From the category archives:

Ask the Expert

Indulge during the holidays, go on a strict diet after? That’s the message our culture sends, and to many people it’s confusing. This is especially true for those struggling with an eating disorder. Colleen Schreyer, an eating disorder specialist, shares a few tips about how to eat healthily during the holidays.

Tip #1: Self-Monitor
If you're worried about calorie counts and potential weight gain during the holidays, there are dozens of free apps and online programs to help you keep track. Schreyer recommends one called It's normal to weigh yourself a few times a week and see fluctuations in weight, especially after a big meal. You should be concerned if you see major fluctuations in weight from week to week, but the difference of a few pounds from day to day is considered normal and healthy.

Tip #2: Set Goals
Plan out your week and set SMART goals for your meals. It's not very realistic to set a goal of not eating a single bite at a holiday party, but it's more realistic to say you will limit yourself to a certain number of appetizers or munchies. Remember, SMART goals are:

  • Specific
  • Measureable
  • Achievable
  • Reasonable/realistic
  • Time-bound

Tip #3: Stimulus Control
Along with setting goals, you can plan ahead to control any food-related stimuli that might cause you to stray from your desired eating plan. Don't grocery shop on an empty stomach; have a healthy snack before a meeting where there might be not-so-healthy snacks in the center of the room; change your walking route to avoid the table with holiday goodies. Also, at home, keep what you want to eat. Tuck your chips and snack foods in the back of the cupboard and set out a bowl of (nice looking) fresh fruit, so your decision to snack healthily is easier and more convenient.

Tip #4: Take a Lap
When attending a holiday party with many food options, take a lap around the room to see all the food available before filling a plate. Likewise, if there are passed appetizers, don't fill up on the first few things that come out the kitchen door. This will help you more easily count calories or track food intake.

Tip #5: Exercise
Even if you don't have time to hit the gym for an hour workout, stepping away from your desk to talk a short, 10-minute walk can do you good. Do workouts in bouts of 10 minutes, which is the threshold for your body to convert to calorie-burning mode. Also, it's easier to commit to a New Years resolution of exercising more in 2016 if you incorporate some kind of exercise or workout into your routine in December.

Tip #6: Look to Social Support
You're definitely not the only one in the room who is watching their weight! Talk to friends about how hard it is to stay on track during the holidays and how hard it is not to grab that second or third dessert from the table. You may find great ideas and additional tips for maintaining your weight management plan during the holidays.


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Kimberley SteeleAccording to the Centers for Disease Control and Prevention, obesity has more than doubled in children and quadrupled in adolescents over the past 30 years. Addressing obesity at a younger age can help prevent obesity-related diseases and illnesses later in life. One way to do this is through adolescent weight loss (bariatric) surgery.

In today’s Ask the Expert column, bariatric surgeon Kimberley Steele answers several common questions about childhood obesity and bariatric surgery as a treatment option. Submit any questions you may have in the comments section below.

At what point is a child or teen considered to be overweight?
To be considered for bariatric surgery, a teen must meet the following criteria. However, meeting these criteria does NOT necessarily mean that weight loss surgery is right for someone.

  • Body mass index (BMI) greater than or equal to 40 (generally more than 120 pounds over ideal weight)
  • Obesity-related health problems (obstructive sleep apnea, diabetes, high blood pressure, significant quality of life or mobility problems)
  • Inadequate weight loss with organized weight loss attempts

Can children be genetically predisposed to becoming overweight?
The cause of obesity is felt to be multifactorial and may include:

  • Socioeconomic factors
  • Psychological factors
  • Behavioral factors
  • Genetic factors

What are traditional weight-loss methods suggested for children and adolescents? What other treatments are effective?
Traditional weight loss methods include a balanced and healthy diet and regular exercise.

However, because dieting and “medical” or “traditional” weight loss has been unsuccessful for the majority of teens who are extremely overweight, it has become increasingly important to consider how best to help adolescents in the fight against obesity. We know from adults that weight loss surgery can cure morbid obesity. Research has shown that weight loss surgery can provide an early and effective tool for the patient to help prevent serious health problems.

When is weight-loss surgery appropriate?
Weight-loss surgery is appropriate when traditional weight-loss methods have not been successful or if a child’s weight is a greater health threat than the potential risks of surgery. Studies show that the risk of adolescent bariatric surgery is no greater than that of adults undergoing the same procedure. In fact, adolescents tend to have fewer complications and a faster recovery.

There have been more than 5,000 adolescent bariatric cases performed since 2004. We believe that this increase demonstrates a realization that surgery does work for weight loss and that surgery can reverse significant health problems.

How does bariatric surgery help adolescent patients?
Research has demonstrated that bariatric surgery can be a successful measure for improving hunger and fullness signals in adolescent patients. It has also helped alleviate or at least improve adolescent patients who have multiple medical problems associated with their obesity, including type 2 diabetes, high blood pressure and sleep apnea.

What can parents do to prevent pediatric obesity?
The first thing is to identify factors in a child’s lifestyle that are promoting weight gain and to do something about those behaviors.

We use the term “behavioral modification” to explain how we can modify our behavior to decrease risks that lead to obesity, such as aiming to decrease the intake of calories.

Here are a few simple ways that every family can better understand nutrition and to make better food choices:

  • Cut back on sugared beverages, including soda and fruit juice
  • Reading food labels and cut out foods that list sugar in the first three ingredients
  • Eat a healthy breakfast!
  • Think about ways to increase activity throughout the day

If a child or teen is preparing for weight loss surgery, encourage them to adopt healthy eating patterns and develop an exercise routine. This will help surgical candidates prepare to be in the best physical condition for surgery. It is especially important that parents are committed to helping their child have success and be supportive of the entire process.


If you or your child is interested in a consultation with the Johns Hopkins Center for Bariatric Surgery, visit to view an online information session or see a list of in-person seminars.

Other recommended sources include The American Society of Bariatric Surgery and the American Obesity Association.

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In today's Hopkins Happenings post, hear from orthopedic surgeons Edward McFarland and Andrew Cosgarea, who explain the difference between "good pain" and "bad pain," signs to look out for, treatment options and more.

What exactly is good pain?

"No pain, no gain" is a common phrase heard by athletes. What is perceived as the "burn" in muscles during physical activity is additional stress put on the muscle, which helps to increase strength. This is "good pain," which should be short-lived and only occur during activity. The temporary fatigue should leave you somewhat exhilarated, not exhausted.

What are signs of bad pain?

If muscles, tendons ligaments, cartilage and bones are forced to react to stress too quickly, tissues begin to fail and respond in their own ways and begin to produce "bad pain." Failure can be caused by too much stress too fast, or by stress accumulated over time. Here are a few common examples of how each tissue reacts and causes bad pain.

  • Muscles - If a muscle is exercised too much, it may become very sore to move and touch, and may even swell. In sever cases, the muscle may be too damaged and parts of the muscle tissue may begin to die. In extremely rare cases, extreme overexercising of the muscles can lead to death. McFarland and Cosgarea generally recommend "whatever amount of exercise you think you can do, cut it by one-third the first few times."
  • Tendons - Tendons respond to too much stress but getting inflamed, which causes pain and sometimes swelling known as tendonitis. This typically occurs during exercise and can continue after exercise when doing activities that use that tendon or associated muscles.
  • Bones - When bones see increased amounts of stress, they respond by creating more bone in the areas with more stress, which helps strengthen the bone. But if bones see stress too fast, the bone will begin to fail. This can result in a stress fracture and pain along the bone. If untreated, the bone can actually break.
  • Cartilage - Cartilage is the tissue on the ends of bones that allows them to move smoothly over one another. Though cartilage sees wear and tear as we age, if stressed too quickly, it can cause pain and fluid in a joint. Joint swelling is a bad sign and indicates that the cartilage is irritated, with the swelling making exercise and daily activity difficult and painful.

How can good and bad pain be treated?

For any ache or pain, we recommend cutting back on exercise for a period of time, with the length of time dependent upon the severity of the pain. Don't do anything that hurts. Icing is also a recommended treatment after activity by way of an ice pack or ice massage for 20 minutes. Also, continue to move the joint or extremity to avoid stiffness. Medications such as over-the-counter pain relievers or anti-inflammatory agents can help to decrease pain and swelling.

When should I be concerned about pain?

It is advised to seek professional treatment if the pain:

  • Lasts for an extended period of time after exercise
  • Affects your sports performance
  • Does not go away with rest
  • Affects your function outside of athletics (walking, sleeping, etc.)
  • Is constant or increases over time and does not go away
  • Does not improve with treatment
  • Requires increasing amounts of pain medication
  • Wakes you up
  • Causes weakness, tingling or numbness in an extremity
  • Is accompanied by fevers, chills or severe sweating at night

What should I know about pain associated with injury?

Signs that an injury is more serious include severe pain that makes you nauseated or uncomfortable, deformity or immediate swelling at the injury site, loss of function, tingling or numbness and inability to move fingers or toes. Things do not swell/hurt for no reason and injuries that are more severe have more swelling and pain. If you have any question about whether an injury is serious or not, you should seek treatment sooner than later.

Want to know more? Visit to read the full article and to request an appointment.

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Bringing lunch to work instead of eating out can save money and improve health. But choosing nutritious, tasty and easy-to-make meals day after day can be challenging. Meet Diane Vizthum, Meghan Ames, Melissa Moser, Hong Brereton, Susan Oh and Bobbie Henry, six Johns Hopkins dieticians who shared in the July/August issue of Dome their favorite lunchtime inspirations as suited to their lifestyle.

All six women shared that they load up on fruits and vegetables, avoid foods made with artificial ingredients, and drink lots of water. They also eat healthy fats, enjoy occasional indulgences--including pizza!--and don’t obsess about calories. Check out what tips they have to offer and share your own comments on how you eat healthy during the work day.

The Low-Carb Eater: Bobbie Henry, 31, began eating a low-carbohydrate diet about five years ago to combat reactive hypoglycemia, a condition that impairs her ability to regulate blood sugar. As a result, her dramatic energy spikes and troughs have disappeared, she says. Henry treats patients in the Adult Epilepsy Diet Center, where research is showing that diets that are high in fat and low in carbohydrates can lower seizure rates. Her indulgences: super-dark chocolate (85 to 90 percent cocoa), pizza.

The Local and Sustainable Advocate: Diane Vizthum, 29, gravitates toward food that is locally grown. Recently, she and her husband purchased one quarter of a cow—more than 100 pounds of meat—from a Harford County farm. The grass-fed beef is portioned, packaged and in their freezer, and is ready for quick meals made with “a lot of vegetables, healthy fat, whole grains and protein,” says Vizthum. Her indulgences: dark chocolate, cookies, brownies.

The Athlete: Melissa Moser, 25, runs about 70 miles per week and needs a diet that fuels all those footsteps. She tries to get about 60 percent of her calories from carbohydrates, 20 percent from protein and 20 percent from fat. Her research showing the dangers of food additives for people with kidney disease inspires Moser to “eat real food.” Her indulgences: apples with peanut butter, trail mix, dry cereal, ice cream, chocolate.

The Antioxidant and Estrogen Proponent: Hong Brereton, 66, likes to cook, modifying recipes from her native Vietnam to meet her nutrition goals. She adds broccoli sprouts and other members of the cabbage family to prevent cell damage and fight disease, andshe includes flaxseed and other foods with plant chemicals called phytoestrogens to combat the symptoms of menopause. Her indulgences: fruitcake, mango, dates and a banana eaten with a wedge of Laughing Cow cheese.

The Busy Food-Lover: Meghan Ames, 27, captains a bicycling team, rock-climbs, hikes and takes yoga classes. When she can grab a few minutes in the kitchen, she’ll make a big pot of something easy, like soup or a grain-based salad, and bring the leftovers with a green salad for lunch. Ames, a nursing nutrition instructor and state obesity program coordinator, offers simple weight-loss advice: Move more, and eat lots of produce. Her indulgence: mint chocolate chip ice cream.

The Working Mom: Susan Oh, 43, sneaks as much produce as she can into the diets of her three children, ages 8 to 12. She often makes entrees with tomato sauce, which contains the antioxidant lycopene, and adds pureed vegetables, including butternut squash, mushrooms, carrots, bell pepper, onions and garlic. She cooks on the weekends so she can heat up dinners during hectic weeknights; her family brings leftovers for lunch. Her indulgence: chocolate cake.

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In a live chat on the Johns Hopkins Medicine Facebook page on June 23, 2015, dermatologist Crystal Agi answered readers’ skin health questions. Hear what she had to see about skin health and learn more from the Johns Hopkins Medicine Health Library.

Concerned about your skin health? Schedule an appointment or learn more through the Department of Dermatology at or 410-955-5933.


What are some good practices for those with sensitive skin?

Avoid harsh facial scrubs which can irritate and cause small tears in the skin. Dry skin gets irritated more easily, so make sure to moisturize daily to prevent further irritation. If you have oily skin, make sure your moisturizer is oil-free.

If you are sensitive to certain types of sunscreens, look for those that contain zinc oxide or titanium dioxide as the primary ingredients.

What do I need to know about sunscreen use?

In general, we recommend using a “broad spectrum” sunscreen with an SPF of at least 30 on a daily basis. Broad spectrum means that it blocks both UVA and UVB rays. This is very important since we now know that both types of UV rays can lead to skin cancer and aging skin. SPF tells you how much UVB is blocked, though there is currently not a standardized labeling for the degree of UVA that is blocked.

An SPF of 30, when applied correctly and reapplied, blocks 97 percent of the sun’s rays. So there is not much of a difference between a sunscreen with an SPF 30 and one with an SPF 100. Reapplying sunscreen throughout the day—at least every two hours—greatly reduces the amount of sun exposure. It is also suggested to use a shot glass amount of sunscreen when applying and reapplying.

Sunscreen should also be used every day, year-round. This includes cloudy, gray and rainy days. The UV rays that cause skin cancer, aging skin and sunburns can be present during all daylight hours even when it is overcast.

The FDA requires that all sunscreens retain their original strength for at least three years and some sunscreens include an expiration date. Write the date of purchase on bottles of sunscreen to help keep track of how old they are. Look for visible signs, such as change in color or consistency, which may indicate when a sunscreen is no longer good. If you use sunscreen in the correct amount every day, a bottle should not last that long.

Visit the American Academy of Dermatology’s website for more tips on sunscreen use.

What’s the best way to treat a sunburn?

To start, get out of the sun. Move indoors or move to a shady, protected area to minimize any further damage to your skin.

Put a cool, damp towel on the sunburned skin and take a cool shower or bath as soon as possible. Use a moisturizer after showering to help prevent the skin from drying out.

Anti-inflammatory medications like ibuprofen will help battle redness and inflammation.

Drink water to help replenish fluid that will be lost through your skin.

If you develop blisters, do not pop them. If you feel sick, seek medical attention as this may indicate a very severe burn.

How can you tell the difference between a mole and melanoma?

It is important to examine your skin on a regular basis and recognize any changes in markings and moles that could be identified as melanoma. Use the ABCD chart to help detect malignant melanoma in its earliest stage. Warning signs include:

  • Asymmetry – when one half of a mole does not match the other half
  • Border – when the border (edges) of a mole are ragged or irregular
  • Color – when the color of a mole is not the same all over
  • Diameter – when the mole’s diameter is larger than a pencil’s eraser

Refer to the Johns Hopkins Medicine Health Library for photo examples of normal moles and melanoma.

What are some tips for summer skin protection?

The American Academy of Dermatology suggests five basic rules for skin protection in the sun.

  1. Apply broad-spectrum, water-resistant sunscreen. Use sunscreen with SPF 30 or more on all exposed skin when spending time outside. Reapply sunscreen after a few hours, especially after activities where it may wash off your skin, such as swimming. Sunscreen can no longer be labeled “waterproof” or “sweatproof.”
  2. Wear protective clothing. Long sleeves, sunglasses and a hat can help protect you from the sun’s rays. Clothing labeled with an Ultraviolet Protection Factor (UPF) is most effective.
  3. Stay out of the sun during peak hours if at all possible. The sun’s rays are strongest between 10 a.m. and 2 p.m., so avoid being in direct sunlight whenever possible.
  4. Be careful, especially at the beach. Water and sand can reflect and intensify the sun’s rays, so be extra cautious to avoid sunburn.
  5. Avoid tanning beds. Tanning beds, like the sun, can cause skin cancer. If you want to look tan, consider using a spray or self-tanning product, but continue to use sunscreen as well.


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According to statistics from the Centers for Disease Control and Prevention, there were more than 25,000 confirmed cases of Lyme disease across the United States in 2013. Lyme disease is the leading cause of all insect-borne illness in the country. The disease takes its name from Lyme, Connecticut, where the illness was first identified in the United States in 1975.

John AucottBut what exactly is Lyme disease and how does someone get it? John Aucott, a Lyme disease expert in the Division of Rheumatology at Johns Hopkins, explains preventive measures and treatments for Lyme disease in today’s Ask the Expert.

He also talks about the new Johns Hopkins Lyme Disease Clinical Research Center, housed at Johns Hopkins Bayview Medical Center, which he directs. Through this research center, Aucott is leading SLICE, the first controlled study in the U.S. to examine the impact of Lyme disease on patients’ immune systems and their long-term health.

Learn more about Lyme disease and submit your own questions for Aucott to answer.

How does a person get Lyme disease?

Lyme disease is a bacterial infection that is transmitted by the bite of a deer tick. Deer ticks are common along the East Coast. They are present in wooded areas that surround our homes and areas where we enjoy the outdoors. The peak season for ticks to bite and transmit Lyme disease is during the late spring and summer, peaking in June, July and August.

What are some symptoms of Lyme disease? Is it contagious?

Lyme disease rashThe main symptoms of acute Lyme disease are those of a flu-like illness with fever, chills, achiness and fatigue. In many patients, this is accompanied by a round red skin lesion at the site of the tick bite. This usually begins several days to weeks after the bite, and the redness expands for many days or weeks when it isn’t recognized and treated. The skin lesion is often mistaken for a spider or bug bite. Lyme disease is not contagious between people.

If I find a tick on myself, do I need to get tested for Lyme disease?

The majority of tick bites do not transmit Lyme disease. If you remove an attached tick, look carefully for a round or oval red skin lesion that may develop at the site of the bite. Blood tests do not accurately diagnose Lyme disease in the first few weeks of infection, so being vigilant about looking for symptoms is a more reliable way to identify an early case of Lyme disease. Blood tests do become positive in most people after three to four weeks of infection, and they can be performed at that time if infection is suspected.

What are some preventive measures people can take to avoid Lyme disease?

The risk of getting Lyme disease is greater the longer a tick is attached. Therefore, doing tick checks is important so they can be removed before they transmit Lyme disease. Even better is to avoid being bitten by ticks in the first place. The best preventive advice is to avoid exposure in wooded, overgrown areas and to stay on trails when you hike. Deet can be used on your skin, and permethrin can be used on your clothes to help repel ticks.

Can you explain more about SLICE?

The Study of Lyme Disease Immunology and Clinical Events (SLICE) recruits individuals with the rash of early Lyme disease and follows them after standard antibiotic treatment for an additional year of observation. The study tests for changes in health and immune system function that may develop after treatment. Blood samples collected in the study are being used to develop more accurate diagnostic tests and to discover abnormalities in the immune system that may accompany the different stages of Lyme disease.

Learn more about this new center by reading the press release, “First U.S. Center to Study Lyme Disease Launched at Johns Hopkins Medicine.”


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Do you often feel a burning sensation in your chest after enjoying Indian food or several helpings at a Thanksgiving feast? If you experience heartburn, you’re not alone. Hear from a few Johns Hopkins experts on how to safely manage heartburn and whether it really has anything to do with your heart in today’s Ask the Expert.

For more information, visit the Johns Hopkins Division of Gastroenterology and Hepatology’s website at


What is heartburn? Does it affect my heart?

Heartburn is typically described as a burning discomfort in the mid-to-upper chest that can also feel like pressure or bloating. It can be accompanied by acid reflux and often occurs after eating a big meal. About 20 percent of Americans will have acid reflux symptoms at least once a week, while half will experience these symptoms once a year.

Heartburn is one of many symptoms associated with gastroesophageal reflux disease (GERD), which can include acid reflux as well.

The difference between heartburn and heart problems is often found in the symptoms. Symptoms of heart trouble often follow a period of walking or exerting yourself and continue in increasing frequency as you continue to move around. Symptoms may include shortness of breath and pain in the neck, jaw, arm or shoulder.

When should I see a doctor?

Heartburn should be of concern if you experience it more than two to three times a week, for more than two weeks at a time, or if it doesn’t go away after taking antacids.

Gastroenterologist John Clarke also says that the big worry with heartburn is the irritation of the esophagus, strictures or possible Barrett’s esophagus or esophageal cancer. You should also consider seeing a doctor if you have symptoms accompanying heartburn such as weight loss or difficulty swallowing, if you’re older than 50, or if you have a family history of Barrett’s esophagus or esophageal cancer. Your doctor may recommend an endoscopic screening to rule out one these conditions.

Is it safe to take medications to treat heartburn?

Ellen Stein, assistant professor of medicine, says that the risk of not treating heartburn is pretty low compared to benefits, so if you have a good reason to take the medication, you shouldn’t have to worry about taking them.

Stein suggests Tums or Malox for infrequent heartburn, though more frequent symptoms may require a more daily medication or even a prescription medication, such as Zantac, Prilosec and Ranitidine.

Some studies have shown risks after long-term heartburn medication use, including osteoporosis, low levels of calcium, magnesium and phosphorous, and increased risk of some infections. Talk to your doctor about your concerns and before starting any long-term medications.

What are some alternatives to medication?

Some people may not want to rely on medication to fix their heartburn symptoms. Here are a few lifestyle changes and suggestions to consider that can help alleviate heartburn symptoms.

  • Lose weight – Losing as little as 5 percent of total body weight can be very effective
  • Cut back on coffee, soda and other acidic foods, which can exacerbate heartburn
  • Stop smoking and drink alcohol in moderation
  • Eat smaller quantities of food
  • Leave at least two hours between a meal and lying down
  • Don’t eat late at night

Remember, medication can’t always compensate for a Big Mac and fries at 10 p.m., according to Stein!


Resources for this Ask the Expert included:

Eating Well for Digestive Health, Johns Hopkins Medicine Health Library
“Feeling the Burn,” Johns Hopkins Health, winter 2010
Heartburn Q&A with Ellen Stein, Johns Hopkins Medicine YouTube channel

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Whether eating to lose, gain or maintain weight, we’ve all heard about—or tried—our fair share of diets. Johns Hopkins research dietitians Diane Vizthum, Melissa Moser, Bobbie Henry and Nga Hong Brereton have answered some commonly asked questions about eating styles, recent trends and other diet-associated habits. Read what they have to say and submit your own questions to be answered in today’s Ask the Expert on nutrition and diet.

What are some recommendations for eating to lose weight?

This is a great question! While there are many ways to lose weight, the key to maintaining weight loss is developing a healthy way of eating you can stick to. Follow these steps to get started.

  1. Keep a food log. Record not only what you eat, but when you ate, where you were, if you were doing other things, how you were feeling, how hungry you were before eating and how full you were after. This can be done with an app, website, or paper and pencil.
  2. Use the information you gathered from your food log to make some changes. Are you snacking in front of the TV at night? Eating large portions and feeling stuffed? Eating emotionally? Pick one thing you can change and get started!
  3. Follow the plate method: Make one-half of your plate vegetables, one-quarter lean protein and one-quarter whole grains. Use a small portion of healthy fat, such as a spoonful of olive oil. Eat slowly, listen to your body and stop eating when satisfied but not stuffed. This may take practice!
  4. Limit the junk food. There’s always room for favorite treats, but these can be saved for occasional indulgences, not made part of a daily diet.
  5. Eat mindfully. Eat slowly and without distractions like your phone or TV to get the most satisfaction from your meals.

Some consider eating styles like Paleo, gluten-free and the Whole30 Program to be fads or trends. Is there a benefit to eliminating certain foods or food groups from your diet?

Elimination diets are definitely trendy right now. These diets advocate eliminating foods or food groups from your diet. Common foods that may be eliminated include grains (wheat, rice, oats, quinoa, barley, rye and corn are some examples), gluten (this is a protein found in wheat, rye and barley), dairy, beans, peanuts, sugar, food additives, artificial sweeteners, alcohol or caffeine.

Although each of these diets is slightly different, if you follow an elimination diet, you will likely wind up cutting out highly processed foods that have excess sugar, fat, salt and calories. This is good for almost everyone!

Additionally, many of the foods commonly eliminated, such as dairy, beans or whole wheat, can cause digestive discomfort and may be poorly tolerated. If you suspect a certain food is giving you trouble, see your doctor to rule out a more serious medical condition, and visit a dietitian to make sure your diet is balanced after eliminating the poorly tolerated food.

Of course, for those with celiac disease or food allergies, eliminating the trigger food is essential. But for otherwise healthy adults, there is no need to eliminate whole foods from the diet.

How do pre- or post-exercise powders, tablets and gels enhance performance or benefit the body?

Good nutrition is essential for both the performance athlete and the casual gymgoer to get the most out of their workouts and reach their fitness goals. In most cases, a well-rounded and carefully planned diet is exactly what’s needed. Beyond following a healthy diet, some nutritional supplements can be useful because of their convenience or to give competitive athletes an edge in their training regimen.

Although most people meet their protein needs through their regular diet, protein shakes and powders can be a good tool for those who don’t get enough or want a convenient, portable protein source. Most recreational athletes need 0.5 to 0.7 grams of protein for every pound of body weight. It’s not necessary to take protein shakes during or immediately before a workout, because the body is primarily utilizing carbohydrates as an energy source during that time. Your body can use about 20 to 25 grams of protein after exercise to help rebuild muscles, but this should be paired with carbs for refueling.

Endurance athletes, such as long-distance runners or cyclists, may benefit from nutritional products that help maintain electrolyte levels and blood sugar during prolonged exercise. To maximize performance in cardio exercise lasting more than an hour, athletes may use sports gels, chews, drinks or tablets that contain easily digestible carbohydrates and electrolytes like sodium and potassium. These can prevent athletes from “hitting the wall” and help avoid electrolyte imbalances that can occur with very strenuous and prolonged activity.

Is a full-body cleanse ever necessary? How does it work?

A full-body cleanse may sound perfect now that bathing suit season has started. Well, did you know that your body has its own way of detoxifying or filtering the multitude of toxins we are exposed to every day? Instead of “cleansing” with over-the-counter products or high-sugar juices, aim to enhance your body's natural detox process by cleaning up your diet. Try this for seven to 14 days.

  • Focus on eating lots of fruits and vegetables. Follow the “Dirty Dozen” and “Clean 15” guides (found here: to help in your organic produce selections.
  • Eat fish two to three times per week and choose lean meats the rest of the time.
  • Eliminate processed and fried foods. Minimize refined carbohydrates like bread, bagels and pancakes, and choose whole grains like quinoa, amaranth and teff instead. Avoid alcohol.
  • Get healthy fats from avocados, olives, nuts and coconut (oil or unsweetened flakes).
  • Flavor foods with herbs and spices like cilantro, basil, rosemary, turmeric and cumin.

Be sure to drink plenty of water and engage in a sweat-producing activity a few times a week. The most important part of the process is to evaluate how you feel at the end of the seven- to 14-day period and how you feel after going back to your old way of eating. This can help you find an eating style that makes you feel the best and makes your body work the best!

What are some health benefits to adopting a Mediterranean diet?

This popular diet is based on traditional foods from many of the Mediterranean countries. The diet is high in vegetables, fruit, olive oil, nuts and whole grains; moderate in beans, fish, poultry, unsweetened dairy and alcohol, especially red wine; and limited in red meat, butter, cream and sweets.

Studies show that following this diet pattern is associated with decreased risk of heart disease, stroke, some cancers and cognitive decline. In one large study, people advised to follow a Mediterranean diet supplemented with extra virgin olive oil or nuts had a 30 percent reduction in risk for cardiovascular events compared to a control group advised to follow a low-fat diet. Researchers think the diet may work by improving blood pressure or reducing inflammation and oxidative stress. The diet is high in many beneficial nutrients, and it’s possible that the overall combination of nutrients provided by a variety of foods is the most important factor. Remember, the Mediterranean lifestyle also includes physical activity and less stress!

Need more help with your diet? The nutrition clinic at The Johns Hopkins Hospital offers outpatient appointments. Call 410-955-6716 for more information.



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Have you ever laid awake at night due to a stressor in your life? We all experience stress in our lives, so hear from a few Johns Hopkins experts about what it’s really doing to your body and what you can do to help manage it.

Learn more about stress in the Johns Hopkins Medicine Health Library.

How does stress affect the body?

Stress is a normal physiological response that can come in short-term or long-term form. Short-term reactions to stress can cause increased heart rate, decreased appetite and greater alertness, which can help deal with stress in the short term. Stress negatively affects the body when it is exposed to long-term or chronic stress. Serious health conditions that can be caused by long-term stress include:

  • High blood pressure
  • Increased susceptibility to substance abuse and illness
  • Less resistance to disease
  • Depression
  • Heart disease
  • Weight gain or los
  • Diabetes
  • Gastrointestinal problems

Won’t work-related stress go away after I retire?

A recent Hopkins Happenings poll surveyed employees about the top factor in their life that causes stress. The results: work, followed by finances and family.

But once someone retires and stops working, the stress may not automatically disappear. Michelle Carlstrom, senior director at the Office of Work, Life and Engagement, says that although many people consider retirement to just be a financial decision, “That alone won’t determine happiness. Even if you feel financially secure, there are other issues to consider.”

Here are a few ways to think about managing stress after retirement.

  • Plan activities with purpose. You may find yourself lacking in social interactions or a sense of purpose once you leave the workplace environment.
  • Consider continued work as a volunteer, part-time employee or small-business owner. Plan ahead and look for opportunities rather than waiting until retirement to figure it out.
  • Ground yourself in reality by taking a hard look at the things that cause you stress. Are they real, imagined, or anticipatory stressors? Determine whether you are worrying about the unknown future, or if your stressor currently exists, and develop a stress management plan to instill a sense of control over the situation.
  • Adjust your stress management style and focus on healthier options to manage your stress.

What are quick, easy ways to handle a stressful situation?

Managing stress does not have to costly, time-consuming or difficult. Here are a few simple, effective ways to handle stress, according to Hugh Calkins, director of the Cardiac Arrhythmia Service at Johns Hopkins.

Opt for a long walk over a long nap. Exercise is a great way to elevate your mood, plus it has the added benefit of burning calories and keeping you healthy. Stash a pair of comfortable walking shoes in your car or office to get outside for a quick 20-minute walk.

If you don’t have somewhere to walk, find a place where you can take a short break and escape into your surroundings. Spend a few quiet minutes alone, read a short story or article, or listen to music. Make a list of what you’re grateful for to help maintain a positive mindset.

Grab a healthy snack, like nuts, which contain tryptophan, an amino acid found in protein that improves depression and promotes relaxation.

Think positive thoughts. Talking to yourself in a negative light won’t help address stressors. Try reframing negative thoughts into positive ones to turn your stress reaction around. For example, instead of thinking “This is awful” or “This is such a mess,” think “This is rough, but I can get help” or “Things could be worse.”

Try relaxation strategies proven to help reduce stress, such as yoga, meditation and deep breathing. You can practice these techniques on your own at home. Yoga is proven to have many health benefits in addition to reducing stress, including back pain relief, more energy and brighter moods, heart help and better joint health.

What are other ways to reduce or manage stress?

  • Eat a healthy diet and exercise regularly. A nutritious and well-balanced diet, combined with regular exercise, helps keep your body fit and able to resist disease.
  • Talk about stressful situations with someone you trust. Talking through your problems and concerns can put them into perspective and give you insight about how to deal with them effectively.
  • Stay organized, which will help manage your time more effectively.
  • Nobody can do it alone! Don’t be afraid to ask for help when you need it.
  • Practice relaxation techniques to calm your mind and your body. You can enroll in mind relaxation, meditation or yoga classes to get started.
  • Get professional help if you need it.


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According to Johns Hopkins Medicine’s Health Library, more than 60 million Americans suffer from poor sleep quality, and more than 40 million meet the diagnostic criteria for sleep disorders. Lack of sleep can negatively affect your memory, concentration, performance, mood and more. A few Johns Hopkins experts offer tips and personal best practices on how to get a better night’s sleep.

For more information or to schedule an appointment with a sleep specialist, check out the Johns Hopkins Sleep Disorders Center website. Also, learn more about sleep and how it affects your health in the Johns Hopkins Medicine Health Library.

Turn off or put down electronics at least 30 minutes before bedtime. Screens with lighting, like a TV, computer, phone and tablet stimulate the mind and mess with our natural circadian rhythm. Cutting down on this stimulation allows the body and mind to naturally relax as it gets closer to bedtime.

Minimize alcohol and caffeine, which make it harder to sleep. Though alcohol can make it easier to fall asleep, it prevents you from getting the REM sleep you need to feel refreshed. Since caffeine can stay in your system for hours, abstain from it in the afternoon and evening.

Stick to a consistent bedtime schedule, which means going to bed and waking up at relatively the same times, during both weekdays and weekends.

Create a good sleeping environment, which can include:

  • Temperature between 54 and 75 degrees Fahrenheit
  • No bright lights, including if you get up in the middle of the night to use the bathroom
  • Mattresses and pillows that will support your head, neck and back; replace old mattresses as needed

Trade sleep aids for sleep hygiene. One in five adults turn to drugstore sleep remedies, which often contain antihistamines that can cause dangerous daytime drowsiness. Try to upgrade your sleep habits to see if you can kick the meds altogether. A few tips include:

  • Create a bedtime ritual (get dressed for bed, do something non-stimulating but relaxing, avoid stressful activities)
  • A peaceful bedroom, free of distracting clutter or reminders of stress (bills, to-do lists, etc.)
  • No electronics 30 minutes before bed
  • Dim or turn out the lights; darkness in the evening helps our brains prepare for sleep

Rule out health problems like reflux or sleep apnea, which can rob you of quality sleep. Treatments can ease nighttime reflux. Symptoms of sleep apnea may include loud snoring or gasping/choking at night. Sleep and heart health are related, and some medicines for heart issues may impact your sleep. Conditions like heart failure may also make it difficult to lie comfortably.

Cognitive behavioral therapy (CBT) for insomnia trains your body and mind for a deep sleep. Ask your health care provider how to give it a try.

Exercise during the day, which can help you get ready for nighttime sleep.

Adjust sleep habits for shift work, which can often make it difficult to get a good night’s—or day’s—sleep. General recommendations are to try and stick to a regular schedule around your work schedule. On days off, try to maintain your work week schedule for being awake and asleep. Although this can be socially difficult, it is very difficult for human circadian system - our internal body clock - to adjust to large changes in your sleep zone. Trying to sleep at night on your days off is like traveling at least 4-8 time zones by plane. Suggestions include:

  • Wear light-blocking sunglasses when driving home
  • Sleep in a cool dark room
  • Turn off phones and other electronics
  • Use ear plugs or a white noise maker to block out other ambient sounds
  • Napping for 20-30 minutes before your shift to maximize alertness
  • Avoid napping during breaks on your shift


Susheel Patil, Clinical Director of the Johns Hopkins Sleep Medicine Program, makes sleep a priority. “I try to get in bed and wake up at predictable times. I know I need seven to eight hours of sleep in order to function well the next day. If certain things don’t get done by the end of the day, they just have to wait, if I’m going to be helpful to patients the next day.”

His advice for better sleep: Create a calm, dark, quiet, place for sleep. Use your bedroom for sleep and sex only—not TV-watching, web-surfing, working, texting or even reading.

Rachel Salas, a neurologist and sleep specialist at Howard County General Hospital, puts worries to bed by thinking of three things that make her happy before going to sleep. “I’ve found that people tend to be negative about themselves before they go to bed. Negative thoughts feed insomnia and potential nightmares.” At bedtime, try to focus on the positives and leave your concerns about relationships, money, work, health and other issues for another time of day.

Salas also stresses the importance of saying no to TV binge-watching. “I have to remind myself, just like my patients, to make sleep a priority. It’s so easy to say, ‘I’ll just catch up on some work for a while or watch a TV-show-a-thon on my DVR.’”


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