Archive for July, 2016

On Beer Bellies, Heart Disease And Sexual Function

July 30, 2016

Andrew Siegel MD  7/30/16



A bit of fat is good…but not too much

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and it is used in the manufacturing process of several hormones.

All fat is not created equal…It’s all about location, location, location.

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat. Visceral fat–also referred to as a “pot belly” or “beer belly”– is internal fat located deep within the abdominal cavity. Subcutaneous fat–also known as “love handles,” “spare tires,” “muffin top,” or “middle-age spread”–is superficial fat located between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more hazardous to one’s health than subcutaneous fat since it increases the risk of heart disease, diabetes and metabolic disturbances. Subcutaneous fat is inactive and relatively harmless and generally does not contribute to health problems.

Factoid: A beer belly is called a beer belly for good reason. One of the real culprits in cultivating visceral fat is drinking liquid carbs, whether they are sweetened beverages (sodas, iced tea, lemonade, sports drinks, etc.), fruit juices such as orange, grapefruit, grape, cranberry, etc., or alcoholic beverages. These liquid carbs have no fiber and are essentially pre-digested, stimulating an insulin surge and rapid storage as fat. It is always better to eat the fruit rather than drink the juice, since the fruit is loaded with fiber that fills you up and slows the absorption process and contains abundant phytonutrients. You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat essentially is a metabolically active endocrine “organ” that does way more than just create an unsightly protrusion from our abdomens. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body. So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, thymus gland, etc.). This name should convey the dangerous nature of this “gland.” I suggest “die-roid” gland because of its dire metabolic consequences, including risk of diabetes, cardiovascular disease, low testosterone, erectile dysfunction (ED) and premature death.

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

Factoid: Anybody with a big belly is pre-diabetic, if not diabetic already.

“Metabolic syndrome” is a cluster of risk factors that are dangerous to one’s health. These include visceral obesity as defined by waist circumference (men > 40 inches; women > 35 inches), elevated blood sugar (> 100 mg/dL), high blood pressure (> 130/85 mm), elevated triglycerides (>150 mg/dL) and low HDL cholesterol (the good cholesterol): (men < 40 mg/dL; women < 50 mg/dL).

Sexual dysfunction

Beer belly and metabolic syndrome are highly associated with low testosterone and poor erection and ejaculation function. The fatty tissue present in obese abdomens contains abundant amounts of the enzyme aromatase, which converts testosterone to estrogen—literally emasculating obese men. So, visceral fat can steal away our masculinity, male athletic form and body composition, mojo, strength, as well as the ability to obtain and maintain a good quality erection.

ED serves as a good proxy for cardiac and general health. The presence of ED is as much of a predictor of heart disease as is a strong family history, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the initials ED to mean: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of heart disease); and Early Death (if missed).

Factoid: The penis can function as a “canary in the trousers.” Since the penile arteries are generally rather small (diameter of 1- 2 mm) and the coronary (heart) arteries larger (4 mm), it stands to reason that if vascular disease is affecting the tiny penile arteries and causing ED, it may affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaque that compromises blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a genital “stress test.”

“Fatal retraction”

While the penis can genuinely shrink for a variety of reasons, most of the time it is a mere illusion—a sleight of penis. Obesity causes a generous pubic fat pad that will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding or buried behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Yet another reason to remain lean!

Trivia: It is estimated that for every 35 lbs. of weight gain, there is a one-inch loss in apparent penile length.

What does this all mean?

  • Visceral fat is a bad, metabolically-active form of fat that is highly correlated with metabolic syndrome, diabetes, heart disease and sexual dysfunction.
  • ED often occurs in the presence of “silent” heart disease (no symptoms) and serves as a marker for increased risk for heart disease (as well as stroke, peripheral artery disease and death) often occurring 3-5 years before heart disease manifests. Early detection of ED provides an opportunity to decrease the risk of heart disease and the other forms of blood vessel disease.  ED has a similar or greater predictive value for heart disease as do traditional factors including family history, prior heart attack, tobacco use and elevated cholesterol. The greater the severity of the ED, the greater the risk and extent of heart disease and blood vessel disease.
  • Intensive lifestyle intervention has the potential for reversing visceral obesity, metabolic syndrome and sexual dysfunction. This lifestyle intervention involves achieving a healthy weight, losing the belly fat, healthy eating, regular exercise, smoking cessation, moderation of alcohol intake, stress management, etc.
  • The good news about visceral fat is that it is so metabolically active that with the appropriate lifestyle measures it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be virtually impossible to lose.

Wishing you the best of health,

2014-04-23 20:16:29

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