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Immunity Genes for E.Coli Found

THURSDAY, Jan. 28, 2016 (HealthDay News) — Researchers say they’ve identified immune-related genes that might protect people against E. coli illness.

E. coli is a leading cause of bacteria-triggered diarrhea, and it comes from food, the environment or the intestines of people and animals. But while the bug makes some people extremely ill, it has little to no effect on others, the researchers said.

In this study, researchers exposed 30 healthy adults to E. coli and took blood samples to analyze the volunteers’ gene expression — the extent to which some genes are turned on or off.

When the investigators compared participants who became sick and those who remained well, they found significant differences in the activity of 29 immune-related genes.

“Within each group, there were changes in the patients’ gene expression patterns happening throughout the experiment,” study senior author Dr. Ephraim Tsalik, an assistant professor of medicine at Duke University in Durham, N.C., said in a university news release.

“We found there were differences with the subjects that seemed to predict who would become sick. We interpreted those as signals that show an innate resistance to infection. There may be certain genetic traits that can increase or decrease your chances of being infected after exposure to a pathogen,” he explained.

The study was published recently in the Journal of Infectious Diseases.

The next step is to look at other types of infections, including viral and respiratory illnesses such as the flu.

“We have found a set of immune-related genes to focus on,” Tsalik said. “Now if we can understand how the expression of these genes imparts this resistance and susceptibility, we might be able to offer new ways to boost your immune system to protect against prevalent infections such as E. coli or better predict who is at greatest risk of getting an infection.”

According to the U.S. Centers for Disease Control and Prevention, E. coli illness usually appears within an average of three or four days after swallowing the germ. Illness can be severe and include diarrhea, often bloody, and abdominal cramps.

Most people will recover within a week, but in some the illness can progress to kidney failure. Children under the age of 5, older adults and people with weakened immune systems are at highest risk from E. coli illness, the CDC says.

More information

The U.S. Centers for Disease Control and Prevention has more about E. coli.





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Too Few Older Adults Tell Doctors About Memory Loss: Study

THURSDAY, Jan. 28, 2016 (HealthDay News) — Do you worry that forgetting names, or where you put your keys, might be a sign of impending dementia? If you’re like most older Americans, you don’t bring this up with your doctor, a new study shows.

Researchers who looked at federal government data on more than 10,000 people found that in 2011, only 1 in 4 adults aged 45 or older discussed memory problems with a health care professional during a routine checkup.

In fact, the likelihood that a person would admit to a memory problem in a doctor’s office visit actually declined with advancing age, says a team led by Mary Adams, of On Target Health Data in West Suffield, Conn.

The findings were published Jan. 28 in the journal Preventing Chronic Disease.

“Routine checkups are a missed opportunity for assessing and discussing memory problems for the majority of older adults,” Adams said in a journal news release.

Experts agreed that the stigma around memory loss and dementia may hold people back from discussing these issues with their physicians.

“Because dementia is unfortunately an all too common illness, older adults are quite familiar with its heralding signs and symptoms, which they have painfully observed in a long time neighbor or a family member,” said Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Health in New Hyde Park, N.Y.

“This reality leads to denial and avoidance, both on the part of the patient and the physician,” she said. “‘As long as we don’t mention it, maybe it’s just normal aging.'”

But mentioning memory troubles is important, because it doesn’t necessarily have to herald dementia, Wolf-Klein said. “Memory loss may well not be due to dementia, but another highly treatable condition, such as depression,” she noted.

And if it is linked to dementia, recognizing that fact early is crucial, she said.

“Patients can promptly meet with family members and elder law advisers, who can best help them in making individualized decisions for their care, rather than rely on last-minute decisions completed by family members at a time when patients now lack capacity,” Wolf-Klein said.

Dr. Bruce Polsky is chair of the department of medicine at Winthrop-University Hospital in Mineola, N.Y. He acknowledged that talking about “memory loss and the possibility of the early development of dementia is a difficult discussion for both the physician and patient, mostly because of the long-term implications.”

But early diagnosis of dementia can be important, he said.

“Even mild memory loss associated with early Alzheimer’s disease may be improved with some of the medicines now available, although these medications do not stop the progression of the disease,” he said. “Lifestyle modifications, such as smoking cessation, may also be of value in some cases.”

“Although it is difficult for individuals to assess whether their own subtle memory loss is ‘normal’ or not, open discussion with their physician and, in some cases, testing may result in answers that could potentially lead to treatment and improved functioning,” according to Polsky.

More information

Find out more about memory loss and Alzheimer’s disease at the Alzheimer’s Association.





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What Your Sweat Reveals About Your Health

Photo: Getty Images

Photo: Getty Images

TIME-logo.jpg

Every time you sop up sweat with a towel after a hard workout, you wipe away potentially revealing information.

But sweat won’t be taken for granted for much longer. A new kind of wearable technology may soon be able to continuously measure what’s in your sweat and translate it into valuable health intel, according to the promising results of a new study published in Nature.

“There are so many chemicals in sweat it’s unbelievable,” says Ali Javey, professor of electrical engineering and computer sciences at University of California, Berkeley and the paper’s senior author. “And every chemical is associated to different information about your health.”

In a project led by Javey’s Berkeley lab, a team of researchers at the University of California, Berkeley, and Stanford University developed and tested a sensor that can continuously track skin temperature and four important health markers—sodium, potassium, glucose and lactate—all through sweat. Levels of sodium and potassium, both of which are electrolytes, can signal if you’re dehydrated, and lactate can tell if your muscles are fatigued.

In the study, the scientists placed sticky electronic sensors that monitored these levels on the skin of 14 men and women. They bought sweatbands and filled them with a small flexible circuit board, which beamed the data from the sensors to an app in a smartphone, where scientists could monitor those levels live.

The men and women wore the sweatbands and sensors while doing different kinds of exercise, like cycling or running, for varying lengths of time. Some drank water, while others didn’t, and some exercised outdoors while others stayed inside.

The scientists found that the sensor worked with a remarkably small amount of sweat: only a fifth of a drop. While the group that drank water didn’t show electrolyte levels of dehydration, the thirsty group did, and the scientists were able to observe that in real time by looking at their sodium concentrations.

It can measure a lot of things you can normally measure in blood”—the gold-standard for getting information about one’s clinical state—“but this gives you the opportunity to make many, many measurements over time,” says Ron Davis, one of the authors and professor of biochemistry and genetics and director of the Stanford Genome Technology Center.

“We realized if we wanted to find meaningful information from sweat, we needed to measure a bunch of things at the same time,” says Sam Emaminejad, co-lead author and a joint-postdoctoral scholar at University of California, Berkeley and Stanford School of Medicine. “The vision is to get as much data as possible.”

The researchers think that in the future, scientists will be able to tell even more from sweat. They’re working on minimizing the amount of sweat required for an accurate reading so that it’s possible to use without having to exercise. Biosensors like these could have multiple medical applications, including diagnosing a heavy metal poisoning, warning a person that they’re in a severe enough depressive state to warrant medication and signaling that the body is getting an infection.

“We’re going to see lots of these kinds of things in the future, trying to make medicine cheaper and better,” Davis says. “Fortunately the National Institutes of Health is taking that seriously, and there are lots of young people with a lot of excitement about how to do it.”

This article originally appeared on Time.com.




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What Is a Doula? 4 Reasons Pregnant Women Might Want One

Photo: Getty Images

Photo: Getty Images

Are you pregnant or trying to conceive? New research may inspire you to consider hiring a doula before your due date.

A study published this month in the journal Birth compared two groups of pregnant women: 1,935 moms-to-be in Minnesota who used state doula services and 67,147 women in the northern and midwestern U.S. who did not. (The medical expenses of both groups were covered by Medicaid). Researchers found that women with doula care had 22% lower odds of giving birth prematurely, and were less likely to have a c-section. (Among the women with doulas, 20.4% gave birth via cesarean, compared to 34.2% of women without doulas.)

If you’ve never heard of a doula before, they are certified professionals who offer emotional and physical support through pregnancy and labor, either in a hospital setting or at home. (The term doula comes from the Greek word for “a woman who serves,” according to the training association DONA International). We spoke with Jada Shapiro, who founded the referral service Birth Day Presence in New York City, for insight on the various ways doulas can help moms-to-be. Here, four reasons why expectant parents might want to hire one.

RELATED: 10 Foods Pregnant Women Shouldn’t Eat

They provide extra care and support

Although every doula has a unique approach, their main role is to care for the mom-to-be. “Doulas offer continuous support to women both during pregnancy and after childbirth,” Shapiro explains. “In a way, we are trying to recreate what was typical in old-world communities when women were surrounded by a vast support system of female friends and relatives during pregnancy.”

And while doulas are not medical professionals, they possess a wealth of knowledge about pregnancy and childbirth that can be extremely helpful for expectant moms. “We work closely with our clients to de-mystify pregnancy terminology and help women interpret their options,” says Shapiro. That said, one of the most common misconceptions about doulas is that they interfere with a woman’s obstetrician. Shapiro says it’s important to note that this is not the case. “Doulas complement the care a woman receives from her doctor,” she says. “We don’t get in the way of medical decisions.”

She also adds that while many people believe you can only work with a doula if you want a medicine-free birth, this is also untrue: Women with all kinds of birth plans can find it helpful to consult a doula during their pregnancy.

RELATED: 15 Factors That Can Affect a Woman’s Fertility

They can assist with pain management

“Doulas are well-trained in physical comfort and can offer a wide range of pain relief techniques and tools,” says Shapiro, including acupressure, hydrotherapy, birthing balls, massage, and suggesting position changes during labor. Doulas can also help moms relax with soothing imagery, music, and breathing exercises.

This individualized level of care can help moms feel a little calmer during one of the most physically and emotionally challenging days of their lives. “I believe that many mothers just feel generally more cared for and less alone during the experience of childbirth with the help of a doula,” Shapiro says.

RELATED: What Pregnancy Does to Your Health

They provide support to both moms and their partners

“Something I hear from many of my clients is that they can’t believe how intimate their childbirth experience was, even with a doula there,” says Shapiro.

She adds that because childbirth can be such an overwhelming experience for families, having the support of a third party can be just as useful for partners as it is for moms-to-be: “Doulas can help recall important information from midwife or doctor appointments, lend a helping hand if mom needs a massage, or just generally absorb some of the stress from the partner,” she says. “In this way, a doula can allow partners to be fully present in the experience.”

RELATED: 12 Ways to Soothe Heartburn in Pregnancy

They’re there for you on the big day

Doulas are a resource for moms-to-be throughout their pregnancy, but most importantly, they’ll be there when you’re in labor. “Doulas are typically on-call 24/7 during a client’s ‘due window’ of 36 to 42 weeks,” says Shapiro. When a woman goes into labor, her doula will be available for physical and emotional support both while she’s laboring at home as well as accompanying her to the hospital.

And in addition to the aforementioned relaxation and pain relief techniques, doulas know a lot about childbirth (Shapiro, for example, has attended “more than 350” births in her 13 years as a professional doula). “During labor, doulas might suggest alternate positions; encourage different non-medical techniques to potentially help speed up dilation, such as walking around; and just generally act as a sounding board for difficult medical decisions,” she says.




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So You Blobbed Your Eyeliner, Now What?

We’ve all been there. You’re coasting along with your makeup routine when all of a sudden out of nowhere, a sneeze, a skip, a hiccup—something happens to trip you up, and you end up with your makeup blobbed all over your face. It’s the worst, and it tends to happen at the most inopportune moments, like when you really don’t have the time to start over. We feel you sister, and we’ve got the fix to get you back on your way, despite hitting a little speed bump. Check it out!

RELATED: There’s a Proper Way to Apply Your Dry Shampoo

RELATED: This Is the Correct Way to Moisturize Your Face

And, per usual, we’re also gonna slow it down for you, because we really want you to master it.

1. The dreaded blob. Ideally this won’t happen.

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2. Sweep on some concealer to clean up some of your mistake.

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3. Tap your concealer so that it really blends in with your skin (no streaks allowed).

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4. Smile, you averted cosmetic disaster.

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This post originally appeared on MIMIchatter.com.




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Exercise Has Its Limits for Losing Weight, Study Finds

By Amy Norton
HealthDay Reporter

THURSDAY, Jan. 28, 2016 (HealthDay News) — That daily 5-mile run may not be burning as many calories as you think, a new study suggests.

In fact, the researchers found, moderate exercise — the equivalent of walking a couple miles per day — may be the best way to burn extra calories. Beyond that, the body seems to adapt its metabolism so that calorie-burning plateaus, no matter how hard you work out.

The findings, published online Jan. 28 in the journal Current Biology, may sound counterintuitive — or at least disappointing.

“The predominant view is that the more active you are, the more calories you burn every day,” said lead researcher Herman Pontzer, an associate professor of anthropology at City University of New York’s Hunter College.

This study, according to Pontzer, supports a different view: “It’s really not a simple dose-response relationship,” he said. “The body adapts to exercise, and it begins adapting at a moderate level of activity.”

His team arrived at that conclusion after studying 332 adults, aged 25 to 45, from the United States, Ghana, Jamaica, Seychelles and South Africa.

All of the participants wore a device that recorded their activity levels for a week, and the researchers used standard tests to measure each person’s total calorie-burning for the week.

Predictably, people with moderate activity levels burned somewhat more daily calories than sedentary people did — an extra 200 per day, on average.

But more intense activity brought no additional benefit — at least as far as calories.

Pontzer stressed that exercise has many benefits for a person’s health in general. “There’s nothing in this study that suggests exercise is anything but good for you,” he said.

But if your goal is weight loss, exercise alone is unlikely to cut it. And that message, Pontzer noted, is not new.

“We know that diet changes are the most effective way to lose weight,” he said. “This study adds another piece of evidence to support that.”

Two researchers who were not involved in the study agreed that exercise alone isn’t enough.

“The reality is, exercise by itself is not great for weight loss,” said Dr. Timothy Church, a professor of preventative medicine at Pennington Biomedical Research Center, in Baton Rouge, La.

But, he added, exercise does boost weight loss from diet changes — and it helps people keep the pounds off.

Dr. Chip Lavie, director of exercise laboratories at the Ochsner Heart and Vascular Institute in New Orleans, made the same point.

“Also,” he said, “there are numerous benefits of exercise besides just weight loss.”

According to Lavie, those benefits include improved fitness (with high-intensity exercise generally getting better results), a lower risk of heart disease, stress relief — and fun.

But why wouldn’t greater amounts of exercise help the body burn more calories every day? Behavior could partly explain it, according to Pontzer: When people exert themselves at the gym or on a run, they might compensate by sitting or lying down more throughout the rest of the day.

But Pontzer thinks there is also a physiological adaptation. In an earlier study, he and his colleagues focused on the Hadza, a traditional hunter-gatherer population in Tanzania. The Hadza are highly active every day, Pontzer said — walking long distances and performing hard physical labor.

And yet, his team found, the average Hadza adult burns a similar number of calories each day as the typical American.

In the new study, there was a point at which the daily calorie burn from exercise leveled off. Pontzer described it as the equivalent of walking a couple miles per day.

But, Church pointed out, there appeared to be relatively few study participants who got much more exercise than that. And that makes it harder to draw firm conclusions.

Plus, he said, the typical American falls far short of the “line” where calorie-burning plateaued in this study.

“I question how much this would mean to the average American trying to lose weight,” Church said. “Physical activity is going to add to calorie expenditure for the vast majority of them.”

More information

The U.S. Centers for Disease Control and prevention has more on exercise and health.





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Hepatitis C Reported at 19 Dialysis Clinics: CDC

THURSDAY, Jan. 28, 2016 (HealthDay News) — Reports of hepatitis C infections among dialysis patients in the United States are rising, largely because of poor infection control practices, health officials say.

Between 2014 and 2015, the U.S. Centers for Disease Control and Prevention received reports of about 36 cases of hepatitis C infection at 19 kidney dialysis clinics in eight states.

So far, investigators have determined that patient-to-patient transmission of hepatitis C occurred at nine of those clinics.

Lapses in infection control procedures — such as injection safety, cleaning and disinfection, and hand hygiene — were common at these clinics, the CDC reported Wednesday. The exact means of hepatitis C transmission could not be pinpointed, but all of these deficiencies could contribute to transmission of the virus.

Hepatitis C, which can cause lifelong liver disease, is spread primarily through contact with the blood of an infected person, according to the CDC.

Improved screening and awareness of the risk of hepatitis C infection in dialysis facilities could partly explain the rise in the number of reported infections, the agency said in a news release.

Whatever the causes, the report “underscores the widespread potential for patients to acquire serious infections during dialysis care,” the CDC said.

Hepatitis C “transmission can be prevented when proper infection prevention and environmental disinfection practices are consistently followed,” the CDC added.

Dialysis is a life-saving treatment for people with advanced kidney disease. In the United States, about 400,000 such patients undergo dialysis each year, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

The CDC pointed out that all dialysis facilities need to continually assess and improve their infection control, hepatitis C screening practices, and cleaning and disinfection methods, whether or not infections have occurred among their patients.

Any new case of hepatitis C infection in a dialysis patient is likely to be a health facility-associated infection and should be promptly reported to public health authorities, the CDC said.

Noting that one hepatitis C outbreak at a dialysis facility lasted five years before being detected, the agency said screening is essential to identify infections early and prevent further transmission.

The CDC urges dialysis facilities to follow their recommendations to help prevent and detect hepatitis C infections. The agency also offered the following advice to dialysis patients:

  • If you do not know if you have or might have hepatitis C, ask your health care provider.
  • Ask your dialysis provider if it follows CDC recommendations, whether you need to be tested for hepatitis C, and what can be done to protect you from hepatitis C infection during dialysis treatment.
  • Read educational material for patients on dialysis safety and hepatitis C.

More information

The National Kidney Foundation has more about dialysis patients and infectious diseases.





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More Women Killed by Someone They Know in States With High Gun Rates

THURSDAY, Jan. 28, 2016 (HealthDay News) — American women living in states with high rates of gun ownership are more likely to be shot and killed by someone they know than those residing in states with fewer firearms, a new study finds.

Boston University researchers examined state-specific murder data from the FBI and found a “substantial” association between state gun ownership rates and killings of women by guns.

The investigators concluded that while multiple factors predict rates of gun deaths of males, “the prevalence of firearm ownership alone is enough to predict the rate of firearm-related homicide of females in a state quite well.”

Every 10 percent increase in gun ownership in a state was associated with a 10.2 percent increase in gun-related murders of women, the researchers said in a university news release.

There was no evidence that greater availability of guns protects women from murder. Instead, greater availability appears to increase a woman’s risk of “non-stranger” murder — murder by a family member or another person they know, said study lead author Dr. Michael Siegel. He is a professor of community health sciences at Boston University School of Public Health.

Gun ownership rates alone explain 40 percent of the variation in women’s murder rates, compared with 1.5 percent of the variation in men’s murder rates, according to the study.

The findings were published online recently in the journal Violence and Gender.

However, Siegel acknowledged that the study doesn’t establish a direct cause-and-effect relationship between greater gun ownership and women’s murders. Other factors may influence the association, he said.

Average gun ownership rates in the United States between 1981 and 2013 ranged from a high of 73 percent in Wyoming to a low of 12 percent in Hawaii, the researchers said.

The study results suggest that if Wyoming’s gun ownership rate fell from 73 percent to 40 percent, there would be a 33 percent decrease in the murder rate among women.

Because nearly 90 percent of female murder victims are killed by someone they know, these findings are important for those trying to reduce women’s murder rates, said study co-author Emily Rothman. She is an associate professor of community health sciences and an expert on domestic violence.

Nationwide, the average gun-related murder rate among men was 7 per 100,000, ranging from 18 per 100,000 in Louisiana to 1.2 per 100,000 in Iowa, the study reported.

Gun-related murder rates among women were lower, ranging from 3.3 per 100,000 in Wyoming to 0.4 per 100,000 in Massachusetts, the researchers found.

More information

The U.S. National Institute of Justice has more about gun violence.





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Barbie Is Now Available In Curvy, Tall, and Petite Body Types

 

barbie-new

Thanks to a new makeover, Barbie now looks a little more like a “normal” woman.

Mattel, the maker of the iconic doll, announced today that they are introducing three new body types for Barbie: Petite, Tall, and Curvy. The new dolls (sold alongside Original Barbie) are available with a variety of skin tones, eye colors, hair colors, hair textures, and even flat feet. All of this means young girls will now have a better chance of playing with a Barbie that more closely resembles their own appearance.

RELATED: 5 Body-Positive Resolutions You Should Make in 2016

First released in 1959, Barbie has long faced criticism for sending the wrong message to girls. (Many have argued that if a real person had Barbie’s proportions she would be severely anorexic.) But in recent years, as the body positivity movement has taken off, Barbie’s crazy-unattainable shape has seemed even more absurd. At the same time, competitors have started selling dolls with real-life proportions and characteristics, such as the Lammily doll, which has stretch marks, acne, cellulite, and even gets her period.

As Time reports in their cover story:

American beauty ideals have evolved: the curvaceous bodies of Kim Kardashian West, Beyoncé and Christina Hendricks have become iconic, while millennial feminist leaders like Lena Dunham are deliberately baring their un-Barbie-like figures onscreen, fueling a movement that promotes body acceptance. In this environment, a new generation of mothers favor what they perceive as more–empowering toys for their daughters. 

RELATED: 5 Rules for Loving Your Body From Model Ashley Graham

In recent years, Mattel has made strides to combat Barbie’s reputation as anti-feminist. Last year, it launched its “Imagine the Possibilities” ad campaign, which portrayed young girls in different professions; and released 23 new dolls with different hair and skin colors. But this latest update is the first time that Barbie’s body shape has changed to reflect real-life proportions.

The new dolls are available today on Mattel’s website as part of the “Fashionistas” line and will start appearing in stores later this year. Welcome to the real world, Barbie.




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Does Dry Brushing Really Reduce Cellulite and Help You Look Younger?

Photo: Getty Images

Photo: Getty Images

There’s always a new skin trend popping up rumored to vanish wrinkles, smooth dimples and zap cellulite. But most turn out to be temporary tricks and, more often than not, too good to be true. Cue dry brushing—is it really worth the hype?

Dry brushing, as the term suggests, quite literally entails brushing your bare skin—thighs, butt, arms, you name it—with a soft-bristled brush in order to give skin a fresher, smoother appearance. While there is scant scientific research to back up claims that it cures cellulite, it has some cosmetic benefits, explains Mona Gohara, MD, a dermatologist at the Yale School of Medicine—although they are fleeting at best.

The motion improves circulation and helps flush waste and toxins by stimulating the lymphatic system, explains Dr. Gohara, who is also a fellow of American Academy of Dermatology. “Doing all of that can certainly parlay into skin radiance and glow and a plumper appearance.”

Another power of dry brushing is the element of exfoliation, she adds. While exfoliating “won’t shave off 20 years,” Dr. Gohara says, it helps remove dry, dead skin cells and makes your derm more susceptible to moisture and hydration. “Exfoliation really is a tenant of healthy, younger-looking skin.”

RELATED8 Steps to Healthy Skin at Every Age

How to dry brush properly

Using a brush made with natural, ultra-fine bristles, run the brush over your bare skin in gentle, circular motions. It’s best to do it before you shower; both your skin and the brush should be dry. “I generally recommend doing it once a week, one pass per body part,” Dr. Gohara adds.

The brush makes all the difference; stiff or synthetic bristles can cause irritation or even microscopic cuts. “You should use a brush that would be safe even on a baby’s skin,” Dr. Gohara recommends.

You should avoid dry brushing if you have very sensitive skin, acne, or a condition like rosacea or eczema. “There’s a good chance any type of sensitive skin will react to this type of stimulation,” she says.

You may notice plump, fresh skin for a couple of hours. “Think about it,” Dr. Gohara explains, “when we go for a jog, our hearts are pumping blood to our organs, our face gets flushed, and then it fades away. Or imagine what happens when you pinch your cheeks.”

The bottom line: Dry brushing can act as a short-lived fix to energize your skin. But is it a permanent anti-aging solution for all lumps and bumps? “Absolutely not,” she says. “All of us would be scrubbing ourselves with brushes constantly, every day.”

RELATED: 15 Myths and Facts About Cellulite

Five dry brushes to try

Our top picks boast natural, soft-to-the-touch bristles and various handle lengths to reach any lower or upper body area.

Best for: Brushing hard-to-reach spots

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Skin Brush .jpg

Elemis Spa At Home Body Brush ($45; timetospa.com)

Best for: Brushing beginners who don’t want to spend a lot

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The Bathery Bath Brush ($6; target.com)

Best for: Super-controlled brushing

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Wholesome Beauty Dry Body Brush ($12; amazon.com)

Best for: Keeping on display between uses

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Dry Revive: Dry Body Brush ($14; sephora.com)

Best for: Hanging in the bathroom

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Brush the Fuzz Brush ($9; amazon.com)




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