Episode #81: Keeping Your Skin and Hair Healthy During Weight Loss with Guest: Dr. Brenda Dintiman

Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast.

Announcer:
Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Hello everyone and welcome to this episode of the Conquer Weight Podcast. I have a special guest with me today, Dr. Brenda Dintiman. She is a dermatologist, the owner and primary physician at Dermutopia Wellness, and she is located in Vienna, Virginia, so in the Northern Virginia area, and I’m so excited. Thank you, Dr. Dintiman, for joining us today. We are talking about skin and hair and all of the stuff that is associated with weight loss. Thank you for being here.

Dr. Brenda Dintiman:
Thank you for having me. It’s so fun to be here. I’m a board certified dermatologist that specializes in a holistic approach to skin, hair, and nails, and I’m excited to talk to you about how this will coincide with your weight loss journey.

Absolutely, and it’s such a fun thing to think about because dermatology is a huge field of medicine and I think a lot of people may have had experiences with dermatologists in the past and dealing with maybe acne or abnormal moles or a rash, but we know that dermatology extends also into our health and wellness, and so we think about things like skin and our hair. We think about the role that even cosmetics can play or how we help support our skin, especially during the weight loss journey. And as you, as I have talked about previously, I have a lot of patients who come to me or on social media who reach out and they are really frustrated with the way their skin is changing as they’re losing weight. So I would love to hear from you in the weight loss journey, what can patients do in order to best support their skin?

Well, I think the most common question I hear is should I wait till I’ve lost all my weight to come and talk to you about rejuvenating my skin or improving the volume in my face or the texture of my neck? And I think we need to enjoy our skin along the journey. I think that there are so many things that we can do to help you as you’re going into this holistic approach to improving your body physically, improving your emotional health, and really just how you appear inside and out because of your skin and all the wonderful things you’re doing with your weight loss.

Absolutely. Well, and tell me a little bit when you say rejuvenation, for someone who’s never seen a dermatologist, doesn’t know anything about some of the maybe cosmetic dermatology options, what does that even mean? What type of things might patients be looking for?

Well, the first thing we always do is evaluate your skin to make sure there’s no concerns for skin cancer or any things that have been ignored. But most importantly, we start to look at the texture of your skin and rejuvenate a lot of the sun damage that occurs over time, which can be done with microneedling. There’s a wonderful way to stimulate new collagen just like you’re working on your body mask while you’re losing weight, we need to also work on the collagen in your skin. So that can be done with microneedling. The other super exciting thing that we’ve been doing is hyperdiluted radiesse instead of just putting filler in the area. And this is where people may say, well, should I wait until I’ve lost my weight to see where I need to enhance my cheeks or where I’ve lost volume? No. There’s a way to use a very thin stimulatory filler called radiesse that you put underneath the surface to help your body make new collagen. And this has been really wonderful. We use it a lot in very thin faced runners. We use it when people have lost a lot of weight and it’s a process over time. Again, just like your weight loss processes.

I love that. And I think when we think about fillers, there are some people for whom their experiences only seeing maybe in the media or in social media, people who’ve had fillers done sometimes done to the extreme or done in a way that is maybe not as tasteful. And that’s one of the big things that when you say fillers, it’s a pretty broad category. There’s a lot of different things that fall into that. Some that could be maybe more extreme or done in a heavy handed way and some that can be really pretty subtle and someone may have no idea that you had underdone any type of cosmetic dermatology work. Is that fair to say?

Absolutely. And I think that our approach is to really try to keep it as natural as possible to look at your beauty, your shape of your lips, your shape of your cheeks, what you may have had four or five years ago, and to draw the eye upward to your cheeks, to your eyes, because we tend to get this downward feeling of our face with aging and with the squaring of our jaw. And so it’s really like an illusion you’re creating, but very natural illusion not changing who you are.

I love that. And tell me if someone is interested in having these type of procedures or having fillers done, what is a good thing for them to come and ask their dermatologist or even if they’re looking at someone that does these type of procedures, what type of questions should someone be asking to understand if it’s going to be the right fit for them?

Well, of course I am a big proponent of going to a board-certified dermatologist to someone that can do a cosmetic consultation and go over the options for you. I am not afraid to refer you to someone if I feel like you need surgery over time or need your eyelids blepharoplasty because you want someone to give you an honest opinion what they can do against your skin, but who we could partner with to help you look your best.

And I think one of the things that’s really important to point out is that the barrier to being someone who is doing fillers, who’s doing injections, doing Botox, that type of thing isn’t high. So myself as a family medicine physician, I could go and take a weekend course and could learn about some of how to inject these things and then I could do that as part of my practice. And that is very different from someone like yourself who has studied the facial anatomy in a way that they understand we have many muscles in our face, we have many different muscles that contribute to our expressions. We want to make sure that we’re avoiding certain nerves or arteries and that type of thing. And even though I’m a physician, even though I’m a board-certified family medicine physician, I’m doing obesity medicine, that’s really out of my realm of practice.

And even after doing this, if I did a weekend course for example, that would be much different compared to someone going into your clinic and seeing someone who’s a board-certified dermatologist has been doing this for many, many years. And so I think that experience piece is really a great question to be asking because if I was injecting, I wouldn’t trust myself to inject my own face and I would never do that then to someone else. And I think that’s a really important point to think about. What about for people who are saying, okay, I don’t know about any microneedling fillers that seems a little bit aggressive. Are there things that I could do on my own at home that would be supportive of my skin? Talk to us a little bit about that.

Well, I think it’s good to know that microneedling is not considered aggressive. It’s a very easy recovery time procedure, 24 hours of redness and put sunscreen on and go about your way. You don’t have a lot of downtime. So it’s good to understand, and that may be something that’s helpful to look at a person’s website. You can look at our Instagram and we demonstrate procedures because that’s really important to understand the pain component to it, the time it involves and the recovery time. We all have busy schedules and we don’t want to be down for the count too long when we’re trying to do a procedure. So you need to know which things can be done quickly and get results over time and which things you’re going to have to take time off, which most of the ones in dermatology and in talented injectors, you don’t need to take a lot of time off.

I think things you can do at home. I am a huge proponent of your number one anti-aging cream is tinted sunscreen. It’s your best money you can spend. It give you protection not only from being in the sun, but driving also from your screen time, fluorescent lights. All these things contribute to aging. And my philosophy is that you put it on in the morning, you don’t even look to see if it’s going to be a sunny day, and that is the best thing that decreases sun damage. In addition to that, we use retinols. They can be used all year round, especially with tips and techniques to keep you from getting drying and chemical peels. Gentle chemical peels can be done for people who are acne prone, rosacea prone. You may find as you’re going through your dietary changes, your weight loss that your skin will change and you may start to develop some different things that you didn’t have problems with before, and that’s where you can reach out to your dermatologist.

Yes, absolutely. Well, it makes me think about, you and I were talking another time about a patient of yours who had had nutritional deficiencies in the skin. And it’s interesting to think about in the weight loss journey, particularly on some of these GLP-1 medications or after bariatric surgery even. There are very specific nutrition and dietary recommendations that we need to follow in order to make sure that we’re getting not just our macronutrients, those carbs, protein and fats, but also our micronutrients. So all of our vitamins, all of our minerals, and those contribute in a lot of ways in our health overall. But even within our skin, we know that those things can play a role in the health of our skin. And so certainly one of the things that I recommend to any of my weight loss patients is that they take a multivitamin because that is a great sort of fail safe if you’re not getting the adequate nutrients that you need in your diet.

Getting that in a multivitamin is an excellent way to make sure you just have your bases covered. And so people are always asking me, what is your favorite multivitamin? I will say just like whatever’s cheapest, whatever you can buy at your favorite pharmacy at Whole Foods, something like that. I do recommend getting one with iron, and we’ll talk a little bit later while you recommend that and not to get any gummies. So gummies can get stuck in the teeth can cause cavities. My best friend is a dentist, and so certainly one of the things I’ve been told is make sure you’re not giving people cavities along the way in their weight loss journey. But a multivitamin is an excellent tool and that can play an excellent role for your skin and for your hair. So let’s talk about that too, because they do know during the weight loss journey, some people have no issues with hair. Other people feel like their hair is just shedding all over the place, and that can be really, it’s scary and it’s such an awful feeling when you brush your hair and there’s just clumps and clumps of hair in that. So talk to me a little bit about the role of hair loss and weight loss, how you see that and what are some of your recommendations there?

Well, definitely we’ve known for years that people can, when they lose weight, they lose hair, and it usually happens about three months after your weight loss. So imagine the most classic situation is you have a baby and you’re losing weight very quickly afterwards and you’ll have intense shedding of your hair and that’s called telogen effluvium. All the hair kind of goes into the falling out phase. It’s kind of recalculating and you shed and shed and shed. We also see that when people are under extreme stress, we saw it a lot during COVID, pre-vaccine, post-vaccine, whether people had COVID or not. And again, now we’re seeing it with the weight loss drugs. I think it’s something we just need to take a breath and work through. It will settle out. You need to have the vitamin support, like you said, especially the B vitamins and especially vitamin D are the two things.
And to make sure that you’re not anemic. As you know, when you go and get your blood work done, they’ll tell you whether you’re anemic. But there’s also a level called ferritin, which is your iron storage, and we like to see your iron storage closer to 80 to a hundred, even though the level is 20 to 200 is normal. So the hair likes the iron, the hair likes B vitamins, the hair likes vitamin D, and the hair likes protein. So that’s perfect for your weight loss journey because we all know that protein helps us with hunger and helps us with our continue our weight loss journey and also keep our muscles from losing muscle mass during weight loss.

Yes, absolutely. When I think all of, there’s so many great points there that we could pull out. And the protein piece, I think my patients are used to hearing me say protein, protein, protein. We know that protein plays such an important role, as you said in satiety. It helps make us feel full, feel full for longer. And then when we think about the role of maintaining our muscle mass during weight loss, protein is one of the best ways that we can support our muscle mass. And making sure that we get adequate protein is really important for our hair and skin, which is really made of some types of proteins with keratin, right? So when we think about protein, it plays all of these different roles. The other thing I love that you mentioned ferritin, and I want to take a minute to talk about that because for those of you who don’t know what ferritin is, it’s our storage form of iron.

So when you go and have routine labs, it’s very common that your physician will order a CBC, a complete blood count. And in that we see hemoglobin, which is sort of the end marker. You’re looking, are you anemic? Do you have enough red blood cells? And the answer to that question sometimes is no, right? There’s plenty of reasons that people are actually anemic, but very commonly people are not anemic. They have normal hemoglobin levels and their body sort of just keeping up. They have all of the iron that they need in order to build those red blood cells to build that hemoglobin, but they don’t necessarily have enough in the form of storage. And so that ferritin is the storage form of iron and it’s implicated in a lot of things. When we think about things like restless leg, even just honestly when people talk about chronic fatigue, lack of energy, a lot of times we’ll see patients, I check patients who have ferritin levels all the time of six.

And it’s shocking. People who have normal hemoglobin levels are not anemic and they’re still just barely holding on. They have absolutely nothing in the reserves. And so that can be really challenging when it comes to your body sort of surviving, but not necessarily thriving. And so that’s how I often describe it and making sure that we’re getting adequate iron and that can come from food sources, so things like meats and poultries and fishes, but also in some of our dark leafy green vegetables. Think of Popeye and his spinach. Iron is in a lot of those dark and leafy green vegetables and getting a supplement maybe necessary as well, especially when you’re depleted. Building that up is something that’s really, really important. I think about myself and going through three children and three breastfeeding journeys with them. I’m like, my body, I feel like I can see it in my hair and my skin and my nails. My body has just simply been through a lot and all of us, depending on what our situations are, when your body has gone through pregnancies, when it’s gone through weight loss, when it’s gone through menopause, all of these things make major differences in our stores and it’s important that we’re really paying attention to that. And a doctor like myself, you may be really helpful in guiding along that.

And I think the thing to remember too is you can have more than one kind of hair loss. You can have androgenic a hormonal type of hair loss that may be more familial. So it’s important to go to your dermatologist and have them not only talk to you about what we just talked about, but also evaluate the scalp and make sure the scalp is healthy. So the scalp is sort of like your garden and the hair or the flowers that are there either laying dormant, trying to come out and need support or already there and maybe not thriving. So we often will treat you not only internally, but we’ll also use something topical like a compounded Rogaine with other substances, even Retin A in it to help enhance and make the garden healthier so that the little baby hairs that are trying to come out start to come out and your existing hair thickens. And a lot of this involves patience because again, it takes three to four months to fill the tank nutritionally and three to four months to see in that same time that the scalp is health. It will take time, but your hair will come back.

And there’s that little period of time you look like a chia pet in the middle where you’ve got all the little short hairs coming out.

Exactly.

I feel like I’m still a little bit in that phase or finally starting to lay down a little bit, but I love your garden analogy. And when you think about growing a garden, you think about different soils. If you’re trying to grow in rocks or clay, your garden is not going to thrive. You really want to have that rich black dirt that has lots of nutrients in it, and that is what’s really going to support your healthy garden. And so when we think about our scalp and making sure that you have really good support there, I think one of the things that’s interesting is that people are willing to really take experiments sometimes and plop anything on their face, anything on their head, and it’s easy to understand. I think I can even think back to times in my life where I’m like, oh, let me just see if this works or if that works.

But if you feel like you’re really struggling, especially if you’re dealing with chronic hair loss, maybe not even related to your weight loss journey or sometimes your weight loss journey, losing hair as part of that may bring out, there was an underlying predisposition towards hair loss anyway, as you said, seeing a dermatologist asking that question. Lemme ask you though, when we think about dermatology, even within this field of dermatology, there are many people who have different areas of expertise. Is there something, if someone’s online and they’re looking up a dermatologist, would you say that they could go to just any dermatologist to talk about their hair? Or is there something specific they should be looking for in their profile on their website, something like that?

Well, all dermatologists are experts in hair loss. But you will find by looking at if they have an Instagram, if they have their website, whether they have an extra interest in it, and maybe doing other procedures such as PRP injections for the hair or they using minoxidil, we’re going full circle back to using oral minoxidil for hair and having great success. But really any dermatologist, you may find though that some are more skin cancer surgically oriented, and so you probably want to lend toward a dermatologist seems to be not only interested in doing your skin exam, but also talking about your eczema, your psoriasis, any rash if you may develop acne, and also your cosmetic approach to it. And I think most of the time you can see that by looking at their website and what they’re featuring in their Instagram.

Yes, absolutely. I love that. Well, let me ask you Dr. Dintiman, in the last couple of minutes here, is there anything we haven’t had an opportunity to talk about that you feel like is really important and you’d like to share with my audience?

I think just to reiterate that my approach is to try to love the skin you’re in. And what I mean by that is that I have a patient that started on their weight loss journey. I was not involved in it, and I noticed that she came in and started to address the pigmentation on her base and then little by little, some unsightly lesions or moles or skin tags, and we worked on that. And then that progressed into wanting to work on the texture, and then I turned her and said, oh, you’ve lost some weight, haven’t you? And she goes, yes, I’m doing it. And I think that it’s just helpful to start working on yourself holistically and not feel like you have to do one thing than the other. I think it’s really a great way to feel better and feel more of a glow while you’re going through this process, and that’ll help you get where you’re trying to get healthy physically and emotionally and enjoy yourself.

Absolutely. Well, I so appreciate you taking the time to come on this morning and share with us, my listeners, we have not heard anything like this before. I’ve never had a dermatologist on this show, and so this has been really a special treat. Thank you so much for coming in.

Great love to see you in Vienna, Virginia in person. We also do online virtual calls and we have an app. The DermUtopia app is in the Apple store if you have a problem while you’re traveling or your college student is away. So there’s a lot of ways that we can help you.

I love that. And so for all my patients here in the Charlottesville, Virginia area, she is about hour and a half, two hours away and easily available by telemedicine, which is a great option for many things. It’s surprising. We really learned that during COVID, how much you can do during telemedicine and certainly no skin biopsies or anything like that, but it’s amazing what we can do. So thank you so much for being here today. We will have all of your information in our show links, and so if anyone’s interested in learning more about Dr. Dintiman and about her practice, you can see all of that in the show notes below, and we’ll see you all next week.

SARAH STOMBAUGH, MD

Episode #81: Keeping Your Skin and Hair Healthy During Weight Loss with Guest: Dr. Brenda Dintiman

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