How Processed Is My Food? A Simple Guide to Understanding Food Labels

Updated on Apr 3, 2024 | Your Health

Food labels are supposed to help you understand what’s in your food, but deciphering endless lists of ingredients, nutrition facts, and marketing claims can often feel impossible—especially when you’re on the go.

Taylor Stein, RD

“Knowing how to read food labels is key to making good food choices,” says Taylor Stein, Associate Researcher and Registered Dietitian at The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai. “But keep in mind that food labels don’t tell you how the food will make you feel. You might eat a protein bar that says ‘20 grams of protein’ but still feel hungry afterward. This is important to consider, since foods that don’t fill you may trigger you to overeat later.”

In this Q&A, Ms. Stein explains why it’s so important to read the labels and offers seven tips to help you separate the good from the bad.

Check the Nutrition Facts

Most people only look at the marketing copy on the front of the product (for example, “25 percent less sugar,” “gluten-free,” or “fat free”). Marketing claims are often misleading. A bag of potato chips may claim to be 25 percent less fat, but compared to what? If the comparison is to potato chips in general, 25 percent is still a lot of fat. The Nutrition Facts on the back of the product gives you the actual breakdown of nutrition. People also often overlook the subsections under the Nutrition Facts—added sugar, saturated fat, carbohydrates, dietary fiber, etc., which are just as important as the totals. Fiber, for example, helps you feel full and is essential for gut, heart, and brain health.

Quick tips

  • Look at the Nutrition Facts and Ingredients on the back or side of the packaging, rather than the marketing labels on the front, which are often misleading.
  • The first ingredient is the primary ingredient. Generally, the more ingredients, the more processed the food is.
  • If the product does not look anything like the food that’s supposed to be in it, it’s likely highly processed (ultraprocessed). Ultraprocessed foods often contain many calories with little substance, which can lead to overeating.
  • Pay attention to the subsections under the Nutrition Facts—added sugar, saturated fat, carbohydrates, dietary fiber, etc.
  • To know how much sugar has been added to a product, divide the added grams of sugar by four. This gives you the exact number of teaspoons that were added.

Pay Attention to Serving Size

People often misunderstand “Serving Size” and “Percent Daily Value” on the Nutrition Facts panel. They think serving size is how much of a product they should eat. A serving size is simply the amount of nutrition that is in a specific amount of the product. If the number of calories is 100 and the serving size is one cup, then you are consuming 100 calories if you eat one cup. It does not mean that you should only eat one cup. The “Percent Daily Value” is based on a standardized 2,000-calorie diet or the recommended daily allowance of that nutrient, and is not representative of what you as an individual should consume.

Some Added Ingredients Are Good for You

Many people assume added ingredients are bad for them, but some products, such as cereals, are fortified with ingredients that are good for you. Unless you have a food allergy or intolerance, you don’t need to avoid any ingredients. The Food and Drug Administration regulates food, so anything truly hazardous is not sold. People may also not realize the ingredients list is ordered by weight. The first ingredient is the primary ingredient. As you go down the list, the amount of the ingredient gets smaller—the last ingredient is the smallest amount. If the first ingredient is sugar, that tells you the product is predominantly sugar.

Be Mindful of Foods Without Labels

Some people assume food products that don’t have labels, such as fresh vegetables and meat, are healthier than packaged foods. This is generally true of produce, whole grains, fish, and lean meats; however, red meats and certain cheeses, for example, may be high in saturated fat, and should be limited.

How Can I Develop a Healthy Eating Pattern?

Look Out for Ultraprocessed Foods

Processed foods are foods made from whole foods that have been broken down into their basic components (sugars, starches, fats, etc.) and reassembled to make packaged foods. There’s a spectrum of how processed a food could be—anywhere from not processed at all (whole foods, including those with minimal processing, such as frozen fruit) to foods that are extremely processed (ultraprocessed). These include chips, sodas, lunchmeats, ice cream, sweetened cereals, etc. One example is protein bars made from soybeans that have been turned into a powder. The manufacturer adds fats and sugars to make it tasty, which adds calories but not substance. The food is so processed that your body cannot tell when it should be full. For example, you can eat 500 calories of corn chips and not feel full, versus eating a whole corncob filled with fiber and water that satisfies you. For this reason, consuming too much ultraprocessed food can lead to chronic health conditions, such as obesity and diabetes.

How can you know how processed a product is? Look at the food—does it look like what is supposed to be in it? Applesauce has been ground down, but you can still tell it comes from apples. It’s processed, but not very. A bag of snacks claiming to be made from vegetables features images of carrots and onions, but the product does not look anything like vegetables—it’s actually made from potato flour and starch (with a little added carrot and onion flavoring).

Look at the Number of Ingredients

The number of ingredients, and the breakdown of ingredients, is another way to tell how processed a food is. Generally, the more ingredients, the more processed, though this is not always the case (trail mix, for example). Applesauce has a few ingredients, but it’s not been radically changed from its original form. In comparison, the bag of ultraprocessed “veggie” snacks contains a long list of ingredients.

Limit Your Sugar

The American Heart Association recommends no more than six teaspoons of added sugar per day for women and nine for men. We all know what a teaspoon looks like. But the Nutrition Facts panel lists ingredients by weight, in grams. In the Nutrition Facts panel, added sugar is listed separately under the total amount of sugar. An easy way to know how much sugar has been added is to divide the added sugar by four, which gives you the exact number of teaspoons. For example, if the added sugar is 12 grams per serving, divide that by four, which gives you three added teaspoons of sugar per serving.

Schedule an appointment with the Mount Sinai Physiolab for personalized health and awareness recommendations.

For This Spine Patient, Success Is a Walk in the Park

Updated on Apr 5, 2024 | Patient Stories, Your Health

“Before, I couldn’t travel too far and couldn’t go international. When I went to Washington D.C., I was limited by my ability to walk,” says Jose Eduardo Vazquez Bonano. “But right now, with spring coming up, I’ll be happy to do the inside loop of Prospect Park.”

Jose Eduardo Vazquez Bonano, 62, started having trouble walking a few years ago. “I noticed as I was getting older, my walking was starting to slow down,” he said. “I thought it might be age, or diabetic neuropathy, which I do have.”

But when the diagnosis started pointing to spinal issues, Mr. Bonano looked into several spine programs in New York City before settling on Divaldo Camara, MD, at the Spine Program at Mount Sinai Morningside. “I always do research before I take an important step, and when I saw his profile and read some of his history, I said, okay, this is a man I can trust.”

Now, he’s looking forward to long, leisurely walks.

“When I was younger, one of my hobbies that I loved was walking distance. But it got to the point that I couldn’t even walk half a block,” said Mr. Bonano. “But I’m recovering from my surgery very quickly. Right now, my goal is to walk the inside loop of Prospect Park, which is 3.5 kilometers. That’s what I’m looking forward to this spring.”

Divaldo Camara, MD, the Spine Program at Mount Sinai Morningside

Dr. Camara started seeing Mr. Bonano in January of 2023. He had severe back pain and pain running through his left leg. He also had a “foot drop” which means he had trouble lifting his left foot because of the nerve. Dr. Camara usually sees patients two or three times before recommending surgery unless it’s an emergency. They normally will first try physical therapy and other non-surgical treatments, but they weren’t working in his case. Doctors ordered imaging and saw evidence of degenerative disease on his MRI.

“By March, the compelling findings in his images led us to discuss surgery as the next best step in his case,” Dr. Camara said. “He had a severe sagittal and coronal imbalance which was compressing the nerve, which means the curvature of the spine was off both front to back and side to side.”

“I was hesitant about surgery,” said Mr. Bonano. “It took about a month to make sure this is the right thing for me. I talked with my partner and considered my age and my health condition. But I went for it. I said, at this point in my life, why not?”

Part of Mr. Bonano’s decision was based on discussing his goals with Dr. Camara. “I try to establish a relationship, understand the patient’s complaints and their goals for treatment,” said Dr. Camara. “When I asked Jose what things he’d like to do, he said that he would like to drive to Florida to see relatives. And that was one thing he couldn’t do in his current condition.”

Because of the severity of Mr. Bonano’s case, he needed two spinal surgeries, one from the front and one from the rear. The front surgery, an anterior lumbar interbody fusion, or ALIF, removed one of the damaged discs. The rear operation provided the corrective bracing.

“It was a complex surgery, but we were confident of a good outcome,” Dr. Camara said. “And the two surgeries allowed us to correct much more than we would have been able to otherwise.”

Mr. Bonano had the first surgery on a Monday and the second one on Thursday. He remained in the hospital between surgeries and was able to begin rehab in the hospital. He was in the hospital about a month.

“It’s an advantage when patients go to our rehab program,” said Dr. Camara, “because if there’s any concern about the patient’s improvement or wound healing, we can follow up easily.”

“The doctor did an excellent job. I recovered very fast,” said Mr. Bonano. “I’m not 100 percent back to normal, but so far, so good. Even the cut from the operation is just visible as a line. To see how well they did that was phenomenal.”

Now Mr. Bonano is looking forward to being able to walk and travel.

“Before, I couldn’t travel too far and couldn’t go international. When I went to Washington D.C.—there’s all the monuments to see and you’re always trying explore as much as possible—I was limited by my ability to walk. But right now, with spring coming up, I’ll be happy to do the inside loop of Prospect Park.”

Learn more about the Spine Program at Mount Sinai Morningside

Purple Day: Raising Awareness, Ending Stigma of Epilepsy

Mar 28, 2024 | Featured, Research, Your Health

Every year on March 26, people and organizations around the world band together in solidarity for Purple Day. They wear purple and host events to raise awareness about epilepsy, with the goal of ending its stigma. For Purple Day this year, we got together experts from the Mount Sinai Health System to explain what epilepsy is and answer other top questions people might have.

Is epilepsy contagious?
“You cannot spread epilepsy from one person to the other,” says pediatric neurologist Natasha Acosta Diaz, MD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai.

Epilepsy is not an infection. It is a neurological condition characterized by seizures caused by abnormal brain electrical activity, says Dr. Acosta Diaz.

Is epilepsy electroencephalogram (EEG) testing painful?
In a standard EEG test, electrodes—small metal discs—are attached to the scalp with the help of a glue. The EEG test is not painful, says Anuradha Singh, MD, Director of the Epilepsy Monitoring Unit, and Professor of Neurology at Icahn Mount Sinai.

EEG tests study brain rhythms to look for any sign of irritability.  A standard EEG test records these brain rhythms for 20 minutes to an hour, says Dr. Singh. “Sometimes you get a little glue left on your scalp but it’s not painful at all,” she adds.

Is epilepsy surgery dangerous?
“The myths about the danger of epilepsy surgery come from the past, from about the last 100 years or so,” says neurosurgeon Fedor Panov, MD, Director of the Adult Epilepsy Surgery Program and Associate Professor of Neurosurgery at Icahn Mount Sinai. “What you currently find on the internet (about the dangers) unfortunately is not appropriate and it just perpetuates this myth that epilepsy surgery is dangerous,” he notes.

Epilepsy surgery has its risks and benefits. “Most certainly, the benefits outweigh the risks,” says Dr. Panov. As the epilepsy care team might phrase it to patients, the risk of going through a year with epileptic seizures far outweighs the risk of a surgical intervention to cure the epilepsy, he says.

Can epilepsy seizures be triggered by flashing lights?
There is a type of epilepsy that can be triggered by flashing lights, called photosensitive epilepsy. “However, this is very rare,” says Dr. Acosta Diaz.

When testing a patient for epilepsy, flashing lights are used to see if they provoke a seizure, and if so, appropriate recommendations for care can be given, she adds.

Can people with epilepsy drive a car?
“You can drive a car if you’re seizure-free,” says Dr. Singh. However, different states can have different rules and regulations. People with epilepsy will have to check with their state’s Department of Motor Vehicles, she notes.

What are some epilepsy surgical options?

Vagal nerve stimulator
Involves placing a small wire around a nerve in the neck to decrease seizure activity. The wire is attached to a small battery inserted under the skin of the chest.

Stereotactic laser ablation
Uses lasers to remove a part of the temporal lobe of the brain to help control seizures. The procedure is guided by magnetic resonance imaging (MRI), allowing for very precise cuts and removal.

Staged craniotomy
A two-stage surgery that involves removal of part of the skull to expose the brain, followed by removal of the brain tissue that is causing the seizures. Removing the damaged part of the brain does not cause deficits, as other parts of the brain adapt and pick up function. The procedure improves the overall brain network because it allows the healthy areas to work without constant electrical interference from the seizure “hot spot.”

Responsive neurostimulation
A device is implanted that automatically records and detects electrographic seizures, then rapidly delivers electrical stimulation to suppress seizure activity. It is the first device that the U.S. Food and Drug Administration has approved for use in the brain to listen, learn, and respond to seizures.

Can people with epilepsy have a job?
“Absolutely,” says Dr. Panov. “It’s a myth to say you cannot work if you have seizures.” Epilepsy care teams are available to help patients be a part of their community, including having and holding jobs. The Americans with Disabilities Act prohibits discrimination against people with disabilities in several areas, including employment.

While it is not mandatory that people with epilepsy disclose their condition to employers or coworkers, it is recommended that someone at the workplace is aware, says Dr. Acosta Diaz. “Just in case you have a seizure, somebody can be with you or help you,” she says.

Can people with epilepsy have children?
People with epilepsy can have happy, healthy children, says Dr. Singh. Women with epilepsy should work with their OB/GYN and epileptologist to ensure they’re on the safest drugs for the pregnancy, says Dr. Singh.

Can people with epilepsy stop taking medications when seizures stop?
The goal of any Comprehensive Epilepsy Center is to get patients seizure-free, and ultimately off the medications, says Dr. Panov: “The idea is that you will come off your meds once the seizures stop.”

It is important, however, that patients do not stop taking medications without discussing with their specialists, says Dr. Singh. A lot of factors go into the consideration of stopping medications, including EEG results and MRI scans, so that process should be done in consultation with an epileptologist.

Can people with epilepsy swallow their tongue?
“No way, there’s no way that you’re going to swallow your tongue,” says Dr. Acosta Diaz. During a seizure, the tongue can go to the side of the mouth and people can accidentally bite their tongue. To assist someone with a seizure, be calm and lay the person on the side, and definitely do not put anything in the mouth, such as a spoon, she says.

Does a ketogenic diet help people with epilepsy?
It does, in certain cases, says Dr. Singh. A ketogenic diet is a high-fat, adequate-protein, and low-carbohydrate diet. It is more often used in pediatric epilepsy, especially for children in whom medications do not work well, says Dr. Acosta Diaz.

Ketosis, a state where the body derives its sources of energy from fat rather than glucose, is known to have anticonvulsant properties. However, it’s not easy for a person to enter into ketosis. That is why an epilepsy care team involves overseeing a patient’s metabolism and nutrition as well, notes Dr. Acosta Diaz. “It’s not something you can try by yourself at home. It’s not just doing a keto diet to lose weight,” she says.

Caring for people with epilepsy is a team effort. At the Mount Sinai Epilepsy Center, staff members across all levels of care work together to provide exceptional care. Here’s the Center at a glance:

100+ team members

• Adult epileptologists  • Pediatric epileptologists  • Neurosurgeons  • Neuropsychiatrists  • Neuroradiologists  • Nurse practitioners  • Neurosurgery  • NPs and PAs  • Researchers  • Registered nurses  • Social workers  • Dietitians  • Recreational therapists  • EEG technicians  • Administrative staff

 

 

Designated as a Level 4 medical facility by the National Association of Epilepsy Centers (NAEC), which is the highest recognition of care and expertise for people with epilepsy

Three inpatient Level 4 epilepsy centers at The Mount Sinai Hospital, Mount Sinai Kravis Children’s Hospital, and Mount Sinai West, and six outpatient locations in New York City and Long Island.

ABRET-certified labs

Five Mount Sinai sites have received American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET) Lab accreditation for achieving highest levels of quality and competence performing neurodiagnostic tests.

In 2023

The Mount Sinai Health System performed more than 13,000 electroencephalograms and completed 100 surgeries to reduce or eliminate seizures for adult and pediatric patients.

To call the Mount Sinai Epilepsy Center

212-241-2627

In addition to treating patients with epilepsy, the Mount Sinai Health System and Icahn Mount Sinai conduct research to push the frontiers of understanding the neurological conditions and what is possible with treatment. Here are some examples of what Mount Sinai is doing to further science in epilepsy.

Clinical trial: Epilepsy associated with Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is a severe form of epilepsy, with seizures beginning in early childhood. To treat seizures that have not been well controlled through conventional medication, researchers are using novel responsive neurostimulation (RNS) strategies. This is the first clinical trial using RNS for LGS.

The trial is supported by a five-year grant from the National Institutes of Health, and conducted in collaboration with five other centers in the United States.

Click here for more info.

Clinical trial: Efficacy of subanesthetic doses of IV ketamine for treatment-resistant epilepsy

Ketamine is an anesthetic that provides pain relief, and came into clinical use in the 1960s. In a hospital setting, ketamine is used intravenously at anesthetic doses to treat unrelenting seizures known as status epilepticus in comatose patients. Mount Sinai researchers are exploring using ketamine at subanesthetic doses in an outpatient setting for patients who have treatment-resistant epilepsy. With subanesthestic dose-ketamine recently approved by the FDA for treatment-resistant depression, researchers are optimistic about its safety, and are hopeful that this will provide relief for patients with hard-to-treat epilepsy as well.

Click here for more info.

Clinical trial: Phase 3 trial for a once-daily, oral treatment for those living with focal seizures (XTOLE2)

Focal seizures are when brain cells on one side of the brain malfunction, causing symptoms, and are considered the most common type—making up more than half of all seizures. Symptoms could include one or more of the following: motor, sensory, autonomic, or cognitive. While treatment can stop or reduce the frequency of the seizures, for some patients, current treatment options may be insufficient. Mount Sinai is participating in a Phase 3 study with Xenon Pharmaceuticals to explore the use of XEN1101, a potassium channel opener, along with the patient’s existing medication, for focal seizures. Clinical data from previous trials have shown up to around 50 percent reduction in focal seizures among participants who have received the drug.

Click here for more info.

Clinical trial: Phase 3 trial for Staccato® Alprazolam in participants 12 years and older with stereotypical prolonged seizures

Benzodiazepines are more commonly known for treating anxiety or panic disorders, but they can also be used to terminate most seizures in an inpatient setting. Approved therapies include a rectally-administered gel and intranasal formulations. However, there are no approved treatments for rapidly terminating an ongoing seizure in an outpatient setting. Mount Sinai is participating in a Phase 3 trial with pharmaceutical company UCB to study the effectiveness and safety of Staccato® Alprazolam, a breath-triggered device that delivers the benzodiazepine deep into the lung for rapid absorption and systemic exposure, with the goal of achieving rapid epileptic seizure termination (REST). In a previous clinical trial, in an inpatient setting, nearly 66 percent of participants who received the drug responded to the treatment, compared to 43 percent of participants who received a placebo. For participants who responded to the intervention, the Staccato® Alprazolam group saw seizure cessation in a median time of 30 seconds, compared to 60 seconds for those who had received a placebo. The Phase 3 trial tests the treatment in an outpatient setting.

Click here for more info.

Clinical trial: Electrographic seizure pattern modulation biomarkers in responsive neurostimulation for epilepsy

Although the therapeutic benefit of RNS is well established, predicting how well and when a patient might respond to the device is difficult. It may take several months for a patient to report a reliable change in seizure status, during which time the programming clinician has no objective guidance regarding whether or not to adjust settings. RNS devices can provide EEG recordings, offering an insight to seizure patterns, but there is little knowledge about how to use these recordings in individual patients. Thus, a critical need exists to develop methods for using a patient’s own data to predict when seizure reduction should be expected or to confirm objectively the presence and maintenance of a clinical response.

Icahn Mount Sinai researchers are working with Massachusetts General Hospital to apply machine learning, neurostatistics, and data science to improve the effectiveness of RNS, especially for children and adults who are not considered suitable surgical candidates.

Click here for more info.

Laboratory for Human Neurophysiology

The Laboratory for Human Neurophysiology seeks to understand how human cognition arises from the interaction of multiple brain areas and neurotransmitter systems, particularly in decision-making behavior. These research efforts involve studying prefrontal cortical and subcortical areas directly in the human brain by conducting intracranial electrophysiology recordings in patients undergoing neurosurgical treatment.

Ongoing research projects in the laboratory include investigating the neural basis of human decision-making under uncertainty using distributed intracranial EEG recordings in epilepsy patients, decoding overt subject behavior from preceding, distributed brain activity in reward-related brain regions, and studying reward and mood processing across multiple brain areas in epilepsy patients with and without comorbid depression. The lab is led by Ignacio Saez, PhD, Associate Professor of Neuroscience, Neurosurgery, and Neurology at Icahn Mount Sinai.

Click here to read more about the lab.

Botox and Other Treatments for Wrinkles: Everything You’ve Always Wanted to Know

Mar 27, 2024 | Your Health

Botox® has been one of the most popular cosmetic treatments of the last 20 years.

For many, Botox and other brands of botulinum toxin injections have been a great way to maintain their youthful appearance. Botox injections work by blocking nerve signals to muscles. The injections prevent muscles from contracting for several months. While Botox injections are used to ease certain medical conditions, the results are not a cure and always temporary.  These injections are also used to treat hyperhidrosis (sweating), overactive bladder, migraines, and neck spasms.

In this Q&A, Ahuva Cices, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, discusses the ABCs of Botox and other brands, including how they work, how long they last and how to know if this is the right treatment for you.

How does Botox work?

Botox is a brand.  It’s like saying Kleenex or Coca-Cola. It’s a type of neurotoxin or neuromodulator. This neurolmodulator comes from bacteria called Clostridium botulinum. We use the toxin that it makes to temporarily paralyze or control muscles.

The way that it works is that the neurotoxin prevents the nerve from activating the muscle by preventing the release of acetylcholine, which is a neurotransmitter that stimulates muscles to contract. It’s simply blocking the signaling that allows the muscle to contract. Other brands besides Botox are Dysport®, Xeomin®, Jeuveau®, and Daxxify®.

Patients will sometimes come in and ask me for Botox, but they don’t actually mean the brand Botox, they want a neurotoxin. It’s better to speak to your provider about which one would be best for you. Your doctor can determine the best treatment for by evaluating the individual patient, including the area to be treated and the patient’s goals.

What are the conditions you typically treat with Botox?

We use it for mostly for cosmetic purposes. The most common use is for the upper face, including the forehead, the glabellar area including the 11 lines between the eyebrows, and the lateral canthal lines, which are around your eyes.

Patients often say “I have these lines on my forehead” or “I look angry.” Those are some of the most common concerns. But there are many other cosmetic uses for neurotoxins. We use them in the mid face for areas like bunny lines; for correcting a “gummy” smile that shows more of your gum; and for a subtle lip enhancement with a lip flip. We can also prevent a downward turning of the mouth, which is common as we get older.

In addition, we can treat the neck. The platysmal bands can pull down on the neck, and we can get horizontal lines in the neck—we call this tech neck or necklace lines and they are becoming quite common from all the screen time. We can use neurotoxins for facial slimming by injecting the masseter muscles. We can also treat the masseters for bruxism for patients who grind their teeth or clench their teeth.

How long does Botox typically last?

In most people, these injections will last about three to four months. This can range from two to six months when patients will feel like it’s either started to wear off, fully worn off, or worn off enough to the point where they feel like another treatment is indicated.

The duration depends on the individual patient and product used. Different people have different metabolic rates of how fast their body metabolizes the injections or how it is degraded by the body. Different toxins also can last different lengths of time in different people. Over time, some people can develop antibodies to a specific toxin, and that one will not last as long or won’t be as effective. There are also certain areas where it will not last as long. For example:  if you’re correcting those lip lines, because the lips are moving so much it tends to be metabolized quicker in that area. It’s possible that people who exercise a lot tend to metabolize faster as well.

Duration also depends on the product used, dose of neuromodulator, and the concentration. For example, Daxxify lasts closer to six months and higher doses of any neuromodulator will last longer.

How soon do patients see the results?

Everyone may react a bit differently, but there are some overall trends. Daxxify works fast. It usually kicks in within 24 hours. Dysport usually kicks in within one to three days after treatment. Jeuveau is also on the quicker side, usually two to three days. Botox is a little bit slower. It can kick in at three days, but often it takes a bit longer about five days. All of the neurotoxins should have their full effect two weeks after the treatment.

At what age do you recommend patients begin these treatments?

I generally do not do these treatments on patients under the age of 18. I think anyone over 18 can be eligible. What I tell my patients is that when you start seeing lines that are staying in the skin and lingering after you make an expression, that’s the optimal time to start.

Once the lines are already etched in the skin, we can’t promise that the toxin will erase those lines. We can soften and smooth them. Over time, they may fade.  You want to catch it before those lines become etched in the skin permanently.

What are some of the potential side effects of these treatments?

Generally, these neurotoxins are very well tolerated. You can expect a little bit of discomfort with the injections. There could be a little bit of localized discomfort or temporary swelling. Bruising isn’t uncommon, but it’s not something that happens every time and it may happen just at one injection site. Some patients do develop a headache afterward, but it’s usually mild and does not last long.

Some patients  may have brow heaviness, and this is more common for a first timer, but this usually would resolve within the first few weeks and occurs from over treatment. Also, improper preparation can cause an infection at the injection site. Improper technique can cause a symmetry drooping; temporarily paralyzing a muscle not intended for treatment, which can either lead to asymmetry. All of these side effects would be temporary, so it’s still very safe.

What makes someone a good candidate?

Neurotoxin treatment is great for everybody who is not pregnant or needle phobic. It’s obviously not necessary, but I think it is a wonderful treatment for most patients.

Can you stop treatments once you start?

Completely. The effects are temporary. There’s no evidence of long-term changes or atrophy. The biggest downside is that neurotoxin treatments can be very addictive because it looks so good. You may not want to stop. In fact, many patients will do it recurrently for a long time, stop when they get pregnant, and then pick it right back up after.

What other treatments are popular?

Upper face cosmetic treatments are by far the most popular. More patients are asking about other cosmetic uses. We’re using it a lot in the lower face and in the neck. These subtle changes can actually give you the cosmetic look without being an obvious change.

Many people may not know these treatments are very versatile. Neurotoxin is covered by some insurances for underarm hyperhidrosis. But we can also use neurotoxin on the scalp to reduce sweat and allow for extended time between washes.

Learn more about Dermatology services at Mount Sinai

How Can a Skin Prick Test Help Me With My Allergies?

Mar 27, 2024 | Your Health

If you live with allergies, also referred to as allergic rhinitis, you know how annoying the symptoms can be. The itchiness, congestion, trickle in the throat—they can make it difficult to do the things you need, or want, to do.

It can also be difficult to determine the cause of your allergies (allergic rhinitis). For example, you could be allergic to airborne or environmental factors, such as ragweed or something in your home. Or it could be a seasonal condition. Whatever the cause, Alexandra Demeglio, a Physician Assistant in the Department of Otolaryngology at Mount Sinai Doctors – East 85th Street, says patients can get relief.

“Knowing what you are allergic to is helpful because there are ways to manage or eliminate the symptoms you are experiencing,” she says.

To make an appointment with Alexandra Demeglio, PA, call 212-241-9410.

Understanding your airborne and environmental triggers starts with a simple, rapid skin prick (also called a puncture or scratch) test. The test takes about two minutes to administer, and in as little as 15 minutes you can get results that can be used to develop a treatment plan. In this Q&A, she explains how that process works.

What are common allergy (allergic rhinitis) symptoms?

The most common allergy symptoms include:
• Nasal congestion, which may be accompanied by clogged ears
• Itchiness in the eyes, nose, ears, or throat
• Watery eyes or nose
• Post-nasal drip—mucus from your nose or sinuses that drips down your throat
• Red eyes or dry eyelids
• Worsening asthma symptoms
• Fatigue or brain fog

What is causing my allergy symptoms?

Many environmental and seasonal factors can trigger allergy symptoms. These include:
• Pollen (grass and trees in spring and summer; ragweed, pigweed, and mugwort in fall)
• Mold and mold spores
• Pets and other animals
• Pests, such as mice and roaches
• Feathers
• Changes in humidity
• Dust mites

Some causes are not just seasonal but also regional in nature, such as mold, which is relatively common in some states, including New York, but virtually nonexistent in other states, such as Arizona. Also, your home furnishings and décor can contain months—even years—of allergens, so keeping them clean will help to reduce or prevent symptoms.

Should I be concerned about my symptoms?

If over-the-counter medications are not providing relief from allergies and your symptoms are worsening or severe enough that they affect your quality of life, you should see an otolaryngologist about testing and treatment options.

Untreated allergies can lead to conditions such as nasal polyps, eczema, and asthma. To prevent that from happening, it is important to desensitize your immune system to affecting allergens. That starts with getting a better understanding of what you are allergic to.

A consultation with an otolaryngologist usually begins with a review of your medical history and symptoms followed by a nasal endoscopy of your nose and sinuses. Based on the findings, the otolaryngologist may prescribe an over-the-counter medication and lifestyle changes, recommend further consultation with a rhinologist, or refer you for a skin prick test.

What is a skin prick test?

The skin prick test is designed to deliver quick insights about the seasonal or environmental factors that are triggering your allergic symptoms. It is typically performed using the forearm among adults.

Before the test begins, the health professional will clean the forearm skin with alcohol. Using a device with multiple small needles, the professional will make gentle scratches along the skin and apply 40 different allergen extracts, such as pollen, cat hair, and mold. In cases involving suspected food allergies, a referral will be made to an allergist for the skin prick test.

The process typically takes two minutes. During the test, the health professional will apply two other substances to measure patient reactions to the allergens—histamine, which is released by the body during an allergic reaction, and a glycerin saline solution, which typically produces no reaction.

How do I prepare for a skin prick test?

To prepare for a skin prick test, you should:
• Stop taking prescription and over-the-counter antihistamine medications, including sprays, at least one week before the test. This will ensure that the test is accurate in identifying allergies and the degree of severity.
• Discontinue oral acid reflux medications up to three days before the test.
• Delay taking any blood pressure medication until after the test.

Patients who are taking steroid-based nasal sprays or other medications to treat asthma or allergic asthma can continue to do so.

Skin prick tests are not recommended for patients who are not able to suspend medications that can interfere with the outcomes of the test. In these cases, a blood test will be performed. Skin prick tests are also not recommended during pregnancy to prevent the risk of a bad reaction that affects blood flow to the fetus.

What happens after the test?

Once the allergen extracts have been applied to the skin, the health professional will wait 15 minutes and then check the patient’s forearm for reactions. They are looking for anything that resembles a mosquito bite, which is a positive. They will also look at the degree of sensitivity, which they measure using a scale from one to four, with four meaning a large hive. That tells providers what a patient is very allergic to.

The results, which are revealed the day of your appointment, will determine treatment recommendations. Patients who demonstrate a mild reaction are typically prescribed a six-to-eight-week regimen of over-the-counter antihistamines. Patients who demonstrate a severe reaction, or whose symptoms are not controlled, or worsen, during antihistamine treatment, are referred to an allergist or immunologist for further assessment and, in some cases, allergy immunotherapy shots. Patients whose test results are negative despite displaying symptoms will be referred to an allergist for intradermal testing, in which the allergens are injected under the skin.

Ultimately, once you have a better idea of what is causing your symptoms, you have options that can provide relief from allergies. Mount Sinai’s team of otolaryngologists, allergists, and immunologists are available to help you.

“Our otolaryngology program spans everything from head and neck to rhinology,” Ms. Demeglio says. “Our clinicians are on the cutting edge in treating people efficiently and effectively. We know the appropriate treatments, and we can individualize them so that we can improve your quality of life.”

Make an appointment with Alexandra Demeglio, PA

How to Safely Observe a Solar Eclipse

Updated on Mar 27, 2024 | Featured, Your Health

Mount Sinai researchers used state-of-the-art imaging to closely examine a patient’s retina after the solar eclipse of August 2017 burned a crescent shape into her eye.

The tricky thing about a partial solar eclipse is that if you look at it directly, you won’t feel any immediate pain. But the sun’s energy can still permanently damage your retina—and your vision.

In this Q&A, Avnish Deobhakta, MD, Associate Professor of Ophthalmology at the New York Eye and Ear Infirmary of Mount Sinai, explains how to safely look at a solar eclipse and the potential harm that can occur if you do not follow basic precautions for viewing this spectacle, which will take place Monday, April 8.

Avnish Deobhakta, MD

Why should I avoid looking at a solar eclipse? What damage can it do to the eye?

The solar eclipse is a very, very dangerous event for your eyes. Light beams from the sky carry a lot of energy that can be transmitted into the retina and damage it. Usually, the sun is very bright and it’s almost impossible to look directly at it without discomfort. But during a solar eclipse, you can look at the sun for a long period of time and be fooled into thinking that it’s safe because it doesn’t hurt. This is because most of the sun’s rays are blocked off by the eclipse. But the sun’s rays that you see during a partial eclipse are the most damaging to the eye. It’s almost like you’re getting a disproportionate helping of the most energetic and damaging rays because all of the other rays are blocked and the ones that make it through are not so bright that they force you to look away.

What can happen if I take a quick peek?

Even a very quick look at a solar eclipse can burn your retina. During the last solar eclipse, in 2017, one of my patients looked at the eclipse and sustained damage to her retina. She thought she was using protective glasses—but they weren’t the right type. She still has a blank section, a visual blind spot, in the center of her visual field. I used groundbreaking technology to take a close look at the damage to her eye. The damage was in the exact shape as the moon—a crescent shape. We were one of the few sites that had that prototype machine and could take that photo. It may not help the patient, but it gave us new information about the damage caused by exposure to the sun’s rays. Other people have been known to have visual distortions in part of their visual field. Even with a total solar eclipse, there will always be a moment when the sun re-emerges, and some of those rays can damage the retina.

Is the damage permanent?

Yes. We cannot fix it. At the New York Eye and Ear Infirmary of Mount Sinai, we have the technology to take an image and see the part of the retina that is damaged, but there is nothing a doctor can do to treat it. The damage doesn’t go away. Even decades later, your vision will still be impaired.

Can I look using a mirror?

No. Mirrors reflect the damaging sun rays. Looking in a mirror is the equivalent of looking directly at the solar eclipse–it’s not safe.

What about special sunglasses? Are those safe?  

It’s fine to use approved sunglasses that have the right filters. However, you have to make absolutely sure that you have those filters, and you need to obtain them from a reputable vendor. If you are not sure of either of those things, then you should not look at the eclipse, and instead look at a projection of the rays. Most of the people I’ve seen whose eyes were damaged by looking at a solar eclipse thought they were wearing the right glasses. And if you think you’re protected, you’re going to look longer, which increases the chances—and the extent—of damage. (Click here to learn more about safe viewing on the JAMA Patient Page created by the Journal of the American Medical Association.)

How about using a camera, like the one on my phone?

Generally speaking, if you look through your phone camera, you’re looking at an image rendered through the camera. You’re not actually looking directly at the sun, which means, theoretically, that it is safe. What worries me is not the phone camera—it’s that when people hold the camera up toward the sun, they might look around it for even just a brief period of time and can end up with a damaged retina. Think about a concert, when people have their phones out and are recording the concert, but they’re also looking around and watching the band on the stage. That’s not safe during a solar eclipse.

Is there a safe way to look at a solar eclipse?

Pinhole cameras are safe. They reflect light off an object and onto a surface such as a cardboard box or a wall. That way you’re not looking at the rays themselves, you’re looking at a projection of what the rays look like. You can watch a pinhole camera image as long as you’d like; you can even watch the entire solar eclipse reproduced on a pinhole camera and it’s perfectly safe. (Click here to get instructions on how to make your own pinhole camera.)

What if I’m outside during a solar eclipse but I don’t look up?

I don’t want anyone to think if they’re just in the presence of a solar eclipse they’re going to go blind. It’s okay to be outside during a solar eclipse, just be very careful. Be very mindful not to look directly at the sun in any way–and certainly not on purpose. The problem is that if you don’t know what’s going on and the sky looks different all of a sudden, your first instinct is to look up at the sun. The first instinct of all humankind is to look up. But that instinct can be dangerous during a solar eclipse.

Learn more about patient services at New York Eye and Ear Infirmary of Mount Sinai

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