Posts Tagged ‘wellness’

Penile Erection Geometry

June 7, 2014




(Illustration credited to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, original publication 1918, public domain)

Blog # 156

A flaccid penis is soft like a marshmallow and dangles limply from its attachment to the pubic bone. With stimulation, the penis fills, firms, and increases in length and girth, as tumescence turns to rigidity. Not only does the penis undergo a metamorphosis into a rigid erection, but it also starts angling up towards the heavens—majestically pointing towards the sky, a marvel of human hydraulic engineering in defiance of the laws of gravity. At its extreme, the erect penis can touch the abdominal wall. A young man’s erection can easily support the weight of a towel.

Who Knew? Birthday and New Year’s Eve party blowouts—those party toys that when blown unfurl and extend outwards—are a useful means of thinking about erections. In the flaccid state, the erectile cylinders are very similar to the party blowout when it is not being blown into; in the erect state, the erectile cylinders are comparable to the party blowout when it is being blown into.  In the flaccid state, there is an acute bend at the junction of the external and internal penis. With a rigid erection, this acute angle is lost and the external penis develops an obtuse angle relative to the internal penis.

Analogous to penile size, there is a great amount of variability in the angle of the erect penis relative to the body (the pubo-penile angle). Like belly buttons that can be “outies” or “innies,” erections can be “uppies” or “outies,” depending on a number of factors. “Flagpoles” can be vertical, horizontal, or any angle in between.

Who Knew? In summer camp there was always that smart aleck camper who cited a complex equation of the physics of erection intensity, involving the “angle of the dangle,” “the heat of the meat,” “the direction of the erection,” “the dimension of the extension,” “the torque of the pork,” etc. Who knew that there was actually validity to some of these factors in determining the angle of erection!

The pubo-penile angle is determined by the following factors: the tension in the suspensory ligaments of the penis; the attachments of the penis to the pelvic bones; the size of the penis; the extent of the erection; and the tone and strength of the ischiocavernosus (IC) and bulbocavernosus (BC) muscles.

The suspensory ligaments support and maintain the erect penis in an upright position, essentially anchoring the base of the penis to the pubic bone. The tighter the ligaments are, the greater the potential upward angulation of the erect penis.

Who Knew? In an effort to increase penile length, some surgeons perform a procedure in which the suspensory ligaments of the penis are cut. What this actually does is to expose some of the internal penis, allowing more of the penis to hang outside the body. The price one pays for this sleight of hand is that one’s erection will no longer point majestically to the heavens. Essentially, one gains a bit of flaccid length and loses angle—robbing your Peter to pay Paul, literally!

As the suspensory ligaments provide support and anchorage of the external penis from above, so the attachments of the erectile cylinders to the pelvic bones provide support and anchorage of the internal penis from below. Every individual has different anatomy, and the variations in pelvic anatomy and support can engender variations in erectile angulation. In general, the more firm and secure the attachments are from below, the greater the potential foundation of support and the greater the potential upward angulation of the erect penis.

Who Knew? The internal, concealed penis that is attached to the pelvic bones can be thought of as the roots of a tree. Similarly, the external penis can be considered in terms of the trunk of a tree. Without a solid root system—the foundation—no tree can assume a tall and erect stature. But with a solid foundation, the penis, like the tree, has the support to point high to the heavens.

Penile size is generally inversely proportional to the potential for upward angulation. Largely due to the force of gravity, there is a tendency for less upward angulation with longer and heavier penises.

Conceptually easy to understand, if flaccid is considered a 0% erection and full rigidity is 100%, the greater the magnitude and extent of the erection, the greater the upward angulation.

There are two particularly important pelvic floor muscles called the bulbocavernosus (BC) and ischiocavernosus (IC) muscles. These muscles are crucial to male sexual function. There are a total of 3 erectile cylinders that form the bulk of the tissue of the penis. The solitary erectile cylinder known as the “corpus spongiosum” (“spongy body”) runs from the perineum (the area between the scrotum and anus)” through the length of the penis to the “glans,” the head of the penis. Its innermost, protuberant portion is known as the “bulb.” The corpus spongiosum contains the urethra (urinary channel) and during sexual stimulation, the corpus spongiosum and the glans become swollen and plump. The BC is the muscle that covers the penile “bulb.” The “corpora cavernosa” (“cave-like bodies”) are the paired erectile cylinders are responsible for rigid erections. The IC refers to the muscle that covers the inner, deep aspects of the corpora cavernosa.

Bulbocavernosus and ischiocavernosus muscle strength can factor strongly into erectile angulation. A voluntary contraction of the BC and IC muscles will cause the erect penis to deflect in an upwards direction. As the BC and IC muscles are flexed, one can easily observe movement of the external penis towards the heavens as the increased blood filling of the erectile cylinders nudges the external penis up. The better the tone and conditioning the BC and IC muscles, the greater the potential upward angulation of the erect penis.

We must accept what nature has given us regarding our suspensory ligaments, our attachments of the penis to the pelvic bones, and the size of our penises. However, the factors that we can modify are the extent of our erections and the strength of our IC and BC muscles. So if we want to maximize our pubo-penile angle, PFM exercises become of paramount importance

An erection needs to be hard enough to penetrate, but flexible enough to be able to negotiate the various “acrobatic” requirements of different sexual positions. So, although an erection that points to the heavens is a wonderful phenomenon, one that is so angled to the extent that it is inflexible will not help one’s performance in the bedroom.

Who Knew? The vagina is shaped like a banana, with its innermost and deepest part angling downwards toward the sacral bones. In order to accommodate female anatomy and position, a penis needs to be both rigid and flexible at the same time—“flexible rigidity,” to use an oxymoronic phrase. If one has a highly angled, inflexible erection, sexual positions such as the reverse cowgirl or woman on top leaning backwards can be painful and can potentially inflict damage to the penis, as well as prove uncomfortable for the woman.


Andrew Siegel, MD


The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.


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Preventing Chronic Diseases

March 8, 2014

Blog # 144   Andrew Siegel and William Stewart

Bill Stewart, a 67 year-old friend of mine who has participated in countless full marathons and is passionate about living a healthy lifestyle, sent the following note to me that I want to disseminate because it is spot-on (it is edited to a very minimal extent):

“I got back from Boston this weekend after a very depressing week with my sister, whom I’ve always looked up to.  Just a few years ago she had language skills beyond most Americans; now she has skills at about age 5-6 level, but with significantly less recent memory than children those ages.  I toured an assisted care facility with my sister, which actually exceeded my expectations.  But this is certainly not a place I ever want to be in! 

I am now seeing most of my contemporaries having issues with chronic diseases to a greater or lesser degree, which, I believe could have been avoided or delayed to a later stage in life.  Most people work so hard and really look forward to the day they retire, but, unfortunately for most, retirement becomes one filled with chronic disease, accelerated physical decline, and endless visits to the doctor’s office, hospitalizations with surgical procedures, and gobs of drugs that may help alleviate their conditions, but often cause other conditions. 

I take the attitude that we’re given one period of up to 100 years of life on this earth, and with health it can be a joy, but without health the joy is diminished or gone.  I do believe that the majority of people, barring a particularly bad set of genes, can live an active and happy (or relatively happy) life to within a few years of their genetic clock expiring, whether it be at age 75, 80, 90 or 100 – but not in the prevailing culture of bad food and sedentary habits. 

There is a very vocal minority who are pointing the right way, such as Andy, Dr. Mark Hyman, Dr. Oz, Pastor Rick Warren (The Daniel Plan – an interesting motivator here, maybe not for everyone), etc.  But they are going against some very powerful special interests that make lots of money from the status quo – most physicians, health insurers, big pharma, big agriculture, food processors, fast food industry.  And unfortunately, the US government, for the most part, supports and encourages this. With heavyweight lobbyists representing these industries (many of whom were formerly gov’t officials regulating these industries!), it’s an uphill battle. I think at some point government will realize that Medicare and Medicaid can’t keep expanding because it will totally break the government budgets.  For example, the government now supports and encourages biotech drugs that cost $500,000 or more a year per patient; this is simply not sustainable. But currently it’s very difficult for the government to fund, support, or even encourage studies of preventive strategies because there is not much money to be made from these (but there could be huge savings!!!).

I looked up Dr. Robert Lustig and he had a great video on his web site about high fructose corn syrup and the damage that it does to the body (Sugar, The Bitter Truth). It is a bit technical and somewhat long (about an hour, but fascinating).  And the story he gives about Coca-Cola is really amazing.  I watched the winter Olympics and, of course, Coke presented itself as synonymous with 20th century American culture (this is really nauseating!). There is a Coca-Cola Beverage Institute for Health and Wellness, which I find particularly amusing. 

To my way of thinking, early 50 to mid 60 year-olds are at an age when most people’s health can be “saved”, so to speak, by modifying their habitual exercise and diet behavior before chronic illnesses take a firm hold; I’m really at the back end when, for the most part, the chronic illnesses are in firm command and people are really resistant to changing their habits.”

So what are the key elements for avoiding chronic diseases and living a long, healthy and happy life?  The following summary is excerpted from my first book: Finding Your Own Fountain of Youth: The Essential Guide to Maximizing Health, Wellness, Fitness & Longevity:

  • Maintain an active, purposeful, and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose—this allows one to structure one’s time effectively and maintain a sense of community.
  • Make a long-term commitment to ample exercise and physical activity.  Stay mentally engaged and passionate about interests and hobbies such as: reading, travel, games, art, music, crafts, pets, sports, etc., etc., etc.
  • Fuel yourself with the healthiest diet possible.
  • Avoid self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun exposure, undue risks—maintain an “everything in moderation” attitude.
  • Maintain close ties with family and friends—put great effort into your marriage/primary relationship, as it is a vital contributor to aging well.
  • Have an optimistic and grateful attitude—a cheery, happy, and upbeat disposition, a sense of hope about what the future will bring, and a good sense of humor.
  • Learn to deal positively with stress.
  • Counter life’s inevitable losses, changes, and vicissitudes with adaptation.
  • Practice preventive maintenance and avail yourself of all the advances medicine and technology have to offer.
  • Care about yourself, respect yourself, invest in yourself—LIVE and LIVE well!

Andrew Siegel, M.D.     Our Greatest Wealth Is Health

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


Amazon page:

For more info on Dr. Siegel:

Anti-Oxidants 101

September 21, 2012

Blog #76   Andrew Siegel, M.D.

The image above depicts a meal teeming in anti-oxidants.  It is actually my lunch from today, which is very Mediterranean is style.  In the large bowl is a terrific salad with mixed greens, tomatoes, cucumbers, carrots, red cabbage, onions, red pepper, olives, falafel and feta cheese; on the side is whole wheat pita bread with hummus; ice water with fresh lemon as a drink; for dessert, non-fat yogurt with fresh blueberries, strawberries and figs.  

Oxidation is a chemical reaction that occurs in the presence of oxygen and water: given sufficient time for the oxidative reaction to occur, the process is capable of altering physical appearances—and, unfortunately, not for the better. Oxidation is the process responsible for changing the original copper-colored Statue of Liberty into the greenish color it now appears.  Oxidation is responsible for changing the appearance of the exposed inner portion of a cut apple from white to a brownish discoloration. Oxidation corrodes the exposed iron on a scratch on our cars, causing rust.

Oxidation can promote the aging of our cells, the rusting of our cellular structure, if you will.  Insofar as humans are an immense array of cells organized into tissues and organs, oxidation is one of the processes responsible for causing aged, “rusty” human beings.

The oxidative stress theory hypothesizes that over the course of many years, oxidative damage occurs via the accumulation of by-products of our metabolism, from environmental toxins to which we are all exposed, and from the general wear and tear of our bodies. What results are free radicals, unstable oxygen compounds that contribute to DNA damage. These reactive oxygen species engender inflammation, aging, diseases, and ultimately, death. These reactive oxygen species adversely affect normal cell functioning. For example, free radicals can attack collagen and elastin (responsible for skin elasticity and tone), resulting in aged-appearing, wrinkle-laden, saggy skin. Free radicals can also damage cells in the eye, causing age-related macular degeneration, a leading cause of blindness.

The great irony is that oxygen is an absolute necessity for life, but reactive oxygen species can shorten life. What to do? Anti-oxidants can slow the oxidative damage process. These are vitamins, minerals, enzymes and natural food pigments that act as “scavengers” that can mitigate the damage caused by the reactive oxygen species. 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 found in beans, fruits, vegetables, grain products and green tea. The bright colors of many fruits and vegetables are a good clue as to the presence of high levels of anti-oxidants—so  give some thought to adding a rainbow of colors to your diet including pinks, reds, oranges, yellows, greens, blues, and purples.  For a few examples, pinks include pink grapefruit; reds include pomegranate and tomatoes; oranges include squash, oranges, carrots, cantaloupe, papaya, apricots and sweet potatoes; yellows include butternut squash, bananas, mango and lemons; greens include broccoli, spinach, kale, kiwi, avocado, and asparagus; blues include blueberries and Belgian endive; and purples include plums, red grapes, cherries, purple cabbage and eggplant.

In addition to a bountiful intake of anti-oxidants, minimizing exposure to first-hand and second-hand cigarette smoke as well as excessive ultra-violet radiation from sunlight can help control harmful free radical accumulation. As beneficial as anti-oxidants are, they carry some potential negatives, specifically when it comes to their intake via vitamin supplementation.  For example, excessive beta-carotene (Vitamin A) supplementation has been linked in some studies to an increased risk of lung cancer in smokers. Mega amounts of Vitamin E in those with heart disease or diabetes have been associated with an increased risk of heart failure. It seems that no one truly knows all of the risks associated with high vitamin supplement doses, nor for that matter, all of the salutary effects of anti-oxidants on the aging process. Hopefully, ongoing scientific studies will further elucidate this matter. For the meantime, the best advice is to consume your vitamins by eating your fruits and vegetables, especially brightly colored ones. If your diet is inadequate in these terms, vitamin supplements in moderate doses can be an excellent source of anti-oxidants and may be considered a beneficial dietary measure until proven otherwise.

The ravages of aging, exposure to sunlight, tobacco, alcohol, environmental chemicals, etc., are constantly damaging our cells.  When a cell is damaged, on occasion this aberrant cell can replicate, multiply and ultimately develop a blood supply of its own—when this occurs, it is known as a cancer. Food and nutrition can act as a promoter or killer of aberrant cells.  Plants contain anti-cancer compounds,  so consuming a variety of fruits and vegetables, particularly vibrantly colored ones can be a boon to our health. The following are a list of some of the pigments in fruits and vegetables that can have profound salutary benefits: Indoles, found in cruciferous vegetables such as cauliflower, broccoli and brussel sprouts; lycopene, a red pigment found in tomatoes, watermelon and pink grapefruit; carotenoids, an orange/yellow pigment found in carrots, corn and cantaloupe; anthocyanins, a blue/purple pigment found in blueberries and raspberries.

Here, then, is the take home message:  Choose a diet rich in plant-based foods from the colors of the rainbow—these will help to maximize the efficiency and effectiveness of your cells in staving off disease processes as well as many of the signs/symptoms of aging.  They will provide you with all the vitamins and anti-oxidants you need to for optimal health and wellness.

Andrew Siegel, M.D.

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

Available on Amazon Kindle:

Refined Foods: Not So Fine For Us

February 11, 2012


Blog # 45   Andrew Siegel, M.D.=



Nature is ever so clever—look at our human species—amazingly engineered, evolved and adapted not only to survive, but also to thrive on this planet.

Whenever nature provides us with a nutrient that is potentially unhealthy, it protects us does by limiting our access to that nutrient.  Take, for example, sugar—also known as sucrose or alternatively, 50% glucose/50% fructose—clearly unhealthy and a key contributor to the obesity epidemic.  The major sources are sugar cane and sugar beets.  Did you ever try to get the sugar out of a sugar cane or sugar beet plant?  They are fibrous and unyielding and if we want to derive calories from these, it will require great effort and we will likely end up frustrated.  It’s like chewing on a stick of bamboo!

However, because of the collective intelligence of mankind—standing on the shoulders of giants, if you will—we are now able to easily remove the protective fiber matrix and process the sugar cane or sugar beet into a pure, refined and powdery product.   This process enables unrestricted access to the sugar and allows many “naked” calories to be easily consumed in a short time period. That is NOT the way nature intended, but humankind has prevailed over nature. Processing has allowed us to cheat nature by refining sugar, permitting consumption in immoderate and unhealthy amounts, contrary to nature’s design.

Now lets move on to a discussion about the processing of grains—specifically wheat, since these amber waves of grain are one of the staples of the American diet. However, this same line of thought is relevant to other grains including rice, corn, rye, oats, barley, etc.  The bottom line is that processing leaves us with a very refined product—not unlike sugar—again cheating nature’s “natural” protective mechanisms.  Unfortunately, when we cheat nature, we ultimately cheat ourselves.

Wheat needs to be processed to make it available and accessible to us. Threshing is the means whereby the chaff  (the wheat husk) is separated from the wheat kernel, the diamond of wheat.  Highly efficient milling enables the wheat kernel to be separated into the following three components—the bran: the outer covering of the wheat kernel; the germ: the embryo or sprouting section; and the endosperm: the source of the white flour that contains starch and protein.

White flour has the bran and germ removed, resulting in a pure, highly refined powder as opposed to whole-wheat flour that contains the bran and germ. By removing the fiber-rich bran and germ, the resulting product has a longer shelf life and makes for lighter and fluffier breads, as opposed to the darker, coarser, heavier breads made from the whole-grain wheat.

The removed bran and germ—the wholesome and healthy components of the wheat kernel—are often used to produce animal and poultry feed.   Interestingly, the farm animals are fed the wholesome, slow-digesting grain components and us humans end up with the refined and unhealthy component!  Go figure!  In fact, the nutritionally depleted and deficient processed white flour needs to be fortified with vitamins and minerals to replace those that were lost with refining, hence the term “enriched” wheat flour.

What is the problem with enriched wheat flour?  Simply, wheat grain that is hulled and stripped of the bran and germ results in a pulverized, super-fine, silky-white powder. This highly refined substance is very similar in appearance to cocaine or heroin. This pre-chewed, pre-digested, melts-in-your-mouth, adult baby food equivalent is absorbed extremely rapidly and is promptly transformed into glucose; it is not unlike getting an injection of intravenous glucose into one’s bloodstream.  Insulin levels (remember that insulin is our “fat” hormone) surge in response and any glucose that does not need to be immediately used as fuel gets stored as glycogen in our muscles and liver and when that is maximized, any excess glucose gets stored as fat.

This quick fix of sugar is not particularly filling because of the absence of fiber; it is a short-lived satisfaction that begs for more consumption, establishing a vicious cycle. The result is a push in the direction of weight gain, insulin-resistance, obesity, diabetes and heart disease. Furthermore, the refined product does not induce the “thermic effect” that many more substantive foods do, in which the body’s metabolism increases because of the energy expenditure it takes to digest a wholesome, fiber-rich product.

In contrast to the refined, enriched wheat flour product, whole-wheat flour is made by grinding up the entire wheat kernel. “Whole” refers to all three grain components used—bran, germ, and endosperm.  Whole-wheat flour is brown in color and textured, as opposed to the silky-white enriched wheat product. Whole wheat is very nutritious because the bran and germ components contain abundant fiber, protein, calcium, iron and other minerals. Because of the fiber, absorption and glucose transformation occur in a slow, gradual and well-regulated fashion. Whole wheat is filling, satisfying and substantive and literally sticks to your ribs.  Whole-wheat adds heaviness to breads or to whatever recipe it is used for and requires more flour to obtain the same volume of bread as white flour. Whole-wheat has a shorter shelf life than white flour because of its higher oil content—the source of the oil being the wheat bran, and the oil being a healthy one.  Products containing oil will go rancid faster than products that do not contain oil.  Whole-wheat flour is more expensive than white or enriched wheat flour.  It is easy to understand why the Industrial Food Complex is enamored with enriched wheat flour.

Now let’s go way beyond mere processing and separation of a natural product into its components and get into a real chemistry experiment—high fructose corn syrup (HFCS).  HFCSis a sugar substitute that is derived from corn via a complicated chemical process. Corn is milled to produce cornstarch, a powdery derivative. The cornstarch is processed into corn syrup, which contains glucose. Glucose is converted to fructose by using a process developed in the 1970’s by food scientists in Japan. Glucose is then added back in differing percentages to the fructose to achieve the desired sweetness. 55% fructose HFCS is used to sweeten soft drinks and a 42% fructose HFCS is used in baked goods. HFCS is abundant in processed foods and drinks.

Why does the Industrial Food Complex adore HFCS?  It is less costly than sugar because of corn subsidies and sugar tariffs. It is easy to transport as the viscous syrup lends itself to huge storage vats within trucks.  Fructose is the sweetest of all naturally occurring carbohydrates and does not crystallize or turn grainy when cold, as sugar can do in cold drinks such as iced tea. Because HFCS is highly soluble, its use makes for softer products and its ability to retain moisture allows for moister and better textured baked goods. Finally, it acts as a preservative to help prevent freezer burn as well as maintain the freshness and extend the shelf life of processed foods.

While HFCS may help preserve processed foods, it does not help preserve us; in fact, I would describe HFCS as killer sweetener.  It’s not just about the “naked” calories of the refined, fiber-less carbohydrate but is all about the fructose, which can be thought of as “poisonous” carbohydrate that has unique and distinct properties.  Fructose is remarkably similar to a carbohydrate that is very familiar to all of us—ethanol, a fermented sugar that is an acute toxin to the brain. However, fructose can only be metabolized by the liver and not by the brain, so in the words of Dr. Robert Lustig, fructose is “alcohol without the buzz.”   While ethanol is an acute toxin, fructose can be thought of as a chronic toxin. The “beer belly” from alcohol is not unlike the “soda belly” seen in those who overindulge in products containing HFCS.

Fructose is metabolized entirely differently from the way glucose is.  Every cell in our body can metabolize glucose, but only the liver can metabolize fructose. Fructose does not stimulate insulin release, as does glucose.  Fructose does not stimulate thesecretion of our satiety hormone leptin, nor suppress our hunger hormone ghrelin, so that foods containing fructose, unless couched in fiber, do not fill us up and curb our appetites. Fructose much more readily than glucose replenishes liver glycogen, and once the liver is saturated with glycogen, triglycerides (fats) are made and stored. Thus, HFCS ingestion can readily lead to obesity, elevated cholesterol, fatty liver, hypertension, insulin resistance and metabolic syndrome. The bottom line is that excessive HFCS ingestion pushes our metabolism towards fat production, and it doesn’t take eating that much processed food to cross the excessive HFCS threshold.

Fructose is the predominant sugar in many fruits, hence the name fructose. The difference between this sugar contained within a piece of fruit as opposed to that within a bottle of cola is that fruit fructose is natural (not created in a chemistry lab) and the amount is significantly less than the load contained within the soft drink. Additionally, the fruit fructose is accompanied by a substantial amount of fiber, anti-oxidants, and other phyto-nutrients, all health-promoting ingredients not present in the cola.


Bottom line:  Resonate with nature and literally think “outside the box,” can, package, bottle, etc., by eating whole, natural foods and not their refined by-products. Whole and real foods do not require a label because what you see is what you get. Leave the chemistry experiments to the chemistry lab and not for our consumption. Processing is a necessity to make some foods accessible to us, so read food and nutritional labels as carefully as you would read the ingredients in a medication, because when it comes down to it, food is medicine. The best diet is the “anti-processed-atarian” diet.  Your body will thank you.



Andrew Siegel, M.D.

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

Where’s Your 6-Pack?

January 28, 2012

Blog # 43 written by Andrew Siegel, M.D.


I posed this question to my nurse friend Jen and she replied “in the fridge.”  She made me laugh with that reply, but in reality she has a pretty hard body, especially for a woman who has given birth to several children.  However, if your answer to the question truly is “in the fridge,” then you might just want to read on!

If you would like the short version, skip to the end of this blog where you can read “10 pearls to help your washboard abdomen emerge”—itprovides nuggets of information that if heeded, will allow your to firm up your abdomen and start the process of unveiling the 2-pack, 4-pack or 6-pack that lies obscured within.  Read the full blog if you would like to know the more detailed science.  Although vanity may be an important driving force for wanting to develop that 6-pack, it’s really about living a healthy lifestyle—in brief, the aesthetics will follow a healthy existence and our internal health often mirrors our external physiques.

Sporting a six-pack is a badge of honor emblematic of one’s discipline, restraint and tenacity.   A “hard core” can only be earned through the combined efforts of healthy eating and vigorous exercise.  Chances are if you’re wearing a 6-pack, then you are fit and healthy and that in all probability you have rejected the Western diet of processed foods, lots of added fats, sugars and loads of refined grains and instead have chosen a healthy diet consisting of real food that comes from nature, rather than from a chemistry lab.

We all have 6-packs hidden beneath our winter-weighted physiques.  We may be flabbier and less toned than desirable, but somewhere within is a sinewy, tight, and lean torso.  The question is: what can we do to bring out this svelte body?  How do we reduce our shapeless stockpile of stored energy that is shrouding our underlying sculpted physique?

Michelangelo’s “David” was at one time a mere solid block of marble.  The master artist crafted this magnificent sculpture by knowing exactly what to carve away—what did not belong. In the words of Antoine de Saint-Exupery (author of Le Petit Prince): “Perfection is not when there is no more to add, but when there is no more to take away.”  The late Steve Jobs was a grand master at removing the unnecessary and superfluous to reveal the elegant simplicity that remains. In the words that follow, I will offer sound advice on how to peel away the nonessential to reveal your own magnficence that lies obscured.

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat actually serves a number of useful purposes.  It functions to cushion our internal organs and as insulation to conserve heat.  Fat provides a means of storing energy and fat-soluble vitamins.  During periods of decreased caloric intake, fat reserves are broken down to release energy.  Fats are important parts of the structure of the brain and cell membranes and are used in the manufacture of several important hormones.  Fat has more than twice as many calories per gram than carbohydrates or protein.   Anybody who has barbecued any kind of meat with a high fat content and has witnessed their would-be dinner engulfed in flames realizes what a concentrated form of fuel that fats are.

As we age, many of us tend to slowly and insidiously gain weight.  A collection of fat often becomes apparent on our abdomens, particularly around our waistlines.  An accumulation of fat in our midsections not only is unattractive from a cosmetic standpoint, but also can have dire metabolic consequences.  It is important to distinguish between visceral fat and subcutaneous fat.  Visceral fat—also referred to as a “pot belly,” “beer belly,” or “Buddha belly”—is internal fat deep within the abdominal cavity.  Subcutaneous fat—also known as “love handles,” “spare tires,” “muffin top,” or “middle-age spread”—is present between the skin and the abdominal wall.  Although neither type is pretty, visceral fat is much more hazardous than subcutaneous fat since it increases the risk of diabetes, cardiac issues, and metabolic disturbances.  Subcutaneous fat is inactive and relatively harmless and does not contribute to the health problems that visceral fat does.

The good news is that by losing abdominal fat, the potentially bad health repercussions can be reversed and the six-pack within can become more unveiled.  The dangerous visceral fat submits relatively easily to diet and exercise whereas the less harmful subcutaneous fat at the waist is more stubborn and resistant to reversal measures.  It is this accumulation of belly fat that masks the underlying rectus abdominis muscle that is our 6-pack muscle.

And now a few necessary paragraphs on metabolism: Dietary carbohydrates are broken down to the simple sugar glucose, which is the “energy of life” and the fuel source of every cell in our body. When it is not used immediately for energy, it is stored as glycogen. The pancreatic hormone insulin is responsible for converting glucose into glycogen. Glycogen is present in our liver and muscles; when a state of saturation has been achieved and no more glycogen can be stored in our liver and muscles, the excess glucose is converted to fat.  There is a finite limit to the amount of carbohydrate stored in the muscles and liver—it amounts to about 1600-1800 calories.

When talking metabolism, it is helpful to think of our glycogen as our “small fuel tank.”  Once the fuel in the liver and muscles is exhausted, our “large fuel tank”—our fat—needs to be tapped to provide energy.  In contrast to the limited carbohydrate storage in our liver and muscles, our bodies abundantly store fat.  Depending on how much fat we have, many days to weeks of energy can be provided.  To reveal your 6-pack, you need to have as small a “large fuel tank” as possible, since it is these stored energy reserves that are obscuring the glorious sculpted abdominal musculature that lies beneath.

There are a few important facts that are fundamental to our understanding of the science of fat. First off, our fat stores are not static, but are dynamic.  In other words, there is continuous mobilization of our fat (as fatty acids) and storage (as triglycerides).  Secondly, fat storage is largely under hormonal control.  Hormones are chemical messengers that cause specific actions in our body.  The hormones involved in fat metabolism are insulin, cortisol, estrogen, and testosterone.  Thirdly, fat is not just fat—it is a metabolically active endocrine organ that does not just protrude from our abdomens in an inert state, but has a life of its own.  Fat produces pro-inflammatory factors, hormones and immune cells.  Fat has an abundance of the hormone aromatase, which converts testosterone to the female hormone estrogen.  One consequence of too much fat in men is excessive conversion of testosterone to estrogen, creating the potential for male breast enlargement.

Insulin is the principal regulator of fat metabolism. After a sugar and carbohydrate load, insulin is released to get the fuel into our cells. When we go without food, as happens when we sleep, insulin levels decrease and fat is released to be used as fuel.  Insulin levels are determined primarily in response to our carbohydrate intake in order to keep our blood sugar regulated.

Insulin has much to do with the way our bodies store or burn fat. You can think of insulin as our fat hormone. When insulin levels are elevated, we accumulate fat; when levels are low, we burn fat for fuel.  Insulin is all about increasing fat storage and decreasing fat burning—this is why diabetics on insulin injections typically get fat.  If we have a substantial amount of belly fat, then by definition we have insulin-resistance, a condition in which our pancreas works overtime to make more and more insulin to get fuel into our cells.  This is a precursor to diabetes, cardiovascular disease and all the havoc they can wreak.

Our insulin levels are determined by the carbohydrates we eat—the more carbs we eat, the sweeter they are, the easier they are to digest, the greater the insulin levels and the more that fat accumulation is driven.  Insulin secretion caused by eating carb-rich foods—flour and cereal grains, starchy vegetables like potatoes and rice, sugars and high-fructose corn syrup—is what makes us fat.  The sweeter the food, and the easier it is to digest, the fatter it will make us, and liquid carbs such as sodas, fruit juices and beer are the biggest culprits.

If we want to get leaner and reveal the 6-pack within, we must lower our insulin levels.   To lower our insulin levels requires carbohydrate restriction, meaning decreased consumption of sweets and starchy carbs.  Even if we don’t reduce our quantity of carb intake, we can improve the quality of our carb intake by eating healthier carbs—whole grains, fruits, vegetables, legumes, etc.  Aside from shrinking our waistlines, there are numerous other health benefits that accrue from a lower carb diet.  If we replace a high carb diet with a diet lower in carbs and higher in healthy protein and healthy fat, the consequences are the following: weight loss; HDL (good) cholesterol rises; triglycerides decrease; glucose levels stabilize; blood pressure decreases; heart disease risk decreases; body fat reduces; energy levels surge.

The adrenal gland hormone cortisol—releasedin response to stress—can stimulate our appetites and cravings for sugar, causing fat storage and promoting weight gain and obesity. This is the very reason people on corticosteroid medications tend to have enormous appetites, gain weight and have a central distribution of body fat known as centripetal obesity, even if they were very thin prior to starting on the cortisol.  Chronic stress literally can make us soft and flabby and sabotage our efforts to achieve that chiseled 6-pack.  So what can we do about stress, because we all have it, and it’s not going away anytime soon?  Stress busters include exercise, yoga, meditation, massages, getting into a Jacuzzi, aromatherapy, chamomile or other herbal teas, sex, etc.  Sounds nice…relax to help bring forth that 6-pack!

The sex hormones estrogen and testosterone play a key role in fat regulation. One of the key reasons that women have a different physical appearance and body fat distribution than men is because of the different levels of these two hormones in each gender.  Around the time of menopause, when the ovaries stop producing estrogen, central fat deposition is promoted and many women start packing on pounds in their mid-section.  Similarly, as men age, testosterone levels often drop, contributing to a loss of muscle mass and an increase in body fat. Low testosterone is present in about half of obese men.

Believe it or not, a good night’s sleep will help us on our mission for that elusive 6-pack.  When we sleep poorly and become sleep-deprived, we are often driven to eat. Sleep deprivation results in decreased levels of leptin, our chemical appetite suppressant, and increased levels of ghrelin, our appetite stimulant, in addition to increased levels of the stress hormone cortisol.  Furthermore, being exhausted can sabotage our exercise regimen.

Six-pack diet

Lean sources of protein including egg whites, wild salmon (or any other wild fish that is grilled or broiled), skinless chicken, turkey breast, fat-free yogurt and soy products such as tofu and edamame are money.  We need to be sparing with meat and dairy intake since they are rich in saturated fats and high in calories.  Vegetables—including nuts, avocados and olives—are a much healthier source of fat.

High fiber foods—vegetables, fruits, legumes (lentils, peas and beans) and whole-grain cereals and breads—are very filling and the fiber regulates the rate of carbohydrate absorption. Intake of a variety of brightly colored fruits and vegetables will ensure getting ample doses of phyto-nutrients and anti-oxidants. Dietary fiber (roughage) refers to the indigestible part of a carbohydrate.  Insoluble fiber, e.g., cellulose from plant foods, serves as plants’ armor against predatory pests and serves as humans protection against obesity.  Since we do not have the enzymes necessary to dissolve insoluble fiber, it increases stool bulk, decreases intestinal transit time, increases our satiety, reduces the rate of carbohydrate absorption and the conversion of complex carbohydrates to simple sugars, and decreases the absorption of some fats.  Soluble fiber binds cholesterol in the intestinal tract; for example, oatmeal can help lower serum cholesterol levels.

It is very important to minimize refined carbohydrates, substituting whole grain products for white bread, white pasta, white rice, etc.  Curtailing sugar intake is equally important since sucrose is a 50% fructose/50% glucose combination and fructose gets metabolized completely differently from glucose, pushing our bodies towards fat deposition.  The same is especially true for high fructose corn syrup (HFCS), that gooey liquefied sweetener abundant in processed foods and beverages in a 55% fructose/45% glucose ratio. Every cell in our body can metabolize glucose, but it is primarily the liver that metabolizes fructose. Fructose, more readily than glucose, replenishes liver glycogen, and once the liver is saturated with glycogen, fats are made and stored. So, HFCS gives us a fatty liver, a fatty body and a masked 6-pack.  Fructose does not suppress ghrelin (our hunger hormone), does not stimulate insulin, and is truly a toxin to our body in immoderate doses. Let fruits be the source of fructose for our bodies, not refined sugars and HFCS.

Nature is very clever—whenever it provides us with a nutrient that is potentially bad for our health, it limits access to that nutrient by adding lots of fiber to it.  So when nature has given us fructose, it has also included the antidote.  Did you ever try to get the sugar out of a sugar cane plant?  It is literally like gnawing on a piece of bamboo stick—you can’t chew it and have to suck it out!  Processing has allowed us to cheat nature by refining sugar, permitting consumption in unrestrained, unhealthy amounts, contrary to nature’s design.  For example, it is very easy to drink 12 ounces of orange juice, to the tune of about 170 calories of fiber-free sugar.  To get that kind of caloric load from nature’s whole product—the orange—you would have to eat almost 3 of them.  Can you imagine sitting down and eating three oranges?  I sure can’t.  So go easy on anything that comes in a bottle, box, carton or can…think whole foods that resonate with nature, not refined foods that are unfaithful to nature.

While at the dinner table the other evening, I found myself staring at a colorful salad on my left and a basketful of white Italian bread (not whole grain) on the right.  I pondered the “order” of eating in terms of insulin release—would there any difference if I had salad first followed by bread vs. bread first followed by salad, vs. eating them together and would the order of eating play a role in the way calories are burned or stored?

Salad first followed by bread (bulky, fiber-rich carbs then fiber-less carbs): This gives us a gradual, low-level insulin spike followed by rapid, high-level insulin spike.  It is likely that the bolus of salad slowly digesting in the gut will modulate (regulate) the insulin spike from the bread’s fiber-less carbs, resulting in less of a tendency for fat deposition.

Bread first followed by salad: (fiber-less carbs then fiber-rich carbs):  This gives us a rapid, intense insulin spike followed by gradual, lower-level insulin spike.  It is likely that this order will result in fat deposition, since by the time the salad gets to the gut, the bread has already been digested and absorbed.

Together: The salad mixing in the gut with the bread will modulate the insulin spike from the fiber-less carbohydrate load of the bread, resulting in less of a tendency for fat deposition.

Bottom line: If you are going to eat white carbs, you can minimize the intensity of the insulin spike and thus the tendency for fat deposition by mixing in some fiber-rich foods; better yet is to ditch the white carbs completely and eat the whole-grain product. If you are going to use the strategy of using the powers of fiber-rich food like salad to lessen the “damage” from fiber-less white carbs, be sure to go easy on the croutons, cheese and excessive amounts of salad dressing that can sabotage the strategy.

A very important principle in the acquisition of a 6-pack is not to drink calories, so avoid liquid calories such as soda, juices, processed iced tea, lemonade, etc.  These are particularly bad since they are essentially pre-digested, fiber-less carbohydrates that get “mainlined” into our bodies causing a massive insulin spike and caloric storage as fat.  A “beer belly” resulting from the carbohydrate alcohol and a “soda belly” resulting from the carbohydrate fructose are substantially equivalent. The best drink is water or seltzer—it can be jazzed up with a squeeze of lemon or lime.  Water keeps us well hydrated, dampens our appetite and will quell our thirst that is sometimes confused for hunger.

It is important to be careful not to overdo sodium intake as it can cause fluid retention, high blood pressure, bloating, weight gain and a number of potential cardiac issues, aside from thwarting the emergence of our 6-packs.

Six-pack exercise regimen:

A general rule of thumb is to think “athletics” and the “aesthetics” will follow.   The key to exercise is diligence—carving out the time—and variety—strength  (resistance) training, cardiovascular (aerobic) training and core (abdominal and torso) conditioning, and perseverance.  A core synergistic exercise regimen, which is a combination of the aforementioned three types of exercise, provides a terrific overall workout. Pilates, yoga, and martial arts are three great means of obtaining a hard core, although there are many other effective exercises as well.  Pilates, in particular, is an awesome means of developing core strength.  I have been taking Pilates lessons weekly for over a year from an amazing instructor, Catherine Byron, who has been instrumental in helping me achieve a toned abdomen, core strength, better balance, posture and muscle symmetry (  My friend and yoga instructor Ben Wisch, has also helped whip my core into shape (  I  enjoy and have derived great benefit from home exercise DVDs from  the P90x “ab ripper,” “core synergistic,” and “yoga” workouts and the P90x plus “abs-core” workout can’t be beat.

Muscles play a key role in our metabolism: they are extremely metabolically active, each pound of lean muscle burning about 50 calories/day.  With a sedentary existence and aging, there is a gradual loss of muscle mass and a resultant slowing in our resting metabolism.  By building and maintaining our muscle mass with strength training, we will raise our resting metabolic rate and burn more calories.  Additionally, exercise serves to increase the “insulin sensitivity” of muscle, which means that are muscles become more efficient at burning off carbohydrates as fuel. Exercise is also our endogenous stress reducer, lowering cortisol levels, suppressing our appetites and helping us burn carbs before they have a chance to be stored to fats.

We can measure our maximal heart rates by doing an aerobic activity, such as swimming, running or cycling full throttle until we can’t go on, and then taking our pulses.  In our workouts, if we can achieve a heart rate of 75% of our maximum rate and sustain that for 30-60 minutes daily, it is easily conceivable to burn 600 or more calories per day.   High intensity interval training—alternating between extremely intense exertion and regular “normal” exertion—can rapidly help propel us towards that sculpted body that lies within.
10 pearls to help your washboard abdomen emerge:

 1.    If you want a hard waist, you must incorporate exercise into your lifestyle, achieving balance between aerobic, resistance and core workouts.

2.    Eat high-quality, whole-grain, high-fiber carbs, lean protein sources (easy on meat and dairy) and healthy fats (vegetable and seafood-origin).

3.    Eat in accordance with nature’s design—meaning whole foods.  Avoid processed foods.  The best diet is an “anti-processed-atarian” diet.

4.    If you want to look good naked, don’t eat “naked” calories (stripped of fiber), so restrict sugar, simple white carbs, and liquid calories.  Aggressively steer clear of high fructose corn syrup.

5.    Soft foods (sugared drinks, white pasta, white rice, white bread, doughnuts, bagels, potatoes, etc., will earn you a soft core; hard foods (whole grain pasta, brown rice, whole grain breads, legumes, whole fruits and vegetables) will help earn you a hard core.

6.    Avoid giant meals in which the caloric load will be stored as fat; substitute with multiple smaller meals in which the calories will be used for immediate energy.

7.    Limit after dinner snacking since unnecessary calories at a time of minimal physical activity will be stored as fat.  If you restrict your evening snacking to one piece of fruit, you will wake up in the morning with less to pinch on your waistline.

8.    Drink plenty of water; use salt sparingly.

9.    Minimize stress; if you can’t eliminate it, manage it.

10. Get adequate amounts of quality sleep.


Andrew Siegel, M.D.

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

Harmonize (Like Simon and Garfunkel) with Good Eating and Physical Activity

December 24, 2011

Blog #38 by Andrew Siegel, M.D.

Harmonizing is combining simultaneously sounded musical notes to produce chords having a blended, soothing and pleasant effect. In my opinion, Simon and Garfunkel harmonize like no other two singers—each alone have amazing voices but together they combine with a powerful chemistry to create a really special sound—think Scarborough Fair:

The mathematical metaphor for harmonizing (synergy) is 1 + 1 = 3.  I am reminded of one of my favorite sci-fi movies, The Fifth Element, directed by Luc Besson, in which a climactic scene shows the harmonizing of the four elements earth, wind, water and fire with the fifth element (a character played by the actress Milla Jovovich) to create a unique and memorable synergy.

I borrow these music, mathematical and cinema metaphors and apply them to the wellness arena.  Here, the two players are healthy eating and exercise.  There are four permutations of these two players:

Healthy eating + exercise

Healthy eating + no exercise

Unhealthy eating + exercise

Unhealthy eating + no exercise

On the wellness index, the top combination reigns supreme; the middle two, less so; and the bottom clearly ranks as a bad duo.

To put it another way, if Paul Simon’s voice represents healthy eating, Art Garfunkel’s voice represents exercise, my tonally challenged voice represents unhealthy eating and my wife’s tonally challenged voice represents no exercise, then we have the following combos:

Paul Simon + Art Garfunkel = Simon and Garfunkel

Paul Simon + my wife = not so good, as my wife will poison Paul Simon’s sound

Me + Art Garfunkel = not so good, as I will poison Art Garfunkel’s sound

Me + my wife = disaster (lol)!

The foundations of wellness are the combination of healthy eating and exercise.  Healthy eating means the right quality and quantity of the food that we consume.  Healthy eating and maintaining a healthy weight are very important, but are simply not enough to achieve wellness, in the absence of exercise.  By the same token, subjecting our bodies to exercise on a regular basis is fundamental to our good health, but not sufficient to maintain wellness.  Physical fitness has everything to do with how much we exercise and does not bear a direct correlation with our weight. (Of course, if we are obese, there is no way that we can be fit since fitness demands a reasonable weight.) There are very lean individuals who eat well but never exercise and are clearly in a poor state of physical fitness; if they had to run a couple of miles, they would likely end up incredibly winded. By the same token, there are very athletic and physically fit individuals who exercise daily but do not eat well, consuming excessive calories and carrying too many pounds. So, wellness demands healthy eating, maintaining a reasonable weight AND exercising to achieve cardiovascular health (endurance) and strength (involving our core and skeletal muscles).

A human body is far better engineered than the most expensive Mercedes Benz.  Both the costly vehicle and our bodies need to be cared for.  They both require high quality fuel in their tanks.  They both need to be used regularly—the way they were designed to—not sitting idle in the garage or couch, respectively, wasting away and gathering dust.  They both thrive on being taken out on the road for sprints as well as long rides.  They both demand being cared for and not abused.  If their engines and their bodies are kept clean, shiny, bright and humming, they will both last a very long time. Both the car and our bodies may have a lot of miles and years on them, but if attended to properly, they can run like new for many more miles and years.

It makes sense to fuel up with premium fuel so that our engines run as efficiently as possible.  We are most fortunate to be alive and only go through life once, so it behooves us to eat quality, nutritious foods that will provide us with energy and the proper balance of carbohydrates, proteins, fats, vitamins, and minerals to allow us to live a healthy and long existence.  Unlike our vehicles, our bodies are in a constant state of flux—tissues are continually being destroyed and remade.  The building blocks for the repair process come from the makeup of our diets.  So we literally are what we eat.  Furthermore, we are what we eat eats, and what we eat eats eats as well.  In other words, if your salmon dinner last night originated from the Pacific Northwest and dined on krill and other natural foods, its composition was very much different from the farmed salmon brought up on corn products and processed salmon feed.  The point is to have your building blocks be high quality components, just as you would use if you were replacing vital parts in your car.

Our food choices go a long way in terms of forming the foundation of our wellness destiny. Healthy eating is a lifelong experiment that should continue to evolve if one eats mindfully.  It is not so much what we choose to eat, but what we elect not to eat—essentially, by avoiding the “bad,” by default we will be fueling ourselves with the “good.”  In other words, there are a great variety of quality, healthy foods that can nourish us, and it is not that important what our specific choices are as long as there is balance, sufficient intake of macro-nutrients (protein, fats and carbohydrates) and micro-nutrients (vitamins and minerals), and avoidance of excessive calories. The key is to stay away from processed, reconstituted, unhealthy, mystery, fake foods. Processed food is real food that has been altered in order to lower its cost, lengthen its shelf life, make it look more appealing and make us want to eat more of it, resulting in a reduction of nutritional content and an increase in chemicals, dyes, preservatives and toxins.

Like our vehicles, our bodies also need to be used the way they were meant to be.  We were not designed to be sedentary creatures, but were given the gift of motion to help us survive.  Whether this motion is organized into exercise, sports or fitness pursuits, or is integrated into our lifestyles matters not; what matters is that we keep on moving.  Exercise burns calories, improves our strength and fitness and makes us feel energized.  The short-term positive effects of exercise are the psychological and physical benefits of stress busting, improvement of mood, fatigue reduction, and increase of energy. Long-term benefits include reduction in risk for diabetes, cardiovascular diseases, stroke, hypertension, some cancers, osteoporosis, chronic medical problems, falls, and physical disability. An exercise regimen is also useful for increasing muscular strength and tone, reducing body fat, and helping with weight control. Exercise will help lower blood pressure and our “bad” cholesterol (LDL) as well as raise our “good” cholesterol (HDL). Biological aging is thought to be partly on the basis of oxidative stress, which is reduced by exercise, so exercise can keep us looking and acting youthful.

When our physical fitness improves, it seems to help inspire good eating habits. Equally so, good eating habits seem to motivate many of us to exercise. So, there seems to be a harmony between exercise and healthy eating—healthy habits engender more healthy habits and unhealthy habits promote unhealthy habits. Many of those I interviewed for Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food reported that if they were actively engaged in some sort of exercise regimen, they were less likely to binge or eat poorly, and if they were not exercising, they were more likely to succumb to unhealthy eating behaviors. The military term cascading system failure refers to a failure in one area causing a failure in a different area that would not ordinarily fail. That is precisely what often happens to our eating habits when we fail to maintain our exercise regimen and what often happens to our exercise regimen when we are not vigilant about our eating. Hopefully, the cognitive dissonance that occurs when healthy eating occurs without exercise or exercise occurs with out healthy eating will act to promote the harmonious incorporation of both into our daily routines.

Why do exercise and healthy eating harmonize so nicely together?

Many of those who have the self-restraint to eat a healthy diet and maintain a good weight come to an understanding that adding exercise improves the way they feel and their overall well being.  Those who are ardent exercisers usually come to the realization that they need to fuel up with quality nutrition to maximize their performance and keep their weight steady.  Additionally, those with the discipline and perseverance to put in the hours and the effort to exercise on a regular basis simply do not want to spoil their hard work by poor eating.

Bottom line: healthy eating and exercise harmonize in a way that will make your heart sing!

George, age 53

“When I exercise, I am more careful about eating.”

Justin, age 35

“Exercise drives my healthy eating; when I fall off my exercise regimen, I start eating pizza, burgers and deli sandwiches. The combination of exercise and healthy eating creates great rhythm.”

A wonderful Christmas and Hanukkah to all!

Andrew Siegel, M.D.

“Health and wellness sure beats wealth and hellness.”

Exercise To Exorcise

November 13, 2011

I just read a great blog by Inspire Fitness Now that can be accessed at:  The subject was “sweat a little to feel a little.”  I wholeheartedly recommend subscribing to her blog.  Reading her wise words inspired me to expand a bit on the subject of exercise and how meaningful it is me and to our health in general.  Like healthy eating, exercise is one of the cornerstones of wellness.

Exercise dependency, in which exercise becomes your “drug,” is one of the few healthy dependencies you can have (although it certainly is possible to carry it to an extreme). The euphoric state achieved by jogging, for example, is often referred to as “runner’s high”; I personally find that it takes me at least three miles of running to achieve it. When you can achieve this Zen-like state, monotony actually can become pleasurable and repetition can become a source of comfort! This “entranced” state is ideal for letting the mind ruminate and meditate; I keep a notebook and pen close at hand and often have to stop for a moment and scribble down an interesting thought or idea.

This phenomenon of achieving a Zen-like state is not exclusive to running as any prolonged aerobic endeavor can result in this calm, lucid, mood-elated feeling. The “runner’s high” certainly does not occur every time I engage in an aerobic exercise, but I always do end up feeling better after then before I began exercising. An added bonus is that one always looks better, too—there’s nothing quite like the “afterglow” of a vigorous, sweat-inducing workout.

Exercising is useful for exorcising your demons away, whatever they may be. I find myself using the salutary, short-term effects of exercise to combat fatigue and stress. That’s right: expend energy to gain energy!   It sounds counter-intuitive but is not at all! As a physician, I am subject to quite a bit of stress, and exercise serves as a fine tonic to help deal with these issues.  Working out is absolutely transformational under many circumstances including to cure the ills associated with traveling and to serve as an antidote to jet lag.

I find that when I attend a medical conference that requires sitting and listening to lectures for more than a few hours, I am left deeply fatigued and feeling unwell because I am an energetic individual who relishes activities. My only solution for assuming a state of normalcy is very aggressive, sweat-drenching cardiovascular exercise, functioning to transform me back to my typical energetic self. The same holds true for putting in a long day in at the office—after ten hours or so of seeing patients, I often find myself exhausted AND very stressed. As soon as I get home, I change into workout clothes and head downstairs to my basement. After a good aerobic workout coupled with some strength training, followed by a nice, hot shower, I emerge—physically and emotionally invigorated, my stress released, and fatigue having gone by the wayside—to join my family for dinner with a cathartic fresh outlook and a heady sense of well-being.

I contend that we, as humans, have an amazing pharmacy within our own bodies, one that is capable of naturally manufacturing a significant portion of all the pharmaceuticals that we will ever need. Exercise is able to tap and manipulate our pharmacy within to release a symphony of chemicals that can help make us feel happy, alert, and alive.         Simultaneous with our body sweating out “poisons” (sodium, chloride, potassium, uric acid, urea, ammonia, and lactic acid), our brains and glands are producing a whole cocktail of drugs, including hormones, neurotransmitters, etc. These may include endorphins (morphine-like chemicals with pain-relieving properties), serotonin (which may be responsible for causing heightened emotions and senses), corticosteroids (naturally-occurring anti-inflammatory hormones), and phenylethylamine (also found in chocolate and somewhat similar to amphetamines in terms of its ability to improve mood and ability to focus and purportedly released in the brain when people fall in love). At the same time, exercise causes levels of adrenaline (our stress hormone) to decrease.

While the specifics and reactions of the chemicals involved remain largely elusive, vigorous aerobic exercise can and does for many people cause a “rush”–like sensation, heightened awareness, and a feeling akin to the infatuation state of a loving relationship! Internal chemical release may also be responsible for the improvement of joint pain in those suffering with arthritis, decrease in hot flashes in women going through menopause, and improvement in the symptoms of many chronic conditions and diseases.

When I found out that my father had prostate cancer, I was flabbergasted. Similarly, when I received the call from the laboratory that my wife was a carrier of the BRCA-1 gene that is associated with a markedly increased risk of developing breast and ovarian cancer, I was in a state of shock, anxiety, and confusion. On both occasions, my immediate means of attempting to cope with these horrible medical reports was to put on my running shoes and go for a long, slow jog. I was literally drawn to run, almost by an external force—not music-inspired, happy running, but angst-inspired physical exertion, allowing me time to ruminate, mull, and contemplate—somehow, this meditative, physical exercise helped me deal with the psychological issues at hand.  I found consolation by finding my running shoes—fitness and exercise being my “religion” on many levels.

 So what I am saying is that exercise actually IS the drug Norvasc (lowers blood pressure), and Lipitor (lowers cholesterol), and Aspirin (helps prevent untoward cardiovascular events), and Lexipro (helps manage anxiety and depression) and Viagra (helps manage erectile dysfunction) and then some!  It is exercise that is my performance- enhancing drug! If the benefits of exercise could be incorporated into a pill, it would be a blockbuster for any pharmaceutical company!

In summary, the short-term positive effects of exercise are the psychological and physical benefits of stress busting, improvement of mood, fatigue reduction, and increase of energy. What about the long-term benefits? These include reduction in risk for diabetes, cardiovascular diseases, stroke, hypertension, some cancers, osteoporosis, chronic medical problems, falls, and physical disability. An exercise regimen is also useful for increasing muscular strength and tone, reducing body fat, and helping with weight control. Exercise and its resultant weight reduction will help lower blood pressure, total cholesterol and “bad” cholesterol (LDL), and raise “good” cholesterol (HDL). Biological aging is thought to be partly on the basis of oxidative stress, which is reduced by exercise, so exercise can keep us looking and acting youthful.


“Those who think they have no time for bodily exercise will sooner or later have to find time for illness.”

Edward Stanley, The Conduct of Life

If you would like to watch my ten-minute video on exercise, go to:


Andrew Siegel, M.D.

Aging Young

September 17, 2011

With the occurrence of my birthday this past week and lots of birthdays of family members this month, I have been thinking about longevity, the aging process, and why—for so many of us—there is a glaring discrepancy between how old we are and how old we look.

Our collective longevity has improved dramatically over the past few centuries.  The 19th century was the Century of Hygiene (improved public health and sanitation saved more lives than any other cause), the 20th century was the Century of Medicine (vaccines, antibiotics, transfusions, chemotherapy, etc., helped contribute to longevity), and the 21st century will be the Century of Healthy Lifestyles—whereby longevity will be increased by reducing risky behaviors and making positive changes with regards to exercise and nutrition.

Aging is an inevitable occurrence, but how we age is within our control to a significant extent. We have it within our own power to maintain health, vitality, and quality longevity—to walk with a spring in our steps and to feel energized and content. Aging is, of course, a 100% fatal proposition, and the best recommendation to push the limit of it is to first do no harm by avoiding malignant behaviors. So the first general rule is active omission—avoid doing bad—do not eat excessively, stay away from harmful substances such as fast food, tobacco and drugs, be moderate when it comes to such things as alcohol and ultra-violet light exposure, minimize stress, etc. The second recommendation to push the limit of aging is active commission—do good—eat properly, exercise vigorously, get enough sleep, seek preventative maintenance, respect yourself, invest in yourself, engage in the fitness and health lifestyle, live well!

“You have to work on longevity…” “My ‘secret’ is that you have to plan for your life. You need to plant the seeds and cultivate them well. Then you can reap the bountiful harvest of health and longevity.” 

(Jack LaLanne, at age 92)

“The secret to aging well is simply living well.”

(A rabbi in his 80’s, who is a patient of mine)

Chronological age refers to how old you actually are (in years, months, days, etc.); physiological age refers to your functional age, the age at which your organ systems and other body parts are functioning.  There can be a great disconnect between chronological and functional ages—one can have a chronological age of 40 and a functional age of 30; or alternatively, someone may chronologically be age 40, yet have a functional age of 60. This disparity basically comes down to genetics and lifestyle. A desirable goal is to maintain a functional age that is as young as possible.

Through my interviews with many chronologically older adults who were physiologically much younger than their years of life would seemingly indicate, certain attributes of aging well and aging long became obvious:

  • An active, purposeful and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose
  • Ample exercise and physical activity
  • Mental engagement and commitment to interests and hobbies—reading, travel, games, art, music, crafts, pets
  • A healthy diet
  • Avoidance of self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun, excessive risks—an “everything in moderation” attitude
  • Close relationships with family and friends with sources of strength being a good social network and perhaps religious/spiritual pursuits; in particular, being in a good marriage seems to be a very important attribute of aging well
  • Optimistic and grateful attitude—cheery, happy and upbeat dispositions with a sense of hope about what the future will bring, a good sense of humor and the ability to deal positively with stress
  • The ability to adapt to loss or change
  • Good genes
  • The practice of preventative maintenance
  • Care about yourself, respect yourself and invest in yourself—live well

Andrew Siegel, M.D.

If interested in a free electronic download of Finding Your Own Fountain of Youth: The Essential Guide to Health, Wellness, Fitness & Longevity, go to the Promiscuous Eating site and click on “links.”

Wealth Is Health: Your Exercise Savings Account

September 10, 2011

Your Exercise Account: Building Sweat Equity

Sadly, many people seek and ultimately obtain financial wealth at the expense of their health, not realizing the fact stated so clearly by poet/author Ralph Waldo Emerson:“the first wealth is health.”  Without health, having financial wealth is absolutely meaningless!

We do our best to save for retirement, although with our current economic crisis—high unemployment, slow gain in wages for those fortunate to be employed, falling house prices, our national debt burden and the strong possibility of a double-dip recession—it has become much more of a struggle to do so.  We earmark money for Individual Retirement Accounts and 401K plans, annuities, and other similar retirement vehicles that allow us to sock away resources in investments for the future.  Some day, we will no longer be working and will need to tap our savings to live.  And hopefully, we will be living for many years after retirement.

Sweat equity is a business term used to describe the non-financial contribution of time and effort that is fundamental to the success of a business endeavor. I borrow this term and extend its use to the fitness and health arena.  As many of us hopefully have retirement savings accounts, I propose that we all have a Sweat Equity Account as wellbasically, a Fitness Account.   It consists of time and effort put into exercising and maintaining fitness.  The tenets of obtaining and maintaining a fitness account run parallel to the principles of obtaining and maintaining a retirement account and are as follows:

  • Have a plan.   Understand the need for and the importance of your fitness account.  If you invest wisely in this account, it will pay you back in spades. 
  • Pay yourself first.   Carve out the time for fitness and commit to it automatically—this guarantees that it is a priority to be tampered with only under the most unusual circumstances.  This will ensure regular deposits to build your personal fitness nest egg.
  • Slow and steady approach.   A moderate amount of exercise, deposited to the account on a diligent and regular basis, will ultimately allow for complete funding of your fitness account.
  • Start early.   The earlier you begin the fitness account, the more time available to work the magic of compounding, when the investment returns themselves earn further returns. You will earn returns in the form of “interest and dividends” (improved quality of life), and “capital gains” (augmented quantity of life).   If you missed the boat on starting early, don’t waste another minute…start today.  It is never too late.
  • Long-term perspective.  The greater the investment in terms of time invested, the larger the fitness nest egg builds.  The commitment to this plan needs to be a lifetime endeavor.  No gimmicky investments!    No shortcuts!  No tricks or instant rewards!  No nonsense!
  • Seek investment counseling.   Not everyone is capable of managing his or her own fitness account—if not, seek the services of a professional personal trainer or fitness instructor.  Their services will be well worth their cost.
  • Diversify.   Deposit into your account all different forms of fitness investments, including aerobic and endurance activities, weight training, core, flexibility exercises, etc…. include lots of variety in your portfolio.  Shake it up a bit.  I personally like cycling, tennis, golf (always walking the course, if possible), yoga, Pilates, P90x, etc.—by doing something different every day you don’t give yourself an opportunity to get bored and you get the benefit of working different areas of your body and different aspects of fitness.
  • Eliminate debt.   Pay down and eliminate debt, of which one component can be thought of as the fitness deficit that you owe yourself from past exercise omissions.  The other component should be thought of as your current debt in terms of excessive body weight and the burden of bad lifestyle choices.  You will reap the benefits of becoming debt free through exercise and healthy lifestyle and eating habits.

Your contributions to your Fitness Account will ultimately make you wealthy; that is, “healthy wealthy”…it just takes time and tenacity.  And some day, when sickness or disease will inevitably surface, you will be equipped to strike a noble fight because of your years of investment in yourself. 

“Living is a pain in the butt.  Dying is easy.  It’s like an athletic event.  You’ve got to train for it.  You’ve got to eat right.  You’ve got to exercise.  Your health account, your bank account, they’re the same thing.  The more you put in, the more you can take out.”

Exercise is king and nutrition is queen: together, you have a kingdom.”

Jack LaLanne (2006)

Andrew Siegel, M.D.

To view my brief video on the merits of exercise, visit: