Posts Tagged ‘weight gain’

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

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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



Obesity and Urology

April 5, 2013

Andrew Siegel, M.D.  Blog #101

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

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

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

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

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

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

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

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

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

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

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

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

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Emotional Eating: Podcast Interview Of Dr. Siegel

September 7, 2012

This week’s blog is a change of pace–it is a podcast of Morty Lefkoe interviewing Andrew Siegel on the subject matter of Dr. Siegel’s book.  The interview delves into maladaptive, emotional eating patterns and tactics and strategies that can be employed to develop healthier eating behaviors.  Click on the following link to access the interview :

Morty Lefkoe is president and founder of The Lefkoe Institute, and is the creator of The Lefkoe Method, a series of psychological processes that result in profound personal and organizational change, quickly and permanently. He is also the author of Re-create Your Life: Transforming Yourself and Your World.  Morty has written over 100 articles and columns for such publications as the Wall Street Journal and the New York Times. He has also appeared on over 100 radio and TV shows, including Today, Leeza, ABC World News Today, and Fox Cable News. He is a member of the American Counseling Association and has written articles describing the Lefkoe Method in The California Therapist, The Group Therapist Perspective, and the California Psychologist. In addition, Morty has spoken before groups such as the American Management Association, Vistage, American Psychotherapy Association, American College of Counselors, American Association of Integrative Medicine, National Wellness Coalition, Managed Health Care Congress, Association for Fitness in Business, and the American Psychological Association-National Institute for Occupational Safety and Health. He has conducted over 200 seminars for groups of CEOs on “A Proven Method for Successfully Instituting Change” and “Limiting Beliefs, Business and Personal: How to Identify and Eliminate Them.”

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

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S.A.D. (Seasonal Affective Disorder) Makes Me F.A.T.

December 10, 2011

If we had no winter, the spring would not be so pleasant; if we did not sometimes taste adversity, prosperity would not be so welcome.

Anne Bradstreet (17th century poet)

Like many others, I adore the spring and summer—relishing the sunshine, the vibrant blues and greens that dominate the outside palette, and the long hours of summer daylight.  One of the greatest thrills I have ever experienced was to be in Northern Europe in June where it stayed light until near midnight.  I feel most alive when exposed to sunlight, warmth, vibrant natural colors, scents such as honeysuckle and lilacs, and the background white noise of cicadas.  How delightful it is to be outdoors scantily clad in shorts and a short-sleeved shirt—cycling, playing tennis or golf, or just throwing a Frisbee for my English Springer Spaniel, Charley Morgan.

Light profoundly affects my mood.  Sitting in my living room on one of those days when the sun is in and out behind a cover of clouds, I am made acutely aware of how a sudden darkening of my environment makes me gloomy and a sudden lightening makes me happy.  I can virtually dial up my mood when the brightness of the lighting in my basement or living room is controlled with a rheostat.

I am among the 5-10% of the population that suffer with an affliction known as Seasonal Affective Disorder (S.A.D.). The prevalence of S.A.D. is highest towards the north and south poles and lowest at the equator.  It is quite common in the Scandinavian countries, where light is in limited supply during the winter.  Due to the very short winter days, these winter blues are characterized by variable degrees of melancholy brought on by the dark, cold and colorless external environment. The feelings of hibernation and stagnancy are distinctly unpleasant for any of us who are afflicted with S.A.D.  I am fortunate to be affected in only a mild way, much less so than many who suffer with depression, concentration issues, loss of energy and sexual drive, sleep disturbances, exhaustion, and withdrawal from friends, family and social activities. Various theories have been proposed to explain S.A.D., including a biochemical basis involving the chemicals serotonin and melatonin, but the jury is still out on the precise underlying basis.

Cold weather and darkness also directly affect our eating behaviors; they seem to conspire against healthy and disciplined consumption patterns and beg for relief by means of comfort foods.  For many of us, winter fosters a type of foraging activity that causes us to satisfy carbohydrate cravings and seek solace in rich, heavy foods including stews, creamy soups and starches.  Additionally, being more housebound in the winter leaves abundant opportunities for “boredom” eating, providing fewer distractions from eating that are possible in the warmer times of the year. The sleep disturbance that many with S.A.D. experience can lead to “fatigue” eating. During winter, outdoor exercise/activities dramatically decline; at the same time, there is less availability of healthy fresh fruits and vegetables that are abundant in summer.  There is less opportunity for grilling, a healthier form of cooking than many other alternatives. Unfortunately, all of the forces discussed above can work together and lead to winter weight gain.

So what to do to cope with S.A.D. causing the winter doldrums and the potential for unhealthy weight gain?  Options include melatonin supplements (a naturally-occurring hormone that maintains our circadian rhythms); anti-depressant medications; and cognitive-behavioral therapy or occupational therapy (both of which can help S.A.D. sufferers function at more optimal levels during their “dark” times).  My preference is to use exercise as an effective means of keeping the blues at bay.  It nudges the pharmacy within to release a cocktail of “happy” chemicals including serotonin (which modulates mood, emotion, sleep and appetite). A daily dose of exercise will not only help release the natural anti-depressants within, but will burn calories and help prevent the weight gain.  I wholeheartedly recommend tapping into our own pharmacy within before reaching for the products of Big Pharma.

If you can swing it, a winter vacation to a nice sun-drenched Caribbean island can be just what the doctor ordered.  If this is not feasible, a therapeutic bright light box is an alternative that can provide the much-needed daily dose of light.  Another tonic to soothe the blues is music, capable of producing a steep rise in a listener’s serotonin levels.  Ultimately, having purpose and remaining busy, productive and engaged in meaningful activities is one of the best means of staying focused and keeping the effects of S.A.D. at bay.  So whatever it is you choose to do to chase those blues away, do it with passion and gusto.

 In the depth of winter, I finally learned that within me there lay an invincible summer.

Albert Camus

Andrew Siegel, M.D.

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

Available at; e-book available on Amazon.

My “Freshman Fifteen”

August 20, 2011

‘Tis the season for the start of the academic year so I thought it would be worthwhile doing a short blog on the weight gain that many college freshman experience…also known as “The Freshman Fifteen.”

Many moons ago, as a freshman at Middlebury College, I developed a very bad habit of consuming two glazed doughnuts every evening at around 10PM!  An enterprising fellow student made the doughnut rounds in the dormitory and I found them to be an irresistible and soothing tonic to the stress and anxiety brought upon by the first semester in college and a demanding premedical curriculum. My nocturnal habit of regularly downing these gooey, sticky, sugary treats contributed towards my gaining 20 lbs or so by winter break.

The following is a breakdown of the behavioral chain of events in psychological terms: The prompt to eat was stress, the impulse to eat led to the act of the doughnut consumption and the compensation was the stress relief derived. Fortunately, I was ultimately able to give up this seemingly innocent but pernicious behavioral pattern that was not doing me nor my waistline any good at all. I came up with the following thought process: doughnuts have more than 500 calories; they make me feel disgusting; my weight gain, which I find abhorrent, is in a large part on the basis of these late-at-night unnecessary calories; my tight pants repulse me; I went jogging in Florida with my brother over winter break and could not keep up with him because I was so out of shape. This is opposed to the following lines of thought that goaded me to consumption: doughnuts taste great and are something to look forward to after the tedium of studying for hours on end; they soothe, calm and sedate me; I owe myself this reward because of my hard work; I do not wish to deprive myself.

Mindfulness is a useful tool when applied to figuring out what drives internal prompts and how to deal with them in an appropriate and healthy manner.  So, the concept of mindfulness disrupted what had become an ingrained pattern of behavior. Essentially, in psycho-speak, mindfulness functioned to de-condition the link between the compensation and the prompt, to disrupt the cycle.  Both the internal prompt of stress/anxiety and the external prompt of seeing the tray of doughnuts being paraded around the dormitory helped drive my behavioral pattern.  The stress and anxiety from the change of life of moving away from home and starting college, as well as the intensity of studying, etc., drove the desire for “compensation.” As we all have to adapt in response to changes in our environment, so would I adjust to this new life, and I would need to learn to deal with my emotions in a healthier and more appropriate fashion. I substituted swimming for the doughnut habit, a much more suitable activity! Once again, it came down to the mindfulness of swapping an alternative behavior—exercise—equally effective as a doughnut or two in terms of dealing with stress and anxiety, believe it or not. An additional effective tool is that in knowing how we may succumb to our weaknesses, we can limit our exposure to such external prompts, which in my case was by purposely avoiding the doughnut vendor.

Whether the prompt is “managed” by comfort foods or exercise, the same “cocktail” of internal chemicals, including endorphins, is released into our bloodstreams, resulting in compensatory relief of the altered emotional state. We are all stressed to some extent, and one thing for sure is that stress is unlikely to disappear any time soon.  If it is not one source of stress, it will be another. So when the root cause is not necessarily remediable, the next best bet is to deal with it in a healthy way—healthy in terms of psychological, emotional and physical health. So why not seek relief with the more appropriate and healthy means? I could also have had the mindfulness to trade the doughnut consumption for a healthy replacement food item such as an apple.

I realized that by giving in to my impulses, I merely received the benefits of a short-term and temporary reward that did not truly address the problem at hand. In psychological terms, this enabled and facilitated a vicious cycle and a dysfunctional habit and thus the creation of a secondary problem . . . .now I faced stress over school as well as new stress over my unseemly weight gain. By actively not indulging my impulses, I managed to weaken the behavioral pattern that had been established, helping to break the cycle. I did lose those 20 lbs., but by no means was that an easy feat.

Andrew Siegel