Just a quick note. Despite giant gyms, the LA influence and some really remarkable outdoor recreation. Las Vegas has been named the fattest city in America by Men’s Fitness magazine. This puts it ahead, apparently, of most of Texas since the remained of the top 5 fattest cities are there.

Why Vegas? “Poor eating habits and an alarmingly sedentary population kept Sin City atop the gluttony charts.” Can’t argue with the eating habits, this city has got some of the most tempting restaurants in the world, couple that with buffets and there’s a recipe for weight disaster. The unwary have more than enough options to consume.

Our Mayor was non-plussed and commented, “I don’t understand how they do this besides being cute.” The reality of it is that Men’s Fitness isn’t necessarily wrong.  Since weight loss is an active part of my practice it’s clear no matter how many lean entertainers there are here that there’s a seemingly limitless supply of people who have let extra weight accumulate. Heck, even some of our more notable entertainers are big.

All is not lost, however. A quick web search for “las vegas fitness” pulls up no shortage of gyms and trainers. There are dedicated diet clinics all over this town ready to help people slim down. It’s all a matter of taking the first step.

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Inspired by today’s announcement at the American Academy of Dermatology of the successor product to the highly successful Kinerase, Pyratine-6, it seemed to me that a few words were in order about skin care. Many anti-aging doctors place less emphasis on skin care than I do. I’ve gotten into some heated arguments about the importance of process and product with my peers. The dermatologists, though, almost never disagree with me. Here are my thoughts.

Skin care may not be the most dramatic or sexiest anti-aging intervention that you can make but taking care to prevent environmental damage and maximize the health of your facial skin can go further over time than many other anti-aging choices you might make.

Skin care isn’t hard but it does take time. Be you male or female, using quality product is key. Most body washes and bar soaps are really too harsh to use as face washes and will tend to leave skin too dry. Committing to a good quality, face targeted skin care line is important. I have my biases here, but there are a lot of good product lines. The minimum product level that I’d consider from a major retailer is something like Garnier or the high end of the Olay line, Regenerist. The biggest problem that major retailer products have is a lack of expert advise. Buying from your physician’s office or esthetician should, in theory, help you get products well matched to your skin.

The process is pretty simple and basically 3 steps. Cleanse, tone, moisturize. Some lines have products that shortcut this, but I’m skeptical whether skipping a toning step works as well. Historically toners removed the oily residue of non-waterbased cleansers. Modern toners adjust the pH of the skin and prepare the skin for the third step, moisturizing. There’s a great video demo and explanation of the whole process here. Regardless, the daytime moisturizer that you use should have a sunscreen in it with an SPF of at least 20, higher is probably better but I dial this number down a little to bias toward the products I use.

Additional steps can come in the form of eye creams and specialty products. Whether eye creams matter or not is a subject of debate. As for other specialty products there are many products for anti-oxidant protection like Prevage, reducing wrinkles like Kinerase or skin recovery like TNS Recovery Complex. There are even prescription product lines like Obagi that include actual pharmaceutical products in the skin care routine. Do you need these? Get your skin looked at by a professional. Finding a professional you can trust is hard, but worth it.

I use SkinMedica product, personally. I like it, I know the line and it works well for my skin. What you settle on for skin care will be dependent on your needs and budget, but get serious about skin care. It’s one of the simplest changes you can make to age against the machine.

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Gary Taubes, science writer, is busting out in Britain and the Telegraph is there. This is the same book that was released in the States last year as Good Calories, Bad Calories. The book is tauted as challenging the conventional wisdom on diet and calories, and does in a sense. What Taubes does is take a long look at historical diet thinking, modern thinking and the knowledge that comes in between. Those of us that help people lose weight for a living already know most of what Taubes disusses.

Atkins knew it. The Eades know it. The Paleolithic Diet does it. So does the No-S Diet and the Lunch Box Diet. The Mediterranean Diet depends on it. Even the American Diabetes Association has had to accept it.

What is it? It’s a simple fact. Obesity has more to do with consumption of carbohydrates than any other factor. Period. No matter the dietary mix of proteins and fats, it’s the white stuff that does in the best of dieters. The bread, pasta, potatoes, rice, tortillas and such. These ready sources of blood sugar cause a physiologic cascade that results in rapid weight gain and worse yet, stimulates the cravings for more carbohydrates.

The negative impact of high carbohydrate diets becomes clearer all the time. Carbohydrates result in higher inflammatory states, for instance.

For those looking to lose weight, control chronic diseases including high cholesterol, and contribute to their overall health through diet now is the time to find ways to curb the refined carbs and steer toward a diet more biased to protein and healthy fats. Oh, and for those looking at the Mediterranean diet, add a little red wine.

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A couple of weeks ago, the New York Times wrote an excellent summary piece on the dangers of plastic water bottles. These can be as subtle as heavy metals leaching out of reused bottle water bottles to endocrine disrupting compounds found in otherwise seemingly benign polycarbonate bottles.

Officially, polycarbonate bottles are completely benign with their major contaminant being bisphenol-A. Of course, that’s the official word. Bisphenol-A is a know agonist for estrogen receptors which means that it can in adequate concentrations activate the receptors. The implications are significant. Activating or blocking receptors can interfere with the normal actions of estrogen in females or stimulate estrogen like responses in males and children. Not good, right? It’s worrisome enough that the city of San Francisco banned products for children and infants that contained bisphenol-A in 2006. It does look like they repealed this ban, though.

So what does this matter for adults? This is one of those ongoing scientific arguments. Literature suggests that in-utero exposure to bisphenol-A increasing the lifetime risk of obesity. The chemical industry has spent a lot of money trying to quash this and self described non-partisan think tanks have pumped out paper after paper. The scientific community continues to come up with small study after small study that points to bisphenol-A being less that fully benign. Canada has labeled the compound: inherently toxic. What’s the truth?

Well, for sure bisphenol-A can speed development of fat cells. Exposure to bisphenol-A can speed growth and puberty as well as increase body weight in mice. Whether these are at concentrations similar to what one gets from bottled water is really unknown. Whether the same can be noted in humans is also unknown.

The take home, very likely is to use non-plastics for your water bottle filled from a home reverse osmosis filter. Of course, realistically, most of us will shrug off the risk and use cheap water bottle bought from the warehouse store. It’s not like we haven’t been warned, but like so many things it’s calculating the risks versus convenience.

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Scouting through the literature today revealed a study in the journal Circulation. This study showed that low testosterone was a predictor for cardiovascular disease in aging men.

Searching the archives of this same journal finds that in 1999, this study found, “Short-term intracoronary administration of testosterone, at physiological concentrations, induces coronary artery dilatation and increases coronary blood flow in men with established coronary artery disease.” The study actually infused testosterone at normal levels into the coronary arteries of men and observed the flow rate effects on the arteries. Italian researchers found that normal testosterone levels improved ischemia in men who already had heart disease according to this study.

This is one journal and 3 studies. All of these show positive findings relative to testosterone levels in aging men. Searching the endocrine literature reveals more of these kinds of studies. Looking back to last week, the bias of JAMA is more apparent the farther one looks into specialty specific journals.

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