4: Taking Care of Your Skin with Cris Berlingeri MD

We’re all familiar with obesity being linked to issues such as heart disease, diabetes, and high blood pressure but the skin consequences of obesity remain inadequately discussed.

I was delighted to interview dermatologist Dr. Cris Berlingeri, to help us better understand how weight intersects with certain skin conditions, as well as problems with hair and nails.

If you are someone that has wondered about how hair loss is linked to weight loss, how the skin changes when you lose weight, and how you can best take care of yourself during weight loss from a dermatologic standpoint, Cris provides all the answers we need. No more scrolling online for hours each day, questioning if the information that you have is right or not. 

Common dermatology issues related to weight

One of the most common issues that Cris sees in her patients is a condition called acanthosis nigricans, which are darkened, velvety areas of the neck, sometimes on the armpits, that can be a signal for insulin resistance or diabetes. 

Multiple skin tags is also a common problem.  Skin tags tend to grow in the skin folds, where the skin rubs against itself, such as on the neck, armpits or groin. This is why they tend to affect overweight people who have excess folds of skin and skin chafing. When Cris sees patients with four or five or more skin tags, she always asks if they have a history of insulin resistance or diabetes and if not, if a first degree family member has. She advises to get yearly examinations with your primary care physician. 

In dermatology, Cris also sees a lot of patients with psoriasis and many of the patients with psoriasis have metabolic syndrome with either high blood pressure, insulin resistance, or diabetes. The waist circumference is elevated and as she discusses psoriasis treatment with them, she also integrates it with the science behind obesity. The medicines for psoriasis decrease the inflammatory markers that are associated with the diseases and comorbidities that many of these patients can share. 

What are the frustrations that patients experience when trying to treat these issues?

Patients commonly won’t get a diagnosis of eczema, for example, because  their dermatologist might say ‘oh, your itching is from stress and you need to lose weight’, but they won't actually get medically evaluated. 

Quite a number of physicians adopt the mentality of ‘if only they just lost weight…’ but there's just so much more to it than that, There is so much happening inside our body with hormones, inflammatory markers, cytokines, it's a lot more intricate than just telling a patient to lose weight and all your problems will be fixed. 

What we need to be doing is explaining the science to patients who have lost weight or are struggling with their weight. They should know that when your fatty tissue decreases, your hunger hormones go up, and your satiety hormones go down because it's produced by the fatty tissue. 

This would provide enormous relief to patients who have been told all their lives, not only by the media and their family members, but by the medical profession, that they are weak or need to have more self-control. It's very empowering for them to have it explained from a physiological perspective because they know what's going on and are less likely to attribute it to willpower. The more you know, the more power you have to deal with the situation. 

What happens to the skin when someone loses a lot of weight?

Fatty tissue provides cushioning and structure for the body. So when you lose fat tissue, you can have skin sagging. Often you can see skin sagging not only in the abdominal area, or the arms or thighs, but also on the chin, particularly on the submental area. If a patient is older than around 50 years old, you start noticing it more there. 

Women naturally have a lot of fatty tissue in the breast area for evolutionary reasons, so patients may complain about their breast size and form as well. 

Depending on how quickly the weight loss was, you can lose hair and your nails may get brittle. There is a condition called telogen effluvium, which occurs when there is a marked increase in the number of hairs shed each day.. The body is designed to conserve energy, so when it loses energy by weight loss, the body's senses that there's an emergency and tries to fix it but that stress signal can cause your hair to start falling out. This is usually just temporary.

What is the best advice to deal with these consequences to the skin?

Cris always encourages her patients to make sure they're eating well and not to stress about the hair loss because then it will just get even worse. 

Patients should make sure to hydrate well and eat from all food groups. Hair, nails and our skin, like other organs, need micronutrients in order to develop well and be healthy. Usually we can get those micronutrients at the level that we need them with a standard diet. 

Nail brittleness does not have as much to do with calcium as people often think. It’s usually to do with water content, not just in the sense of your water intake, but actually soaking your nails in water. If your nails are brittle, one thing that can help tremendously is having a routine at night or during the day or whenever you have 20 minutes, to soak them in water and then immediately after put Vaseline or coconut oil on and cover them up. Nighttime is good because then you can sleep with the nails covered in that and it will help the brittleness of the nails.

If our body has a lot of stress and it's losing weight, what's the life cycle of hair like?

Usually when the stressor happens, it's three to four months after the stressor that the hair starts to fall out. That can then last another three to six months. If the stressor is removed, then it goes back to normal. You can lose up to 50% of your hair when you're going through this, but around 20 - 30% is more common. There’s a kind of  ‘3, 3, 3’ rule. It happens about three months after the stressor, lasts about three months, and you can lose on average about 30% of your hair.

What is the link between vitamin D and the skin?

If you are losing weight, or have had any procedures or unknown medicine that is causing you to not absorb vitamin D, Cris encourages you to take some supplements and to talk to your physician about it. This is important because low vitamin D levels correlate with psoriasis and other skin conditions as well.

More about Cris

Cris was born and raised in Puerto Rico, but has been living for the last 14 years in Texas. Cris is a physician by trade and works as a dermatologist and dermatopathologist, but also has many other passions and ventures, including life coaching and owning a bakery selling Hispanic goods to the local community. What unifies all of her work is her passion to empower Hispanic women living in the United States. 

Cris has experienced her own weight loss journey where she lost 50 pounds and has managed to maintain that for the past 4 years.

Connect with Cris Berlinger MD:

Follow her on Facebook

Visit her website: https://www.crisberlingerimd.com/

Listen to her podcast: The Joyful Weight Loss

Listen to the Spanish version: Una Cita Contigo

Find out more about her bakery here.
Follow the bakery Instagram: @lemonyellowlatinbites