Posts Tagged ‘mind-body connection’

You Can’t Think It Up, But You Can Think It Down

November 21, 2015

Andrew Siegel MD   11/21/15


(Above fortune from Chinese fortune cookie relevant to this discussion.)

Q: What is the most powerful sex organ?

A: If you think it is the erect and throbbing penis, you are incorrect. The BRAIN is the bossman and the most influential force driving sexuality. The penis is a mere buck private soldier that responds and bends to the will of the five-star general and commander-in-chief of sexuality, the central nervous system.

Despite the authority and assertive presence of the brain, it is only under rare circumstances that it is capable of willing the limp penis to become erect. Some form of touch or erotic stimulation is most often necessary to get the erection process going, with the exception of nighttime-related erections associated with a phase of sleep known as REM (Rapid Eye Movement).

If the central nervous system cannot will the limp penis to become erect, it certainly can will the erect penis to become limp or will the limp penis to remain limp. This is the case with performance anxiety, a classic instance of the powerful mind-body connection. In this circumstance, stress or anxiety causes the output of high levels of adrenaline, which functions to constrict penile blood flow and erectile smooth muscle relaxation, resulting in a limp penis.

The central nervous system is the commander-in-chief of sexuality, but it demands working the way it likes to work, i.e., naturally, unhindered and unburdened by cognitive thought. Conscious and willful thought clearly can interfere with the smooth function of the central nervous system. When conscious thought enters the picture, the ability to perform many complex movements goes south. Much the same as a golf swing or any action like using a fork to feed yourself or walking down a flight of stairs, when it comes to sexuality, the brain works best when it is working subconsciously. Overthinking is the enemy of any complex motor activity. With all of these examples, one needs to be in the moment and engaged in the activity without conscious thought, in order to enable a smooth execution.

The moment one starts overthinking, the complex motion is virtually destined to be flawed. The golf swing is a classic example, with a poor shot almost guaranteed if one has too many swing thoughts that confound execution and performance. For the non-golfers, try walking down a flght of stairs at a good clip, stating to yourself in your inner voice each step in the process and you will likely trip up. When you are in a sexual situation, if you focus on thinking about your sexual function or lack thereof or reliving a previous problem, then your performance will most often be doomed to failure.


(Thank you, Pixabay for image above)

Too much thought is capable of empowering self-fulfilling prophecies and bringing them to fruition. If one has had erection issues and in a passionate moment starts thinking, assessing, evaluating and analyzing, he is almost certain to be incapable of obtaining or maintaining an erection. Likewise, if one suffers with premature ejaculation and his thought pattern becomes obsessively focused on this possibility instead of being in the moment and enjoying the situation, he is almost certain to ejaculate way sooner than desired. The same is true with the rarer but equally disturbing problem of delayed ejaculation. Focusing on trying to make oneself ejaculate will most often bring on the inability to ejaculate.

Masters and Johnson coined the term spectatoring, an intense self-focus during sexual interactions as opposed to immersing oneself in the sensory aspects of the sexual experience. Essentially, spectatoring is observing and monitoring yourself having sex as if you were a third party, often accompanied by an anxious internal, self-conscious dialogue with concerns about some aspect of your sexual performance. It is being a spectator instead of the player and it will DESTROY your game.

The solution to spectatoring is to “be present” and “in the moment,” totally immersing yourself in the experience without observation or conscious internal thoughts. When you lose yourself in the sensations and do not allow thoughts to interfere with the process, you maximize your chances for an optimal performance. When distracting thoughts uncontrollably float into the present like dark clouds in the sky, take a deep breath, exhale slowly and allow the thoughts to pass and return to a state of being present.

Bottom Line: Overthinking is the enemy of complex actions, including erections and ejaculation. Allow the central nervous system to do what it does so well– subconsciously– without trying to help things along with deliberate thought.  Let instinct prevail over conscious thought–you cannot make it happen, you have to let it happen. There is an  time and place for conscious thought, but it is not in the heat of the moment in the bedroom.  Be present without thought of the past or future. 

Wishing you the best of health,

2014-04-23 20:16:29

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Pilates and Male Pelvic Fitness: Part 2

April 12, 2014


Blog #149

Pilates is a discipline that has a strong foundation in core strength and pelvic floor conditioning. This blog is the second part of an interview of Catherine Byron, Pilates trainer and owner of CB Performance Pilates ( This material is excerpted from my forthcoming book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health. (now available in ebook format on Amazon; soon to be available on iBooks, Nook, and paperback)

Dr. Siegel: Can you elaborate on the mind-body connection?

Catherine Byron: Integrating “awareness” and the “mind-body” connection are key components to reaching your potential. The art of being in the moment, of involving the intellect with movement is the key to reaching one’s goals. Often, we are not living in the moment but are simply going through the motions, a condition known as “mindlessness.” Pilates is rooted in “mindfulness”—staying alert and aware in the present moment. Not only does Pilates educate a person about his anatomy, but also how to use it more efficiently.

Dr. Siegel: But doesn’t too much thinking interfere with our ability to do a physical task in a natural and fluid fashion?

Catherine Byron: During the rehabilitative/reconditioning phase of training, mindfulness is key. Over time, these patterns become natural and intuitive and the need to “think” about it will diminish. Initial “heightened” focus is part of the overall process 

Dr. Siegel: In your opinion, what constitutes fitness in general and pelvic fitness in specific?

Catherine Byron: Being physically fit has its roots in the foundations of stability, flexibility, strength and aerobic conditioning. Pilates adds spinal alignment, muscle balance and core strength. Throughout your book, you have emphasized the importance of blood flow to the pelvis, linking it to cardiovascular and penile health and function. Cardiovascular fitness is a foundational pillar of good health and should be a lifestyle habit that is incorporated into one’s existence. In terms of pelvic fitness, a simple formula is improve blood flow, improve function.

Dr. Siegel: What differences have you observed in working with men vs. women?

Catherine Byron: One of the main differences between men and women is range of motion. Most males do not have the degree of joint flexibility as do females, particularly around the hip region. Movement is directly related to this range of motion or flexibility. The more flexible a person is, the more they can “articulate,” meaning move the body with greater detail. For example, think of a ballerina in terms of how she moves. She has the ability to move her ribs and hips with petite, incremental articulations and singular, ratcheted movements as opposed to the chunky, massive movements of many men. The good news is that through stretching and Pilates, men can greatly improve their range of motion and muscle function and begin to perform pelvic movements with greater articulation. The resulting improved range of motion ultimately translates into awareness and improved control of your core, pelvic floor and all-importantorgan, the penis.

Dr. Siegel: How will your 10-step Pilates program improve male pelvic health?

Catherine Byron: The Pilates exercises will develop the deep stabilizers of the spine and improve pelvic movement. These muscle groups work to “hold” or “stabilize” the hips and spine in place. They greatly contribute to the strength and endurance requirements of pelvic movements. There are two types of muscles—movers and stabilizers. For example, your biceps muscle allows you to move your arm but does not work to stabilize any part of your body. Stabilizer muscles are located throughout the body and, in essence, hold you together so that you don’t collapse. In terms of pelvic fitness, Pilates focuses on the pelvic stabilizers. The pelvic floor muscles lift, support and stabilize our pelvic organs. Without the pelvic stabilizer muscles, we would all be wearing diapers. Unfortunately, over time, these lose elasticity and tend to collapse to some extent, which is why strengthening them is so vital.

Dr. Siegel: How does pelvic stabilization help sexual function?

Catherine Byron: Pelvic stabilization builds endurance of the pelvic floor muscles and surrounding core region. This directly equates to improved function, stamina and the length of time that the pelvic muscles can contract before they fatigue. An improved pelvic floor coupled with active pelvic floor muscle contractions will enhance sexual function by allowing a man greater control over his erections.

Dr. Siegel: What about breathing?

Catherine Byron: Breathing is literally the “lifeline” of the entire body. Inhalation brings a surge of oxygen to every cell of the body, fueling and providing energy. Exhalation is a necessary release not only of waste gases but also of physical tension. Holding one’s breath or a lack of coordinated and full breathing diminishes this fuel connection and can result in tense and rigid movements. Breathing is part of that mind-body connection and can help to maximize the integration of body, mind and spirit.

Dr. Siegel: What is the relationship between stability and flexibility?

Catherine Byron: Stability and flexibility can be likened to a tree’s roots and branches. The roots represent stability and the branches, flexibility. If either function is in greater measure than the other, an imbalance occurs. Pilates creates a body that is stable and flexible in equal measure. Over-development or under-development of one or both of these can lead to injury and dysfunction. Pilates exercises produce both length (flexibility) and strength in the muscles, creating a harmonious balance.

Dr. Siegel: What is a Pilates ring?

Catherine Byron: The Pilates ring, also called a Pilates “circle,” is a device used to activate the inner and outer muscles of the pelvis and pelvic floor. The ring is excellent at directly targeting and allowing one to develop the core muscles addressed in this book. For this reason, the 10-step program will require one. The ring is positioned inside or outside the hips, activating hard-to-reach stabilizers required for spinal, urinary and sexual health. Using this device will ignite the “hidden” muscle groups, rarely targeted in traditional gym style exercises.

In addition to strengthening the pelvic stabilizers, the 10-step program involves movement patterns so that muscle development will occur not only statically, but also dynamically during motion. While using the ring, movement in several planes of motion will function to develop the pelvic region in a balanced fashion. Creating balance in this region results in greater performance. Strengthening the front, back and sides of the hips is of vital importance because all are connected. Mastering movement withstabilization is our primary goal in order to enhance core strength and pelvic floor function to the maximum!

Dr. Siegel: What does Pilates offer men if they already know how to exercise their pelvic floor muscles including the bulbocavernosus, ischiocavernosus, and pubococcygeus muscles?

Catherine Byron: The 10-step Pilates exercises will maximize the strength and endurance of the pelvic floor muscles. This program will target and ignite the pelvic floor and will allow one to work the pelvic floor more deeply, effectively and efficiently.

Dr. Siegel: How is the 10-step exercise program geared towards men?

Catherine Byron: To reiterate, one of the main differences between men and women is the way in which they move. Women move with greater and more focused detail. It is easier for a woman to move her pelvis and tilt it one vertebra at a time as compared to a man whose pelvis is typically “thicker” and moves more in “chunks.” In addition, men tend to choose sports, exercises and hobbies that further exacerbate this bulky, heavy movement style. The result is a serious restriction of motion that can lead to diminished performance and potential injury.  For the 10-step program, along with step-by-step photos of the technique, please refer to Dr. Siegel’s book.


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Pilates and Male Pelvic Fitness

April 5, 2014


Blog #148

Pilates is a discipline that has a strong foundation in core strength and pelvic floor conditioning. This blog is an interview of Catherine Byron, Pilates trainer and owner of CB Performance Pilates ( This material is excerpted from my forthcoming book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health.

Dr. Siegel: What is Pilates?

Catherine Byron: Pilates is a system of exercises designed to strengthen the core. Pilates pays particular attention to spinal alignment and muscle balance. There are many ways to strengthen the core, but what makes Pilates exercises unique are the movement patterns through the spine, specifically articulating one vertebra at a time. As a result, the exercises are not only done with fine control and detail but also serve to strengthen the body evenly: they work both the front and back sides of the spine and, most importantly, include the pelvic floor. A regular gym approach to the core often targets the superficial (outer) muscles of the core while Pilates will target the spinal stabilizers (deepest layer), which attach to the vertebrae of the spine. In Pilates, a great deal of emphasis is placed on a person’s alignment, posture, and movement patterns.

Dr. Siegel: In your opinion, what constitutes the core?

Catherine Byron: The core is the trunk of the body—cut off the arms, legs, and head and what you have left is the core. The “foundation” or “primary core” is the area around the hips—the lumbar pelvic region.

Dr. Siegel: What does Pilates have to do with the male pelvic floor?

Catherine Byron: Pilates activates the pelvic floor muscles and the surrounding muscles that provide additional support for male pelvic function. In order to maximally benefit this area, the muscles have to be treated as a “team.” Similar to developing a sports team, you would never concentrate on only one player. Instead, you would focus on building the entire team. In much the same way with the human body, you never isolate and train individual muscles. If you can think of the complexity of the pelvic floor as a hammock that comes together to lift, you are going to engage that hammock and build up the endurance of the pelvic floor muscles. With Pilates, this area of the body is a specific target and, of course, because the nether parts are so intimately connected, this area is improved as well.

Dr. Siegel: Are Pilates exercises meaningful for male pelvic health?

Catherine Byron: As a certified trainer, fitness advocate, and owner of a Pilates studio, I can attest that no other core strengthening system compares with the conditioning program established by Joseph Pilates. For the very specific needs of the musculo-skeletal system of the male pelvis, these exercises are not merely a direct hit or even a home run, but a grand slam!

Dr. Siegel: Is Pilates good for sex?

Catherine Byron: I don’t think there is any other form of exercise that so directly targets the muscles used in sex. Pilates strengthens the exact muscles that are discussed in this book. During sex, there is a lot of pelvic movement. Moving the hips back and forth repeatedly requires more stamina than strength. Pilates-style exercises develop those muscles that function to stabilize and hold, the ones that provide endurance. Sex demands staying power of the backside of the pelvis, that is, the lower back region. In many exercise routines, there is way too much emphasis on the abdominals, developing the front side of the pelvis—the muscles that assist in the “pushing forward” phase. But the truth is, the more vital requirement is for the endurance of the lower back muscles that assist in the “pulling back” phase. It is the pulling back—the winding up so to speak—that is key to enable pushing forward. Also, muscle balance is an important prerequisite to proper movement and function. Balanced training of the entire pelvic region—the front, back, outside and inside—are essential for improved sexual performance. The 10-step program laid out at the end of this chapter will largely target these muscle groups.

Dr. Siegel: What are the key principles of Pilates?

Catherine Byron: Pilates principles are based on spinal alignment, muscle balance and core strength. Pilates emphasizes spinal alignment—properly positioning one’s hips, ribs, shoulders and head in their anatomically neutral positions. Pilates is a mind-body exercise—all movements are executed with control and strongly linked to breath. Pilates will develop a balanced body, meaning all muscle groups, on all sides of the body, are evenly developed. Core strength is stressed and the deep stabilizers of the spine are focused upon. Practicing these exercises will improve balance, stability, strength, and enhance flexibility through detailed articulation of all movements.

Dr. Siegel: As a Pilates instructor, what is your take on the human body?

Catherine Byron: As a fitness professional, I have 25 years of experience in observing the musculo-skeletal system of the human body in both its static (still) and functional (motion) states. I have always marveled at the human body and its well-conceived design. Nothing is happenstance as every bone, muscle, organ and system is perfectly engineered to harmonize with its counterparts. When this harmonious balance is disrupted, the body “speaks” by producing symptoms. It is through the understanding of these “symptoms” that we gain insight into not only our bodies but also ourselves.

Dr. Siegel: What symptoms occur when there is lack of balance or harmony?

Catherine Byron: Usually a stress point occurs, causing inflammatory conditions. Pain is a “shout out” by the body for attention. Many of the disorders described in this book can easily arise when the pelvic floor muscles and surrounding core area are not holding or functioning properly. When there is a lack of balance to the system or any kind of disruption occurs, “dis-ease” occurs.

Dr. Siegel: So how do we strive to achieve this balance?

Catherine Byron: Finding balance in our lives can be just as great a challenge as creating it in our bodies. The art of doing so comes with great discernment and requires the courage to be honest with ourselves as we determine what areas are in our power to change and what areas are not. It’s that age-old adage: we must accept what we cannot change and change what we can. You have clearly delineated the importance of recognizing what it is that we cannot change about our anatomy. Learning to accept what nature has given us is the first step towards the achievement of harmony with respect to our bodies and ourselves. The second step is identifying what changes can be made in order to improve one’s pelvic fitness as well as overall health and lifestyle.

Dr. Siegel: What can we change and what can’t we change?

Catherine Byron: You cannot change genetics. Your size, strength and even your flexibility to some degree are all dictated by hereditary factors. However, the specifics of your anatomy and how to properly use it can be taught and developed. By working with a professional trainer you can learn to retrain movement and function. My goal is to address those areas that can be changed through a 10-step Pilates-based program. The exercises are specially designed to empower you by improving pelvic health, strength and stability

Dr. Siegel: Before getting into the specifics of Pilates exercises, can you say a few words on general health and wellness?

Catherine Byron: Attitude and personal philosophy have a profound influence on our health. Before discussing the Pilates exercise program, there must first be a consideration of two major areas, lifestyle and mind-body connection. As a foundation for improving one’s health, it is imperative to be aware of our lifestyle habits. These include diet, exercise, sleep, stress management, attitude, etc. As you have acknowledged, it is important that diet and lifestyle be recognized as key players. When a physical disorder is traced back to its root cause, much of the time lifestyle and diet are implicated. In the quest towards health and fitness, introspection about one’s diet and lifestyle is a monumental step in the process of change and progress. If you want to improve, you must first be aware. Self-awareness is a fundamental prerequisite to self-improvement. Developing and refining the mind-body connection can be transformational and is capable of boosting an amateur athlete towards far greater levels if he has the right attitude and is willing to put in the time and effort.

To be continued next week.


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”:

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

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

Available on Amazon in Kindle edition

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity (free electronic download)

For more info on Dr. Siegel:

Happiness Deconstructed

April 27, 2013


Andrew Siegel, MD   Blog #104


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

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Pavlov, the Munchies, and the Bladder

March 23, 2013

Andrew Siegel, MD   Blog #99

Ivan Petrovich Pavlov (1849-1936) was a Russian physician, physiologist and psychologist who won the 1904 Nobel Prize in medicine.  Pavlov is best known for describing classical conditioning, summarized as follows: Pavlov recognized that meat causes dogs to salivate, an instinctual reaction called an unconditioned response. He used a metronome to call his dogs to their meaty meal and, after a few cycles of repetition, the dogs began to salivate just on the basis of the sound of the metronome. The reaction to the metronome is called a conditioned response, since it is a learned behavior.

Humans are little different from Pavlov’s dogs. Many foods literally elicit a “mouth watering” unconditioned response and certain specific contexts can exact a conditioned response in the absence of the specific food item. This can help explain the foraging for food that many of us undertake when the television gets turned on, or alternatively, the desire for snacks when we go out to the movies—I refer to this as the “media munchies.”  Similarly, when we enter our homes and head into the kitchen, many food-associated context clues—the refrigerator, pantry, kitchen table, cookie jar, etc.—trigger our desire to eat via the classical conditioning pathway. The importance of classical conditioning with respect to eating is that food-associated context cues can elicit a conditioned response that can trigger eating and drive overeating, weight gain and obesity.

Let’s now shift gears to the bladder—I must admit that this is a strange segue!  Many develop a conditioned response to cues that we associate with the act of emptying our bladders.  Any source of running water—the kitchen sink, bathroom fixture, shower, etc.—can elicit a conditioned response in which exposure to such a trigger causes urinary urgency, defined as the sudden desire to urinate and need to get to the bathroom in a hurry.  At times, it can even cause incontinence, leakage occurring before arrival to the bathroom.

When I was a wee lad (no pun intended!), I noticed that I consistently experienced the sudden need to urinate when I brushed my teeth.  For years, I was perplexed about this, thinking it had something to do with the act of brushing of my teeth, only to realize years later that it had nothing to do with the toothbrush, toothpaste or act of brushing, but with the water running from the faucet!

For ages, parents have been trying to get their infants to learn to urinate on command by sitting them on the toilet and turning the bathroom sink on, creating and reinforcing an association between running water and urinating.  It is truly a helpful tool in the effort to achieve toilet training; however, this conditioned response can come back to haunt us later in life, when exposure to running water triggers an involuntary bladder contraction (the bladder squeezing without our permission) and hence urgency and perhaps even urgency incontinence!  Other common Pavlov-type conditioned responses that can elicit an involuntary bladder contraction are putting the key in the door to one’s home, arising out of a car, and getting closer to the bathroom.  “Latchkey” incontinence is a very common condition in which simply placing the key in the lock is enough to cause intense urgency and the need to literally scramble to get to the bathroom on a timely basis.  Any cue that reminds us of the act of voiding is enough to trigger this response.

What can we do about these maladaptive and annoying conditioned responses?  If our bladders are truly full, nothing will help short of emptying them.  However, if our bladders are not full, but are simply contracting involuntarily in response to the trigger, there is a simple and effective means of countering it.  The answer is to deploy our pelvic floor muscles to counteract/prevent the involuntary bladder contraction.  Whether female or male, by doing a few rhythmic contractions of the pelvic floor muscles (Kegel exercises), either after the urgency is triggered or preferably before exposure to the trigger, the involuntary bladder contraction can be terminated/obviated.

In fact, pelvic floor muscle exercises have a number of very helpful uses and benefits and will be the subject matter of my forthcoming book entitled “Male Pelvic Fitness: Optimizing Sexual and Urinary Health.”  The female version will follow.  In the meantime, if you would like information on the pelvic floor muscles, take a look at my YouTube video, which can be accessed at:

Bottom Line: The mind-body connection is powerful beyond our understanding.  Contextual cues can provoke responses and actions in the absence of the original stimulus.

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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The Mind-Body Connection: How it Relates to Our Eating Behaviors

December 31, 2011

 Blog # 40

(Much of the following first paragraph is excerpted from the December 29, 2011 obituary of Dr. Robert Ader, written by Paul Vitello and published in The New York Times.)

Dr. Ader was an experimental psychologist who was among the first scientists to show how mental processes influence the body’s immune system, a seminal discovery that changed modern medicine.  You might say that he was the father of the “mind-body” connection.  His research was a touchstone for studies that have shown the communication network among immune cells, hormones, and neurotransmitters.  This field—psychoneuroimmunology—provides the science behind notions too often considered “magical thinking”:  that meditation helps reduce arterial plaque; that social bonds improve cancer survival; that people under stress catch more colds; and that placebos work not only on the human mind, but also on cells themselves.  Dr. Ader demonstrated that stress worsens illnesses, sometimes even setting them off, and that stress reduction is essential to health care.  To summarize Dr. Ader’s work in one phrase: Stop worrying or you’ll make yourself sick.

The fact that mental processes affect the immune system, hormones, and neurotransmitters has a profound influence on our eating behaviors.  An understanding of our mind-body relationship is fundamental in the effort to conquer eating issues.

Carly, age 40: “When I am stressed or have things on my mind or I am really tired, I eat sweets, like cakes and cookies. I don’t even give it any thought. I feel bad after and think about eating better or exercising, but I don’t act on these thoughts.”

Although it is convenient to think of our minds and bodies as separate and discrete entities, our emotional and cognitive sides do not exist independently of our flesh and physical beings. Our minds and bodies are very much commingled, and our mind-body connection is extensive. Our bodies house our minds, and our minds control our bodies, but our minds are made of matter just as our bodies are, and our bodies have a vast array of neural networks running through them that essentially are peripheral extensions of our minds. When our minds are unhealthy, often our bodies become unhealthy, and vice-versa. Optimal human functioning and performance requires a coordinated and harmonious relationship between our minds and bodies.

The following are a few examples of the mind-body connection:

When you become embarrassed your cheeks get a crimson flush.

When you are driving and the car in front of you comes to a sudden and unexpected stop, you respond by slamming on your brakes and just miss a rear-ending collision, your heart races, your pupils dilate and your breathing pattern is rapid and deep. 

When you are fatigued after a hard day of work but can muster up the fortitude for a workout, you can emerge physically and emotionally invigorated, stress relieved, fatigue washed away—refreshed with a wonderful feeling of well-being.

The above examples show how our minds can affect our bodies—blood flowing to our face in the blush response and the classic physiological stress response; and how the body can affect the mind—physical exercise transforming an emotional state. The essence of the mind-body connection is that our thoughts, feelings and emotions can affect our body chemistries and cause a physical response, and conversely, our physical actions, like exercise or laughter, can influence our brain chemistries and affect our thoughts, feelings and emotions.

How is the mind-body connection relevant to eating?

We are highly emotional creatures and it these feelings that are one of the key features that separate us from other members of the animal kingdom. We bring our emotions to every situation, and on a certain level we are all emotional eaters since we all bring our emotions “to the table” in this sense. It is impossible to separate emotions from eating and, with this in mind, it becomes easier to understand how our emotions can cause unhealthy eating patterns.

There are wide ranges of emotions that can trigger eating. Exhaustion, stress, boredom, anxiety, anger, loneliness, sadness, depression, frustration, resentment, disappointment, issues of self-esteem, and interpersonal conflicts are some of the negative emotions that can drive eating. Positive emotions including hopefulness, happiness and confidence can also spark emotional eating. In general, it appears that negative emotions demand neutralizing and positive emotions fuel our passion for eating. There are many among us who use food as a refuge from negative emotions, and for whom food serves as both a “friend” and “therapist”; however, there are certainly, some of us who turn off from eating under the same circumstances. Thus, there is a wide range of eating responses to emotions and all of us “metabolize” our feelings differently.

Stress seems to be our most compelling emotional drive to eat, second only to hunger as a motivation to eat. It is the rare person who does not lead a stressful existence. Stress seems to pummel our souls and eating serves as a mechanism to sooth our beaten-up inner beings— a means of distracting us from our troubles and escaping from the real-life problems and unpleasant aspects of our daily lives.  Life can oftentimes be very tough and food can provide an immediate source of comfort and relief, just as a cigarette can to a smoker or alcohol to a drinker. Many of us, particularly after a very stressful day, head straight for the refrigerator after arriving home from work, seeking solace, refuge and sanctuary.

Interestingly, it seems that when we eat for negative emotional reasons we tend to gravitate to unhealthy foods—it would appear that we desire the kind of foods that will match the emotion driving the eating. Self-destructive emotions beg for self-destructive eating behaviors and self-destructive foods.

In accordance with the work of Dr. Ader, there is a biochemical explanation for stress eating. The adrenal gland hormone cortisol—released in response to stress—can stimulate our appetites and cravings for sugar.  This is the very reason people on corticosteroid medications tend to have enormous appetites, gain weight, and have a tendency for obesity. Cortisol also functions to reduce the satiety hormone leptin, further stimulating our appetites. Additionally, the consumption of certain foods, especially those containing sugar and fat, can cause release of endorphins that are powerful morphine-like chemicals with pain-relieving properties. Is it any wonder that food serves a role as a sedative?  It is of great interest to note that exercise can also release large amounts of these endorphins, so better to head to the gym than the fridge when stressed!

In summary, our emotional state—in a constant state of flux—affects our neurotransmitters, hormones and immune cells.  The variable state of our internal biochemical environment that occurs in response to our emotional state is capable of profoundly influencing our behaviors, including eating. In spite of the biochemical imperative to eat driven by certain emotions, understanding the influence of the mind-body connection is one of the first steps towards overcoming unhealthy eating patterns.

A healthy and sunny 2012 to all!

Andrew Siegel, M.D. for more info on my book: Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food