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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • June 13, 2018

    By MedStar Health

    Summer is here...time to get outdoors and enjoy the warm weather. But for seniors, the heat and sun can be dangerous if the proper precautions aren’t taken.

    “Hot weather is a serious health concern for seniors. As we age, our bodies are less efficient at sweating, which is the body’s way of cooling. Also, the sensation of thirst decreases,” says Elizabeth Richmond, CRNP, a nurse practitioner in the Center for Successful Aging at MedStar Good Samaritan Hospital.

    “To further complicate matters, many older adults have heat-related problems caused by prescription medications that limit the amount of fluids they can safely drink, electrolyte imbalances due to a salt-restricted diet, and chronic diseases that can impact blood flow or increase the possibility of dehydration,” she notes. Here are some tips that the elderly, as well as their caregivers, can use to make sure they have a safe summer:

    Drink Lots of Water.

    The rule of thumb is to drink half your body weight in ounces. However, be sure to check with your doctor to make sure your fluids aren’t restricted. In addition to water, Richmond recommends that seniors drink sweat replacement products containing salt and potassium.

    Stay in Air-Conditioned Areas.

    If you don’t have air-conditioning, try to get to a public building such as a mall or library. During heat waves, many communities in our area set up cooling centers for seniors and other vulnerable populations.

    Dress for the Weather.

    When it’s hot out, wear light-colored, loose-fitting clothes and a wide-brimmed hat. Put on sunglasses to protect your eyes from harmful UV rays and don’t forget the sunscreen.

    Know the Risks of Hyperthermia.

    Be cautious about abnormally high body temperatures—a condition known as hyperthermia. Heat stroke is an advanced form of hyperthermia that can be life-threatening at any age, but more so in older adults. Know the warning signs and get medical attention immediately if you or anyone you know is experiencing these symptoms:

    • Body temperature greater than 104 degrees
    • A change in behavior, such as acting confused or agitated
    • Dry, flushed skin
    • Nausea and vomiting
    • Headache
    • Heavy breathing or a rapid pulse
    • Not sweating, even if it’s hot out
    • Fainting

    “Elderly individuals are more prone to heat stroke,” adds Richmond. “If your neighbors or loved ones are elderly, check on them regularly to ask how they are doing. Even over the phone you can usually tell if there is something wrong.”

    For a free cool neck wrap and water bottle, complete this form or call 410-248-8322.

    This article appeared in the summer 2018 issue of Destination: Good HealthRead more articles from this issue.

    Location Information

    Center for Successful Aging
    MedStar Good Samaritan Hospital
    Russell Morgan Bldg., Suite 502
    5601 Loch Raven Blvd.
    Baltimore, MD 21239
    443-444-4720

    Related Article

  • June 13, 2018

    By Christopher M. Gallagher, MD

    Data from a 2018 study have confirmed the standard of care for many women with early-stage breast cancer: chemotherapy isn’t always necessary, and actually is unlikely to be effective in certain women This is incredible news because more women potentially can avoid the toxicity of chemotherapy as well as the financial and time burden of chemotherapy treatments.

    The new study published in The New England Journal of Medicine, revealed that a majority of women over 50 who have estrogen receptor-positive and lymph-node negative breast cancer don’t benefit from chemotherapy. This is the largest prospective study ever conducted in terms of breast cancer treatment, and the findings have the potential to impact treatment decisions of up to 70,000 patients a year in the United States.

    The results validate the standard of care for breast cancer patients that we have provided at MedStar Washington Hospital Center for over a decade. All our patients receive personalized care, including the use of genomic tests such as was done in this study to make recommendations on whether individual women might benefit from chemotherapy. The study focused on cases in which chemotherapy’s value to women with breast cancer was already in doubt as a standard of care, including cancers that are:

    • Hormone receptor-positive, or grow due to estrogen or progesterone
    • In the early-stage and have not spread to lymph nodes
    • Not the type that the requires use of targeted drugs such as Herceptin
    A study from @NEJM suggests that chemotherapy is not always necessary for women with intermediate-risk, early-stage breast cancer. bit.ly/2MjqfPr via @MedStarWHC
    Click to Tweet

    What the data say

    Researchers in the study examined the results of more than 10,000 women with breast cancer who had a test called Oncotype DX. The test is performed on their tumor to estimate the risk of recurrence through measuring the activity of several cancer genes involved in cell growth and their response to hormone therapy (a cancer treatment that limits the growth of cancer causing hormones) and chemotherapy. Women were only included in the study that had estrogen receptor positive (ER+) tumors, tumors that were negative for human epidermal growth factor receptor (HER2) over expression, and had negative lymph nodes.

    Approximately 17 percent of women who met criteria for this study had high-risk scores and were advised to undergo chemotherapy. Approximately 16 percent of women had low-risk scores and were recommended to only receive hormonal therapy.

    The results focused on the remaining 67 percent of women who were considered at intermediate risk. All these women had breast cancer surgery and hormone therapy, and half also got chemotherapy. After nine years, 94 percent of the patients from both groups were still alive, and about 84 percent of the survivors had no signs of cancer, which suggests that chemotherapy made no difference in their types of cancer.

    What’s next for chemotherapy?

    Even before this study, breast cancer treatment standards had been moving away from chemotherapy for select patients. As more advanced and personalized treatment options have become available, chemotherapy recommendations are made less often. Moreover, I expect as more targeted therapies and immunotherapies are scientifically studied and become available, less chemotherapy (and associated toxicity) will be needed.

    At MedStar Washington Hospital Center, we routinely use genomic tests such as Oncotype Dx to identify patients who are at low or intermediate risk of breast cancer recurrence and are not likely to benefit from chemotherapy. However, we know that women at high-risk of breast cancer recurrence who have breast cancer that is triple-negative, HER2-positive, or lymph-node positive can benefit from chemotherapy.

    This research will help validate treatment decisions for more women and their doctors. The next step in research will be extended, longer-term follow-up of breast cancer patients. Taking it a step further, we may improve genomic assays to determine whether there is a better line in the sand at which we can feel 100 percent confident that a woman doesn’t need chemotherapy. I don’t know when we’ll ever get there, but I do think there will be improvements in the near future. In the short-term, I believe we’ll see women with breast cancer and their doctors feel more comfortable using genomic tests to make decisions about chemotherapy.

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  • June 13, 2018

    By MedStar Health

    Conservative Approach Improves Quality of Life

    The Center for Successful Aging at MedStar Good Samaritan Hospital continues to expand its services to address the needs of individuals experiencing age-related conditions. With the addition of a new program focused specifically on geriatric arthritis, older adults dealing with this often debilitating degenerative joint disease have easier access to specialized care.

    “Osteoarthritis is the third most common diagnosis in the elderly and can cause significant pain leading to disability and decreased quality of life,” says Carmen Pichard-Encina, MD, the new chief of Geriatric Orthopaedics at MedStar Good Samaritan. “Unfortunately, many believe that the only treatments for this condition that provide real relief are surgical ones. That could not be farther from the truth.”

    Working on-site with the geriatrics experts at the Center for Successful Aging, Dr. Pichard-Encina focuses on patients who may be suffering with arthritis and its symptoms. She emphasizes the importance of customized treatment plans that rely on non-surgical options for managing it.

    “Many older individuals are not candidates for surgery and some individuals simply do not want surgery,” she explains. “There are numerous other treatment options that can provide them with relief from the pain and other symptoms they may be experiencing.”

    Carmen Pichard-Encina, MD

    Novella McLean, a patient of George Hennawi, MD, director of the Center for Successful Aging, is a good example. The 100-year-old had been experiencing a lot of pain in her knee as a result of osteoarthritis. “My mom is very independent … she wouldn’t even agree to move here from her home in North Carolina unless she could have her own apartment,” says Rev. Brenda Tuggle, her daughter. “But her knee pain was affecting her quality of life. She was not getting any relief taking medications and she didn’t like taking them. At her age, surgery was out of the question and, for a long time, she refused to consider any other options.”

    Finally, she agreed to see Dr. Pichard-Encina. “The best treatment plan depends on the cause of the pain as well as any other issues that may be contributing factors. That’s why a team approach that ensures a complete understanding of each patient’s complex needs is so important,” she says.

    Dr. Pichard-Encina notes that conservative measures play an important role in the management of osteoarthritis-related pain and disability in the geriatric population due to increased risk of other existing conditions, medication toxicity, and the use of multiple medications.

    George Hennawi, MD

    “In the elderly, treatment options like exercise, weight loss, physical therapy, bracing, and the use of assistive devices, such as canes and walkers, should be considered first to minimize the adverse effects of medication,” she says. “Unfortunately, these treatments aren’t effective for all individuals, so we rely on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to treat osteoarthritis pain. Several other oral, injectable, and topical agents are available as well. We try to avoid the use of narcotics.”

    To help alleviate McLean’s pain, Dr. Pichard-Encina recommended an intra-articular cortisone injection, a minimally invasive treatment for pain that involves injecting a corticosteroid medication into the joint to help decrease swelling and thus relieve the associated pain. Today, McLean is feeling much better and is thriving.

    “Most elderly patients are dealing with multiple health issues. We provide them with access to all the specialists they may need, all in one place, which promotes communication and collaboration. As a result, treatment plans address the needs of the whole person, not just one condition,” Dr. Pichard-Encina adds.

    For more information, visit MedStarHealth.org/DestinationGoodHealth or call 410-248-8322.

    This article appeared in the summer 2018 issue of Destination: Good HealthRead more articles from this issue.

    Location Information

    Center for Successful Aging
    MedStar Good Samaritan Hospital
    Russell Morgan Bldg., Suite 502
    5601 Loch Raven Blvd.
    Baltimore, MD 21239
    443-444-4100

    Learn More About Arthritis and Geriatric Care

    Did You Know?

    Osteoarthritis is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine.

  • June 13, 2018

    By MedStar Health

    We know how challenging it can be to keep track of your health records and appointments. That’s why we developed myMedStar—a free and secure online patient portal where you can conveniently manage your health information anytime, anywhere.

    “Many patients, especially those with complex medical histories, have found myMedStar to be an invaluable tool for helping to take charge of their health,” says Herbert Friedman, MD, MBA, chief medical information officer at MedStar Good Samaritan Hospital.

    “Because the portal is fully integrated with our electronic medical record system, patient information is available in real time, within one system. That means only one myMedStar account is needed to communicate with all participating facilities,” he notes.

    With myMedStar, you can:

    • Review most laboratory test results, after provider review
    • View a summary of your hospital stay or office visit
    • Send your medical information securely to other healthcare providers
    • Exchange email messages securely with your MedStar healthcare providers
    • Pay your physician or hospital bill
    • Request prescription refills, request appointments and request referrals from your MedStar healthcare providers

    "In addition, we continue to enhance the portal through the addition of many of the health management resources that are now available,” he explains. “For example, we now offer the ability for you to securely connect some apps, such as fitness trackers, dietary trackers, and more, to your health record.”

    Plus, it’s easy to enroll. When you register at a MedStar Health hospital or one of our physician offices, our associates will ask for your email address. We will then email you a Personal Identification Number (PIN) and a link to our website. Click on the link and follow the instructions.

    Or you can self-enroll by going to myMedStar.org. You will be asked to agree to our Terms of Use. All portal enrollments require your unique MedStar Health patient ID, which can be found on the visit or discharge summary you received during your last visit. If you cannot locate it, please ask an associate or click the link at myMedStar.org to submit a secure request.

    Self-enrollment is available for MedStar Health patients who are age 18 or older. Parents and guardians must request access to the accounts of individuals they care for on-site from one of our associates.

    “To protect the privacy and confidentiality of any personal information that is transmitted, the myMedStar patient portal uses highly secure encryption technology,” adds Dr. Friedman. “This ensures that messages cannot be intercepted, deleted, copied, or altered in any way.”

    For more information go to myMedStar.org or send an email to mymedstar@medstar.net. You can also speak to one of our representatives by calling 877-745-5656.

    This article appeared in the summer 2018 issue of Destination: Good HealthRead more articles from this issue.

  • June 12, 2018

    By MedStar Health

    One of the major goals of our Limb Salvage and Wound Care program is to avoid amputation when we can—and our efforts and those of similar programs around the country are paying off. The Centers for Disease Control and Prevention reports a 65 percent decrease in diabetes-related amputations in the U.S. between 1998 and 2006.

    But sometimes amputation is the best choice for a patient. This is particularly true when diabetic foot ulcers lead to multiple serious infections. Diabetes causes problems with sensation in the feet, which leaves patients susceptible to foot injuries that can go undetected long enough to become severely infected. These patients are in and out of the hospital constantly and sometimes face repeated surgeries. This cycle dramatically decreases their quality of life and disrupts their home, social and work lives.

    Before we recommend amputation, we consider any other therapies that might work to treat a patient’s condition. In an effort to do this for more patients, we’ve created a special program to identify and provide proactive care for people at high risk for amputation.

    LISTEN: Dr. Elmarsafi discusses diabetes-related amputation and risk reduction in the Medical Intel podcast.

    How we identify people at high risk for amputation

    We have a strong system of working closely with local primary care doctors. I regularly visit family medicine and internal medicine doctors to ensure that they know about our Limb Salvage and Wound Care program. Community doctors can refer their diabetic patients with foot complaints to us immediately, before a wound develops, so we can proactively manage their risks.

    When we identify these patients early, we often can prevent wounds and neuropathy, or loss of nerve sensation in the feet, from developing. Neuropathy is one of the biggest risk factors for developing problems and infections in the feet that lead to amputation.

    We tailor foot-care plans for high-risk patients based on several factors, including:

    • Foot complaints
    • Foot type
    • Level of sensitivity in their feet
    • How they walk
    • How well their diabetes is controlled

    These factors tell us how often a patient needs to be monitored for changes in their feet. We use a variety of methods to improve and maintain foot health, including general health coaching and even surgery to prevent recurring foot sores in certain patients.

    Related reading: How negative-pressure wound therapy has changed diabetic foot care

    When diabetes risks are addressed and managed early enough, we can avoid having to discuss amputation as a treatment option. Much of this depends on the patient’s ability and willingness to participate in their own care at home by following some basic self-care practices.

    What patients can do to reduce their risk of amputation

    I can’t emphasize enough the importance of checking the feet every day for redness or irritation. Whether a diabetic patient went jogging or simply walked around the house a bit, it’s important to examine the feet, because you might not feel a cut or blister if neuropathy has set in. These tiny injuries quickly can turn into serious infections if left untreated.

    General good health also can reduce amputation risk. This includes keeping sugar levels under control and communicating regularly with the wound care team, primary care doctor and endocrinologist to improve overall health. If a wound does develop, we make sure the patient has the necessary dressings and medication, as well as training in how to use them.

    What to expect if you do need an amputation

    Diabetes-related amputation refers to many types of surgery, from removing part of a toe to removing a large portion of the leg, with the goal of saving a person’s life from complications of a wound or infection.

    Regardless of the type of amputation a patient and doctor are considering, reasonable goal-setting should be an important part of the discussion. Each patient needs to understand how mobile they can expect to be after surgery. Healthier patients in their 20s to 50s who could walk before likely will be able to walk again after with a few months of rehabilitation and the use of prostheses, or artificial feet or legs.

    Older patients and those who were sedentary before surgery tend to face greater challenges after amputation. However, focused physical rehabilitation and follow-up support can help patients overcome these barriers and more easily move from their bed or chair to the bathroom or kitchen.

    In general, patients do well and can walk again for lower-extremity amputations at the level of the foot or toes. They tend to have the same level of balance as they had before surgery and can wear essentially the same shoes. Typically, the biggest issue they face is getting used to how the foot looks. Most patients find that they feel so much better after surgery that the aesthetic changes are worth it.

    Making the choice to have an amputation

    This change is a process, and each person goes through a different rate of acceptance. It’s not a decision to be taken lightly, and it’s important to seriously consider your doctor’s recommendations, even if you’re afraid of losing part of your foot or leg.

    This was the situation I encountered with a patient I cared for during my residency. She’d had multiple foot infections due to diabetes and ultimately developed sepsis, a serious blood infection. Her doctors encouraged her to undergo a midfoot amputation, which is removal of the toes and the part of the foot just below them. She fought the recommendation until the surgeon told her she was going to die if she didn’t have the procedure. Finally, she decided to go through with it.

    As soon as she came out of surgery, the patient already was feeling better. Over the next 12 hours, her health blossomed. She left the hospital within a few days, and when I saw her a couple weeks later in outpatient care, she was like a new person. The first thing she said was, “I wish I had taken the doctor’s advice a long time ago.”

    Choosing to have an amputation can be an emotional journey. A wound care expert will not recommend amputation if there is another effective way to treat your condition. We want what’s best for you, and for some patients, amputation is the right choice.

    Call 202-877-3627 or click below to see a Limb Salvage and Wound Care doctor if you're concerned about your diabetic foot health or your risk of amputation.

    Request an Appointment

  • June 11, 2018

    By MedStar Health

    According to the Centers for Disease Control and Prevention (CDC), obesity affects more than one-third of adults and one in five children in the U.S. This trend is associated with a combination of the amount of food we eat and a decline in physical activity—we gain weight when we eat more calories than we burn.

    A key contributor to this imbalance is oversized food portions. Over the past 20 years, U.S. food portions have doubled or tripled, making it easier than ever to overeat. When we order meals in restaurants, there's often enough food for two or even three people.

    It can be challenging to determine appropriate portion sizes when we’re used to seeing massive sandwiches and huge side dishes. This “portion distortion” affects what we think of as normal portion sizes when we cook at home, too.

    Although our food portions are much larger today than they used to be, it doesn’t mean we need to eat everything just because it’s in front of us. You can battle the tendency to overeat by working with a registered dietitian and by following three easy tactics to control your calorie intake and make healthier food choices.

    3 Strategies to Control What You Eat

    1. ChooseMyPlate

    The United States Department of Agriculture (USDA) offers the ChooseMyPlate website, which provides a visual example of what a healthy meal should include for most Americans. You can use the visual aid to plan meals, eat out, or cook at home.

    The plate is divided into the five healthy food groups—fruits, vegetables, grains, protein, and dairy. Ideally, half of the plate should be fruits and vegetables, one-quarter should be a lean protein, and the final quarter should be grains. Dairy is shown as a side cup or dish next to the plate. ChooseMyPlate also offers recommended daily amounts for each food group, all of which vary based on an individual’s unique nutrition needs and level of physical activity.

    Below are some guidelines to think about when you use ChooseMyPlate:

    • Vegetables: Any type of vegetable or 100 percent vegetable juice. Fresh vegetables—cooked or raw—are recommended, but canned, pureed and frozen are acceptable as well.
    • Fruits: Any fruit or 100 percent fruit juice. Like vegetables, fruits can be fresh, canned, pureed or frozen, and also can be dried.  
    • Proteins: Lean meat, lean poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds. Red meat is recommended just every now and then.
    • Grains: Foods made from wheat, rice, oats, cornmeal, barley or other grains. Common foods in this group include bread, pasta, oatmeal, cereal, tortillas, and grits. At least half of the grains you eat should be whole grains.
    • Dairy: Milk and many foods made from dairy are considered part of this food group if they have calcium. Eligible foods include yogurt, cottage cheese, and calcium-fortified soymilk. Dairy products that don’t have calcium are not included in this group, such as cream, butter, and cream cheese.

     2. Measure With Your Hands

    A recommended serving size is the amount of each food you should eat during a meal or snack, while a portion is the amount of food that you actually eat. If you eat more than the recommended serving size, you likely will get too many calories or too much of a certain nutrient.

    An easy solution is to measure the food we eat. But how can you determine a proper serving without specific measuring tools? You can use your hand and fingers to measure appropriate food portions.

    Use this cheat sheet for estimating portions of specific foods:  

    • Your thumb is roughly equivalent to an ounce.
        • Cheese
        • Peanut butter
    • Your closed fist is about the size of one cup
        • Vegetables
        • Milk or yogurt
        • Cooked rice, pasta, or cereal
        • Fruit, raw or cooked
        • Fruit juice can be one-half cup, or half a fist
        • Leafy salad greens can be 2 cups, or the size of two fists
    • A handful is about an ounce
        • Nuts or dried fruits, such as raisins
        • Larger snacks, such as chips, pretzels, or popcorn can be about two handfuls
    • Your palm is roughly equivalent to 3 to 5 ounces
      • Meat, fish, and poultry

    While it’s not an exact science, this method can help you keep proper portion sizes in mind wherever you go. For example, if you get a piece of chicken at a restaurant that’s the size of both your palms, cut it in half and share it or save the other half for tomorrow’s lunch. You can train your brain to avoid portion distortion. Every now and then, measure your favorite foods on a food scale as well so you can have a visual of the appropriate portion size.

    3. Read Your Food Labels

    Many of us grew up starting our mornings by pouring a heaping pile of cereal into a bowl. How much cereal we ate depended largely on the size of our bowl. However, many cereals suggest a serving size of less than a cup, and many of us eat much more than that in a sitting.

    We all need to understand food labels, not only to learn the recommended serving size, but also to use the nutrition information in the context of our entire day. The nutritional elements included in the label, such as total carbohydrates, sodium, or sugar are suggested amounts in the context of a serving size.

    If we have double the serving of cereal, for example, we’ll eat double the amount of sugar or sodium listed on the food label. Use these tips when reading food labels and incorporate the recommendations into your daily food intake:

    • Check the serving size. Sometimes more than one serving is listed.
    • Follow the USDA’s 2015-2020 Dietary Guidelines for Americans Unless otherwise directed by your doctor or dietitian, eat and drink:
      • Less than 10 percent of calories per day from added sugars.
      • Less than 10 percent of calories per day from saturated fats.
      • Less than 2,300 milligrams (mg) per day of sodium.
    • Pay attention to the order of food ingredients. They’re listed in order of quantity, from greatest to least. Keep in mind that just because something is far down the list doesn’t mean there’s just a little of it. For example, tomatoes may be the most prevalent item in salsa, but it might have a lot of sodium, even if salt is the last ingredient listed.
    • Check how many ingredients are in the food. A long list of ingredients may be a sign of artificial additives.
    • Understand the daily recommended amounts of ingredients. Using sodium as an example again, the recommended daily amount for adults without health complications is just 2,300 mg per day, or just a little more than one teaspoon. The percent of daily value number on the label is an easy way to see how much of a day’s worth of a certain nutrient is in the food you’re about to eat.
    • Eat foods that don’t have labels. In other words, opt for whole foods, such as fresh fruits and vegetables, more often than processed foods.

    Use these tips to beat portion distortion at home and while eating out. If you need a little extra help, consider working with a registered dietitian to get your nutrition on the right track. Before you know it, portioning, choosing healthy foods and reading food labels will become second nature.  

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