Looking To Lose The Spare Tire?

63% of Americans are overweight with a Body Mass Index (BMI) of 25 or greater. How do you know if you are overweight? You can calculate your BMI, which is based on your height and weight (divide your weight in kilograms by your height in meters, squared); or you can go to one of many websites with BMI calculators and simply input your weight and height (pounds and feet and inches) and it will do the math for you (Google "BMI calculator"). A BMI under 18.5 is considered underweight (most models), a BMI of 18.5 to 25 is considered normal or healthy, a BMI above 25 is considered overweight, and a BMI over 30 is considered obese. BMI is not accurate in very muscular individuals who are heavy for their height but do not have much fat. A DEXA scan is a much more accurate way to determine BMI or percentage of fat in body composition.

Overweight people are more likely to have diabetes, heart disease and hypertension, stroke, dyslipidemia (elevated levels of cholesterol and/or triglycerides), liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems and certain types of cancer (endometrial, breast, colon). North Carolina, where I live, was number 8 on the nation's top 10 most obese list with 29% of its citizens being obese in 2008. Estimated direct and indirect health costs for North Carolina's obesity epidemic in 2006 were $57.37 billion for adults and projected costs for 2011 are $75.64 billion.

What are some of the reasons for being overweight? Bottom line, the calories taken in exceed the calories expended; and, no matter how much we would like there to be a magic way to avoid calorie restriction and exercise, they always come into play when we are talking about weight issues. But other factors can also be a part of the picture. Hormonal imbalance can cause weight gain. For example, polycystic ovary disease, menopause and hypothyroidism (low thyroid hormone) can all be associated with weight gain. Stress, with its elevated levels of cortisol, can be associated with weight gain. Lack of sleep can cause weight gain--people who sleep less the 7-8 hours per night have an elevated BMI compared to those who sleep 8 hours or more regardless of their caloric intake! Common medications associated with weight gain are antidepressants, anti-diabetes drugs, oral contraceptives and steroids.

Sometimes we are doing everything right, but we have that one problem area that just won't seem to cooperate with our workout. We have the love handles, the muffin top, the spare tire or the saddlebags that don't respond to diet and lifestyle changes. Some of the latest technology is geared toward losing the problem area or sculpting, losing some inches and gaining some encouragement and enthusiasm for continuing on the path of the virtuous. There is a bewildering array of procedures and techniques available, so here is a brief summary of what is new and not so new.

Oldest among the body sculpting techniques is liposuction. Liposuction has progressed over the years from a procedure requiring anesthesia and often blood transfusions to the current state-of-art liposuction with tumescent anesthesia using microcannulas, which allows the procedure to be done with the patient awake and with little scarring. Newer additional modifications include various assist technologies such as ultrasound, laser or water jets to make the liposuction easier for the surgeon and more efficacious for the patient (allows suctioning of more fat, faster.) One of the problems with liposuction is that along with the fat there are blood vessels, lymphatic vessels, connective tissue, fibroblasts, etc. that are disrupted by the procedure and can take 6 months or more to fully heal. The tissue located just under the skin neither looks nor feels normal for 6 months or more.

An even more invasive procedure for body sculpting is abdominoplasty or "tummy tuck" which is fairly major surgery, requires general anesthesia, and, again, will take 6 months or longer to fully heal.

Non-invasive (non-surgical) methods have been added to the list of available techniques, and one that has been around a long time is mesotherapy, also called lipodissolve, lipostabil, lipolysis or injection lipolysis. With this technique multiple injections are given in multiple sessions to "melt away" unwanted small areas of fat. Some of the problems with this technology include the lack of a standard ingredient list for the material injected, and the FDA currently views this procedure as "unapproved drugs for unapproved uses." Lipodissolve was banned in Kansas in 2007 by the Kansas State Board of Healing Arts, in part due to complaints about the procedure; and three medical associations have issued health warnings cautioning against the use of injection lypolysis, including the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society of Dermatologic Surgery (ASDS). If that's not enough to dissuade you, I don't know what is.

Other non-invasive devices include one that utilizes mild electrical frequencies in conjunction with heat and vibration to "minimize fat", but is supposed to work by reducing cellulite and toning muscles. The manufacturer is vague about its mechanism of action and does not present any clinical studies. It is non-invasive, requires 6 initial treatments, as well as regular maintenance treatments and is basically a non-medical device that is marketed to salons and spas (read ineffective.)

Yet another non-invasive device combines massage and laser to activate fibroblasts in the skin in order to temporarily reduce the appearance of cellulite. Results are not sustained, and treatments must be repeated on a regular basis to maintain the look.

A very popular non-invasive device for cellulite reduction and body shaping uses radio frequency (RF) and infrared light with suction and tissue manipulation (rollers that spread out the skin as the energy is being delivered.) What, no kitchen sink? The theory here is that the combination of infrared and RF energies increase the oxygen delivery to the cells by heating the skin, which increases the metabolism of stored energy, i.e. fat, thereby reducing the size of the fat chamber or cell. The recommended number of treatments is 8-16 (!) with supporting treatments every month thereafter as results are not sustained. There are no studies to support this theory of the mechanism of action, and the manufacturer does not have studies to indicate expected and measurable results.

The latest technology uses a cold laser or low level laser therapy (LLLT) to emulsify fat within the fat cells and create a small pore in the fat cells, allowing fat to flow out of the cells to be taken up and eliminated by the body's lymphatics. Initially used to facilitate healing and decrease pain, this laser was discovered to liquefy and release fat and was used to assist liposuction. It was then realized that it works to reduce inches even without liposuction as once the fat is released from the fat cells it is accessible to the body's systems for elimination. This technology has been well studied and has been shown to result in a sustained loss of fat. This translates to an average loss of 5-6 inches or a drop in 2-7 dress sizes. It involves no discomfort, no surgery and no down time. Additional benefits include a reduction in cholesterol, LDL cholesterol and triglycerides for most people. Studies are currently underway to see how long this effect lasts. There is also a decrease in the hormone, leptin, which results in a decrease in appetite.

The best course of action is to follow a low glycemic diet and to get moving. Get active! Sleep 8 hours a night and destress through meditation or one of the biofeedback or holosync devices available (the subject of another blog.) Make sure you do not have a hormonal imbalance and review your medications with your doctor. Lastly, if you just need a little sculpting, there are many techniques available.

For more information contact Dr. Lisa Hogan at Youthology, Aesthetic & Anti-Aging Medicine, 919-847-1495 or lisa@youthology.md or visit http://www.youthology.md/.

Vitamin D, Steroid King of the Vitamins

Vitamin D has long been known for its role in preventing rickets in children and as a required element for the intestinal absorption of dietary calcium. We are now finding vitamin D to be important in protecting the body from a number of diseases. Vitamin D deficiency has been linked with stroke, cardiovascular disease, osteoporosis, osteomalacia, several types of cancer, some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and types 1 and 2 diabetes, depression and schizophrenia.

Vitamin D has a chemical structure very similar to some of the most important hormones in the human body; and, in many ways, behaves very much like a hormone, a steroid hormone. It binds to specific vitamin D receptors (like a lock and key) in target tissues and turns on specific genes. We know it has profound effects on immunity seen as antiviral and antibacterial effects. It maintains muscle and bone health to such a degree that, in one study, nursing home residents who were given vitamin D supplements had fewer falls than their supplement-free fellow residents. Those on the vitamin D supplementation had fewer fractures when they did fall, compared to the supplement-less residents. No other interventions were performed; just the addition of vitamin D supplements.

Humans begin the process of making vitamin D in their skin when it is exposed to sunlight. Ultraviolet light acts on a cholesterol based molecule in the skin to produce vitamin D3, which is technically a prohormone or precursor to a hormone. Our skin is capable of producing 30,000 units of vitamin D per day. Granted, this would require us to live like cave people, that is, nearly naked and outdoors all day. There is reduced endogenous vitamin D production at times of the year with reduced ultraviolet light (winter), and that is the reason that winter is the season for colds and flu. Also, due to concerns about sun damage and skin cancer, many Americans have limited sun exposure all year. (Let's face it, when we lived as cave people we didn't live long enough to get skin cancer; and we had an intact ozone layer.) The vitamin D produced in the skin is then hydroxylated in the liver to form the 25-hydroxy metabolite that is the main circulating form of the prohormone (still a prohormone). 25-hydroxy vitamin D has a long half-life (hangs around a long time) and is stored in the adipose or fatty tissue. This metabolite is ultimately transformed in the kidneys to form 1, 25-dihydroxy vitamin D--at last, the active form of the hormone.

Formation of active vitamin D is regulated by the parathyroid glands, 4 small glands located near the thyroid glands. When there is a vitamin D deficiency the parathyroid glands work overtime to stimulate the kidneys to produce more of the active form of vitamin D. For this reason, levels of active vitamin D can appear normal, or even elevated, in the presence of a deficient state. In order to truly measure vitamin D status the precursor to the active form of vitamin D is measured to determine the total bioavailability of vitamin D.

Many vitamin D supplements are actually vitamin D2, which is not found in animals. Ergosterol, a compound in fungal cell membranes, is exposed to ultraviolet light to manufacture vitamin D2 commercially. Vitamin D2 is metabolized and activated in the body much like vitamin D3, but it acts for a shorter time and is less active in the body than vitamin D3. Vitamin D2 has to be given in larger doses and more frequently to maintain adequate levels of vitamin D. Given enough vitamin D2, the body's production of vitamin D3 is decreased (suppressed). If vitamin D3 (what humans make) is measured in a person who is taking vitamin D2 (what fungi make), levels can appear low, as if there is a vitamin D deficiency. The take home message is that if you are taking vitamin D2, then you need to measure vitamin D2 levels when you are checking vitamin D levels.

Who Is At Risk For Vitamin D Deficiency?

Elderly people are at risk for vitamin D deficiency for several reasons. As we age, we make less vitamin D precursor in the skin, and our parathyroid glands do not function as well as they once did. Vitamin D deficiency is associated with osteoporosis and muscle weakness, as well as muscle and joint pain.

Dark-skinned people (including children) are at risk for vitamin D deficiency because they require much longer exposure to ultraviolet light in order to create enough circulating vitamin D compared to more fair-skinned individuals.

People who live at latitudes far from the equator (greater than 35 degrees latitude) or those who have limited sunlight exposure due to their work environment or their cultural rules of dress are at risk for low vitamin D levels.

Anyone with musculoskeletal pain (pain in the muscles, joints, or bones) should be tested for vitamin D deficiency because patients with diagnoses of fibromyalgia, low back pain, non-specific musculoskeletal pain, and hypothyroidism are often found to have low vitamin D levels. Supplementation improves symptoms.

All children need adequate vitamin D levels to prevent rickets and allow normal bone development. Infants who are breast-fed, especially those breast-fed by vitamin D deficient mothers, may not be getting enough vitamin D. Maternal supplementation is one solution. Cod liver oil is one of the few foods that provide a good amount of vitamin D and is a great supplement for infants and children. (Your grandmother was right!) Vitamin D deficiency in infants and children is associated with the development of childhood type 1 diabetes.

Overweight or obese people have lower levels of circulating vitamin D because their vitamin D can be bound up in fat stores.

Why Measure Vitamin D?

Vitamin D deficiency can be completely asymptomatic (at least for awhile), and so is often detected as part of routine testing. Deficiency is simple to detect. Supplements are inexpensive and easy to obtain and can improve health status and prevent more serious diseases.

What Is a Healthy Level of Vitamin D?

Levels under 32 ng/ml have traditionally been thought to indicate vitamin D deficiency; and, by anyone's standards, do represent vitamin D deficiency. This accepted standard was originally developed in relation to prevention of rickets. As it turns out, a minimal amount of vitamin D will prevent rickets; and many experts now agree that levels should be higher than 50 ng/ml (and probably 75 ng/ml) for optimal health. Research is in progress to establish more definitive requirements.

Who Needs Supplements, And What Type Is Best?

It is likely that most Americans are vitamin D deficient and need supplementation unless they are already taking it. A simple blood test will detect deficiency, and supplements are widely available. Vitamin D3 is the same as our own natural vitamin D and is more bioactive than vitamin D2 with less risk for toxicity. Supplements that contain probiotics are better absorbed and are good for the digestive system. There is good evidence that daily supplementation of 1000 to 5000 u of vitamin D3 is optimum.

For more information contact Lisa Hogan, MD at Youthology, Aesthetic & Anti-Aging Medicine at 919-847-1495 or lisa@youthology.md or visit www.youthology.md.

Bioidentical Hormones: What Are They And Are They Right For You?

As we age, our hormone production declines in predictable fashion; and it begins earlier than you might think. By the time we are in our thirties and forties our production of sex hormones may be low enough to cause serious symptoms. Although both genders produce all of the sex hormones, men produce predominantly testosterone and women produce predominantly estrogens and progesterone. The sex hormones are familiar to most people as the hormones that determine our gender, our secondary sexual characteristics as we mature and many aspects of our fertility.

But did you know that virtually all of our organs and tissues have receptors for the sex hormones, which means that these tissues respond to the sex hormones. Testosterone, estrogen and progesterone have profound effects on the health of the muscles, bones, cardiovascular system, brain, eyes and other endocrine systems, to name a few. So, not only do we have unpleasant symptoms with hormonal decline, but also it is detrimental to our health.

Until 2002 women were prescribed the synthetic hormone Premarin, conjugated equine estrogens or CEEs, derived from the urine of pregnant horses; Provera, the synthetic medroxyprogesterone acetate or MPA; or Prempro, a combination of the two. Usually, this prescription was issued long after menopausal symptoms had been evident, and usually without any lab testing. One dose was prescribed for every woman.

In 2002 the Women’s Health Initiative (WHI), a study led by the National Institutes of Health looking at the effects of Prempro on cardiovascular health, osteoporosis and cancer, was abruptly terminated just 8 years into the study. The study already showed an increase in the risk of heart attacks and stroke and breast cancer. These study results were widely publicized in the popular press with the result that millions of women suddenly stopped taking their hormone replacement either by their own decision or on the advice of their doctors. Hormone replacement has come to be viewed with fear, and women are basically told you just have to “tough it out.” (Often antidepressants are prescribed.) This is much like telling a diabetic to “tough it out” without insulin.

As for men, symptoms of hormonal decline are often not discussed, not addressed and are largely ignored. Men might be given a prescription for erectile dysfunction, but this does not preserve muscle, bone, heart and endocrine health the way testosterone would.

For women, is there an alternative? And, if so, is it really any better or safer than the out of favor synthetic hormones? The short answer is yes, bioidentical hormones or hormones that are natural versions of human estrogens and progesterone are very different form the synthetics and are more safe. They are usually prescribed on an individual basis, i.e., different dosing for different needs of different women, with lab testing to determine the level of need and the response to therapy.

First of all, women feel better on the bioidentical hormones. Secondly, there are numerous studies showing that bioidentical hormones are protective for the cardiovascular system in several different ways (increased coronary artery blood flow, decreased arterial plaque, decreased arterial spasm, and a favorable influence on lipids), thereby decreasing the risk for heart attack and stroke. Additionally, the synthetic, MPA, has been shown to increase insulin resistance (type II diabetes) compared to bioidentical hormones, which adds to the cardiac risk. Also, because bioidentical estrogen is given transdermally, there is not the increase in clotting factors, inflammatory proteins and risk of thromboembolism (blood clots) seen with synthetic CEEs given orally.

Perhaps most alarming is the known increased risk of breast cancer in women on MPA and the known carcinogenic (cancer causing) components and metabolites of CEEs. The natural estrogen, estriol, has been shown both experimentally and clinically to be associated with a decreased risk of breast cancer. Bioidentical progesterone has an anti-proliferative effect on breast tissue, meaning it has an anti breast cancer effect, which is opposite to the effect of the synthetic, MPA.

The results of the WHI study make sense intuitively—one glance at the path by which our sex hormones are made reveals that small changes in the sex hormone molecules can completely change their function and effects. It should come as no surprise, then, that synthetic hormones that differ from our natural ones have completely different effects on the various tissues of our bodies.

There are many other good reasons for both women and men to be on bioidentical hormone replacement therapy including preservation of muscle and bone health, prevention of Alzheimer’s disease, prevention of eye disease, preservation of urinary tract health, and preservation of libido and zest for life!

Antioxidants: Fact vs. Myth or What the Heck Are They and Why Should I Take Them?

You may have heard the term antioxidant lately as it seems to be cropping up in many products including everything from food to skin care to shampoo. But what does that term mean, exactly?

To understand what an antioxidant does, we need to understand one of the theories of how aging occurs and how cancer occurs. In the process of living, metabolizing food for energy and respiring, our cells create free radicals and reactive oxygen species, which are molecules with a single unpaired electron in an outer shell. Environmental stimuli such as tobacco smoke or radiation can also cause free radicals. Simply put, this means these molecules are “itchin’ for a fight” or looking to steal an electron from another molecule, which creates oxidative damage. Over time, if our cells sustain enough oxidative damage there is injury to the DNA, the cell becomes less adept at repairing damage and we end up with a cancerous cell or an aged cell whose days are numbered.

An antioxidant is a reducing agent, which interacts with free radicals or reactive oxygen species and prevents damage to our cells. We measure the antioxidant activity of a substance using the ORAC or Oxygen Radical Absorbance Capacity score. A high ORAC score means a high antioxidant activity. Antioxidants can be vitamins, vitamin cofactors, minerals, hormones, carotenoids, flavonoids, phenolic acids, and other organic compounds. Antioxidants are commonly found in fruits and vegetables (your mother was right!) Other great sources of antioxidants are nuts, spices and herbs, including cocoa (mmm, chocolate!)
So, the theory is that anything antioxidant should play a role in healing and repairing, preventing cancer and preventing aging. Is this true? This is a hot area of study right now, so the answers are just beginning to come in. There is good evidence that specific dietary antioxidants play a role in preventing macular degeneration (a major cause of visual impairment in the U.S.), preventing Alzheimer’s disease, reducing the risk of some cancers, reducing inflammation and preventing at least some changes of aging. Topical antioxidants have been shown to help prevent skin cancer. Evidence is beginning to emerge that at least one dietary antioxidant (resveratrol) appears to extend our lifespan.

In many of the studies that have been done, intake of whole foods, spices, herbs, etc. are shown to be associated with a decreased risk of cancer, macular degeneration, etc. but just taking a vitamin as an isolated supplement is not always associated with a positive benefit. This may indicate that there is some way in which the complete whole food functions in a different way with its complex composition as compared to an isolated vitamin, or it may indicate that something in the processing of a food may destroy some or all of the antioxidant properties inherently present. We do know that heat and heat processing often decrease the antioxidant activity present in a food. This is why a cold processed high antioxidant food such as Xocai chocolate (raw cocoa, acai berries, and blueberries) or Mona Vie juice (acai berries and other fruits) has greater value as an antioxidant source.

So should you be concerned about antioxidants? It is beneficial to have plenty of fresh fruits and vegetables in your diet, organically grown, if possible, because there is a higher antioxidant activity and greater nutritional value in organic foods as compared to conventionally grown foods. Many people feel they get benefit from the cold processed high antioxidant foods in the form of greater energy and less chronic pain. Finally, there are some definite health benefits and no known drawbacks to taking many of the antioxidant supplements, so why not?

Lisa Hogan, MD
Owner and Medical Director of
Youthology, Aesthetic & Anti-Aging Medicine
(where you can sample some gourmet antioxidant chocolate)
919-847-1495
www.youthology.md

Youthologie Aesthetic & Anti-Aging Medicine

Youthologie is the first eco-friendly medical office in North Carolina to register with the US Green Building Council for LEED (Leadership in Energy and Environmental Design) certification. LEED certification is an outstanding achievement based on the results from ratings in five categories, including sustainable sites, water efficiency, energy and atmosphere, materials and resources, and indoor environmental quality.

This premier medical facility brings both style and sustainability to its state-of-the-art design. Specializing in the latest technologies, Youthologie will offer treatments such as Titan non-surgical skin tightening; Pearl and Pearl Fractional laser resurfacing; laser skin rejuvenation; IPL (intense pulsed light) treatments for “age spots” rosacea, and redness; laser and IPL hair removal; chemical peels; Vibradermabrasion™; light therapy for acne and sun damage; eyelash extensions; Botox® and Juvederm®; sclerotherapy and laser treatment of veins, and hormonal balancing to name a few.

Dr. Lisa Hogan, founder and medical director of Youthologie, states, “Green design is not only part of my personal philosophy; it's a healthier and more soothing atmosphere for patients and staff. At some point in the not too distant future, this will be the standard for all medical practices.” Hogan worked with award-winning green architect, Tina Govan, who is keenly aware of the advantages of creating a green space and the many materials available to turn this dream into reality.

Said Hogan, “Our vision for Youthologie was to create a healing and planet-friendly place with sophisticated design where patients could experience the very best that technology and modern aesthetic and anti-aging medicine have to offer. What makes the quality of interior space so important is that Americans spend approximately 90% if their time indoors. In designing and creating the Youthologie office we used materials that were recycled, reclaimed, and rapidly renewable. All materials were manufactured in an environmentally friendly way and do not release harmful chemicals or volatile organic compounds. The end result is a beautiful and healthy place for patients and employees to enjoy.”

Some of the highlights of Youthologie's forward-looking environmentally conscious design are:
A loft-like wall from reclaimed bricks; Salvaged wood for shelving and interior doors; Organic rugs of vegetable-dyed wool and polished concrete floors; a tankless, on-demand water heater, low flow faucet aerators and faucet sensors in public use areas; Energy Star appliances; an energy efficient lighting design using predominantly warm spectrum fluorescent lighting as well as a design that allows much natural light to flow through the space; an energy conserving heating, venting and air conditioning system with individual controls throughout the space and a sophisticated air filtration system for superior indoor air quality.

Some of the more unique materials in the space are the eco-resin doors and interior clerestory windows that have a gardenlike feel with embedded plant material. These doors play a vital role in the drive to maximize natural lighting throughout the space.

Hogan's passion for environmental sustainability has informed her every decision. From the use of electronic medical records and email communications to conserve paper and the use of post-consumer recycled paper for printed material to the choice of organic product lines in recycled packaging, a comprehensive approach to eco-friendliness takes precedence at Youthologie.

Hogan is considered a national expert in aesthetic procedures and has a commitment to education. Youthologie functions as a training center for physicians and their staff to learn the techniques of laser and IPL operation, sclerotherapy, Botox® injection techniques, and techniques in the use of injectable fillers such as Restylane® and Juvederm® . In addition, medical aesthetician, Nikki Hartman has authored continuing education (CE) classes for aestheticians in laser safety and laser operation.

For more information phone 919-847-1495 or visit http://www.youthologie.md/
Youthologie Aesthetic and Anti-Aging Medicine
10940 Raven Ridge Road, Suite 214, Raleigh, NC 27614