Why Does My Skin Feel So Dry in the Winter?

As the temperatures drop, it’s important to use a moisturizer to keep skin healthy and vibrant throughout the winter months.  On a daily basis, we see advertisements touting the hydrating capability of various lotions and creams. The options can be confusing.  Angela J. Lamb, MD, Director of the Westside Mount Sinai Dermatology Faculty Practice, explains why moisturizing is key for skin health and what type of products are the most beneficial.

What causes dry skin?

Your skin is a barrier that protects our body from diseases and infections. Skin can become dry, scaly, or ashy due to cold temperatures, low humidity, wind, heating and air conditioning, as well as  washing with harsh soaps and not moisturizing. Contrary to popular belief, dry skin does not lack oil. In fact, skin becomes dry when it fails to retain water.

Dry, cracked skin may lead to an infection. It can also lead to an exacerbation of eczema—typically a winter skin condition that causes itching and rash.

What is the best way to keep my skin hydrated?

The best way to hydrate skin is to help it retain water. One way to do this is by avoiding long, hot showers as they will cause your skin to dry out. Try taking a brief shower with lukewarm water, avoid scrubbing your skin or using harsh soaps, and follow with a moisturizer.

Look for soaps that have moisturizing properties, like glycerin or almond oil, embedded. Avoid antibacterial soaps which can be very drying.

What is in a moisturizer?

People typically think that lotions or creams put moisture into the skin; however moisturizers actually work by coating the skin, thereby preventing water loss. Most moisturizers combine both occlusive and humectant agents.

Occlusive agents are heavy moisturizers that are oily. They prevent water loss from the skin by blocking or sealing the skin surface, thereby restoring moisture to it. The best occlusive moisturizer is petrolatum jelly which reduces water loss by 99 percent.  It contains no water and is best applied while the skin is still damp. Most patients do not like using solely petroleum as it is sticky and stains clothing. Other examples in this group include mineral oil, silicon, vegetable oils, and wax esters (like beeswax and vegetable waxes).

Humectant agents attract moisture. A popular ingredient for moisturizers is hyaluronic acid, which is also used in injectable fillers for wrinkles instead of the traditional collagen. Hyaluronic acid helps improve the appearance of the skin by causing the skin cells to swell and be less scaly. Other humectants include sodium lactate, urea, propylene glycol, glycerin, and some vitamins and proteins. Humectants work best at high humidity, greater than 70 percent.

What should you look for in a moisturizer?

Moisturizers that include glycerin or hyaluronic acid are great at trapping moisture in and preventing your skin from feeling dried out. Avoid purely oil based moisturizers. While they make your skin feel good at the time, they do not do a very good job of trapping in water. If you like using oils, I encourage you to layer a thicker moisturizer on top during the winter to prevent skin from feeling dry.

In addition to using an excellent moisturizer to hydrate your skin, humidifiers are a great defender against dryness. Humidifiers raise the moisture level in the environment and prevent evaporation of water from across the skin surface.  If neither a moisturizer nor a humidifier has helped your dry skin or you start to develop a rash with redness and itching, you may need to consult a dermatologist.

Photo of Angela LambAngela J. Lamb, MD, is the Director of the Westside Mount Sinai Dermatology Faculty Practice and Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. Dr. Lamb welcomes patients of all ages and has great expertise in the treatment of acne, eczema, and skin cancer detection. She is intent on partnering with her patients to determine the best course of treatment and ongoing care. She wants her patients to be actively involved in their medical treatment and feels that education is the key to healthy skin.

What is the difference between cream and lotion?

Creams ­are thick mixtures of grease in water or other liquids. Patients tend to prefer creams over ointments, as they contain less grease.

Lotions are mixtures of oil and water, with water as the predominant ingredient. Most lotions are not the best moisturizers for people with dry skin conditions, mainly because the water in lotion evaporates quickly.

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How Much Protein Do You Really Need?

Protein makes its way in and out of the news often, from high-protein/low-carb diet fads to the addition of protein in food products like sports bars and ice cream. Consumers can be left wondering how much protein they truly need.

The 2015 Dietary Guidelines for Americans recommend eating a variety of protein-rich foods, including lean meats and poultry, seafood, eggs, beans, peas, nuts, seeds, and soy products. Some dairy products, such as Greek yogurt and cottage cheese, are also good sources of protein. Whole grains, whole-grain products, and vegetables all contain some protein.

It is recommended that healthy adults consume 0.8 grams of protein per kilogram of body weight per day. Protein needs increase during periods of growth, pregnancy or lactation, infection, and injury such as trauma or surgery. Athletes in particular need more protein for muscle growth and repair. Depending on the type of training, needs range from 1.2 – 2 grams of protein per kilogram of body weight per day. Eating high-quality protein within two hours after exercise can help with this process.

Plant proteins are generally less digestible than animal proteins, which can be a concern for vegetarians. However, if vegetarians have a varied diet, that includes beans, legumes, nuts, seeds, whole grains, and colorful fruits and vegetables, they will likely get enough total protein

The recommended upper limit of protein intake is 30-35 percent of total calories in the diet; however, research is unclear as to how much protein should make up a single meal. Some research indicates that the body can only make use of a certain amount of protein at a time— about 20-30 grams—to build muscles. Other studies do not support a practical upper limit to protein intake at a meal. It appears the difference in these conclusions is due to what foods were eaten at meals, sources of protein, and desired outcome of protein intake. Specifically for muscle building, 30 grams at a time appears beneficial.

Note that exceedingly high-protein diets can harm overall health. Elevated protein levels can cause dehydration, kidney damage, and bone and calcium imbalance. It is recommended to limit red meat such as beef, pork, and lamb to 12-18 ounces (cooked) per week. Avoid processed meat such as bacon, sausage, ham, hot dogs, and other deli meats due to their link to stomach and colorectal cancers.

Overall, protein is an essential part of our diet, and choosing plant-based and/or lean animal proteins will help keep the body healthy. Protein-rich foods should be paired with a variety of fresh fruits and vegetables as well as a small portion of whole grains for optimal meal structure. It is best to spread protein intake throughout the day to ensure all meals are complete and balanced.

For a chart of healthy protein choices, click here.

Rebecca Guterman, MS, RD, CDN, is the Senior Dietitian at Mount Sinai’s Derald H. Ruttenberg Treatment Center which offers a wide range of outpatient services for all cancer diagnoses, with the exception of breast cancer.

What Does Protein Do?

Protein plays a role in many body functions. It helps cells communicate within our body, moves compounds through the blood, plays a role in energy metabolism, and helps with muscle contractions and building. Proteins such as collagen, elastin, and keratin are found in the bones, teeth, skin, tendons, cartilage, hair, and nails. Other proteins provide the body with protection against bacteria or viruses. Minerals such as copper, iron, and zinc are stored in body tissues bound to proteins.

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Why Diets Don’t Work and What to Do Instead

You might be thinking, why is a dietitian telling me not to diet? Don’t they put people on diets?

Well, it’s complicated. Let’s first define ‘diet’ in the context of this post. When I say diet, I am referring to an eating plan with rules focused on restricting foods, food groups, calories, etc. The diet’s primary measure of success is the manipulation of body size or maintenance of an ideal weight. Often these goals are set forth by a societal standard and not the individual person.

Diets also tend to moralize foods as good or bad, healthy or not healthy, clean or—for lack of a better word—dirty. The foods you eat on a diet and how much you eat are usually determined by external rules set forth by an individual or the diet itself, and not internal cues like hunger, fullness, and cravings.

Popular examples include the paleo diet, which heavily restricts highly processed foods along with grains, legumes, and dairy products; the ketogenic diet, a low-carbohydrate and high-fat diet that virtually eliminates fruit and root vegetables; or structured eating plans where you are counting points or calories throughout the day.

Nearly everyone has tried to diet and most have ended up feeling like a failure in one way or another. But it is not the individual who has failed; it’s the diet, because diets don’t work.

In the long term, diets are not sustainable. There is not a single randomized-controlled trial that can show sustained weight loss after two years on any diet. Within five years, 95 percent of dieters will regain all weight lost. Often, the regain will leave folks heavier than they were before the diet, because dieting can adversely affect your hormones and slow your metabolism.

It is absolutely possible to feel good and live a healthy lifestyle without dieting. Instead of the latest fad diet or obsessing over a food tracking app, try the following:

Forget the black and white thinking.

Labeling foods as good or bad makes it really difficult to listen to hunger, fullness cues, and cravings.  Think of all foods as one big, neutral shade of gray. There is a place for every food in a balanced, varied diet. Remove the stigma placed on certain foods and the pedestal we put on other foods. That’s right, have your cake and eat your kale too.

Instead of focusing on weight or body size, focus on how you feel.

What health-promoting behaviors will help you feel good? Make a list of these items: things like eating more vegetables, going for evening walks, taking an exercise class that you enjoy, or cooking dinner for your family. Identify the behaviors that make you feel good but that you may not be doing enough of, and vice versa. These behaviors and the frequency with which we practice them make a difference in long term health, not micromanaging our diets or weight.

Seek out help from a registered dietitian with non-diet, weight neutral philosophies.

Our relationships with food are complicated. It can be extremely hard to break up with dieting and the diet mindset. These specialized dietitians can help guide you on a path of diet freedom and a more positive relationship with food, and help you identify the health-promoting behaviors that can fit within your lifestyle.

Kelly Hogan, MS, RD, CDNKelly Hogan, MS, RD, CDN, is a registered dietitian who focuses on breast cancer nutrition for the Dubin Breast Center of The Tisch Cancer Institute. Ms. Hogan creates patient education and wellness programs and provides individual counseling in the areas of wellness, weight management, and symptom/side effect management.

While diets do not promote prolonged weight loss, they often lead to the following:

Increased cravings

Restricting certain foods and food groups often makes us want them more than ever.

Higher risk of bingeing

The restrictive nature of diets can also cause an increase in bingeing, the body’s physiological response to energy deficiency and starvation.

Nutrient deficiencies

Over long periods of time, eliminating certain foods or food groups can lead to deficiencies in fiber, calcium, and other vitamins and minerals.

A negative relationship with food

In some cases, the hyper-focus on food can lead to disordered eating, which profoundly impacts quality of life.

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How to Pick an Urgent Care Center

There are many urgent care centers throughout New York, and they are not all the same. Mount Sinai’s approach to urgent care is unique. Joseph Feldman, MD, FACEP, Mount Sinai Urgent Care Medical Director, explains why that’s important for you.

What can I expect when I walk into a Mount Sinai urgent care center?

When you visit Mount Sinai Urgent Care you become part of the Mount Sinai family.  Our centers are an integral part of the Mount Sinai Health System, known for quality care and cutting-edge research.

What are the qualifications of the doctors?

You will be treated by board certified Emergency Medicine and Family Medicine physicians along with skilled nurse practitioners and physician assistants. All physicians have faculty appointments to the Icahn School of Medicine at Mount Sinai and often train residents and medical students in the latest urgent care practices.

Why is a connection to a medical school important?

Mount Sinai doctors and researchers are developing strategies that will help patients avoid unnecessary visits to the hospital emergency department (ED). ED visits for conditions that are not true emergencies can be expensive and detrimental to your health. Our urgent care centers play an important role in providing you the right care and have shorter wait times

 Can I really just walk in?

We welcome walk-ins. If you have an urgent medical need that is not a life-threatening emergency, just come into any of our locations throughout Manhattan and Brooklyn. You can also reserve a spot with our online scheduling system. We see patients of all ages, from infants to geriatrics, and we take all insurance plans including Fidelis and HealthFirst.

 What if I need further care?

We have priority access to primary care and specialty physicians of the Mount Sinai Health System, ensuring you can get easy referrals if you need additional care. Some of our urgent care centers even have multi-specialty practices within the same facility. Our urgent care centers are connected to the rest of the Mount Sinai Health System through electronic medical records, making it easy for physicians to communicate about your care.

What exactly do you treat at Mount Sinai Urgent Care?

We treat almost any immediate medical issue that’s not a life-threatening emergency, from sprains and broken bones to wounds and rashes. If you’re feeling symptoms of common illnesses like strep throat, flu, urinary tract infections, or sexually transmitted infections, we can confirm a diagnosis with a test and provide the medication you need. We offer a full array of vaccines and PPD testing for tuberculosis. We can also conduct physicals for school, work, workman’s compensation, and no-fault evaluations.

What kinds of diagnostic tools and imaging are available?

We do a full range of blood work and perform electrocardiograms. Our certified radiology technicians also provide full X-ray services. Some locations offer more advanced imaging, including CT scans and ultrasounds.

Five Tips to Avoid the Flu

Last year’s flu season was one of the worst in recent memory.  The Centers for Disease Control and Prevention says a record number of people were hospitalized in 2017, which demonstrates why it’s so important to prepare for the flu each year.

Here are five simple tips from Joseph Feldman, MD, FACEP Mount Sinai Urgent Care Medical Director, to help protect you and your family this season:

  • Get the flu vaccine

The vaccine is safe and does not the cause the flu. It’s often available with no copay or a low copay. The CDC recommends an annual flu shot for everyone age six months and older.

  • Frequently wash your hands and use hand sanitizer

Pay special attention before eating  or after touching potentially contaminated surfaces like subway poles.

  • Avoid people who sneeze or cough without covering their mouths and noses

This can be tough in crowded spaces, but do your best. And help protect others by sneezing and coughing into your elbow.

  • If someone in your family gets sick, avoid close contact

Try to help your family member during their illness without getting too close and don’t share food or utensils.

  • Get plenty of rest

When you’re tired, your immune system may be weakened, so get enough sleep to ensure your body is prepared to fight off germs.

Following these tips will give you a good chance at a flu-free winter. But if you do feel flu-like symptoms such as fever, cough, sore throat, runny nose, or body aches, visit your primary care physician or an urgent care center immediately so you can begin treatment, if necessary.

“Mount Sinai Now” Offers Urgent Care Via Video Screen

A virtual visit was demonstrated by Nicholas Genes, MD, PhD, Associate Professor of Emergency Medicine, and Natalya Sholomyansky, Director of IT Digital Health.

A new telehealth service, Mount Sinai Now, is available free to Mount Sinai Health System employees and their dependents who are covered by Mount Sinai’s Empire Blue Cross/Blue Shield plan. The service provides patients with urgent care from a board-certified physician, almost always a Mount Sinai clinician, via video conference. If there is an emergency, patients should call 911. But Mount Sinai Now, like other urgent care, can be a good choice for treating conditions such as allergies, colds and flu, nausea, rashes, and sprains, says Abraham L. Warshaw, MD, Senior Vice President, and Medical Director of Physician Access Services, Mount Sinai Health System.

The service, which is available 24 hours a day, is part of Mount Sinai’s mission to take the lead in telehealth and population health management. “The idea is giving the right care, in the right place, at the right time,” Dr. Warshaw says.

In a typical visit, a patient might wake up with a sore throat and nasal congestion. She logs into Mount Sinai Now, and within minutes the visit starts, with the patient communicating through FaceTime or another video tool. The physician asks about symptoms, consults the patient’s medical records, and conducts a virtual examination via webcam and monitor, for example evaluating the throat and tonsils, and demonstrating how to check for swollen lymph nodes. Finally, the physician might call in a prescription, or if the symptoms are ambiguous, recommend an appointment with a primary care physician or a specialist.

More than 1,300 staff have registered and 200 have been treated since Mount Sinai Now became available throughout the Health System in May. The team’s plan is to expand the service to other companies, unions, and the public once insurance models are in place.  “Patients who use telehealth are saving money, saving travel time, and are able to continue their daytoday life without having to interrupt things or schedule an appointment that might be weeks away,” says Eric Cannan, Senior Director, Telehealth, Mount Sinai Health System.

To register for the free service, go to now.mountsinai.org or visit Google Play or the Apple App Store to download the Mount Sinai Now app.

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