Earth Day Tips for Eating Clean While Going GREEN!

By: Angela Luciani, Registered Dietitian

Earth day is celebrated on Saturday, April 22nd. You can help celebrate by incorporating some sustainable practices through your eating habits and daily routine that can protect the environment!

1)      Choose fresh and local - Fresh and local is a great way to help out the environment by reducing fuel for transportation! There are lots of opportunities to ‘eat local’ in Philadelphia through restaurants, food co-ops, community supported agriculture, and farmers markets. Keep in mind the seasonality of the produce. You can find out what is in season by checking out the link here for a list:

2)     Grow your own - If you have the space: start with easy to grow vegetables such as cucumbers, tomatoes, or peppers. If you are living in an apartment or don’t have an outdoor area, you can still grow herbs in a small pot on your windowsill or consider joining a community garden!

3)     Eat clean -  Aim to consume more plant-based, minimally processed foods to cut back on packaging and pollution from transportation and manufacturing. Choose organic, when possible, to reduce pollution in the air and soil, and waste by helping reduce the use of pesticides. Check out the dirty dozen list here for foods that you should aim to purchase organic.

4)     Reduce waste - Food waste has a negative impact on the environment – try getting creative with how to use your leftovers such as taking vegetable leftovers for a morning omelet or using the unwanted ingredients such as the skins/stems for making a delicious broth. When grocery shopping: cut back on food packaging and paper goods by purchasing in bulk for cooking and freeze the rest for another meal and using your own reusable grocery bags!  

When we reduce, reuse and recycle by choosing fresh and eating clean, we can minimize our carbon footprint while simultaneously benefiting our health! If you would like more information on healthy eating, don’t hesitate to schedule an appointment with one of our dietitians today!

Mental Health and Alcohol Abuse

By: Courtney Liggera, Psy.D.

“Beer is proof that God loves us and wants us to be happy.” - Benjamin Franklin

It’s easy to be glib about drinking. It is, after all, a significant element of most social activity.  Drinking alcohol helps us let loose, shake off the strains of a hard day, and connect with good friends. It provides a temporary positive impact on one’s mood. It does all of the above… when enjoyed in moderation.

But alcohol abuse, particularly long-term alcohol abuse, can have devastating effects on your mental health, not to mention your physical health. (Apologies for not being glib about that.)

Alcohol abuse tends to increase mental disorders. Specifically, the odds of developing a mood disorder are 3.6x greater for someone abusing alcohol compared to one who does not.  The odds for developing an anxiety disorder are 2.6x greater (Balhara 2015).

The co-occurrence of alcohol abuse and mental illness is associated with:

●     Greater risk of various psychological, interpersonal, and social problems

●     Impaired decision making

●     Poor therapeutic adherence (not sticking with therapy)

●     Increased risk of relapse

●     Increased risk of self-harm (including the risk of suicide)

The brain depends on a balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting thoughts, feelings and actions – and, at times, our long-term mental health.

The calm feeling one can get after a first drink is due to the chemical changes alcohol causes in the brain. For many people, having one drink can make them feel more confident and less anxious. That’s because the alcohol is starting to depress the part of the brain that is associated with inhibition.

However, the more a person drinks, the more the brain starts to be affected. Regardless of the mood you’re in to begin with, when high levels of alcohol are involved, instead of that calm and relaxing feeling increasing, it’s more likely that a negative emotional response will take over.

In other words, reaching for a drink won’t always have the effect you’re seeking. While having a glass of wine or a beer after a hard day might help someone relax initially, in the long run it can contribute to feelings of depression and anxiety and make stress harder to cope with. This is because drinking a lot on a regular basis can interfere with neurotransmitters in our brains that are essential for positive mental health.

Drinking tends to alter one’s perception of a situation and impacts one’s ability to respond appropriately and accurately to all the cues around us. For example, if someone is prone to anxiety and notices something that could be interpreted as threatening in the environment, it's likely one will focus in on that and disregard other less threatening/neutral information. Or, someone might narrow in on a partner talking to someone they are jealous of, rather than noticing all the other people they’ve been chatting with before that.

If one drinks heavily and regularly, they are more likely to develop some symptoms of depression. That is largely  due to the fact that regular drinking lowers the levels of serotonin in the brain – a chemical that helps to regulate mood.

Someone who already experiences anxiety or depression is more likely to develop drinking problems. For some people, the anxiety or depression came first and they’ve reached for alcohol to try to relieve it. For others- drinking came first, so it may be a root cause of their anxieties.

If you tend to drink to improve your mood or mask your depression, you may be starting a vicious cycle. Here are some warning signs that your drinking is affecting is your mood:

●     Poor sleep after drinking

●     Feeling tired because of a hangover

●     Low mood (depression)

●     Experiencing anxiety in situations where you would normally feel comfortable

Here are some ways to prevent alcohol from affecting your mood and from increasing your dependency on alcohol:

●     Use exercise and relaxation to tackle stress instead of alcohol

●     Learn breathing techniques to try when you feel anxious

●     Talk to someone about your worries. Don’t try and mask them with alcohol

●     Always be aware of why you’re drinking

●     Don’t assume drinking will make a bad feeling go away, it’s more likely to exaggerate it

If you think you have a problem with alcohol or just want to talk with someone about how you are feeling, then the next step is to reach out to someone you trust or to go directly to a mental health professional who can ensure that you get the help and support you need. Getting help for alcohol abuse and mental health issues is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, it’s easy to fall back into old patterns when things get tough.

For some individuals, abstinence from alcohol is the only workable solution. For others, drinking in moderation works. However, alcohol abuse works for no one.

April: Sexually Transmitted Infection Month

By: Maria Mazzotti, DO

April is Sexually Transmitted Infection month. Typically the nicer weather that comes with Spring causes an upsurge in STI’s. People are getting out more and meeting more people which may lead to more sexual encounters. 

Chlamydia is the most common sexually transmitted infection, especially in males and females between the ages of 20-25. Often times patients may not even have symptoms, but if left untreated in females it can lead to infertility. Once diagnosed, it is easily treated with antibiotics.

Gonorrhea is another common STI. In addition to it being found in the mucus membranes of the cervix, uterus and fallopian tubes, it can commonly infect the mucus membranes of the mouth, throat, eyes and rectum. .  Prolonged or undiagnosed gonorrhea infections can also lead to infertility, however this infection can also be treated fully with antibiotics once diagnosed.

Chlamydia and Gonorrhea cause 30-50% of a very serious complication of infections called Pelvic Inflammatory Disease. Symptoms of PID include lower abdominal/pelvic pain, increased discharge, irregular menstrual bleeding, fevers, pain with intercourse, urinary frequency and pain, cervical motion tenderness and inflammation. In addition to being sexually transmitted, these infections can be transmitted through pregnancy/delivery to newborns.

Trichomoniasis is a lesser known STI, but this infection seems to be on the rise. It is also treated with antibiotics. Fortunately, this parasite is not transmitted to newborns through pregnancy/deliveries. All of the above infections are diagnosed with a vaginal swab or urine test in females.

Syphilis is a less common infection these days. In addition to being transmitted sexually, it can also be transmitted through contact with blood products and with pregnancy. Unlike the previous infections, symptoms may (but don’t have to)include a rash and sores in the genital, rectal and mouth areas. Once diagnosed it is treated with antibiotics, but if left untreated it can lead to serious neurological complications.

Another infection that may present with genital lesions is Genital Herpes. This is a viral infection, and unlike the previous infections mentioned above, it is not curable. Antivirals will resolve acute symptoms and future outbreaks. These medications also suppress transmission to future partners. This infection can also be transmitted to newborns with pregnancy/delivery. Currently, the only way to diagnose this infection is with a culture of the lesion (usually obtained by a swab, but this has to be taken during an outbreak).

Hepatitis C has also been considered a sexually transmitted disease in the past, however newer studies show us that sexual transmission of this virus is not very effective. That being said, hepatitis C is still more likely to be transmitted sexually in people with other illnesses (such as HIV or diseases requiring dialysis) and those who may have wound-healing issues. The most common mode of transmission for HCV is parenteral through sharing needles or other instruments. This infection can also go undiagnosed for decades due to the varying severity of viral symptoms. Newer treatments can cause the virus to be undetectable.

Human Immunodeficiency Virus (HIV) is another sexually transmitted infection. In addition to being sexually transmitted it can be passed along in blood products and with pregnancy/delivery. At this time there are multiple regimens that will keep the infection under control or make the virus undetectable.  

Syphilis, Hepatitis C and HIV can be diagnosed with a blood test. When anyone is diagnosed with any of the infections mentioned so far, physicians are required to report the infection to the local health department. The local health department is in charge of preventing the spread of these infections as well as tracking the number of people being infected.

Human Papilloma Viral infections are transmitted with vaginal, rectal and oral sex. There are numerous strains that can cause cervical, rectal and laryngeal cancer. Certain strains also cause warts in these areas. There is no treatment for the infection, but this virus is the only virus which has a vaccine that can be used to prevent the common strains that cause Cervical, Vaginal, Vulvar, Anal, Throat and Penile Cancer. HPV vaccines are recommended for males and females from ages 9-26. 

At this point this summary has probably caused a lot of anxiety about being sexually active. It is important to remember that condom use with every sexual encounter can prevent most transmissions of these infections. Obviously, coming in for regular screenings for cervical cancer or STI screenings, even though they can be scary or painful, is important to you and your partner’s health. The safest thing to do is to Know Your Status! If you have not had STI screenings in some time and have been sexually active without protection - please don’t hesitate and schedule an appointment with one of our providers today. Do not hesitate to take the time to ask any questions that you are uncertain about. Having knowledge about your STI status and what infections are out there can help you make educated decisions about your health!

Nutrition and Kidney Health

By: Marissa Martino, Registered Dietitian

Most of us don’t even think about our kidney health until they are already in danger, whether that’s from uncontrolled blood sugar levels or other complications like high blood pressure or obesity. The status of our kidneys depends greatly on our diets, and is impacted by the different foods that we eat, as well as hydration levels. Before we discuss kidney health, let’s ask the question: What do your kidneys do? About 200 liters of blood are filtered daily through your kidneys, removing up to 2 liters of water and waste products via urine. If our kidneys are not working as efficiently as usual, the process of blood filtration is not as effective leaving dangerous amounts of waste in our body. The kidneys also release hormones that regulate blood pressure and produce red blood cells.

There are also kidney-friendly superfoods that we can incorporate into our diet on a daily basis. These include cruciferous veggies such as cabbage, cauliflower which are high in Vitamins C and K, but low in potassium. Berries are high in antioxidants and also have anti-inflammatory properties which are important for your kidneys as well as your entire body. Healthy fats such as fish and olive oil contain omega-3’s which also help prevent inflammation.

No one wants to deal with dialysis on a weekly basis, so being proactive with kidney health is important and smart. Even without a diagnosis of DM2 or kidney disease, we should take preventative measures. Patients who do have a diagnosis that can compromise kidney health in the future can still utilize these and other preventative measure to care for their kidneys as best as possible. Talk to your doctor about kidney-protective medications and talk to your local dietitian (that’s me) about changing your diet for optimal health. Once kidney damage is done, it’s irreversible, however, avoiding the damage is possible in many cases and can lead you to a much better quality of life.

There are preventative measures that can be taken to keep your kidneys healthy:

-       Limit alcohol intake
-       Watch out for salt by staying away from packaged, processed, canned foods
-       Read food labels -  make sure salt is under 20%
-       Get your bloodwork done! Kidney disease is a silent killer and symptoms don’t start to show until there is already significant damage in place..

Stay healthy and even if you have been diagnosed with a kidney damaging illness - do not lose hope. In many cases, these illnesses are not a death sentence, but they do require more effort to stay active and healthy. When in doubt, call our office and schedule an appointment with your physician or dietitian!

Seizure First Aid

By: Monica Duvall, MD

A seizure is a type of abnormal or excessive electrical activity in the brain that results in changes in a person's awareness and/or behavior. Seizures can be triggered by different mechanisms--head trauma, stroke, infection, tumor, low blood sugar, and excessive alcohol are some causes--and they often come without warning.The person who has a seizure may be injured during the seizure, and s/he may be confused or embarrassed afterward. Awareness of what happens and what to do during a seizure can help to keep the person seizing safe and calm.  

There are many types of seizures. Tonic-clonic, or Grand Mal, seizures are what most people think of when they hear the word "seizure", and this is the most common seizure situation in which first aid is needed. In this situation, a person loses consciousness for anywhere from seconds to a few minutes. The person typically becomes stiff and will have severe jerking movements. Often they lose control of their urine or have a bowel movement. Frequently they have very shallow breathing or may appear to not be breathing at all. Afterwards, the person will have a period of confusion, with no memory of what has happened. The person will likely be scared and embarrassed.

When a person has a Tonic-clonic seizure, it is important to remain calm. Delegate someone to call 911.  The person should be eased to the ground and rolled to his/her side, with the mouth facing downward to allow saliva to drain so s/he can breathe easily. The area should be cleared of any sharp or hard objects that could injure the seizing individual. Eyeglasses should be removed, tight clothing (like a necktie) should be loosened, and a soft item, like a pillow or jacket, should be placed under the head to prevent injury.  You should NOT restrain the seizing person, nor should you place anything in the person's mouth while they are seizing, even if you think they are not breathing.  People who are seizing CANNOT swallow their tongue, but they can choke on or be injured by other things that are placed in the mouth. If someone does stop breathing during a seizure, it is appropriate to start performing CPR only AFTER the seizure is over. Try to keep track of how long the seizure lasts, if possible. Keep crowds away, so the person seizing will not be overwhelmed when s/he returns to consciousness. When the seizure is over and the patient becomes more alert, explain in simple terms what has happened. You should stay with the person until they have fully recovered and/or until medical help arrives.  

Having a seizure is a frightening and dangerous occurrence; as a bystander, remaining calm and knowing what to do in this situation can help to prevent further injury to the seizing individual, and bring much-needed comfort to him/her at a critical time.

Winter Skincare

By: Maria Daly, Practice Manager

Skincare doesn’t end at the end of the summer! Your skin is a huge organ which protects you from the outside elements. Whether this is heat, cold, wind, water, a butter knife or a single bacterial cell - your skin has the capacity to protect you from all of these items and more.

In exchange, as with any item you value - your skin does need to be treated a certain way to ‘hone’ its protective properties and this treatment is a year-round process.

Depending on your climate, winter cold can be drying on the skin, so using a moisturizer on exposed areas such as your face, ears and hands can keep your skin from over drying and cracking in the cold - a process that exposes it to further damage.

Some people get cold rashes all over their body - this skin also needs to be moisturized to prevent the same consequences - overly dry skin can crack and bleed leading to further damage and possible infections.

Another skincare procedure many people opt out of in the winter is using sunscreen! The UV rays that can cause not only skin cancer but also simple ‘skin aging’ changes such as wrinkles affect our open skin whenever the sun is up, so using sunscreen is a vital part of keeping your skin healthy and protected.

At the DermaCenter we offer many types of Sunscreen, including Environ, Avene and La Roche Posay.  Our aestheticians can consult you to see which type of sunscreen is best for you. Please call the office to set up a free consultation to see what products are best for your skin!

The Link Between Your Heart and Your Skin

By: Jayme Hudson, Aesthetic Director

Did you know February is heart health awareness month? Many people are not aware that having a healthy heart and normal blood pressure can aide in the fight against premature aging and other adult skin issues. Elevated blood pressure can lead to fine lines, wrinkles, sagging skin and under eye bags. These problems may occur for a few different reasons. High blood pressure causes lack of oxygen to vital organs, such as the skin, and sleep disorders (lack of sleep). When the skin cells are lacking oxygen, the skin becomes dry leading to pronounced wrinkles and lines while lack of sleep does not allow the skin to naturally heal and repair itself.

Overall, maintaining a healthy heart and normal blood pressure is not only important for your overall health but also plays a big role in your appearance. Having a well balanced healthy diet, exercising daily, and reducing your sodium and alcohol intake are things you can do to improve your blood pressure which will leave you looking and feeling your best!

Blood Pressure and Your Heart

By: Maria Mazzotti, D.O. 

February is American Heart Month. There has been a long debate in medicine about which organ is more important, the heart or the brain. I am not sure we have reached a conclusion, but your heart is a vital organ. Prolonged elevated blood pressure is one of the main factors contributing to heart disease (as well as kidney disease).

Your blood pressure reading is made up of two numbers. When either or both are elevated this is called hypertension. Your systolic blood pressure (the top number in your blood pressure) is a reflection of the pressure in your heart when the blood is returning to your heart. The Diastolic blood pressure (bottom number of your blood pressure reading) is a reflection of the pressure your heart is pushing against to get the blood out of your heart to the rest of your body.

     -Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg

     -Prehypertension: systolic 120 to 139 mmHg or diastolic 80 to 89 mmHg

     -Stage 1 hypertension: systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg

     -Stage 2 hypertension: systolic ≥160 mmHg or diastolic ≥100 mmHg

     -Isolated systolic hypertension: blood pressure of ≥140/<90 mmHg

     -Isolated diastolic hypertension: blood pressure <140/≥90 mmHg

There are multiple factors that impact your blood pressure. Genetics, age, weight, stress and diet can all contribute to causing hypertension. Obviously, you cannot do anything about your genetics and aging. However, we know our blood pressure may go up with weight gain and it can go down with weight loss. Caffeine, alcohol, processed foods, spinach, canned soups, red meat and licorice can increase your blood pressure also. Alternatively foods like flax seed, dark chocolate, olive oil, beets, pistachio, broccoli, bananas, yogurt, white beans, red bell peppers, citrus, seafood, whole grains, and kiwi can lower your blood pressure. Many of the blood pressure lowering foods are high in Calcium, Magnesium and Potassium (Also known as the DASH diet).   

Aside from diet, there are additional ways to decrease your blood pressure:  

  • Exercise and meditation
  • Controlling stress and anxiety
  • Treating any other illnesses you have that may impact blood pressure - such as diabetes.
In turn, your blood pressure can impact other organs. Elevated blood pressure can enlarge your heart, damage your blood vessels (which can, in turn, increase your blood pressure even more), affect your eyes and kidneys. Significant damage to these organs can lead to strokes, kidney failure and heart attacks.  

So during American Heart Month, be kind to your heart.  Focus on watching your diet, exercising and keeping your stress level down and you know you will have done all that you can to control your blood pressure. And in turn you will have one less risk factor for heart disease.

Nutrition Related Birth Defects: Healthy Eating During Pregnancy

By: Angela Luciani, Registered Dietitian

There’s no reason to wait for a positive pregnancy test to start making healthier choices and aim for an overall healthier lifestyle. Incorporating healthy habits is important and beneficial at any stage of pregnancy but also before conception. Implementing healthier habits before pregnancy can improve the health of the mother as well as the baby by preparing the body for the high demands of pregnancy. Women are susceptible to a number of complications during pregnancy.  Research suggests women who are obese (BMI over 30) have a higher incidence of pregnancy-induced hypertension, gestational diabetes, cesarean delivery, and macrosomia. Being either underweight or overweight can reduce the chance of conceiving. Ideally, both partners should aim for a healthy BMI (between 18.5-24.9). Excess body fat or insufficient amounts can interfere with fertility.  Starting pregnancy at a healthy weight can lower the risk of complications. Eating well can help keep blood pressure, blood sugar levels and weight at normal levels and can help reduce incidence of complications. 

While there are a various factors that influence a healthy pregnancy, good nutrition is, without question, a determining factor in both a healthy pregnancy and baby. Women who are overweight or obese before conception are more likely to have a baby with a structural defect, including neural tube defects. Neural tube defects may be preventable through a healthy lifestyle and adequate nutrition. Spina bifida is a condition in which the fetal spinal column is unable to close completely during the first month of pregnancy, causing damage to the developing spinal cord. Anencephaly is a more serious defect and prevents the development of the brain. Birth defects occur in the first weeks of pregnancy. Folic acid can help prevent neural tube defects; therefore, it is important to have these nutrients in your system during early stages of the baby’s development. Women of childbearing age should consume at least 400 micrograms (.4mg) of folic acid daily to prevent these two common and serious birth defects. Women carrying twins or more, and those with epilepsy or diabetes require extra folic acid. Another essential vitamin to prevent neural tube defects is choline. Ensuring adequate choline may not only lower the risk of brain or spinal cord birth defects but it may also enhance the development and function of the placenta and possibly lower an infant’s vulnerability to stress-related illnesses including mental health disturbances, hypertension and type 2 diabetes. The recommendation for choline is 425mg per day for women and increases to 450 mg per day when pregnant and 550 mg per day for lactating women.

Optimal fetal brain and eye development is dependent on omega-3 fatty acids, DHA and EPA which can be found in seafood and fish oil. Research has revealed long-term benefits of prenatal omega-3 fatty acid intake includes higher memory function later on. DHA may lower incidence of colds in infants and shorten duration of symptoms associated such as coughing and fever. Women should aim for 650mg of omega-3 fatty acids, of which 300 mg is DHA per day. Consuming 2-6-oz servings of low mercury fish per week such as wild caught Alaskan salmon, tilapia, shrimp or cod provides 100-250mg of omega-3, of which 50-100mg is from DHA.  Consider incorporating fish oil capsules, which are low in contaminants of mercury to assist in meeting the recommendations.  Vegetarians can obtain DHA from algae-derived DHA supplements.

Iron is necessary for both fetal and placental development and needs increase dramatically after becoming pregnant. Consumption of foods rich in iron is necessary to prevent a deficiency and/or anemia. Research suggests that iron stores at time of conception are a strong indicator for risk of developing iron deficiency anemia later in pregnancy and deficiency may increase risk for preterm delivery. Pregnant woman need at least 27 milligrams of iron each day..  Low levels of Vitamin B-12, which is essential in the production of red blood cells, can also lead to anemia.  The RDA for B-12 for pregnant females is 2.6 micrograms and 2.8 micrograms for breastfeeding females.

The best thing you can do for your baby is eat a healthy, well balanced diet.  It is important to understand the benefits of good nutrition prior to, as well throughout, pregnancy in order to minimize potential risks and complications. A well-balanced diet is achievable; however, may be difficult to obtain optimum levels of nutrients through diet alone; therefore, incorporating a prenatal vitamin prior to and throughout pregnancy may be necessary and can improve your chances of having a healthy baby. 

Preventing Vaginal Infections

By: Dana Shanis, M.D.

Most women have experienced a vaginal infection at some point in their lives and know how it can not only be uncomfortable, but can interfere with daily activities. These infections occur when the natural bacteria that live in the vagina, primarily Lactobacillus types, are unable to thrive. When present in the vagina, these bacteria create a byproduct that keeps the environment acidic, prevents attachment of bad bacteria and yeast, and promotes the local immune system to fight infections. 

Anything that changes the pH of the vagina can reduce or wipe out the good bacteria in the vagina and put you at risk for an infection. This can include stress, medical illnesses, and vaginal irritation by soap, detergents, or lubricants. Changes in hormone levels, due to birth control pills, your period, or around menopause can also affect the vaginal pH and increase the chances of an infection. Taking antibiotics can directly kill the good bacteria and is a significant risk factor for yeast infections. 

Since most of the bacteria in the vagina originate in the intestines, the best way to ensure there is enough good bacteria is to have a diet rich in probiotics. Dairy products and fermented foods (such as those listed below) are especially high in the strains of bacteria helpful in maintaining the vaginal environment. While getting probiotics from food is preferred, if needed, oral supplements can be used as well. Supplements with multiple Lactobacillus species, including L. acidophilus, are the most effective in restoring good bacteria to the vagina. It is also important to have adequate fiber intake in your diet to avoid constipation. Straining can irritate the pelvic floor muscles and cause spasms and inflammation, which can affect the local pH in addition to causing pelvic pain. 

Tips for Maintaining and Restoring Good Bacteria

      Use dye-free and fragrance-free soaps, detergents, tampons, and pads

      Avoid excess moisture by drying area after showering, wear cotton underwear

      Consider sensitive lubricant and/or latex-free condoms

      Do NOT douche

      Have probiotic foods daily

     ○ Yogurt

     ○ Kefir

     ○ Sauerkraut        

     ○ Dark chocolate

     ○ Miso soup

     ○ Pickles

     ○ Tempeh

     ○ Kimchi

     ○ Kombucha tea 

     ○ Soft cheeses                   

      Ensure adequate fiber intake ideally with vegetables and whole grains

Call your provider if you notice changes in your discharge, a new odor, itching, burning, bumps or abdominal pain.

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