Posts Tagged ‘hypertension’

Use It Or Lose It: The Wow of Human Plasticity and Adaptation

May 30, 2014

Blog # 156

Think for a momentabout orthodontics. Braces are applied to one’s imperfect teeth and ever so gradual increasing resistance is implemented over time and, presto, in a couple of years, the teeth are perfectly straight and beautiful.

Exposing our bodies to the right “environment” on a long-term basis can positively affect not only our external appearance, but also more importantly, our internal health. Conversely, exposing our bodies to the wrong environment on a long-term basis can negatively affect our external appearance and internal health.

Essentially, the cells and tissues of our bodies—including our muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. What it comes down to is that our human body is an adaptation machine.

Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon and permits our tissues to maintain normal function when burdened with adverse “resistances.” Conversely, we can tap into this powerful resource by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

An example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is benign enlargement of the prostate gland.  Almost inevitably, all aging males experience this gradual growth of this curious gland wrapped around our urethral channels. As a result of this “crimp” on the urethra, the resistance to the flow of urine gradually increases. However, the bladder muscle adapts by hypertrophying (getting more muscular). The bladder ever so slowly changes from a thin and smooth muscle to a thick and rough muscle in order to generate the higher pressures necessary to enable getting the urine out through the impeded urethral passageway. The unsuspecting individual with this condition may experience no symptoms for quite some time because of this natural compensation. However, compensation cannot occur indefinitely as there are natural limits on this plasticity, so one day he may be unable to urinate because the bladder hypertrophy has become maxed out, yet the prostate growth and increased resistance continues relentlessly, resulting in a condition known as acute urinary retention.

Another example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is hypertension, which totally parallels the situation with the prostate and the bladder. High blood pressure creates an environmental situation for the heart in which it needs to work harder to pump blood because of the increased resistance created within the walls of the arteries. Consequently, the muscle fibers of the heart hypertrophy, resulting in a larger and more muscular and powerful heart that can continue to pump blood effectively through the resistance of the high arterial pressure. The problem is that the “compensated” heart is subject to problems such as angina, arrhythmias and heart failure, and can get to the point—similar to the urinary bladder—where it decompensates and fails. Exercising the heart is desirable, but this is not the kind of exercise you want your heart to have

The powerful resource of plasticity and adaptability can positively and purposely be tapped into by challenging our tissues to adapt to the appropriate environmental changes (resistances) to enable our tissues to perform at extreme high levels of function. One type of resistance that is most beneficial is exercise.

Exercise is all about adaptation. The SAID principle (Specific Adaptation to Imposed Demands) posits that our body will adapt—in neuromuscular, mechanically, and metabolic terms—to the specific demands that are placed on it. This is the very reason why both endurance and resistance exercises get easier the more effort we put into doing them. Asthe body is subjected to gradual and progressive “overloads,” the heart, lungs and muscles adapt and a “new normal” level of fitness is achieved. It comes down to the fact that our muscles are plastic and capable of hypertrophy (growth) or atrophy (shrinkage) depending on the environment to which they are exposed.

I enjoy recreational cycling, but to date this season have not spent as much time in the saddle as I would have liked. I’ve been out for a number of 20-mile rides but last weekend went out with a friend for a hilly 50 miles. The last 10 miles were extremely difficult, as my body had not yet adapted to that kind of challenge; clearly I don’t have my cycling “legs” back yet. My heart and lungs were not the issue, but my glutes and quads were not up to the beating and challenge…but they will be in due time. Just as the marathon runner who gradually builds up to running the distance, so it is with every endurance sport

Adaptation to exercise is applicable to all aspects of fitness: cardiovascular or aerobic fitness in which the heart and lungs adapt to endurance efforts; musculo-skeletal fitness in which our muscles and underlying bony framework adapt to bearing loads and working against resistance, leaving our muscles sinewy, strong and toned; core strength, which is fitness of our torso muscles that allows us to maintain good posture, stability, balance and coordination as well as serving as a platform for efficient use of our arms and legs; and flexibility fitness in which our muscles are elastic, limber, supple and more resistant to injury.

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body to maintain maximal functioning—they need to be employed and put into the service for which they were designed

“Use it or lose it.” As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, known as “disuse atrophy.” Contrast this with the opposite scenario—exercising one’s arms by doing curls on a regular basis—which will result in an obvious hypertrophy of the arm muscles. When our bodies are sedentary—for example on the basis of a severe injury requiring bed rest—there is a rapid demineralization and thinning of our bones. Spinal cord injured patients who are paralyzed undergo just such a rapid demineralization. Astronauts who spend time in zero gravity (which takes all biomechanical forces away from the bones) experience a remarkably fast demineralization and risk not only thin bones—as does anybody with rapid demineralization— but also of developing kidney stones from the calcium mobilized from the bones. The process of adaptation is not limited to our muscles and bones, but involves each and every internal organ, including the kidneys, liver, pancreas, brain, etc. That is why it is so important to expose our bodies to positive “resistances” and not to “negative” resistances.

Our central nervous system is constantly being remodeled in response to environmental exposure. The brain’s neurons undergo anatomical changes and reorganization of their networks with new neural connections in response to new situations or environmental changes (learning). Through the processes of “neuroplasticity” and adaptation, learned behaviors actually modify the electrical hardwiring of the brain, which is dynamic and constantly subject to revision. Synaptic “sculpting” facilitates learning and synaptic “pruning” occurs when patterns are not repeated. Thus is explained on a biological basis how learning occurs.

Bottom line: Humans are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to our advantage and benefit. Expose our bodies to positive cognitive and physical nourishment and they will be carved into beautiful, highly functioning machines. Expose our bodies to negative forces or absence of positive forces and they will falter into ugly, poorly functioning, maladaptive machines.


Andrew Siegel, MD

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.


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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.

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Men’s Health: Lab Tests You Should Be Getting

November 9, 2013

Blog #127

Despite the nihilistic attitude of the United States Preventive Services Task Force—an agency that condemns all kinds of testing and even annual physical exams—it is my fundamental belief that preemptive testing and periodic doctor visits play a significant role in maintaining one’s health.

Clearly, genetics loads the gun and lifestyle pulls the trigger; however, physicians can help your cause and should be considered part of your advocacy team with the goal of maintaining health and quality and quantity of life and lending service when disease rears its head.

There are several lab tests that can lend insight into one’s health or lack thereof, and there are a number of findings on physical examination that must be actively sought after because they cause no symptoms whatsoever.  For example, high blood pressure, glaucoma (high eye pressure), and prostate nodules and lumps all generally are asymptomatic, and if unrecognized and untreated can lead to heart attacks and strokes, blindness, and metastatic prostate cancer, respectively.   Simple examinations can readily detect all of the three aforementioned problems.  Lab tests that are helpful include the following: glucose; hemoglobin A1c; lipid profile; PSA; uric acid; C-reactive protein; testosterone; and thyroid profile.

Glucose:  Glucose (blood sugar) is a major source of energy for our cells.  The level of fasting glucose should range between 60–100 mg/deciliter. Anything over 100 is considered abnormal and could indicate the possibility of a pre-diabetic state.  If substantially elevated, diabetes mellitus is likely present.  This is important to recognize because of the cardiovascular and health ramifications if unmanaged.

The pancreatic hormones insulin and glucagon regulate blood glucose by decreasing and increasing glucose levels, respectively.  Diabetes is a condition in which either there is insufficient insulin present or resistance to the effects of insulin.

Hemoglobin A1c:  This is a measurement of how sugarcoated your red blood cells are.  Anything above 5.7% is considered abnormal and the higher the level, the greater the risk for poorly controlled diabetes.

Lipid Profile:  Total cholesterol and its components consisting of HDL, LDL and VLDL as well as triglycerides are important tests in terms of predicting cardiovascular disease, which remains the leading cause of death in Americans.

PSA:  Prostate Specific Antigen is a blood test for a protein that is produced by the prostate and, if elevated, may indicate an underlying process including prostate cancer, prostatitis, or benign prostate enlargement.   It is most useful after a baseline has been established and year-to-year comparisons are made; when there is a rapid acceleration over a one-year time interval, it demands evaluation to seek out the source.  Absolute elevations in PSA and rapid accelerations in PSA over time are the most common reasons that prostate biopsies are performed and are the underlying basis upon which most diagnoses of prostate cancer are made.  This test allows recognition of prostate cancer years before it may present as a nodule or lump of the prostate gland.  Don’t let anyone tell you otherwise…early diagnosis and treatment saves lives.

Uric Acid:  This chemical is a byproduct of metabolism of purines that are found in rich protein sources including shellfish, red meat, and other foods.   If elevated, it can cause gout and/or kidney stones.  High levels of uric acid are correlated with cardiovascular and kidney disease.

C-Reactive Protein:  This is a protein that is manufactured by the liver, frequently in response to inflammation; when elevated, it is often a signal to check the arteries for blockages.

Testosterone:  This is the all-important male sex hormone that is responsible for much more than male sexuality.   Many experts view the level of testosterone as a general marker of overall men’s health.  Testosterone has a critical role in the masculinizing process at the time of puberty and has a major role in male physical development, promoting tissue growth responsible for the building of muscle mass, bone mass and strength.   Testosterone greatly impacts physical development, sexuality, mood, energy levels, etc., so it is wise to know what your testosterone level is, particularly if you are experiencing any of the symptoms associated with low testosterone.

Thyroid Profile:  This includes thyroid stimulating hormone (TSH) as well as T3 and T4.   The thyroid is our gland that regulates our metabolism and is therefore very important in terms of our weight.

Bottom Line:  Don’t take better care of your car than yourself!  Avail yourself of the diagnostic and preemptive tests that modern medicine has to offer. An annual visit after age 40 to an internist is a prudent move.

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

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

Available on Amazon in Kindle edition

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

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When Our Kidneys Go South

October 26, 2013

Andrew Siegel MD Blog #125

Our kidneys are paired, bean-shaped, fist-sized organs that work diligently and silently behind the scenes 24/7/365, filtering our blood free of toxins and waste products so that we can maintain a healthy existence. When they are working well, they are often taken for granted.  The renal arteries bring blood to the kidneys, the kidneys do their magic, and the cleansed and purified blood is returned into the renal veins, with the liquid waste—urine—excreted into the ureters that drain into the urinary bladder.

If the kidneys stop working properly, excessive fluid and toxic wastes build up rapidly, resulting in death within a matter of days to weeks. Death by kidney failure is described as “euphoric” because of the very abnormal blood chemistries and electrolyte disturbances that occur…not that death is something to be “giddy” about, but kidney failure just happens to be an easier, more peaceful way to exit the planet than many others.

Because of their critical importance to our healthy existence, it behooves us to take great care of these prized possessions, which nature gave us in duplicate. This “spare tire” is capable of sustaining life in the event of trauma, cancer requiring surgical removal, donating a kidney or other issues resulting in loss of one kidney.

The kidneys are multifunctional, not only filtering our blood to remove waste products, but also responsible for regulating fluid, electrolyte, acid-base balance and blood pressure.  They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure.  Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation).

Kidney disease is a very common cause of serious illness with a prevalence of more than 25 million Americans. Each year approximately 110,000 new patients start dialysis treatments in the USA.  Kidney disease is responsible for nearly 100,000 American deaths annually. When the kidneys fail (end stage renal disease), the options are peritoneal dialysis, hemodialysis, kidney transplantation, or death. Peritoneal dialysis uses the peritoneal membrane that lines the abdomen as a filter to clear wastes and extra fluid from the body. Hemodialysis involves being hooked up to a machine that mimics the function of the kidneys; it requires three sessions weekly that take about 3-4 hours per session.

The unfortunate thing about kidney disease is that it typically causes few symptoms until it is advanced; however, simple tests are capable of detecting it.   Symptoms of kidney disease are non-specific and may include the following: fatigue; decreased energy; poor appetite; difficulty concentrating; insomnia; swollen ankles and feet; nighttime muscle cramping; puffiness around one’s eyes; dry and itchy skin; and the need for frequent urination, particularly at night

A definitive sign of kidney disease is the presence of protein in the urine, which is easily detectable on a urinalysis. Additionally, uncontrolled high blood pressure is highly suggestive of kidney disease, as is an elevated serum creatinine, detectable by a simple blood test.  Early detection is critical as it can help prevent kidney disease from progressing to kidney failure. The bottom line is that three simple tests can detect kidney disease:  blood pressure; serum creatinine; urine albumin (protein).

Under normal circumstances, the kidneys filter the blood, removing waste products and excessive fluid, returning into circulation the body’s important chemicals and constituents. When the filtration system is not working properly, one’s system is not cleared of the bad (waste products), resulting in electrolyte disturbances and proteinuria, a condition in which what is good for the body (protein) ends up being filtered out into the urine.

Risk factors for kidney disease are the following: African-American race; diabetes; high blood pressure; and family history of kidney disease.  The two leading causes of chronic kidney disease are hypertension and diabetes, responsible for about two thirds of cases.

Urologists are the specialists who deal with surgical kidney issues whereas nephrologists are the specialists who deal with medical kidney tissues including hypertension and impaired kidney function. If kidney disease is diagnosed, one will typically be referred to a nephrologist for further evaluation and management.  Nephrologists will typically measure the serum creatinine, and do blood and urine tests to assess the glomerular filtration rate, a quantitative test of kidney function.  Often a renal ultrasound is performed and in some cases it is necessary to do a renal biopsy to find the root cause of the kidney dysfunction

Treatment for progressive kidney disease includes interventions such as blood pressure control, often with the use of ACE inhibitors and angiotensin receptor blockers, and control of diabetes.   Nutritional interventions include dietary protein restriction that may slow the progression of chronic kidney disease.   High-protein intake can worsen the proteinuria and result in the accumulation of various protein breakdown products as a result of decreasing kidney function, which can cause toxic effects.

A truly unfortunate fact of life is that many of us are not responsible caretakers of our kidneys (or any of our other “precious physical valuables”); many seem to take better care of their automobiles than they do of their own health.  How many of us change our oil every 3000 miles, bring our cars in for regular service and proudly maintain shiny exteriors while at the same time neglecting our own health by living a harmful lifestyle.  This includes a sedentary existence, excessive stress, insufficient sleep and substance abuse—of alcohol, tobacco and food—with diets high in red and processed meats, sodium and fat laden concoctions, sugar-sweetened drinks, etc., and low in fruits, vegetables, legumes, nuts, whole grains, and low-fat dairy.  The result: obesity, high blood pressure, and elevated cholesterol, which oftentimes leads to diabetes, heart attack, stroke, cancer, and premature death. Sadly, the diabetic situation in our nation—often referred to as “diabesity”—has become epidemic and, as mentioned, is one of the leading causes of chronic kidney disease in the United States.

So how do we care for our kidneys?  The prescription for healthy kidneys is to maintain a healthy lifestyle and, if you have been neglectful in this department, to do a lifestyle remake through the following: good eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.  Additionally, being proactive by seeing a physician on a regular basis for “scheduled maintenance” is of paramount importance in order to detect kidney disease—or any other malady—as early as possible, no matter what the ivory tower pundits say about the ineffectiveness of annual physicals.

Bottom Line: Kidney disease is a debilitating—oftentimes deadly—condition, the risk for which can be greatly reduced by adopting a healthy lifestyle. Never neglect your health, for it is your greatest wealth. 

Andrew Siegel, M.D.

Facebook Page: Our Greatest Wealth Is Health

Please visit page and “like.”

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

Available on Amazon in Kindle edition

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

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

My Blood Pressure Ordeal

July 6, 2013

Andrew Siegel, MD  Blog #111

I consider myself to be a very fit person—for the most part, I eat a very healthy diet with abundant fruits and vegetable and avoid processed, fast and junk foods, don’t smoke, drink alcohol very moderately, and exercise religiously and aggressively.  I’m 5’9” tall and weigh 155 lbs., so I’m not carrying around much body fat.  Nonetheless, in spite of my healthy lifestyle, I was diagnosed with hypertension this year.  I am a strong believer in the mind-body connection and initially attributed my blood pressure issue to the incorporation of electronic medical records into my urology practice, a frustrating and tedious experience that has added hours of time to my workday and much grief and hassle to my life.  That stated, it is difficult to hide from one’s genetics—I have a bunch of family members with high blood pressure, including my younger sister who is a vegetarian and avid cyclist and runner who truly could not be any leaner or in any better physical shape.  But it really irks me that I know many obese and sedentary individuals who do not have blood pressure iss

Earlier this year, I was in Florida with my brother, cousin, and brother’s friend for an extended weekend golf and tennis excursion. We went to the Publix supermarket where we chanced upon one of those free blood pressure machines that you stick your arm in and presto, in a few moments you have a blood pressure reading.   Suffice it to say that among the four of us, I lost the blood pressure contest!   I wrote it off to the stressful week that I had had, but at a visit to my dentist several weeks later, the elevated blood pressure was confirmed.  Suffice it to say that I was not pleased with this news.

You are probably aware that high pressure within the arterial walls (hypertension) contributes to many serious ailments including the following: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA. So it behooves anyone with high blood pressure to get it treated, pronto.

I saw my internist and was prescribed medication called Diovan, which I started immediately.  It controlled my blood pressure nicely, but I experienced some side effects, so I returned to my doctor and I recommended to him a trial of a different class of medication called a beta-blocker.   This is typically not a first-line drug for hypertension and is often used for people with cardiac problems.   It works by decreasing the heart rate and contractility (the ability of the heart muscle to squeeze out blood).   This class of medication generally has a calming effect and I thought that because of my rather “energetic” style and persona, it might have a beneficial effect beyond managing the high blood pressure. Beta-blockers are sometimes used by people before public speaking, work on tremors of the hand, and have a general blunting/“take off the edge” effect.  I have some early morning insomnia and thought that this might help with that as well.

The medication was effective in normalizing my blood pressure.   However, it did “knock” me down a few notches.  I experienced fatigue in the late afternoon that was new to me.  More disturbing was that it was more difficult for me to exercise when it required major exertion.   When working out, I became short of breath and tired much more readily than previously. I’m a recreational cyclist and have always enjoyed bike riding since my earliest days of childhood.  I observed that I was having trouble keeping up with my cycling buddies and that hills—previously one of my strengths—were suddenly particularly difficult.  Understand that I’m going to be 58 years old on my next birthday, so I thought that my age might have finally caught up with me a bit, but I also questioned what role the beta blocker was playing.

My old heart rate monitor that I typically use when I cycle was not working properly so I headed out to Campmor and picked up a new one.  It is basically a chest strap that detects one’s heart rate that is displayed on a wristwatch. It is a very helpful device when cycling that helps one stay in the proper zone of heart rates to assure the appropriate level of exertion.   For example, I know that my maximum heart rate is 160 and a level of 125–140 is a comfortable heart rate for an endurance ride. When I start heading above 145, I begin experiencing shortness of breath and need to tamp down the exertion if I want to maintain the endurance.  I learned all of this when I attended Chris Carmichael hill cycling camp, located in Asheville North Carolina where I went a number of years ago with my cycling buddies to learn the proper techniques of attacking hills.

So I put on my new heart monitor and went out on a hilly ride.  Much to my surprise, my maximum heart rate was now 125, being 160 under normal circumstances.   At 115, I started experiencing shortness of breath; 110 was a comfortable rate.  I was astonished by the profound effect the beta-blocker had my heart rate.

Understand that beta-blockers do not just work on heart rate but also on contractility.  The term “stroke volume” refers to the amount of blood that the heart pumps out with one beat. Beta-blockers reduce both heart rate and stroke volume.   The ability to succeed in aerobic sports such as cycling and running is contingent upon satisfactory cardiac output to provide oxygen and nutrients to our cells. Cardiac output is the product of heart rate and stroke volume. So, cardiac output goes way down on a beta-blocker and clearly explains my sub-normal performance with highly exertion physical sports.

I saw my internist yet again, stopped the beta-blocker, and started an alternative medication—the same one that my sister is on—that has no cardiac effects. I went on a bike ride in Fort Lee Park and Route 9W with my sister and friends and noticed a dramatic subjective improvement in my cycling performance, more in line with my typical cycling functioning of previous years.  This was just one day after getting the beta-blocker out of my system. Objectively, my maximum heart rate was 140, much improved over the 125 on the beta-blocker, but still not up to the 160 that was typical for me.  On my next ride, my maximum heart rate was back to normal and my cycling performance was fully back to days of old.  I was back!  I’m very happy to say that age is not catching up with me—yet.

Bottom Line: The morals of the story are several: 

1.    High blood pressure usually causes no symptoms whatsoever and must be sought after, so get your blood pressure checked periodically even if you’re feeling great

2.    Do not assume that because you are in great physical shape, exercise regularly, are not overweight, are a non-smoker and have a healthy diet, that you are immune from high blood pressure, which is often genetic despite a very healthy lifestyle

3.    Be wary of beta-blockers if you are an endurance exercise enthusiast.   Apparently what I experienced does not happen to everybody, but it was quite profound with me.  

4.    Don’t tell your doctor what to prescribe you even if you are a doctor!  Physician—do not treat thyself; let your internist provide their sage input regarding management of medical problems.



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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Stroke of Unluck

March 2, 2013

Andrew Siegel, MD   Blog #96

The medical term cerebrovascular accident (CVA) is more commonly referred to as a stroke because many years ago it was felt that it occurred when God “struck a person down.” Essentially, a CVA arises when there is a sudden cessation of blood supply to the brain, or alternatively, a rupture of a blood vessel within the brain. Strokes are a major cause of disability and death in Western nations and, in fact, are the number 4 cause of death in the United States.  A stroke occurs every 40 seconds in the USA and a death from a stroke occurs every 4 minutes.

The brain, as with all tissues in the body, requires arterial blood flow to supply oxygen and vital nutrients in order to sustain function. When there is a blockage of blood flow to the brain or bleeding into brain tissue, there is insufficient oxygen supply to the area of concern, and within a short period of time, infarction, or tissue death, occurs. This is not unlike a heart attack (myocardial infarction), in which a region of the heart muscle dies because of insufficient blood flow; therefore, a  stroke can be referred to as a “brain attack.”

There are two major kinds of strokes, ischemic and hemorrhagic.  An ischemic stroke occurs when there is insufficient blood flow to the brain.   This generally occurs from either a ruptured fatty plaque (thrombosis) of one of the arteries in the neck or alternatively, a clot that forms in the heart and is pumped into the brain, acutely blocking the arterial supply (embolism). Ischemic strokes account for 87% of strokes.  A hemorrhagic stroke occurs when a blood vessel in the brain ruptures. Thirteen (13)% of all strokes are hemorrhagic, but the morbidity and mortality of a hemorrhagic stroke is much greater than an ischemic stroke, with hemorrhagic strokes accounting for approximately 30% of deaths from strokes.

A transient ischemic attack (TIA) is a temporary neurologic dysfunction caused by insufficient blood flow, and is the greatest predictor of stroke.  TIAs do not cause permanent brain tissue damage, as do strokes.  The symptoms of a TIA or stroke are very much dependent upon the location and extent of the brain tissue that is affected.   Classic symptoms are the following: sudden weakness or numbness on one side of face or limb; sudden trouble speaking or comprehending; confusion; sudden visual problems; sudden difficulty walking; dizziness/balance problems; and sudden headache.   Sometimes a stroke will cause no overt symptoms whatsoever; such silent strokes have been correlated with the occurrence of dementia.

The greatest risk factor for TIA and CVA is high blood pressure (hypertension). The high pressure within the arterial wall promotes dislodgement of a fatty plaque, or alternatively can stress the arterial wall to the point where the blood vessel itself ruptures.  Other risk factors include the use of tobacco, excessive alcohol intake, obesity, a poor diet, and a sedentary lifestyle with insufficient exercise. Promiscuous eating is certainly a risk factor for TIA and CVA.  A big risk factor for an embolic ischemic stroke is atrial fibrillation, a not uncommon cardiac arrhythmia that promotes clot formation within the heart.

To avoid or mitigate hypertension, lifestyle improvement measures are imperative.  These include weight loss; the DASH (Dietary Approaches to Stop Hypertension) diet; decrease in salt intake; increase in potassium intake, which works to lower blood pressure; exercise on a regular basis; and moderate consumption of alcohol.

So what to do if you experience symptoms suggestive of a TIA or stroke?   The first thing to do is to get to the Emergency Room ASAP or call 911 so that you be transported to an ER as expeditiously as possible, since time is of the essence in the management of a CVA. Many emergency rooms, in fact, have a “stroke protocol” in order to expedite the process, which requires evaluation, imaging (with computerized tomography or magnetic resonance imaging), and rapid management.

The emergency room will schedule the appropriate tests to make the distinction between an ischemic and hemorrhagic stroke.  This is of fundamental importance, insofar as they are treated differently. With ischemic strokes, the expeditious use of a clot-busting medication such as tissue plasminogen activator (tPA) can make a major difference in terms of the presence or extent of the disability sustained after an ischemic cerebral infarction.

A hemorrhagic stroke (intra-cerebral hemorrhage) results in bleeding within the brain, a highly compact organ located within the closed space of the skull that has little margin for the swelling that occurs as a result of the ruptured vessel.  Treatment of a hemorrhagic stroke aims to save the life of the stroke victim, alleviate symptoms, fix the bleeding and prevent complications.  Blood pressure needs to be controlled, the brain swelling minimized, and supportive care administered.  On occasion, a collection of blood known as a hematoma, will need to be evacuated surgically in order to take the pressure off the brain.  Long-term treatment aims to help the stroke victim recover as much function as possible and prevent future strokes.

BOTTOM LINE: Maintain a healthy, active lifestyle in order to minimize the risk factors for stroke. Should you experience TIA symptoms or an actual stroke, time is of the essence: get to an ER immediately in order to maximize your chances of survival and reduced debilitating aftereffects. 

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.

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:

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 by email. Please avail yourself of these educational materials and share them with your friends and family.