Posts Tagged ‘visceral obesity’

Seasonal Weight Gain, Pre-diabetes and E.D.: The Hard Facts

January 5, 2019

Andrew Siegel MD  1/5/2018   Happy New Year!

As reviewed in the last entry, many factors over the past few months have conspired to add inches to our waistlines…Halloween sweets, Thanksgiving treats, December feasts, New Years celebrations, etc., with ample opportunities for over-indulging.  Then there is the added element of the cold and dark season that make exercising outside challenging and fueling the desire for comfort foods.  Before you know it, our pants are snug and we discover that we have gained 10 pounds or so.  

Today’s entry is on the topic of how gaining weight—the possible beginning of the journey to diabetes—can affect one’s manhood and vitality. While optimal sexual function is based on many factors, it is important to recognize that diet and physical activity play a vital role. What we eat—or don’t—and how much we exercise—or don’t—impacts our health and sex lives significantly.  For many, 2019 is a time for New Year’s resolutions, which often involve weight loss and a healthier lifestyle. Yet another benefit of becoming leaner and fitter is improved sexual function.

fat belly

Image above: visceral obesity, often associated with pre-diabetes or diabetes and a disaster for health in general and function “down below”


A Canary in Your Trousers

The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline.  This surge happens within seconds and responsible for the remarkable physical transition of the penis from flaccid to erect. This healthy sexual response is a clear indication of robust blood flow to the genital and pelvic area and intact sexual function serves as an excellent marker of overall cardiovascular health.

Eating Yourself Limp

Weight gain and obesity steal one’s manhood. Men with large bellies are likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it difficult to obtain and maintain good quality erections. Additionally, as one’s belly gets bigger, one’s penis appears smaller, lost in the protuberant roundness of the large midriff and the abundant pubic fat pad. Furthermore, abdominal fat contains the enzyme that converts the male hormone testosterone to the female hormone estrogen, accounting for low testosterone levels and man-boobs in obese men. The combination of a big belly, a small and poorly functional penis and the presence of man boobs translates to emasculation– essentially “eating oneself limp.”  The bottom line is that poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast track to weight gain and obesity and clogged arteries that can make your sexual function as small as your belly is big.

Pre-diabetes and Diabetes

Glucose is the body’s main fuel source.  Diabetes is a disease in which blood glucose levels become elevated. Insulin, a hormone secreted by the pancreas, is responsible for moving glucose from the blood into the body’s cells so that life processes can be fueled. In diabetes, either there is no insulin, or alternatively, plenty of insulin, but the body cannot use it properly. Without functioning insulin, the glucose stays in the blood and not the cells that need it, resulting in potential harm to many organs.

Type 1 diabetes is an autoimmune condition in which the body’s immune system destroys insulin-producing cells, severely limiting or completely stopping all insulin production.  It is often inherited, is responsible for 5% of diabetes, and is managed by insulin injections or an insulin pump.

Type 2 diabetes is caused by overeating and sedentary living and is responsible for 95% of diabetes. This form of diabetes is caused by insulin resistance, a condition in which the body cannot process insulin and is resistant to its actions. Anybody with excessive abdominal fat is on the pathway from insulin resistance towards diabetes.  Type 2 diabetes is a classic example of an avoidable and “elective” chronic disease that occurs because of an unhealthy lifestyle.

Diabetes is the most common cause of erectile dysfunction (E.D.) in the U.S.A. Since Type 2 diabetes is often an evolving process, gradually progressing from a normal metabolic profile to pre-diabetic status to diabetes, it should be no surprise that pre-diabetic status can be associated with E.D. In fact, studies have shown that one in five men with new-onset E.D. have unrecognized pre-diabetes.

Pre-diabetes is characterized by elevated serum glucose levels (100-125 mg/dL) and hemoglobin A1c values of 5.7-6.4%.  Pre-diabetes is also associated with other metabolic abnormalities, including higher body mass index, elevated cholesterol and triglycerides, and lower testosterone.

Chances are that if you have a big abdomen (“visceral” obesity marked by internal fat) you are pre-diabetic. This leaves you with two pathways: the active pathway – cleaning up your diet, losing weight and getting serious about exercise, in which this potential problem can be nipped in the bud and the progression to diabetes can be reversed. However, if you take the passive pathway, you’ll likely end up with full-blown diabetes.

Healthy lifestyle choices are of paramount importance towards achieving an optimal quality and quantity of life. It should come as no surprise that the initial approach to managing pre-diabetes (and sexual issues) is to improve lifestyle choices. These include proper eating habits, weight loss and thereafter maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and minimizing stress.

Fueling up with wholesome, natural and real foods helps prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products—including lean meats and dairy—should be eaten in moderation. The Mediterranean-style diet is an excellent one for helping to reverse the non-inevitable course towards diabetes and E.D.

Bottom Line:  Diabetes progresses in a step-wise fashion from pre-diabetes and is considered to be an “elective” chronic disease caused by an unhealthy lifestyle.  Accompanying a myriad of potentially serious medical problems are sexual consequences that rob men of their manhood and masculinity.  The good news is that lifestyle modifications can reverse this situation.  

 Wishing you a healthy, peaceful, happy (and sexy) 2019,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

MPF cover 9.54.08 AM

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

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

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



How To Raise Your Testosterone, Naturally

September 3, 2016

Andrew Siegel MD  9/3/2016


(CDC/Amanda Mills from Public Health Image Library)

Two weeks ago, my entry was about the medication Clomid–a nice alternative to testosterone replacement therapy. What about a non-pharmacological, natural approach to raising testosterone levels?

Testosterone (T) is produced mostly in the testes, although the adrenal glands also manufacture a small amount. T has a critical role in male development and physical characteristics. It promotes tissue growth via protein synthesis, having “anabolic” effects including building of muscle mass, bone mass and strength, and “androgenic” (masculinizing) effects at the time of puberty. With the T surge at puberty many changes occur: penis enlargement; development of an interest in sex; increased frequency of erections; pubic, axillary, facial, chest and leg hair; decrease in body fat and increase in muscle and bone mass, growth and strength; deepened voice and prominence of the Adam’s apple; occurrence of fertility; and bone and cartilage changes including growth of jaw, brow, chin, nose and ears and transition from “cute” baby face to “angular” adult face. Throughout adulthood, T helps maintain libido, masculinity, sexuality, and youthful vigor and vitality. Additionally, T contributes to mood, red blood cell count, energy, and general “mojo.”

The amount of T made is regulated by the hypothalamus-pituitary-testicular axis, which acts like a thermostat to regulate the levels of T. Healthy men produce 6-8 mg testosterone daily, in a rhythmic pattern with a peak in the early morning and a lag in the later afternoon.  Low T levels can be low based upon testicular problems or hypothalamus/pituitary problems, although the problem most commonly is due to the aging testicle’s inability to manufacture sufficient levels of T. T levels gradually decline—approximately a 1% decline each year after age 30—sometimes giving rise to symptoms. These symptoms may include the following: fatigue; irritability; decreased cognitive abilities; depression; decreased libido; ED; ejaculatory dysfunction; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; and abnormal lipid profile. A simple way to think about the effect of low T is that it accelerates the aging process.

Lifestyle factors are strongly associated with variations in testosterone (T) levels, with healthy lifestyles correlating with higher levels of T and unhealthy lifestyles with lower levels.  Some physicians regard T level as a laboratory marker of male physical health.

One of the key factors responsible for some of the decline in T that accompanies aging is excessive body fat. In fact, there is an inverse relationship between obesity and T levels, with increased body mass index (BMI) correlating with decreased T.

Factoid: Every 5-point increase in BMI translates to a 10% dip in T–an equivalent decline as would typically occur with 10 years of aging.

Fatty tissue – particularly visceral abdominal fat (the “beer belly”) – contains an abundance of metabolically active factors and hormones including aromatase, an enzyme which functions to convert T to the female sex hormone estrogen. Men with large bellies consequently are often found to have lower T levels and higher estrogen levels, which can result in “emasculation” with loss of sex drive, diminished erections, the disturbing loss of penile length and the presence of gynecomastia (man boobs)

Factoid: In addition to the decline in T, for every 35 lb. weight gain there is a 1-inch loss in apparent penile length because of the pubic fat pad that hides the penis.  

The good news is that weight loss will increase T levels and is capable of improving all of the aforementioned signs and symptoms. This has been demonstrated with all means of  weight loss, ranging from caloric restriction to bariatric surgery.

Another important lifestyle factor associated with variations in T levels is the extent of one’s physical fitness. Exercise is clearly associated with higher T levels. The degree of potential increase in T is related to both the quantity and quality of exercise. In general, the more time invested in moderate intensity exercise, the greater the increase in T.  As important as aerobic exercise is for health, resistance exercise is superior in terms of increasing T.

Bottom Line:  To optimize your T level, maintain a healthy weight and engage in an exercise program emphasizing resistance training.  If you are obese and sedentary, it is likely that you have low T, a situation that can be reversed with a modification to a healthier lifestyle. 

Wishing you the best of health,

2014-04-23 20:16:29

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at

Author page on Amazon:

Apple iBook:

Trailer for The Kegel Fix: 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

What’s This Metabolic Syndrome I’ve Been Hearing So Much About?

August 18, 2012

Andrew Siegel, M.D.    Blog #71


The “metabolic syndrome” is a cluster of risk factors that are dangerous to your health.  These include visceral obesity as defined by waist circumference, elevated blood glucose level, high blood pressure, elevated triglycerides, and low HDL cholesterol (the good cholesterol).  Visceral obesity is a collection of fat within the abdomen as opposed to under the skin (subcutaneous fat).

When a patient walks into the office and the first thing observed is a protuberant and bulging belly, a siren goes off screaming “metabolic syndrome, metabolic syndrome, metabolic syndrome.”

If you have at least three of the following five risk factors, you have metabolic syndrome.  Those who have metabolic syndrome often develop cardiovascular disease and/or type-2 diabetes.

 Features of Metabolic Syndrome:


  • Elevated waist circumference: men > 40 inches; women > 35 inches
  • Elevated triglycerides: > 150 mg/dL
  • Reduced HDL (“good”) cholesterol: men < 40 mg/dL; women

< 50 mg/dL

  • Elevated blood pressure: > 130/85 mm Hg
  • Elevated fasting glucose (sugar): >100 mg/dL

One of every four Americans has metabolic syndrome. This syndrome is caused by insulin resistance—the body’s inability to properly process nutrients including sugars and fats because the pancreatic hormone insulin no longer works in an efficient manner to get nutrients into our cells.  The root cause of insulin resistance is too much waist and not enough movement.  Essentially, our well-engineered systems are “flooded” by taking in excessive calories.  Our bodies simply were not designed for chronic caloric overload, and the only people who can handle this caloric flooding are endurance athletes who burn the calories, such as Michael Phelps.

Triglycerides are the main fat in food and the bloodstream.  One in three adults have a fasting triglyceride level higher than 150; optimally, triglycerides should be under 100.  Even a non-fasting triglyceride level should not be that high, because no healthy person should ever develop an extremely high level even in response to a fatty meal.  Diets high in sugar are the major underlying cause of elevated triglycerides.

The good news is that lifestyle modification has a very positive impact on triglyceride level—it is very possible for triglycerides to decline as much as 30% based upon a diet with less calories, sugar, saturated fat and alcohol.  EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are marine-derived omega fats that are capable of lowering triglycerides.  Fish contain these two omega-3 fats because they consume algae that are rich in them.   Exercise is an equally important component of lowering triglycerides, since it activates lipoprotein lipase, which breaks down triglycerides.

Ways To Avoid Metabolic Syndrome:

  • Lose excess weight to improve each of the five features of metabolic syndrome
  • Eat a diet with abundant fruit, vegetables, and fiber
  • Minimize saturated fats and refined carbohydrates
  • Minimize sugar: the American Heart Association recommends a maximum of 6 teaspoons daily for women and 9 for men, including the sugar in processed foods
  • Eat fatty fish high in EPA and DHA including salmon, herring, sardines, halibut and trout; if you don’t eat fish, take fish oil capsules
  • Exercise will facilitate weight loss and will improve every feature of metabolic syndrome

Andrew Siegel, M.D.

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

Now available on Amazon Kindle