Copyright © 2018 Dr. Bawa & Associates. All rights reserved.
Internal Medicine & MediSpa Websites by Optimized360
When trying to lose weight, it is important to look at the entire picture and not focus on one thing only.
For example, to optimize weight one must optimize thyroid and female hormones and not just watch diet and exercise. This is because the thyroid controls metabolism and if the metabolism is slow, it is very difficult to get rid of fat. There can often be subtle imbalances in the thyroid and a detailed test that includes not just the TSH but also T4 and T3 is helpful in making sure thyroid levels are optimal
Even female hormones are important as an excess of estrogen relative to progesterone tends to cause fat cells to divide. Women also make small amounts of testosterone but stop doing so after the age of 50 and this can cause weight gain too. Checking testosterone levels for women is also important when trying to help women losing weight.
Another factor that is often neglected is mental attitude and stress. Stress causes cortisol levels to go up which causes weight gain especially in the belly area. In addition, people often eat more when they are stressed. If the mental attitude is good and stress is under control it is a lot easier to lose weight.
Sleep is an important factor when trying to optimize health. People who snore or have sleep apnea often are too tired to exercise during the day. Lack of sleep also increases stress hormone levels that make it difficult to lose weight.
When trying to help someone lose weight in my clinic, my staff and I work hard to optimize all of these factors. While doing so another treatment that can help get rid of stubborn fat is coolsculpting.
While it has been around for many years, we are finding that we can get better results by optimizing all the factors that make it difficult to lose weight. Coolsculpting keeps working for several months so we can work on optimizing health and start coolsculpting even early in the process.
We are always looking for methods that work to offer to our patients. Coolsculpting freezes fat and gets rid of fat from resistant areas without causing any downtime. But we find that the results are better if one is on a program that addresses all of the different areas such as hormones, supplements and diet and exercise.
Dr. Nitin Bawa, MD is a board certified Internal Medicine physician with a special interest in bio-identical hormones, weight loss, lasers and aesthetics.
Many people think that when they want to look better they should consult a plastic surgeon. However, plastic surgeons want to fill up their surgery schedule and are more interested in performing surgery. Instead of surgery there are many minimally invasive ways of looking better that have fewer risks of side effects.
There are some lasers that are so gentle that there is no downtime or peeling skin. Laser Genesis is a laser treatment that has been shown in clinical studies to shrink the size of pores and make skin looker better without causing any downtime. There is only a gentle sensation of heat and minimal redness on the skin that only lasts about an hour.
Many people do chemical peels to improve the quality of skin. However, people can often have an allergic reaction to some of these chemicals. These chemicals often give off vapors that people breathe for a long period of time and these might not be very good for us in the long run. Lasers, on the other hand can do a better job of peeling the skin. Pearl is a laser that kills off a small layer of cells on the outer surface of the skin allowing better, healthier, tighter skin to the surface. This laser peel is a lot safer, less painful and more effective than chemical peels.
Lasers also able to remove sun spots which are a common problems in Florida. Limelight is a second generation IPL (Intense Pulse Light) treatment that does not cause any peeling skin or downtime but is able to remove sun spots. The dark spots turn darker and flake off within a couple of weeks.
Tightening skin is another function that lasers can do very well. We use a laser called Pearl Fractional that pokes holes in the skin and allows better, tighter skin to come to the surface.
There is also a new machine called infini that uses tiny needles that penetrate under the skin and build radiofrequency heat under the skin. This helps to tighten the skin without causing as much peeling skin and down time as some other lasers.
Many people use different creams that promise to remove lines and make skin look younger. Unfortunately, these creams rarely make much of a difference. Fillers on the other hand help to fill in lines and make a huge difference immediately. Most fillers are made of hyaluronic acid which is collagen and this not only helps to fill in areas that have lost collagen but also help to stimulate one’s own collagen. Combining fillers and Botox makes the biggest difference in terms of reducing lines and wrinkles.
For people who have excessive fat under the chin, there is a new treatment called Kybella that is injected under the skin and helps to kill fat cells. For getting rid of fat in the belly area, in place of a tummy tuck, there is coolsculpting that is a non invasive way to kill fat cells.
So, before you go and consult a plastic surgeon who will probably want to do surgery, consider less invasive options. There are many laser treatments, procedures and injectable medications that can help people look better. We spend much more time helping patients with these non invasive options than plastic surgeons do and in many cases get much better results.
Men tend not visit doctors much and tend to not get preventative health services until it is too late. Women generally have to force men to go in to see the doctor. Here are a few common issues that men face and what can be done about them.
Men tend to develop cardiovascular disease sooner than women and this is the leading cause of death for men. Men tend to run lower levels of good cholesterol so tend to develop plaque in their arteries earlier. Some heart attacks can result in sudden death where the heart stops beating and needs to be shocked to be restarted.
Checking cholesterol regularly helps to see who might be at risk for heart disease. There are more advanced tests like Lipoprotein (a), small dense LDL (sdLDL) and homocysteine that should be checked but not enough people look at this number. Taking a baby aspirin starting at the age of 55 has been shown to help prevent heart disease.
Besides cholesterol, inflammation in the arteries cause the plaque to rupture and cause a heart attack. There are different blood tests that can be done to monitor the level of inflammation. Antioxidants in fresh fruits and vegetables help to lower inflammation.
There is a genetic test called the ApoE gene that can be checked to see who is at higher risk for heart disease. Those who have the bad genes need to be more vigilant about lowering their cholesterol. Genes only control 20% of outcome in life but if one knows that they are at higher risk, it tends to give incentive to be especially disciplined to help control diet and exercise since lifestyle controls 80% of the outcome in life.
Men tend to have poor dietary habits and tend to get belly fat inside the abdominal cavity called visceral fat and this increases the risk of heart disease. Excessive intake of sugar and carbohydrates leads to metabolic syndrome that eventually leads to diabetes. Losing weight can often lower cholesterol and help get diabetes under control.
There are numerous medications that can be used to help with losing weight including Phentermine, Qsymia, Contrave and Belviq. When we try to help people with losing weight we also work on making sure that people are sleeping well, have sleep apnea controlled and all of their hormone levels are normal and stress is controlled. This is because it is a lot easier to lose weight if the energy is good and stress hormones are not making it difficult to lose weight.
After having lost weight, machines such as coolsculpting can be used to get rid of stubborn pockets of fat like love handles and muffin tops. This machine is based on the principle that cooling will kill fat cells even though it does not harm with skin barrier. It was designed by physicians at Harvard and has become an important tool in helping get people sculpt an ideal body shape.
men that get prostate cancer at an earlier age tend to get a more aggressive form of prostate cancer. It is important to start doing a PSA test and prostate exam on an annual basis starting at age 50.
Women tend to get depression more than men and women attempt suicide more than men but men tend to be more successful in doing so. Men tend to not voice their feelings or display their emotions. If there is any concern of depression, it is important to seek out medical help.
Many men, even young men, have low testosterone and start to lose their drive and become couch potatoes. Weight gain is a common problem when the testosterone is running low. Replacing testosterone helps people feel better and often makes it easier to loser weight. Raising testosterone levels helps with erectile dysfunction as well.
Fatigue is unfortunately a very common affliction and many times physicians fail to find the cause of fatigue. Here are a few causes that often get missed.
Lack of sleep is a common cause for waking up tired. There are studies showing that waking up once at night and turning the light on to go to the bathroom drops the melatonin level precipitously and this does not recover for the entire night. Melatonin is the sleep hormone and we do not make enough of it because of all the artificial light around us which includes phones and TV screens and overhead lights. It is important to turn down these lights in the evening so we have a chance to produce more melatonin.
Some people stop breathing at night and this is called sleep apnea. Many people who snore struggle to breathe when they are snoring. Sleep apnea is common in overweight people as the tissues in the neck relax and the weight of them blocks the windpipe causing oxygen level to drop in REM sleep. As a result, people with sleep apnea do not get much REM sleep as the body has to arouse itself when the oxygen level drops. Lack of REM sleep causes the blood pressure to go up and the frequent drop in oxygen level at night puts stress on the heart and lungs.
It is is now very easy to get a home based sleep study where the equipment for a sleep study is sent to your home and you strap this on and it monitors how well you sleep. Most importantly, the equipment monitors your oxygen level to see if the oxygen level is dropping at night which would be sign of sleep apnea.
If you wake up tired in the morning or have a headache every morning on waking up, or if you sleepy during the day, you might have sleep apnea and it would be good to do a sleep study to diagnose it.
Many men wake up multiple times at night to urinate and have to push to get the urine out. Frequent waking up at night to urinate can be a common cause of fatigue for men. There are medications such as Flomax that help to relax the urinary tube coming through the prostate allowing the bladder to empty more fully. There are also other medications such as finasteride and Avodart that help to gradually shrink the prostate.
Many men develop low testosterone and this can be a common cause of fatigue. Lot of men loose the desire to exercise and become couch potatoes. Fatigue is the most common symptom of low testosterone and low libido is not a common symptom. Lot of people including physicians have a misconception that testosterone should only be checked if libido is low. Exposure to environmental estrogens stops testosterone production for men so we are finding many men have borderline low testosterone and do not know it.
The thyroid hormone controls metabolism and low thyroid hormone is a common cause of fatigue. Some people can have borderline thyroid hormone levels and so it helps to check thyroid hormone levels regularly. If levels are borderline, I like natural thyroid supplements that have Kelp as a slow release form of iodine.
For thyroid hormone levels that are very abnormal, there are medication like synthroid but for those who are fatigued in spite of synthroid, there is another medication called armour thyroid or Naturethroid. Armour thyroid has not not just the inactive synthroid but also the active thyroid hormone called T3. The active thyroid hormone is rapidly absorbed and helps more with energy but can also cause palpitations.
Low iron levels are a common cause of fatigue. Many women run low iron levels and this remains undiagnosed as most physicians do not check iron levels. Most physicians only check hemoglobin levels and the “normal” level for women is set much lower than men so the iron deficiency often goes undiagnosed. We check iron levels on all patients and are finding that many people have low iron levels and did not know it. Replacing iron can often help a lot with fatigue.