade men to pursue preventive health services. Over the years, however, getting the male patient into the office has actually become much easier, thanks to the emerging field of sexual medicine, the availability of Viagra and other ED drugs, and Big Pharma’s extensive direct-to-consumer advertising.

Viagra was the initial drug in its class that addressed a previously unmet medical need with the collateral effect of being the “carrot” that enticed men to see their doctor. The direct-to-consumer advertising effort has resulted in a change in name of the pejorative term “impotence” into the more euphemistic term “erectile dysfunction,” de-stigmatizing sexual dysfunction, resulting in patients more readily making appointments. Big Pharma has also made the word “testosterone,” previously the domain of endocrinologists and urologists, into a commonly used household word, and numerous patients now appear in the office requesting to know what their “T” is.

Men may be stoic when it comes to their general health but when it comes to their genital health it is a different story. To many, their penis is literally their GPS, and when its function goes south, they become immediately motivated to find medical help! Never mind that they are having chest pain that gets dismissed as indigestion—an episode or two of failure to launch an erection is all it takes for an “emergency” appointment! There is some real truth to the concept that men think with their penises.

What most men do not realize is that they actually have a “canary in their trousers,” analogous to the “canary in the coal mine” carried by mine workers into the mines, the death of which would indicate the presence of dangerous gases. Since the penile arteries are generally rather small (diameter of 1 to 2 millimeters) and the coronary (heart) arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the tiny penile arteries, it may soon affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaque that compromises blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a genital “stress test.” 

In fact, the presence of ED is as much of a predictor of cardiovascular disease as is a strong family history of cardiac problems, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the initials ED to mean: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of cardiovascular disease); and Early Death (if missed).

Bottom Line: Because many men have an “obsession”—if not a “fascination,” with their penises—a dysfunction in this department is often the motivating factor that drives them to seek medical help, which often uncovers other medical issues. The pharmaceutical companies have developed excellent medications to treat ED and are credited with the name “ED” and for de-stigmatizing sexual issues are also responsible for getting the stoic gender into the physician’s office. So man’s peno-centric focus and Big Pharma are actually beneficial for men’s health.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com

Sex and the Mediterranean Diet

February 1, 2014

Blog # 139

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure.  Although not a necessity for a healthy life, the loss or diminution of sexual function may result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us it is vital that we maintain our sexual health. Loss of sexual function further exacerbates progression of sexual dysfunction—the deficiency of genital blood flow that often causes sexual dysfunction produces a state of poor oxygen levels (hypoxia) in the genital tissues, which induces scarring (fibrosis) that further compounds the problem.  So “use it or lose it” is a very relevant statement when it comes to sexual function, as much as it relates to muscle function.

Healthy sexual function for a man involves a satisfactory libido (sex drive), the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. For a woman, sexual function involves a healthy libido and the ability to become aroused, lubricate adequately, to have sexual intercourse without pain or discomfort, and the ability to achieve an orgasm.   Sexual function is a very complex event contingent upon the intact functioning of a number of systems including the endocrine system (produces sex hormones), the central and peripheral nervous systems (provides the nerve control) and the vascular system (conducts the blood flow).

A healthy sexual response is largely about adequate blood flow to the genital and pelvic area, although hormonal, neurological, and psychological factors are also important.  The increase in the blood flow to the genitals from sexual stimulation is what is responsible for the erect penis in the male and the well-lubricated vagina and engorged clitoris in the female. Diminished blood flow—often on the basis of an accumulation of fatty deposits creating narrowing within the walls of blood vessels—is a finding associated with the aging. This diminution in blood flow to our organs will negatively affect the function of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of oxygen and nutrients and removal of metabolic waste products.  Sexual dysfunction is often on the basis of decreased blood flow to the genitals from pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the blood vessels that bring blood to the penis and vagina.

Sexual dysfunction may be a sign of cardiovascular disease. In other words, the quality of erections in a man and the quality of sexual response in a female can serve as a barometer of cardiovascular health. The presence of sexual dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels).  The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our sedentary lifestyle and poor dietary choices.  Civilization Syndrome can lead to obesity, high blood pressure, and elevated cholesterol and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death.  The diabetic situation in our nation has become outrageous—20 million people have diabetes and more than 50 million are pre-diabetic, many of whom are unaware of their pre-diabetic state! It probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.

Civilization Syndrome can cause a variety of health issues that result in sexual dysfunction.  Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the arteries which function to bring blood to the genitalia.  Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less forceful blood flow through the arteries.  Thus, blood pressure medications, although very helpful to prevent the negative effects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction.  High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction.  Tobacco constricts blood vessels and impairs blood flow through our arteries, including those to our genitals. Smoking is really not very sexy at all!  Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function.  In fact, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical.

A healthy lifestyle is of paramount importance towards the endpoint of achieving a health quality and quantity of life.  Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases that are brought on by poor lifestyle choices.  Sexual dysfunction is often in the category of a medical problem that is engendered by imprudent lifestyle choices.  It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices.  Simply by pursuing a healthy lifestyle, Civilization Syndrome can be prevented or ameliorated, and the myriad of medical problems that can ensue from Civilization Syndrome, including sexual dysfunction, can be mitigated.

In terms of maintaining good cardiovascular health (of which healthy sexual function can serve as a proxy), eating properly is incredibly important—obviously in conjunction with other smart lifestyle choices. Fueling up with the best and most wholesome choices available will help prevent the build up of fatty plaques within blood vessels that can lead to compromised blood flow. Poor nutritional decisions with a diet replete with fatty, nutritionally-empty choices such as fast food, puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!.

A classic healthy food lifestyle choice is the increasingly popular Mediterranean diet.  This diet, the traditional cooking style of the countries bordering the Mediterranean Sea including Spain, France, Greece, Cyprus, Turkey, Southern Italy, and nearby regions, has been popular for hundreds of years. The Mediterranean cuisine is very appealing to the senses and includes products that are largely plant-based, such as anti-oxidant rich fruits and vegetables, whole grains, nuts, seeds and legumes.  Legumes—including peas, beans, and lentils—are a wonderful source of non-animal protein.  Soybeans are high in protein, and contain a healthy type of fat.  Soy is available in many forms— edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), and soymilk. Fish and poultry are also mainstays of the Mediterranean diet, with limited use of red meats and dairy products.  The benefits of fish in the diet can be fully exploited by eating a good variety of fish.  Olive oil is by far the principal fat in this diet, replacing butter and margarine. The Mediterranean diet avoids processed foods, instead focuses on wholesome products, often produced locally, that are low in saturated fats and high in healthy unsaturated fats. The Mediterranean diet is high in the good fats (monounsaturated and polyunsaturated) which are present in such foods as olive, canola and safflower oils, avocados, nuts, fish, and legumes, and low in the bad fats (saturated fats and trans fats).  The Mediterranean style of eating provides an excellent source of fiber and anti-oxidants.  A moderate consumption of wine is permitted with meals.

Clearly, a healthy diet is an important component of a healthy lifestyle, the maintenance of which can help prevent the onset of many disease processes.  There are many healthy dietary choices, of which the Mediterranean diet is one.  A recent study reported in the International Journal of Impotence Research (Esposito, Ciobola, Giugliano et al) concluded that the Mediterranean diet improved sexual function in those with the Metabolic Syndrome, a cluster of findings including high blood pressure, elevated insulin levels, excessive body fat around the waist and abnormal cholesterol and triglyceride levels.  35 patients with sexual dysfunction were put on a Mediterranean diet and after two years blood test markers of endothelial function and inflammation significantly improved in the intervention group versus the control group. The intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol (LDL—the “bad” cholesterol), triglycerides, and blood pressure, with a significant increase in high-density lipoprotein cholesterol (HDL—the “good” cholesterol).  14 men in the intervention group had glucose intolerance and 6 had diabetes at baseline, but by two years, the numbers were reduced to 8 and 3, respectively.

Why is the Mediterranean diet so good for our hearts and sexual health?  The Mediterranean diet is high in anti-oxidants—vitamins, minerals and enzymes that act as “scavengers” that can mitigate damage caused by reactive oxygen species.  Reactive oxygen species (also known as free radicals) are the by-products of our metabolism and also occur from oxidative damage from environmental toxins to which we are all exposed.  The oxidative stress theory hypothesizes that, over the course of many years, progressive oxidative damage occurs by the accumulation of the chemicals the accumulation of reactive oxygen species engender diseases, aging and, ultimately, death.  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 concentrated in beans, fruits, vegetables, grain products and green tea.  Brightly colored fruits and vegetables are good clues as to the presence of high levels of anti-oxidants—berries, cantaloupe, cherries, grapes, mango, papaya, apricots, plums, pomegranates, tomatoes, pink grapefruit, watermelon, carrots, broccoli, spinach, kale, squash, etc.—are all loaded with anti-oxidants as well as fiber. A Mediterranean diet is also high in omega-3 fatty acids, a type of polyunsaturated fat present in oily fish including salmon, herring, and sardines.  Nuts—particularly walnuts—have high omega-3 fatty acid content.  Research has demonstrated that these “good” fats have numerous salutary effects, including decreasing triglyceride levels, slightly lowering blood pressure, and decreasing the growth rate of fatty plaque deposits in the walls of our arteries (atherosclerosis), thus reducing the risk of cardiovascular disease, stroke, and other medical problems. Mediterranean cooking almost exclusively uses olive oil, a rich source of monounsaturated fat, which can lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. It is also a source of antioxidants including vitamin E.  People from the Mediterranean region generally drink a glass or two of red wine daily with meals. Red wine is a rich source of flavonoid phenols—a type of anti-oxidant—which protects against heart disease by increasing HDL cholesterol and preventing blood clotting, similar to the cardio-protective effect of aspirin.

The incorporation of a healthy and nutritious diet, such as the Mediterranean diet, is a cornerstone for maintaining good health in general, and vascular health, including sexual health, in particular.  The Mediterranean diet—my primary diet and one that I have incorporated quite naturally since it consists of the kinds of foods that I enjoy—is colorful, appealing to the senses, fresh, wholesome, and one that I endorse with great passion. Maintaining a Mediterranean dietary pattern has been correlated with less cardiovascular disease, cancer, and sexual dysfunction.  And it is very easy to follow.  It contains “good stuff”, tasty, filling, and healthy, with a great variety of food and preparation choices—plenty of colorful fresh fruit and vegetables, a variety of fish prepared in a healthy style, not fried or laden with heavy sauces, healthy fats including nuts and olive oil, limited intake of red meat, a delicious glass of red wine.  It’s really very simple and satisfying.  Of course the diet needs to be a part of a healthy lifestyle including exercise and avoidance of harmful and malignant habits including smoking, excessive alcohol, and stress.  So if you want a sexier style of eating, I strongly recommend that you incorporate the Mediterranean diet into your lifestyle.  Intelligent nutritional choices are a key component of physical fitness and physical fitness leads to sexual fitness.

Andrew Siegel, M.D.

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:www.promiscuouseating.com

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The Skinny On Salt

October 26, 2012

 

Andrew Siegel, M.D.   Blog # 81

Most of us adore our saltshakers and put them to frequent use.  Salting our foods enhances taste—imagine how bland French fries, scrambled eggs or popcorn would be without salt (aka sodium).  Salt also serves a function as a food preservative and played an important role as such in the days before refrigeration was widely available.  Historically, salt has been a valuable commodity. Think for a moment of all of the salt idioms used in our English language, many of which that convey the value of this essential mineral: “Salt of the earth”; “Worth one’s salt”; “Back to the salt mines”; “Rub salt in a wound”; “To salt away.”

Sodium is an important mineral, a critical electrolyte in terms of regulating fluid exchange within the body compartments, including membrane permeability in cells, nerve conduction, and muscle cell contraction of skeletal, smooth and cardiac muscles. However, when consumed in excess, it can wreak havoc on our bodies. Unfortunately, the majority of Americans consume more than twice the recommended upper limit of sodium, with most of us eating/drinking about 3400 mg sodium daily.

Excessive sodium intake increases our blood volume, which causes increased pressure within the arterial walls, known as hypertension.  Hypertension within the arterial walls contributes to the following serious ailments: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA.  So clearly, excess sodium intake contributes to the hypertension present in at least one of three Americans; this hypertension in turn is linked to cardiovascular disease and death.  Excess dietary sodium also promotes fluid retention and edema.

Although the recommended daily allowance of sodium is 2300 mg (one teaspoon), our bodies actually only require 500 mg of sodium daily, and most Americans would do well to consume no more than 1500 mg daily.

Sources of sodium include table salt, pickles, olives, canned soups, luncheon meats and deli products, cheeses in general and cottage cheese in particular, and bread.  Pizza is very high in sodium.  Snack foods such as chips, pretzels, and popcorn pack a load of sodium.  Condiments and salad dressings are major culprits as are processed, prepared foods, fast foods and many sauces including tomato, soy, Worcestershire and Tabasco. Chinese food and Mexican food are often bathed in salt.  Flavor enhancers such as Accent, for example, are mono-sodium glutamate and are thus very high in sodium.  Restaurant meals are a major source of sodium.  That gyro that I consumed for dinner the other evening was so salt-laden that I was thirsty all evening and the following morning I had trouble getting my wedding ring on!

Generally speaking, roughly 80% of our sodium comes from processed foods and restaurant dining, 10% occurs naturally, 5% is added at the table and 5% is added during cooking.

What To Do:

Lowering salt intake is an inexpensive and practical way to make a major impact on our overall cardiovascular health and avoid morbidity and mortality:

  • Increase potassium intake by eating more potassium-rich foods including root vegetables; sweet potatoes; green, leafy vegetables; grapes; yogurt; and tuna. (Increasing our potassium intake helps to lower blood pressure by blunting the effects of sodium.)
  • Use salt substitutes such as potassium chloride.
  • Read food labels carefully and compare brands—you might be shocked at how many foods that you would not expect have very high levels of sodium.
  • The less processed the better in terms of sodium content—in general, the more highly processed foods have more ingredients, are touched by more hands, and are usually located in the central area of supermarkets.
  • Avoid “instant” foods that are often high in sodium, e.g., Ramen noodles and Rice-a-Roni.
  • Use alternative flavors: think spicy (like chili or red peppers) instead of salty.
  • Eat fresh foods including fresh fruits and vegetables, which are extremely low in sodium.
  • Any animal product will have some degree of sodium as sodium it is a vital chemical to biological existence. Even a glass of milk will have over 100 mg of sodium.
  • Rinse off canned vegetables, tuna, etc.
  • The DASH diet (Dietary Approaches to Stop Hypertension) can be a very effective approach to lowering sodium consumption.

Take everything you read with a grain of salt, but trust me on this one—take your salt in moderation and your body will thank you!

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

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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: https://healthdoc13.wordpress.com/2012/07/20/sleep-to-slim/

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

www.PromiscuousEating.com

Now available on Amazon Kindle

 

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

www.PromiscuousEating.com

Now available on Amazon Kindle

 

Gluttony, Sloth, & Cardiac Care or Healthy Lifestyle & Wellness

February 4, 2012

Blog # 44   Andrew Siegel, M.D.

 

February is American Heart Month, so I put my heart into this narrative about this amazingly engineered, all-important organ that serves us tirelessly and relentlessly. Like our pet canines, this organ requires to be  well fed, to be exercised, and to be given tender loving care.  Be kind to it and it will return the favor big time.

Two hundred years ago, the following words on angina pectoris (chest pain from coronary artery occlusion) from John Warren, M.D. were published in the very first issue of the New England Journal of Medicine and Surgery:

The disease itself is excited more especially upon walking up hill,

and after a meal; that thus excited, it is accompanied with a sensation,

which threatens instant death if the motion is persisted in;

and that on stopping, the distress immediately abates, or altogether subsides.

 

Two centuries later, we are infinitely wiser regarding the diagnosis and management of heart disease, yet unfortunately this illness is more prevalent than ever.  The saddest aspect of this is that coronary artery disease is largely a preventable and avoidable problem.  Every day, many hearts are broken because of the premature and unnecessary demise of loved ones who succumb to cardiac disease. It is my heart’s desire that we become better caretakers of ourselves and avoid the 600,000 deaths to heart disease and 130,000 deaths to strokes that occur every year in the USA.

Cardiovascular disease (CVD), including heart disease and stroke, is the number one cause of death in the USA and other industrial countries.  The only year since 1900 in which CVD was not the leading cause of death was in 1918, the year of the influenza pandemic.  CVD is also the leading cause of death in every region of the world except for sub-Saharan Africa.  The burden of CVD is increasing because of our longer life spans, continued tobacco use, physical inactivity, unhealthy food consumption, obesity, high blood pressure, elevated LDL cholesterol and prevalence of type 2-diabetes.

The following paragraph is a brief historical perspective of some of the important medical advances with respect to the management of heart disease.  The 50-year cardiovascular Framingham study (1948-1998) linked high blood pressure and high cholesterol with angina and heart attacks and originated the novel concept that coronary artery disease and its complications could be prevented.  The advent of the coronary care unit (CCU) vastly decreased the death rate of patients admitted with acute heart attacks by provided sophisticated monitoring with electrocardiograms, closed chest cardiac massage, and external defibrillation (using electric paddles to shock the heart back into a normal rhythm).   Cardiac catheterization and coronary arteriography lead to the birth of cardiac surgery and coronary revascularization (coronary artery bypass).  The field of interventional cardiology enabled balloon angioplasty revascularization of occluded coronary arteries without the need for cracking one’s chest open, using access through a thigh artery.  Cardiac stents, initially metal and currently drug eluting, were developed to prevent coronary re-occlusion.  Statin medications to lower LDL-cholesterol levels and many new and potent cardiac drugs have provided significant advances.  Implantable pacemakers and implantable pacemaker-ventricular defibrillators have further improved the prognosis of those suffering with cardiovascular disease. Sophisticated tests including echocardiograms, treadmill tests, isotope stress tests, Holter monitoring, and computerized tomography of the heart are readily available to help pinpoint the precise cardiac diagnosis.

Despite all of the aforementioned incredible technological advances, coronary artery disease remains highly prevalent and is a major widow-maker and widower-maker.  Why?  It’s really very simple—those all-important, tiny blood vessels that provide the lifeline of blood flow of oxygen and nutrients to that vital organ that pumps our blood 24/7/365 get blocked with fatty plaques.  With clogged coronary arteries, when increased demand is placed on our life-sustaining pump, not enough oxygen can get delivered through the compromised coronary arteries and we develop angina and possibly sustain damage to the heart muscle (a myocardial infarction or heart attack) or its electrical conduction system (an arrhythmia).  Tragically, this compromise to our heart and blood vessels is too often self-induced through bad eating habits, physical inactivity, and the use of tobacco.

To quote the insightful and poetic Dr. David Katz who says it all:

“We are all offspring of predecessors who lived in a world where calories were relatively scarce and hard to get, and physical activity constant, arduous and unavoidable. We now live in a world where physical activity is scarce and hard  to get, and calories constant, effortless and unavoidable.

Atherosclerosis is the process that gives rise to the fatty plaques in our arterial walls that compromise blood flow to our organs.  Atherosclerosisis a chronic arterial inflammation that develops slowly, gradually and progressively over many years.  It happens in response to the biological effects of risk factors.  It begins with changes in the endothelial cells, the unique cells that line arteries.  When subjected to these risk factors, endothelial cells change their permeability and allow white blood cells and LDL cholesterol entrance into the cells.  The risk factors include the following:

  • high blood pressure within the arteries
  • oxidative stress from free radicals (highly reactive molecules known as free radicals are created as a consequence of how our body reacts with oxygen; these interact with other molecules within cells and cause oxidative damage)
  • biochemical stimuli (chemicals from tobacco, high levels of bad fats like LDL cholesterol in the blood, food toxins)
  • inflammatory factors

The presence of white blood cells and LDL cholesterol within the endothelial cells gives rise to a cascade of chemical reactions that causes proliferation of both endothelial and smooth muscle cells and the formation of plaques.  Plaques lead to symptoms by restricting flow through the arteries involved, or alternatively, by provoking clotting that interrupts blood flow.  If the plaque ruptures, more clotting will occur at the site of the disruption, perpetuating the restricted flow, and additionally, the ruptured plaque can travel and jam other blood vessels.  LDL cholesterol is clearly a major culprit and atherosclerosis occurs in direct proportion to LDL levels.

Occlusion of the coronary arteries is a big deal because damage of the blood flow to the heart—the most important organ in our body—is a major concern.  However, it is important to know that the process of atherosclerosis is by no means unique to the heart—it is just that the effects of atherosclerosis on the heart—including angina, heart attacks, arrhythmias and death—are ever so dramatic.  It is critical to realize that if you have atherosclerosis in your coronary arteries, you can bet you have it in every artery in the body—including the aorta and those arteries providing blood to the brain, kidneys, intestines, legs, genitals, etc.  This can give rise to strokes or transient ischemic attacks, kidney disease, pain in the abdomen after meals, pain in the legs when walking, sexual dysfunction, etc.  Suffice it to say that intact blood flow to transport oxygen and nutrients to every cell in our body is our lifeline and we don’t want it compromised.

It is nothing short of wonderful that the medical fields of cardiology and cardiovascular surgery have become so evolved and sophisticated and that we have the medical and surgical resources to manage CVD so well.  Countless lives and loved ones have been saved from premature deaths.  That being the case, I must make an appeal from the bottom of my heart for preventive and pre-emptive measures that can keep the disease away and the cardiac team at bay.  Nature and nurture have roles in CVD and we can’t do a thing about the genetic blueprint that we inherited from our parents that can predispose us to CVD, but we do have incredible power to shape our health destiny with our lifestyle.  In my heart of hearts, I can assure you the truth and the validity of the following statement: Genes load the gun, but lifestyle pulls the trigger.  Even if genetics has been unkind to you, you have the authority and choice to pull the trigger, keep your finger on the trigger, or withdraw your finger from the trigger.

Prostate cancer is the number one cancer in men and one that I spend a great deal of my time managing and treating. Can you guess what the leading cause of death is in prostate cancer patients?  If your answer was prostate cancer, you are wrong.  The leading cause of death in men with prostate cancer is CVD.  After CVD, cancer happens to be the second leading cause of death in the USA and in most developed countries.  Most of our knowledge regarding lifestyle and dietary change for CVD prevention applies to cancer prevention as well.  One of the most dramatic reductions in both CVD and cancer has been through smoking cessation.   A heart-healthy diet and lifestyle will contribute to health improvements in every part of our human anatomy, whether it is the heart, colon, prostate or genitals.

As individuals, we must take responsibility for our health and make every effort towards maximizing our fitness and well-being.  We are the stewards of our own health destiny—no one else is.  Yes, we have physicians, sophisticated diagnostic tests, medications and surgery to help us when things go south, but simply by being smart and living a healthy lifestyle, we can avoid personal grief and the grief of our families.

Please take the following advice to heart:

Pearls to keep your heart ** healthy:

  1.  No smoking or tobacco
  2.  Maintain a healthy weight
  3.  Eat a healthy diet: nutrient-dense, non-processed, whole foods; lean protein including seafood which is abundant in heart-healthy omega-3 fats; eat meat and dairy sparingly (use fat-free dairy products); fruits, vegetables and legumes; nuts and seeds; whole-grain carbohydrates
  4.  Exercise daily: walking is great, but try to get some exercise that makes you sweat, breathe hard and gets your heart pumping. Exercise is all about adaptation. Our hearts and bodies are remarkably adaptable to the “stresses” that we place upon them, whether they be vigorous exercise or sitting on the couch.   
  5.  See a medical doctor for periodic health check-ups: don’t take better care of your car than you do of yourself!
  6.  Minimize and manage stress
  7.  Know your blood pressure and cholesterol levels and maintain them at healthy levels

 ** And every other organ in your body as well.

 

Heartfully Yours,

Andrew Siegel, M.D.

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

www.PromiscuousEating.com

Male Obesity Causes Low Testosterone With Potentially Dire Medical Consequences

July 30, 2011

Testosterone (T) is an important male sexual hormone that promotes 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.  Throughout adulthood, testosterone helps maintain libido, masculinity, sexuality, and youthful vigor and vitality.  The lion’s share of 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% decrease each year after age 30. The decline will occur in most men, but will not always be symptomatic. Symptoms of low T may include one or more of the following:  fatigue, irritability, depression, decreased libido, erectile dysfunction, ejaculatory dysfunction, 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.

Obesity can have a pivotal role in the process leading to low T. Fat is not just fat—it is a metabolically active endocrine organ that does not just protrude from our abdomens in an inert state.  Fat produces pro-inflammatory factors, hormones and immune cells—including cytokines—which function to inhibit T production in the testicles and the release of hypothalamus and pituitary hormones that govern the release of T.  Low T is present in about half of obese men.   Fat has an abundance of the hormone aromatase, which functions to convert T to the female hormone estrogen (E).  The consequence of too much conversion of T to E is the potential for gynecomastia, aka breast enlargement or alternatively, man boobs.

There is a strong relationship between low T and metabolic syndrome.  Metabolic Syndrome is defined as having three or more of the following: high blood glucose levels; abdominal obesity; high fats (triglycerides); low levels of the “good” cholesterol (HDL); and high blood pressure. If we have a substantial amount of belly fat, then by definition we have insulin-resistance, a condition in which our pancreas works overtime in order to make more and more insulin to get glucose into our cells.  This is a precursor to diabetes, cardiovascular disease and all the havoc they can wreak.  Those with metabolic syndrome have a much-increased risk of cardiovascular disease and type 2 diabetes.

Bottom line:  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 unequivocally affect the quality and quantity of our lives. Obesity in males often promotes low levels of the all-important male hormone testosterone, which can have a number of detrimental effects on our sexuality, bone and muscle health, energy, well-being, etc.  The good news is that by losing the abdominal fat, all of the potentially bad consequences can be reversed.

Andrew Siegel, M.D.

http://www.PromiscuousEating.com for information on Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food

http://www.youtube.com/incontinencedoc for educational videos on low T and a variety of other urological and wellness subjects

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

June 11, 2011

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

Gabriel Garcia Marquez, Love In The Time Of Cholera

 

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

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

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

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

 

 

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

Introduction to erectile dysfunction: http://www.youtube.com/watch?v=AQW1HFwBuPc

Anatomy: http://www.youtube.com/watch?v=zPwaXTTfnd8

Penis size: http://www.youtube.com/watch?v=g65bq7CuUyI

Causes of erectile dysfunction: http://www.youtube.com/watch?v=f6N34G11Saw

Treatment part 1: http://www.youtube.com/watch?v=fuhPGharax0

Treatment part 2: http://www.youtube.com/watch?v=Rd47zIQEGcA

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

Andrew L. Siegel, M.D.