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After so many newsletters about pretty deep topics, I thought I’d get really superficial this week and talk about skin. Winter’s dryness and cold plus extra clothing, obsessive handwashing, and indoor heating form a combination that can be very hard on our skin. My whole life, I’ve had skin that dislikes winter. Even if your skin doesn’t get flaky or irritated, taking good care of your skin at this time of year may still help it retain its youthful elasticity and luster. Here are eleven self-care recommendations:
Drink plenty of water. Divide the number of pounds you weigh in half – that’s the number of ounces of watacer to drink evenly over the course of the day (ideally at room temperature).
Eat moistening foods. In Traditional Chinese Medicine, certain foods are considered to build vital fluids in the body which are disseminated to the skin and affect skin moisture. Some of these foods include: sesame seeds (especially the black kind), dark leafy greens, berries, pears, oranges, watermelon, string beans, tomatoes, flax seed, hemp seed, tomatoes, plums, mung beans and sprouts, cucumber, water chestnuts, eggs, fish, nuts, seed and nut oils.
Get a humidifier. In our house in Colorado, the usual tabletop humidifiers make very little difference in the moisture of the air, but I’ve heard good things about “whole house humidifiers” and I plan to get one for our home soon. They hook up to your water line (so you don’t need to refill them) and moisten the air that moves through your heating system. The units cost a couple hundred dollars and installation is a few hundred more (or you could do it yourself if you’re handy).
Put oil on your skin. Lotions are emulsions of oil and water, and while they’re moisturizing, they aim to be well absorbed and to feel light and residue-free. As such, lighter lotions may not cut it if you have very dry skin, or they may need to be applied many times a day. If your skin suffers during the winter, you may need something that functions more as a barrier – that impedes water loss through the skin and protects against the elements – such as: pure oil (coconut, jojoba, grape seed, sesame (untoasted), etc.); a thicker lotion that contains more oil or heavier oils (like castor, rosehip seed, or tamanu oil); or a semi-solid lotion with even heavier, waxy ingredients (shea butter, cocoa butter, or beeswax). However, the richest of these (shea butter and wax) are probably too heavy for the face and could clog your pores.
Exfoliate gently before moisturizing and apply moisturizer to still-damp skin. As long as your skin isn’t irritated, gently removing the top layer of dead cells will make it easier for moisturizers to penetrate. I like a coarse cloth, raw silk gloves, or a natural plant bristle brush for exfoliating the whole body. After bathing, you have a window of a few minutes during which moisturizers will work best. Personally, I enjoy the combination of dry skin brushing followed by a shower and then a brisk self-massage with oil (a practice called abhyanga in Ayurveda).
Use less soap. Soap dries out your skin and is usually unnecessary.
If your hands get chapped, dry them thoroughly after washing. Letting your skin air dry slowly usually results in drier skin. This is especially important for people with eczema.
Avoid colors, synthetic fragrances, and other chemicals in your detergents and body care products. Dry winter skin is often extra sensitive to chemicals – and absorbs them more effectively.
Wash in cooler water. If your skin becomes more sensitive in the winter, and especially if you have a rash, hot water will often make it worse. Bathe in the coolest water you can tolerate.
Use sunscreen. I don’t buy into the idea that we should wear sunscreen constantly, but judicious use has some benefits. Sun exposure feels good, activates immune cells, and stimulates vitamin D production in our skin, which is beneficial to our health in numerous ways. But the UV portion of sunlight causes damage to our tissues through a process called oxidation. (It’s the same process that causes oils to go rancid, vitamins to spoil, and meat to turn grey.)
We all know sunburns are bad, but even without burning, extended exposure to UV light tends to cause yellowing, dryness, and wrinkling of our skin. It damages fibers called elastin, which, as you might guess from the name, gives our skin its elasticity. Over the years, this makes our skin saggy and more prone to tearing. UV light also blesses us with age spots or “liver spots.” And finally, it’s a major risk factor in skin cancers, especially the non-melanoma kinds. So, if you like youthful skin, sunscreen is a good idea – especially in the middle of the day – and it’s easy to forget to use it in the winter. Winter sun isn’t usually direct enough to stimulate vitamin D synthesis, but it’s still strong enough to cause skin damage (especially in sunny places).
I don’t like chemical sunscreens, so I steer my patients to mineral-based ones – zinc oxide and titanium oxide. Zinc is the best option: it’s an excellent skin soother and barrier, and it works better than any other sunscreen chemical approved for use in the U.S. It’s the main ingredient in many diaper rash ointments and was responsible for that classic white stripe on lifeguards’ noses years ago.
Nowadays, most mineral sunscreens aren’t quite as opaque – some are completely transparent – probably because manufacturers have gotten better at creating smaller particles of zinc and titanium. However, this presents a big unknown – are these tiny “nanoparticles” entering our cells and doing something bad? In response to initial concerns, some companies now sell “non-nano” mineral sunscreens, but according to the Environmental Working Group (EWG) even the mineral particles in these products would technically be considered “nano” sized.
Yet, EWG still believes they are our best option. A mixture of particle sizes, some nano and some larger, seems to offer the best sun protection, and the evidence so far indicates that they don’t penetrate into the skin far enough to encounter living cells. However, if you were to inhale a bunch of mineral sunscreen in powder or spray form, that wouldn’t be good for your lungs.
See a good skin care specialist. Believe it or not, I was co-owner of a spa for a couple years before I got my first facial. If I was going to take the time to get a spa treatment, I’d always opt for a massage. But one year, on my birthday, Briana scheduled a facial for me, and it was just lovely. Having someone steam and massage oils into your face is deeply relaxing. And I had to admit, my skin was glowing afterwards. I highly recommend it.
I hope these recommendations help you get through the winter with moister, healthier, happier skin.
Be well,
Dr. Peter Borten
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Every year we collect more and more stories from people who have used the Dreambook to achieve clarity about what kind of life they want to create and then made it a reality. Maybe because of the craziness of 2020, there’s been a big surge of interest in the book this year, so I decided to share a little about what makes it special.
In a time of such uncertainty, many of us tend to abandon long-term and even medium-term plans, just focusing instead on getting through each day. Unfortunately, this isn’t really the same as living in the present moment, and that’s where the richness of life dwells. If there were ever a time to live for the present, it’s now.
While the Dreambook is designed to help people with 1-year, 3-year, 10-year, and lifetime goals, our overarching intention is to help people enrich the journey rather than the destination. The journey is always happening, so it needs to be as full of the good stuff as we imagine the destination will be.
Thich Nhat Hanh’s discussion on washing the dishes is one of the most quoted passages on the topic of mindfulness, but I could hear it and share it a million times: “There are two ways to wash the dishes. The first is to wash the dishes in order to have clean dishes and the second is to wash the dishes in order to wash the dishes. . . . If while washing the dishes, we think only of the cup of tea that awaits us, thus hurrying to get the dishes out of the way as if they were a nuisance, then we are not ‘washing the dishes to wash the dishes.’ What’s more, we are not alive during the time we are washing the dishes.”
The consequences of mindlessly washing the dishes may be minor, but what about the consequences of mindlessly eating, mindlessly doing our job, mindlessly playing with our kids, or mindlessly conversing with our partner? A life without our presence – because we’re just trying to get through it – is devoid of the magic, connection, and grace that make it worth living.
There are a number of ways to change this outcome-focused orientation. One of the most potent, which we share in the Dreambook, is identifying your life purpose.
When you have a purpose, you’re conscious that you’re serving a bigger function than meeting your own needs. When you’re “on purpose,” energy arises to support your work. Opportunities appear everywhere. And, most importantly, you spend more of your life right here, right now, alive and clear.
Various methods exist for determining your life purpose, but when it comes down to it, it’s a matter of intuiting what you’re meant to do, feeling it out, and choosing to pursue it. It’s okay if you later decide to modify that choice.
We have a more involved process in the Dreambook, but for today let’s see what comes to you with just a few minutes of contemplation. Grab a pen and paper and write a few sentences in response to these questions:
What times and places in your life have you felt you were making a meaningful contribution?
What inspires you?
What would people say your strengths are?
When/how do you feel called to serve humankind or the planet?
What are your highest values (e.g., kindness, generosity, honesty, service, integrity, beauty, etc.)?
Based on these responses, craft a statement that conveys how you intend to serve the world. Here are some examples:
- My purpose is to help people heal through creative expression.
- My life purpose is to build healthy communities.
- My purpose is to help people use their voices and awaken their power.
- My purpose is to facilitate playfulness in adults.
- My purpose is to teach people how to live in harmony with the environment.
- My purpose is to help people actualize their potential.
Don’t worry about getting the statement perfect on the first round. For now, choose a statement of life purpose and read it out loud and with intention. How does that feel? Ideally, making this statement should feel powerful and right, or as my friend Reuvain puts it, it should feel like a “Hell yeah!”. It might even give you goosebumps or tingles. If it feels a bit intimidating, that’s ok, too, as long as it also feels true.
If it doesn’t feel like a “hell yeah!” change some of the wording. Consider making it less specific. For instance, if a statement such as, “My purpose is to help children to become healthy adults by learning to process their emotions” doesn't feel as inspiring as you hoped, you could start by broadening it to something like, “My purpose is to help children process their emotions,” or even just, “My purpose is to help children.” Just get it as accurate as you can manage and then write it down. I recommend writing it in a special way on a nice piece of paper. Put it somewhere where you’ll see it and say it every morning.
More importantly, try to keep it in mind throughout your day, applying it as often as you can. Use the Dreambook to integrate it into your weekly planning process and your goals. You can also use the Habit Tracking function to help you remember and assess your progress.
What changes when you’re on purpose? Is it easier to make decisions? Do people respond differently to you? Is there more energy available? Consciously living your purpose is the only way to know if it’s right. As you live your purpose, you’ll get insights that will help you refine your purpose statement. I’d love to hear about your experience with this process.
Be well,
Peter
P.S. My life purpose to love, heal, and awaken myself and the world. I hope I’ve served that purpose today!
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[post_content] => A patient last week told me a story I’ve heard many times in many forms. She started experiencing chest pain that radiated down her left arm. She went to the hospital. There was nothing wrong with her that any test could reveal. She wasn’t having panic attacks and her heart was fine. She went from practitioner to practitioner before someone finally figured it out: it was muscular. In other forms of this story the symptom is abdominal pain, or diarrhea, or sinus congestion, or painful intercourse, or ear ringing, or acid reflux, but the common thread is that multiple doctors failed to consider that the origin was structural.
Often, these mystery symptoms – along with most cases of muscle pain – are caused by a phenomenon known as “myofascial trigger points,” and I believe everyone should know what they are and how they work. I’ve written about trigger points in the past, but I feel moved to explain some of the basics again because this concept remains largely unknown to both practitioners and laypeople. It’s not exactly a fringe idea either – it was developed primarily by President Kennedy’s personal doctor, Janet Travell (the first female White House physician, by the way), whom he credited with saving his political career after she cured his back pain. Her first journal article on the subject was published over 60 years ago.
What exactly is a “myofascial trigger point” anyway? Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state and can produce pain, other sensory changes, tightness, and dysfunction. A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. One of the most valuable contributions of Travell’s work was to map out hundreds common locations of trigger points and their referral patterns – i.e., where they produce symptoms.
If you know where to look for trigger points that could be implicated in an issue, it’s usually pretty quick and straightforward to determine if this is the cause. And if so, you can often fix them yourself.
How do trigger points form?
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. More often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way. This is common in people who work out without warming up, or who suddenly do a very ambitious workout after having not exercised for a year. Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years.
A muscle contracts through the action of nerve impulses – electrical signals that deliver the command to shorten. These impulses stream into the muscle for as long as we wish to hold this contraction. The impulses aren’t distributed throughout the muscle in an even way, though, and the muscle “belly” (the bulky contractile part) becomes slightly twisted during each contraction.
This isn’t usually a problem if we’re doing repeated isotonic contractions. Isotonic contractions are where the muscle causes movement and it alternately shortens and lengthens, working and relaxing. The issue lies more in prolonged isometric contraction or “static” contraction. That’s where a muscle stays contracted without movement – like the way you hold your arms up for hours while typing or driving. The muscle is under constant pressure and the continuous stream of nerve impulses produces a sustained deformation of the muscle belly.
I need a little more science to explain what happens next, so get ready. Over time, the ongoing tension and twisting of the muscle fibers causes an elevation in the resting muscle tone – that is, eventually, the muscle never completely relaxes. It’s always a bit contracted, meaning a bit shortened, and therefore a bit taut. This tightness causes local vasoconstriction – the blood vessels are constricted – and this translates to local ischemia – inadequate blood supply to the tissue (the same thing that happens to heart muscle in a heart attack). The arteries can’t bring in enough fresh blood and oxygen, the veins and lymphatic vessels can’t adequately drain waste and deoxygenated blood. The tissue pH changes, local metabolism is impaired, and fluid and waste products build up in the area.
This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less. Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance.
Over time, this situation results in the development of trigger points. A muscle is composed of numerous parallel fibers and each fiber consists of many end-to-end contractile segments called sarcomeres. When they’re working correctly, they all shorten together when you contract the muscle and then return to their resting length when you relax. But trigger points involve a collection of sarcomeres that remain in a shortened, irritable state, which makes them bulge (often causing a palpable “knot”) and causing their muscle fibers to feel taut and stringy. Finally, with longstanding trigger points, the body deposits gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
Ok, enough with the big words.
The point is, there are tons of resources in print and online to help you locate trigger points and show you the kinds of problems they can cause. As for getting rid of them, the most basic method is to simply press and hold an active trigger point when you find one. After about 30 seconds, you’ll usually feel it soften. You can also press down the trigger point (with a thumb, fingers, or a tool) and then move the tissue, as if deliberately intending to re-lengthen this shortened part of the muscle.
Acupuncture is really excellent at releasing trigger points. Dr. Travell injected various agents into trigger points to cause them to deactivate, but later in her career, she began to realize that the most effective part of this process was simply jabbing the trigger point with the end of a needle. There wasn’t a need to inject any liquid; thus, this method became known as “dry needling.” She worked with an osteopath acupuncturist named Dr. Mark Seem who developed an acupuncture-based methodology for releasing trigger points in a holistic way – that is, while supporting the body as a whole to restore balance. (If you’re interested in trying dry needling, I strongly recommend you receive it from an acupuncturist rather than a physical therapist, since acupuncturists have an exponentially greater amount of needle training and a more sophisticated understanding of how to treat the big picture.)
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free, where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
Be well,
Dr. Peter Borten
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After so many newsletters about pretty deep topics, I thought I’d get really superficial this week and talk about skin. Winter’s dryness and cold plus extra clothing, obsessive handwashing, and indoor heating form a combination that can be very hard on our skin. My whole life, I’ve had skin that dislikes winter. Even if your skin doesn’t get flaky or irritated, taking good care of your skin at this time of year may still help it retain its youthful elasticity and luster. Here are eleven self-care recommendations:
Drink plenty of water. Divide the number of pounds you weigh in half – that’s the number of ounces of watacer to drink evenly over the course of the day (ideally at room temperature).
Eat moistening foods. In Traditional Chinese Medicine, certain foods are considered to build vital fluids in the body which are disseminated to the skin and affect skin moisture. Some of these foods include: sesame seeds (especially the black kind), dark leafy greens, berries, pears, oranges, watermelon, string beans, tomatoes, flax seed, hemp seed, tomatoes, plums, mung beans and sprouts, cucumber, water chestnuts, eggs, fish, nuts, seed and nut oils.
Get a humidifier. In our house in Colorado, the usual tabletop humidifiers make very little difference in the moisture of the air, but I’ve heard good things about “whole house humidifiers” and I plan to get one for our home soon. They hook up to your water line (so you don’t need to refill them) and moisten the air that moves through your heating system. The units cost a couple hundred dollars and installation is a few hundred more (or you could do it yourself if you’re handy).
Put oil on your skin. Lotions are emulsions of oil and water, and while they’re moisturizing, they aim to be well absorbed and to feel light and residue-free. As such, lighter lotions may not cut it if you have very dry skin, or they may need to be applied many times a day. If your skin suffers during the winter, you may need something that functions more as a barrier – that impedes water loss through the skin and protects against the elements – such as: pure oil (coconut, jojoba, grape seed, sesame (untoasted), etc.); a thicker lotion that contains more oil or heavier oils (like castor, rosehip seed, or tamanu oil); or a semi-solid lotion with even heavier, waxy ingredients (shea butter, cocoa butter, or beeswax). However, the richest of these (shea butter and wax) are probably too heavy for the face and could clog your pores.
Exfoliate gently before moisturizing and apply moisturizer to still-damp skin. As long as your skin isn’t irritated, gently removing the top layer of dead cells will make it easier for moisturizers to penetrate. I like a coarse cloth, raw silk gloves, or a natural plant bristle brush for exfoliating the whole body. After bathing, you have a window of a few minutes during which moisturizers will work best. Personally, I enjoy the combination of dry skin brushing followed by a shower and then a brisk self-massage with oil (a practice called abhyanga in Ayurveda).
Use less soap. Soap dries out your skin and is usually unnecessary.
If your hands get chapped, dry them thoroughly after washing. Letting your skin air dry slowly usually results in drier skin. This is especially important for people with eczema.
Avoid colors, synthetic fragrances, and other chemicals in your detergents and body care products. Dry winter skin is often extra sensitive to chemicals – and absorbs them more effectively.
Wash in cooler water. If your skin becomes more sensitive in the winter, and especially if you have a rash, hot water will often make it worse. Bathe in the coolest water you can tolerate.
Use sunscreen. I don’t buy into the idea that we should wear sunscreen constantly, but judicious use has some benefits. Sun exposure feels good, activates immune cells, and stimulates vitamin D production in our skin, which is beneficial to our health in numerous ways. But the UV portion of sunlight causes damage to our tissues through a process called oxidation. (It’s the same process that causes oils to go rancid, vitamins to spoil, and meat to turn grey.)
We all know sunburns are bad, but even without burning, extended exposure to UV light tends to cause yellowing, dryness, and wrinkling of our skin. It damages fibers called elastin, which, as you might guess from the name, gives our skin its elasticity. Over the years, this makes our skin saggy and more prone to tearing. UV light also blesses us with age spots or “liver spots.” And finally, it’s a major risk factor in skin cancers, especially the non-melanoma kinds. So, if you like youthful skin, sunscreen is a good idea – especially in the middle of the day – and it’s easy to forget to use it in the winter. Winter sun isn’t usually direct enough to stimulate vitamin D synthesis, but it’s still strong enough to cause skin damage (especially in sunny places).
I don’t like chemical sunscreens, so I steer my patients to mineral-based ones – zinc oxide and titanium oxide. Zinc is the best option: it’s an excellent skin soother and barrier, and it works better than any other sunscreen chemical approved for use in the U.S. It’s the main ingredient in many diaper rash ointments and was responsible for that classic white stripe on lifeguards’ noses years ago.
Nowadays, most mineral sunscreens aren’t quite as opaque – some are completely transparent – probably because manufacturers have gotten better at creating smaller particles of zinc and titanium. However, this presents a big unknown – are these tiny “nanoparticles” entering our cells and doing something bad? In response to initial concerns, some companies now sell “non-nano” mineral sunscreens, but according to the Environmental Working Group (EWG) even the mineral particles in these products would technically be considered “nano” sized.
Yet, EWG still believes they are our best option. A mixture of particle sizes, some nano and some larger, seems to offer the best sun protection, and the evidence so far indicates that they don’t penetrate into the skin far enough to encounter living cells. However, if you were to inhale a bunch of mineral sunscreen in powder or spray form, that wouldn’t be good for your lungs.
See a good skin care specialist. Believe it or not, I was co-owner of a spa for a couple years before I got my first facial. If I was going to take the time to get a spa treatment, I’d always opt for a massage. But one year, on my birthday, Briana scheduled a facial for me, and it was just lovely. Having someone steam and massage oils into your face is deeply relaxing. And I had to admit, my skin was glowing afterwards. I highly recommend it.
I hope these recommendations help you get through the winter with moister, healthier, happier skin.
Be well,
Dr. Peter Borten
[post_title] => Eleven Tips for Healthy Winter Skin
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