Dear Doctor: Do fat - Nanchang HorizonInnovations Co.,Ltd

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine.North America Syndicate

DEAR DR. ROACH: I’ve heard a lot about fat-removing procedures, such as CoolSculpting and red light therapy, and I’m wondering if they really work. What is your opinion on these products? -- Anon.

ANSWER: The most important point is that these are procedures designed to improve a person's appearance, but they do little or nothing to improve physical health. They do not cause people to lose significant weight, and removal of the superficial fat right below the skin does not improve diabetes or influence heart risk factors. The benefits are purely cosmetic.

CoolSculpting is the brand name of a system that freezes and damages fat cells. Red light therapy, also called "cool laser" or "low-level laser therapy," damages the fat cells without the need to make incisions, such as would be necessary in liposuction. There are more technologies used, such as focused ultrasound and electrical pulse devices, among others.

Trials on CoolSculpting showed that 86% of people saw improvement in cosmetically important areas. The laser treatment is not as well-studied. An early trial found that 70% of people treated with laser were satisfied compared with 26% of those treated with a "sham" device that had no laser, just red lights. The device did show some slimming effects on the hips, thighs and waist.

Unfortunately, not everyone has a good response to these therapies. Several people, including a famous model, have sued the manufacturer due to an uncommon adverse effect of the procedure, called paradoxical adipose hyperplasia, where instead of dying, the fat cells grow and become hard -- and may not even be removable with surgery.

DEAR DR. ROACH: I have had gastroparesis for many years. About two years ago, it led to small intestinal bacterial overgrowth (which I once read about in your column). I worked with a dietitian for several months. One of the treatments she suggested was an herbal product called Iberogast. The combination of herbs helps the stomach to empty quicker. I use it each night before bed (as part of a 12-hour fast) or whenever I have overeaten and feel bad. It has been most helpful for me. Iberogast is available online. -- L.E.

ANSWER: First, for the benefit of other readers, gastroparesis is a too-slow emptying of the digestive system. Iberogast is a combination of nine medicinal plant extracts, and studies in Germany and Austria, where it is most commonly used, have shown the medication to be more effective than the placebo (and about as effective as one common prescription medication) in the treatment of functional dyspepsia and irritable bowel disease.

The medication has generally been regarded as safe, but there are rare cases of liver injury associated with this medication, at least one of which eventually required liver transplantation.

All medications -- whether prescription or over-the-counter, natural or synthetic -- have the potential for harm. Iberogast is pretty safe, with a handful of bad outcomes in its 50 years of use involving millions of doses, but it still can cause rare and severe adverse effects. Iberogast is worth considering in people whose symptoms have not been successfully treated with other therapies.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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