Monthly Archives: September 2015



Because I have been an holistic MD for the last 25 years and anti – aging is one of my specialties, I have an interest in both exercise and nutrition. On the subject of exercising for health, it is impossible to separate nutrition, and stress. You can work out religiously but if you are not eating wisely the full health benefit is not reached, because the body is not receiving the nutrients it needs in order to build healthy tissue and the cellular components for energy renewal. By the same token, if you eat healthy foods but do not exercise the health benefits are diminished. Muscle has to work to maintain or increase its mass. Now if one is doing both of the latter but the routines of either one or both are resulting in stress this can also defeat progress and health. For this blog I will concentrate on exercise; the next blog will be on nutrition. Stress is always a factor in health to me. Not the stress itself but how we react to stress.

After years of abuse, both poor nutrition and lack of exercise can have chronic consequences on the body. This is especially true if proper nutrition has not been followed for long periods of time while the body was under physical stress, such as intense sports training. Mental stresses have similar negative effects because of the constant adrenal – cortisol response to mental stress. (Please refer to my other blogs on stress – A quick reminder is that the body – mind cannot discern between physical and mental stress. The response to both are equal to cause the same output of cortisol for flight or fight protection and the consequences of chronic stress.

I do believe that both aerobic exercise and resistance (weight) training are necessary to keep a healthy body. The resistance is necessary to build strong muscles and bones and to prevent osteoporosis deflating muscles and to keep strong tendons: the aerobic for cardiovascular health. I have  a lot of experience in both and now share my ideas and experience with patients. I find this helpful because many people are either afraid of starting or have no idea of how to start. Stretching both before and after exercise keeps the muscles toned and helps prevent injury. When I was teaching karate I would emphasize to the students that having big muscles is no advantage if the joints do not react properly and are prone to different types of tendon-joint injuries. This is especially true as one advances in age. Exercise does not have to be either strenuous nor boring. In fact, I like to call exercise “funacise.” Today there are many different types from which to choose. Some people would benefit from joining a gym so that the exercise is structured, the equipment is there and varied, instructors are available, and the possibility of a social atmosphere is present. The latter can be especially helpful for those that do not have the incentive to exercise and to those that have depression so they are with other people. (A caveat to this is the many scientifically based studies that demonstrate that exercise is as effective for mild to moderate depression as the pharmaceuticals).There are numerous classes offered in different forms of exercise. Other people prefer to exercise at home, using their own equipment and/or videos. The problem with this is that one may not be using proper form if no one is watching, correcting and teaching and therefore prone to cause injury. It can be beneficial to have an exercise partner so that you can keep each other’s motivation high as well as having time to enjoy the company of each other. The type of exercise that works for you is the one you enjoy. Once in the habit of your choice you may branch out to other forms. Sometimes motivation is diminished because of boredom of the same repetition each time. There is no reason for this. If it is aerobic exercise that one does for 20 minutes or more it is not necessary to do a continuation of the same exercise. One can do 5-10 minutes of bicycling and then switch to rowing or treadmill, Etc.. Of course you can do different aerobic exercises on different days or join certain classes of different types. Walking is still one of the best and least physically invasive forms of aerobics if the person is not a “dawdler.” Your favorite music will help as you can sing with it even if you have a voice no one else wishes to hear (my own personal experience). For myself, I like to combine weights and aerobic by not stopping lifting but rather go right into a different muscle group even if using light weights. This cuts down on the time I spend “funacising” to about 20 – 30 minutes with all the benefits of both. Of course, it is important first to learn good form so you do not injure yourself while trying to improve your health. For those that dislike exercising, especially resistance exercise, you can get around this and be finished quickly if you do the eccentric method. This is done by taking a light weight and doing the extension part very, very slowly. For example, biceps: lift up a weight you consider lighter then normal for yourself but let it down (with good form) to the count of 12 or more. You will ache after 3-5 reps. You can do this eccentric exercise for any group of muscles.

There is a caveat to any form of exercise be it resistance or aerobic.! If you know you are an obsessive and/ or compulsive personality, or competitive personality you need to watch stressing yourself to the point of defeating the purpose of exercising. Why? Because exercising is to relax your mind as you become physically fit. It is not meditation but a form of moving meditation in the sense that you are escaping from the everyday stresses for the time that you are exercising. You do not need to add another stress to the day. When I was running a mile for each round that I fought I would get so aggravated if I did a poor time or was not progressing in my time/mile. This is competitive-obsession. My wife would ask me why do I run and I would say to relax – duh. When I would come home from my emergency-room shift and be “up- tight” and volatile before I was allowed to sit down and eat with my son and wife one or the other would say first go down to the basement and jump rope for half an hour-to-forty-five minutes. It worked every time to get rid of the ER mind trauma so I could enjoy my family meal.

When one starts to do resistance exercise they may get really severe muscle aches the first few times they are working out. Some refer to this as good aches “No pain, no gain.”. This latter is only true if you are going into this for body building and do not care about future osteoarthritis. DOMS (Delayed Onset Muscle Syndrome) is the proper term. They use to believe that these aches were due to lactic acid buildup from the workout. It is really the muscles healing from the nano tears that are a  result of a proper workout. It is the repairing and building up of the muscle. When it occurs be thankful and happy that your body is responding properly. They will not occur after you get through the beginners part except when you decide to start a new plateau or new type of funercise. Sometimes when you leave go of the exercise for a long time and start again DOMS will hit but for a shorter time. Do not forget that form for each muscle group is so important. Above all ”Do no harm!”

Some people tell me that they do not have time to exercise or even relax. Think of it this way; taking time for yourself is doing something.
I point out that they have time to be caretakers each day for their spouse, boss, children, etc, but not an half hour per day for themselves. This is sending a subconscious message to their brain that everybody else is worth their time but they feel they do not deserve time for themselves. “Today I will love myself enough to exercise.”

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it

Prostate Specific Antigen = PSA

prostatePSA is a subject that is often brought up to me during my seminars and with private consultations. To most men it is only initials for a test that states whether they have cancer, potentially have cancer, benign prostate hyperplasia (BPH=enlarged prostate) or they can be relieved to go home feeling free of prostate disease. The answers to these initials (PSA) are not complicated, but should be understood, so a discussion of the prostate can be discussed intelligently with the physician and most often relieve the client of unnecessary anxiety.

PSA (prostate specific antigen) is a protein that is produced almost exclusively by the cells of the prostate. Its function is to keep the prostate fluid (semen) watery so the sperm can swim. Another purpose of this protein is to dissolve the cervical mucous cap to allow the sperm to enter. Although present in large amounts in prostate tissue and semen, it has been detected in other body fluids and tissues. Interestingly PSA is found in concentrations of female ejaculate roughly equal to that found in male semen. It is also found in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium (uterus lining), normal breast tissue and salivary gland tissue. In addition PSA is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.

In the male PSA is normally found in the blood but at low levels (about 0-4ng/ml = nanograms/millimeter= one ng=one billionth of a gram). PSA levels can be increased by prostate infection- irritation, digital rectal examination (DRE), benign prostate hyperplasia (BPH), and recent ejaculation. All the latter can produce a false positive result. Ejaculations should therefore not be present for 24 hours before a PSA test and a DRE should not be done before blood is drawn for this test. Exercise within 24 hours of the PSA exam can also give e a false positive (high). There is also a urological debate whether the PSA normally goes up gradually with age and therefore different normals should be considered. The prostate gland generally increases in size and produces more PSA with increasing age; it is normal to have lower levels in young men and higher levels in older men. Age-specific PSA levels are as follows (age group, upper normal): (40 – 49years, 2.5), (50 – 59years, 3.5), (60 – 69years, 4.5), (70 – 79years, 6.5). But keep in mind that age related normals are still controversial and in practice the 0-4ng/ml is the gold standard.

So in the former paragraph one can see that besides from the cause of cancer and BPH the PSA can rise from other causes. I have already mentioned the PSA can rise just from having intercourse or any ejaculation before the blood serum is drawn or from exercising before the blood is drawn. It can also be elevated due to testosterone converting to the stronger testosterone, dihydrotestosterone (DHT). This latter can happen if the man is on an anti-aging regimen of taking testosterone and he is one of the rarer males that will convert the testosterone to DHT. It happens but the conversion can be stopped either with pharmaceutical intervention,with natural supplementation or with tweaking the testosterone regimen.

Increased levels of PSA may suggest the presence of prostate cancer. But if mildly elevated 7 out of 10 men will not have the prostate cancer. However, prostate cancer can also be present in the complete absence of an elevated PSA level, in which case the test result would be a false negative. Statistically 2.5 percent of men with prostate cancer will have a negative PSA. Obesity has been reported to reduce serum PSA levels; therefore, this can also give a false negative and delay early detection. This may explain the worse outcomes in obese men that have the pathology of prostate cancer but no symptoms, signs or elevated PSA.

Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of PSA screening outweigh the risks of follow up diagnostic tests and cancer treatments when the test is positive.. For example, the PSA test may detect small cancers that would never become life threatening. This situation, called over-diagnosis, puts men at risk of complications from unnecessary treatment. The procedure used to diagnose prostate cancer (prostate biopsy) may cause harmful side effects including bleeding and infection. Prostate cancer treatments, such as surgery and radiation therapy, may cause incontinence (inability to control urine flow),and erectile dysfunction (erections inadequate for intercourse), So the best way to use the serum PSA is to have a base line as an index to refer to for future PSA tests. If this baseline test is normal but the next test goes up about 2 points then suspicion should be heeded by the physician and the test repeated in 2-4 months along with watchful waiting. For example: If my PSA is 1.4 for the first test then one year latter it is 3.6 this is looking a little suspicious. Watchful waiting and a good history plus symptoms and signs that can raise the PSA should be questioned.

Then there still exists the debate at what age is the PSA elevated naturally. But I believe that the above paragraph with the PSA rising more then 2ng/ml in one year is a good indication that further testing and observation should be taken seriously. Also if the man is on testosterone this should be stopped for a few weeks and certain tests should be retaken and reviewed. There are some blood test markers for prostate cancer and a retesting of hormones if the man is on testosterone therapy. Then if so desired by the client and with the consultation of the physician testosterone can be restarted but possibly with a different regimen. There, are different ways of using the anti-aging testosterone that can be tailored to this situation and followed and as mentioned altered to stop testosterone converting to DHT. But in a different blog I will show the evidence based information of why testosterone is not the cause of prostate cancer but rather estrogen is the cause. Note that I only believe in bio-identical testosterone produced by a compounding pharmacist. By doing so I can have the testosterone made specifically for the individual and tweaked if necessary. Also, the body does not know what to do with synthetic hormones since the cells were evolved only for human bio-identical hormones.

So further testing would include a free PSA. Most PSA in the blood is bound to serum proteins. A small amount is not protein bound and is called free PSA. In other words the PSA protein can exist in the blood by itself unattached, or it can join with other substances (protein) in the blood. When it is by itself, it is known as free PSA. With benign prostate conditions (such as BPH), there is more free PSA, while cancer produces more of the attached form and therefore, the free PSA is less then 25%. If a man’s attached PSA level is high but his free PSA level is less then 25% the presence of cancer is more likely. It is easiest to just remember that the free PSA should be above 25%.

Since this can be a confusing concept let me write it in another way. PSA, a protein produced by prostate gland cells, circulates through the body in two ways: either bound to other proteins or on its own. PSA traveling alone is called free PSA. The free-PSA test measures the percentage of unbound PSA; the PSA test measures the total of both free and bound PSA. About 75% of men with an elevated PSA do not have prostate cancer. a free PSA greater than 25% is more likely to have a benign condition than to have cancer, making a biopsy unnecessary. Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer ( Harvard Medical SchoolOriginally published April 2009; last reviewed March 21, 2011. )

So the tests that I do in the case of a rising PSA are:

  1. free PSA

  2. ultrasound

  3. repeat the PSA in 3-4 months making sure that events that could give a false positive have not happened.

  4. DRE-digital rectal exam or have the urologist do this since. I so often refer to them if there is a chance of serious pathology.

  5. IF the man is on testosterone the laboratory chemistry I order are:

    • testosterone free and total

    • estradiol

    • sex hormone binding globulin (SHBG)

    • another PSA and free PSA if the last one was more then 3-4 months

    • dihydrotestosterone (DHT)

    • if there is a suspicion because of signs or/& symptoms it warrants caution. I believe the best way to handle any doubt is to get another opinion from a urologist.

 Many men were diagnosed with, and treated for cancers that would not have been detected in their lifetime if they had not had screening and, as a consequence, were exposed to the potential harms of unnecessary treatments, such as surgery and radiation therapy . Here I am just stating results and not giving advice as to what each individual should do if there is a possibility of prostate cancer. This is up to the individual with guidance from their own physician. Just investigate all options before making a decision.

Scientists are also researching ways to improve the PSA test, hopefully to allow distinction between cancerous and benign conditions, as well as slow-growing cancers and fast-growing, the latter being potentially lethal cancers. These new tests that they are researching and developing are too numerous for this blog and they are still in investigative states. But the reader can investigate all these potential diagnostics via the Internet and should do so if they believe they have a problem since research and progress come about so fast. Too often physicians do not know all the research being done outside their expertise and area and it is up to the concerned client just to Google further information and bring it up to their physician.

I hope this short excursion into PSA helps those men that have anxiety about not understanding the PSA test.

Author: Alan J. Sault MD. ABHM-Diplomat Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your-well being and what you can do about it .