Fasting: Intermittent Fasting and Longer Fasts

Fasting has been around for virtually all of man’s time on earth. When we were hunters and gatherers, we had days of plenty and days of nothing. Our bodies are adapted to have periods of time without food. Once again, there are a plethora of articles on fasting, spanning hundreds of years, but Dr. Jason Fung does a nice job of putting it all together.

I feel it is important to be honest about your sources. Hippocrates (father of medicine – remember doctors all take the Hippocratic oath) believed there were great benefits to fasting. As a religious Jew, we have two 25-hour fasts during the year and several all-day fasts. (Our fasts are tough because we are not even allowed to have any water!) By contrast, the health fasts that I am discussing below definitely encourage plenty of water, tea, coffee, etc. Muslims have the month of Ramadan where they fast all day long for an entire month. Although these fasts are spiritually-based, it would not be surprising if they also had a health benefit. Other than my religious fasts, and my very frequent intermittent fasts of 14-17 hours, I have not yet done any longer fasts, but I am going to definitely try it.

What are the types of fasts?
There are intermittent fasts, which are at least 14 hours (though there is benefit to even 12 hours of fasting) and there are fasts longer than a day, which can even go on for weeks or months!

It goes without saying, do not plan a long fast without proper medical supervision and instruction.

What are the benefits to fasting?
Fasting is a great way to restore your insulin sensitivity, especially if you are not achieving what you want with the shorter intermittent fasts.

Many people will lose a significant amount of weight with fasting. To clarify a common misconception – you will NOT lose muscle mass, unless you stop exercising or your total body fat is very low – about 4%!

It is imperative that you maintain a healthy diet after the fast, if you want to keep the fat off (see my previous blogs on this topic). You will definitely put some weight back on when you return to eating, since some of the initial weight loss is due to water loss and will come back when you return to eating food.

There is a growing body of evidence that your body heals itself (autophagy) during a fast. There is a large increase in stem cells and other markers of anti-aging (increased telomere length etc). I believe over the next few years, we are going to see more and more evidence showing the biochemical benefits of fasting for anti-aging and longevity.

What is allowed during the fast?

You want to avoid all carbs and anything fake or artificial. You can and should have lots of clean, fresh water. You can have sparkling water. Avoid any artificial flavors or sweeteners! You can have coffee (black or with unsweetened almond or coconut milk or half and half), or tea. You can add natural spices to them if you like, such as cinnamon or cardamom. There is evidence that apple cider vinegar diluted in water is also very good for you. Natural bone or vegetable broth is fine, but must be natural. The latter is probably not necessary for a fast less than 24 hours.

I believe ketone supplements make fasting much easier since they cross the blood brain barrier and  (If you want you can click here to find out which ketone supplement I use and to also learn how to buy it for yourself) will decrease your hunger. They also put you in a ketogenic state more quickly.

What happens if I get hungry?
You will get hungry! The more often you fast, the more used to it you will get, and the easier it will become. Fortunately, hunger is not a constant problem, but it will come in waves. Since you know that it will pass, it helps gives you the strength to suck it up. Fasting is much easier if you are very busy. I try and do my fasts on days when I am super busy in the office. It certainly makes my intermittent fasting easier when I am busy at work. It may make it easier to start a fast after lunch.

Is exercising allowed?
Yes! Most people who fast do great with exercising. The key is to drink lots of water and the other items listed above, such as taking in some extra salt. This encourages your liver to break down fat into ketones for energy. Your adrenalin and growth hormone levels increase during fasting and this may promote muscle creation.

How much fatigue should I expect?
There is often a period early on in the fast- often around 18 hours but varies from person to person – where they feel fatigue. However, this will pass and most people report increased, sustained energy during a fast – even for prolonged fasts lasting weeks and months! If your fatigue does not pass, you should stop fasting and get your blood checked.

Should I get dizzy or headaches during fasting?
No! You are probably dehydrated or low in sodium. Drink more fluids and add more salt to your fluids. (If you are on blood pressure meds, you may need to lower the dose). You do not have to rush and stop your fast immediately. Try these remedies and perhaps take a nap.

Muscle Cramps
These are not dangerous and usually will resolve with taking magnesium, which is found as a pill at pharmacies and health food stores etc.

What should I do when I end my fast?
There is a strong tendency to overeat and that will make you feel lousy. Try and force yourself to eat light and slowly. This is psychologically driven and is not due to your body needing anything desperately.

Special considerations: 

  1. Don’t fast if you are pregnant.
  2. Don’t fast if you have very low body fat (under 8%), or at least not without close supervision.
  3. If you have low blood sugar, be supervised by someone knowledgeable during your fast. Of course, check your blood sugars during the fast.
  4. Diabetics – especially those on insulin – need to keep a close eye on their blood sugars during a fast. Of course, have medical supervision.
  5. If you have medical conditions such as cancer, chemotherapy, etc there can be a lot of benefits to fasting, but it should be supervised by someone medical who knows, understands and supports fasting.

Want to discuss available options for decreasing body fat? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

How to Prevent Dull Winter Skin

Written by Nicole Hackett, Master Esthetician

Now that winter is coming, you may start to notice that your skin is becoming drier and starting to look dull. This means it may be time to switch up your skincare regimen. It is very important to continue exfoliating your skin. This is an essential step to your skincare regimen.

You may need to switch from your light moisturizer to a heavier cream. Our favorites are the SkinMedica Dermal Repair Cream, a rich cream that replenishes moisture to dry skin and has high levels of antioxidant vitamins C and E. Another one of our favorites is Obagi’s Hydrate Luxe Cream, a luxurious ultra-moisturizing cream that delivers deep hydration and promotes skin radiance. We also LOVE Hyaluronic Acid Serum.

Hyaluronic Acid Serum is extremely hydrating, it holds 1000x its weight in water – meaning it does an incredible job of locking in moisture and gives you an extra boost of hydration. Hyaluronic acid is great for all skin types. It won’t clog pores, makes your skin look plump and gives you that glow.  Our favorites are Dr. Berman’s Ultra Hydrating Serum and SkinMedica’s HA5 Rejuvenating Hydrator.

These are just a few ways you can change up your skincare regimen. Because everyone’s skin is different, we recommend scheduling a free consultation with one of our estheticians to discover the best products for your skin type!

Now’s the Time to Plan your End-of-Year Surgeries!

It won’t be long before Christmas is over and we will be into a new year. Many people elect to have their plastic  surgery completed during this time, as their jobs are typically less busy and offices are frequently closed. This can be an excellent time to get your more involved surgeries done, for many reasons.

Although the recovery from procedures like a breast augmentation are not too significant (4-5 days off of work) and a tummy tuck (about 10 days off of work, and 10-14 days if you get a breast augmentation/reduction along with a tummy tuck), using this holiday time is a great way to sneak off from work, with people just assuming you are going on a vacation. This also means they will be less likely to ask questions. You’ll still be able to hit the pre-Christmas parties, and have time to complete your  surgery and recovery after the parties are done.

Of course, if you are trying to look your best for those New Year’s parties, then you should get moving on having your breast augmentation, tummy tuck or Smartlipo now or in the near future. These surgeries take time to get your best look (you’ll continue improving post-surgery) and you’ll also want to allow some time between the surgery and showing your results off.

Want to discuss available options for your end-of-the-year procedures? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

How to Lose Weight and Keep it Off: Putting it all Together

This blog will make much more sense if you read my previous blogs on the Ketogenic diet. I have borrowed heavily from Dr. Jason Fung. However, many other doctors — including Dr. Will Cole, whose book, Keto-tarian, takes a more vegetarian and fish based approach to the keto diet) — are saying exactly the same thing! The common pathway relates to high insulin levels, which leads to insulin insensitivity – which can create a vicious cycle.

This can arise from the following:

  1. High sugar and/or processed foods (especially high carb food and flours)
  2. Constantly eating
  3. High cortisol levels due to stress or lack of adequate sleep or prednisone

The solution to this is clear if we look at the causes:

1A) Stop taking in external sugars (this includes virtually all exogenous sugars but also less obvious sugars such as fructose (leads to insulin resistance in the liver) , agave nectar, diet sweeteners, etc.

1B) Eliminate refined grains. Many people are better off limiting their gluten intake, even from whole grains. You have to experiment and see how it affects you. Refined grains increase insulin levels.

1C) Increase intake of healthy fats (note: the shortcoming of the original Atkins diet advocated that all fats are fine), vegetables and fiber. It is common sense that olive oil and avocados are going to be better for you than poor quality meats, such as hot dogs. Nearly everyone agrees that wild caught salmon is very good for you and that should limit fish intake that is high in mercury, such as Swordfish. Nearly everyone also agrees that it is better to avoid animals that come from large factories where they are given antibiotics and hormones, and that free range, organic meat is preferred if you are going to eat meat. There is no benefit to ingesting more protein than you need, since it will raise insulin levels and will get converted to fat. The right amount of protein will vary by person. For example, a serious weightlifter who weighs 200 lbs. needs more protein than a 150 lb. person, with a higher percentage of fat who does not lift weights at all.

2) There is more and more evidence that intermittent fasting is good for almost everyone. This means that you stop eating for an extended period of time.  You should be drinking lots of water. Tea and coffee (either black or unsweetened coconut /almond milk or maybe small amount of half and half) are fine as well. You can also add a few slices of fruit or cucumber into your pitcher of water. You want to aim for 14-16 hours without food. You may want to take in some extra salt since you will lose sodium as you clean out your carbs. This is the most common reason for not feeling well during the fast. I believe taking ketone supplements makes this much easier. I take the supplements during my fast, with great results. The ketones cross the blood brain barrier and dramatically decrease my desire for food. I would add further that it can take time to get used to going longer and longer without food. It certainly did for me. The trick is to keep on working at it, even if you don’t reach your goals early. It is much easier to fast when you are busy at work or doing something to distract you. Incidentally, once you get used to these intermittent fasts (and also for longer fasts), you can absolutely exercise while fasting.

There are likely excellent reasons for trying a longer fast, especially if you are not dropping the weight that you want (also for internal self-healing), but I will blog on this at a later date.

3) All types of stress, such as emotional stress, lack of sleep, prednisone, etc. will raise your cortisol levels and this will in turn increase your insulin level. There are a number of good studies showing how important getting adequate sleep is, as well as dealing with your emotional/work/relationship stress. Activities such as exercising, walking in nature, meditation, getting a massage (I am a huge fan of the benefits of massage) are helpful. Generally things like spending time on the internet or parked in front of a TV are not useful for lowering cortisol levels.

Want to discuss available options for decreasing body fat? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

As always, feel free to email me with your thoughts and questions at info@bermancosmeticsurgery.com.

 

 

Fall is the Perfect Time to Start your Laser & Chemical Treatments

Written by Nicole Hackett, Master Esthetician

Fall has officially arrived and it’s time to schedule your appointments for PicoSureLaser Hair Removal, and VI Peel! Now that the kids are back in school and vacation is over it’s time for you to take care of your skin. We always recommend starting your laser & chemical peel treatments in the Fall because the sun is less strong. Some skin treatments, including PicoSure and Laser Hair Removal cannot be done if you are tanned in the treated area.  The sun is the number one cause of aging and pigmentation, so let us help you reverse the damage.

PicoSure and VI Peel are excellent treatments to help with pigmentation, fine lines & wrinkles. Troubled by acne scars? Picosure and SkinPen Microneedling can help! For PicoSure, we insist on 3 sessions, each done one month apart. Microneedling and laser hair removal also require multiple sessions. Now is a great time to get started, so your skin will be glowing for Christmas.

If you have any questions regarding your skin concerns, call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians!

Recommended Reading: The Obesity Code

I highly recommend The Obesity Code by Jason Fung, MD, a bestseller and in line which what I too am advocating for a anyone wanting to lose weight, particularly fat. Although a 304 page book, it is easy to read and packed with information. I  want to highlight some of the main points that he makes that are relevant to those wanting to lose fat. I feel it is a great support to my suggestion of intermittent fasting and ketone supplements (see my previous blogs on this topic).

Dr. Fung does a great job destroying the constantly cited theory that all you have to do in order to lose weight is decrease your calorie intake. This is ubiquitously advocated by almost all “experts”. They support this falsehood by laws of thermodynamics – if more calories are taken in than out, you will gain weight and if you take in few calories, you will lose weight. He points out a huge number of studies showing how this does not work. It sounds like it should make sense and we are constantly told that – take in less calories and you will lose weight.

Why does the calorie in and calorie out theory not work? It is because what really determines if we store the food as fat or burn/eliminate the food (and drink!!) is our insulin levels. What happens is that we have all sorts of internal hormonally regulated systems in our bodies that adjust our basal metabolic rate (how many calories are used up), how much of what we eat that we actually absorb (the rest will go out in our stools), and how much energy is converted to fat and stored.

What Dr. Fung shows very clearly is that insulin is the key hormone in deterring whether we store or use up fat. The main problem today is that because of both constant eating (this is a relatively new phenomenon that in between meals we constantly snack) and the high intake of sugars and refined foods, we end up with high insulin levels in our blood. This causes the insulin receptors in our cells to be LESS sensitive to the insulin. This causes our bodies to produce even more insulin, which we become less sensitive to over time – and the negative feedback loop continues. High insulin levels tell the body to store fat.

The way to restore our insulin sensitivity is through both intermittent fasting (I think intermittent fasting is easier with the ketone supplements) and decreasing the stimulation to produce insulin which comes from both sugars and refined foods. An intermittent fast is defined as at least 14 hours without anything that will cause insulin to be produced (so unsweetened tea or coffee and water are fine). This has absolutely been proven to work and is a lot of the rationale behind the ketogenic diets.

There are lots of studies proving that refined foods and almost all sugars will raise insulin levels. It is important to note that I am stating “raise insulin levels,” as there are items like fructose and many other sweeteners used by the food and beverage industry that raise insulin levels but not your blood sugar level. This is why using the commonly referenced “Glycemic Index” is not effective.

I know sometimes people get overwhelmed and feel there are conflicting reports and lots of experts weighting in. It is really quite simple. Work up gradually to going 14 hours between dinner and when you eat your next meal (things like water, tea, coffee with unsweetened almond/coconut milk are fine). This is even easier if you can eat a relatively early dinner – if you finish dinner by 7 pm, you just have to delay eating until 9 am. I believe ketone supplements are very helpful when delaying your eating, as they decrease your appetite (especially helpful for people like me who end up eating late, even though I would prefer not to).

To find out what ketone supplement I am using for myself click here. The supplements will also raise your ketone levels which tells your body to breakdown fat for energy. The food you eat should be as unprocessed as possible – think lots of veggies, as organic as is reasonable, as unpoisoned as possible – salmon is great, and grass fed, free range beef etc. Absolutely avoid all sodas and diet drinks (they raise insulin levels and cause weight gain). It is common sense that you want to avoid farm raised fish and mass farming, as they use lots of antibiotics/hormones etc. You don’t have to be perfect at every meal, but you want to make at least some extra effort to select healthier choices. Realize it takes time for you to get used to this new routine, so expect some slip ups – but persevere and you can expect to be much healthier for it.

Want to discuss available options for decreasing body fat? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

How to Exfoliate Your Skin

Written by Nicole Hackett, Master Esthetician

 

Exfoliating is crucial to having nice skin and slowing down the aging process. By exfoliating your skin, you are removing the top layer of dead skin cells and this will help to speed up your cell turnover which slows down as you age. This will let your new skin come in. Exfoliating your skin also allows your other skin care products to penetrate deeper and will help lighten and brighten your complexion.

Ideally, you want to exfoliate 2-3x week, but this can be varied, depending on your skin type. If you over exfoliate, you can cause more oil production, so it’s important to see your esthetician to know exactly how and when you should be exfoliating.

There are two types of exfoliation, mechanical and chemical. Mechanical can use either a tool, like the Clarisonic brush, or a face scrub with beads that physically removes the dead skin.

Chemicals, on the other hand, use ingredients to shed the dead skin. Common chemical exfoliant ingredients are salicylic acid, glycolic acid, and lactic acid. You can find chemical exfoliants in different products like face washes, peel pads, serums, etc.

Mechanical exfoliants can be a bit harsh on the skin, so if you have sensitive skin, I would stay clear of mechanical exfoliators, but it really depends on your preferences and skin type. You can also combine both mechanical and chemical exfoliators.

 

If you have any questions regarding your skin concerns, call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians!

How is High Definition SmartLipo for the Arms Different from Regular Liposuction?

There are a number of things that make High Definition SmartLipo (HDS) to the upper arms different from regular liposuction to the arms.

First, I almost always use Smartlipo, which is liposuction with the additional step  of using a small fiber-optic laser which is inserted directly into the subcutaneous fat. This both melts fat directly and also heats up the skin, so that there is greater skin tightening. This is always done in the office. I am able to do this in a very comfortable fashion for the patient. There are no IV’s, only oral medication.

Typically, when I perform Smartlipo to the upper arms, I use one small incision to the back of the upper arm. This is where most of the fat is located and I can almost always reduce the fat in this area and get some nice skin tightening to the area as well.

When I perform HDS, I will use 6-8 very small incisions per arm, and these will be located on the back towards the posterior shoulder, often on the lower arm, just below the elbow. After marking the upper arm, I will fully numb the area. Thereafter, I will use progressively smaller cannulas to sculpt the upper arms, including around the muscles of the upper arms, to greater highlight them.  I may even have you contract your muscles to help highlight your muscle definition, or even stand up, to see if things change with gravity. In the final step, I will use the Smartlipo to further refine the arms – the laser will both melt fat and tighten the skin. These additional incisions, allow me to access areas around the entire arm that I would not normally be able to reach.

At the conclusion of the procedure, we will place you in a comfortable, snug upper arm garment. You can take it off to shower the next evening and daily. However, I want it worn the rest of the time, for at least 4-6 weeks and sometimes longer. It would be wise to get 2 arm garments since you will need to wash it daily. You will continue improve for 6 months.

 

WHO IS THE IDEAL CANDIDATE FOR SMARTLIPO TO THE UPPER ARMS?

The ideal person for this procedure will have good skin tone in the upper arms, which usually means they are less than 52 years old (of course, this will vary from person to person, so this is a guideline). They will do best if they are within 20% of their ideal weight, though heavier individuals should still benefit significantly. Of course, you should be in reasonable health and not a smoker. Smoking interferes with wound healing – you should quit all nicotine products for 4 weeks before and after surgery

 

IS THERE A COST DIFFERENCE BETWEEN HDS AND REGULAR SMARTLIPO?

HDS takes me a lot more time than regular Smartlipo and requires both greater expertise and specialized equipment.

 

Have questions about High Definition SmartLipo or other cosmetic procedures? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

How is High Definition SmartLipo for the Calves Different from Traditional Liposuction?

There are a number of things that make High Definition SmartLipo (HDS) to the calves different from regular liposuction to the calves.

First, I almost always use SmartLipo, which is liposuction with the additional step  of using a small fiber-optic laser which is inserted directly into the subcutaneous fat. This both melts fat directly and also heats up the skin, so that there is greater skin tightening. This is always done in the office. I am able to do this in a very comfortable fashion for the patient. There are no IVs involved, only oral medication.

CAN THE CALVES ALWAYS BE IMPROVED?
The answer is yes, fat can usually be reduced. However, many women have larger muscles and larger bones than they want and the amount of fat that contributes to this can sometimes be significant and sometimes very little. You can usually tell by feeling the upper and lower calves whether there is a significant amount of fat contributing to the fullness.

WHAT MAKES HDS TO THE CALVED DIFFERENT FROM REGULAR SMARTLIPO?
Normally, when I do Smartlipo to the calves, I use one small incision to the in the posterior, superior medial aspect. This is where most of the fat is located and I can almost always reduce the fat in this area and get some nice skin tightening to this area as well.

When I perform HDS, I will use several very small incisions lower leg and usually medial knee area. After marking the lower leg carefully, I will fully numb the area. Thereafter, I will use progressively smaller cannulas to sculpt the calves and lower legs, including around the muscles of the lower leg, to greater highlight them. I may even have you contract your muscles to help highlight your muscle definition, or even stand up, to see if things change with gravity. In the final step, I will use SmartLipo to further refine the calves – the laser will both melt fat and tighten the skin. These additional incisions allow me to access areas around the entire lower leg, that I would not normally be able to reach.

At the conclusion of the procedure, we will place you in a comfortable, snug lower body garment that needs to extend to the ankles. You can take it off to shower the next evening and daily. However, I want it worn the rest of the time, for at least 4-6 weeks and sometimes longer. It would be wise to get 2 garments since you will need to wash it daily.

You will continue improve for 6 months. The lower legs, because of the gravity, are more likely to swell. For the next several weeks, when you sit down, it is best if you also elevate your legs on a chair. When you go to sleep, try and elevate your feet in 2-4 pillows. When you are relaxing on the couch, do the same thing. You ideally want your legs elevated above your heart.

WHO IS THE IDEAL CANDIDATE FOR SMARTLIPO TO THE  CALVES?
The ideal candidate will have good skin tone, which usually means they are less than 55 years old (of course, this will vary from person to person, so this is a guideline). They will do best if they are within 20% of their ideal weight, though heavier individuals should still benefit significantly. Of course, you should be in reasonable health and not a smoker. Smoking interferes with wound healing – you should quit all nicotine products for 4 weeks before and after surgery

IS THERE A COST DIFFERENCE BETWEEN HDS AND TRADITIONAL SMARTLIPO?
HDS takes me a lot more time than traditional Smartlipo and requires both greater expertise and specialized equipment. Therefore, there will be a higher charge.

 

Have other questions about High Definition SmartLipo or other cosmetic procedures? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

What is High Definition SmartLipo?

WHAT IS HIGH DEFINITION SMARTLIPO?
This is a special variation of SmartLipo that seeks to give much higher definition of the underlying muscles and is particularly applicable to upper arms and calves, though it can be applied to any body part.

WHAT MAKES HIGH DEFINITION SMARTLIPO DIFFERENT?
There are several things that make High Definition Smartlipo (HDS) different. The goal is to decrease the fat in the treated area with a much more aggressive treatment. For starters, it will take much more time to do in the operating room. Secondly, it will require additional incisions, which are very small (about 3 mm), which the patient has to accept. It will generally be necessary to wear the body garment longer (several weeks but will vary from patient to patient) while the body reshapes.With regular Smartlipo, the vast majority of patients will return to work the next day. With HDS, I recommend that they take an extra day or two from work.

HOW LONG DOES IT TAKE TO GET YOUR FINAL SHAPE?
This is similar to Smartlipo in that your body will continue to improve for 6 months.

WHICH AREAS ARE TREATED BY HDS?
Any areas of the body can potentially be treated, but the areas that will yield the greatest difference are the upper arms and calves.

WHO IS THE BEST CANDIDATE FOR HDS?
You need to have satisfactory skin tone, which I can judge when I see you for your free consultation. In addition, the treated body part is part of the rest of your body — meaning that if you have more body fat than is ideal, you are still going to look better if you decrease your total body fat through better dieting and exercise.

IS THIS STILL DONE UNDER LOCAL ANESTHESIA IN THE OFFICE?
Yes, I am still doing this under local anesthesia in the office. I will have to you take a pain killer about 90 minutes before the procedure to keep you more comfortable. I may have you stand at the of the procedure, so that i can fine-tune any areas.

WHAT ARE THE MAIN RISKS?
The main risks are the same as traditional SmartLipo performed under local anesthesia with oral sedation. There is always a risk of uneven skin and wrinkling. There is a remote chance of a skin burn – however I have now performed over 840 SmartLipo cases without any burns. There can always be unevenness. Of course, there is the risk of not being as  good as you hoped you would be – a risk with all cosmetic procedures. The risk of an infection is very low. I have only had one, and she responded to oral antibiotics. The risk of blood clots and fat clots is very low, since you are not being put to sleep.

 

Have other questions about High Definition SmartLipo? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!