Health in Your Hands

total wellness

a ucla student wellness commission publication

health in your

+

hands

your guide to salad greens

ways to wake up from

daytime sleepiness

nutritious & delicious

tasty treats

summer 13 | vol 13 | issue 5

editor’s note Decisions, decisions, decisions. Each day, we are faced with so many choices. For decisions concerning our health, each choice can greatly impact our longterm wellbeing. With a growing amount of self-help and health education resources available, it can oftentimes be confusing to navigate through all this information, discern what sources are reliable, and comprehend what actions are necessary for wellness.

total wellness ▪ summer 2013

Because the ultimate responsibility for our health falls within our own hands, Total Wellness seeks to empower our readers with a depth and breadth of understanding on pertinent health topics. With a team of writers, editors, designers, and leadership as well as a medical review board of healthcare professionals, Volume 13 of Total Wellness has regularly featured our Eat Right, Get Active, Body in Focus, and Mythbusters Departments.

We conclude this volume with the theme Health in Your Hands as a reminder that you have a great control over your own personal wellbeing and that Total Wellness is here to help you achieve your health-related goals.

Explore Health in Your Hands to uncover how your nails can provide you with insight into your health (pages 26-30), how to deal with bloody noses (pages 10-11), and how to properly clean your ears (pages 22-24).

Learn about the differences between running indoors versus outdoors (page 8-9) as well as how to tend to common running injuries (page 34-39).

Mindful of your health but craving something delicious? Discover some salad tips and tricks (pages 17-21) along with some dessert options with health benefits (pages 40-44). Suffering

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from attacks of sleepiness throughout the day? Read up on ways to reduce the triggers of daytime sleepiness on pages 12-16.

We hope you have enjoyed Volume 13 of Total Wellness and gained insights that make the responsibility for your own health more manageable and less overwhelming. Missed our previous issues or want to revisit our older publications? Read them online at http://issuu.com/totalwellnessmagazine.

Hungry for more? Stay tuned for our next volume of Total Wellness! Volume 14 will be launched this Fall Quarter and equipped with new columns and a new staff. We are excited to continue Total Wellness’ dedication to providing high-quality, reader-friendly, practical health education. Until then, stay connected with Total Wellness through our Facebook page (be sure to like us!), website (http://www.totalwellnessmagazine.org/), and email (totalwellnessatucla@gmail.com).

Cheers to your health,

Shannon Wongvibulsin Director and Editor-in-Chief

Total Wellness is a division of the Student Wellness Commission that is dedicated to spreading awareness of and sharing knowledge on issues of student health and health care. By providing an understanding of health and lifestyle issues, elucidating health concepts, providing recommendations for physical, mental, and social well-being, and making visible and accessible various health resources, programs, and events occurring at UCLA, Total Wellness seeks to empower students with up-to-date and accurate knowledge on the appropriate management of their health.

leadership

Julie EscobaR Copy Editor

cindy la Managing Editor

karin yuen Co-Art Director

barbara wong Co-Art Director

annie theriault Outreach Director

Nabeel Qureshi Finance Director

angela hao Assistant Finance Director

Kevin Sung Webmaster

total wellness â–Ş summer 2013

Chalisa Prarasri Assistant Editor-in-Chief

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words from the commissioner I am proud to introduce myself as the new UCLA Student Wellness Commissioner. Two years ago as a confused and dazed freshman, I picked up a Total Wellness magazine for the first time from the Wooden Center newsstand. The magazine was full of interesting health articles - perfect for a health nut like me - and backed by peerreviewed, scientific journal articles to prove the credibility of its claims.

Once I realized it was a student publication, I jumped at the chance to be a part of its creation.

Soon after, I started as a staff writer for Total Wellness, with my first article centered on nutritious smoothie as quick meals Issue 5, Volume 12: The Smoothies Solution. Since then, I’ve written for nearly every magazine and seen first-hand the dedication and effort on the part of the writers, designers, editors, and reviewers. Now, as commissioner, I hope to support it in any way I can and use the magazine to educate the student body regarding pertinent health topics. (And, hey, I might still write an article or two, like the IUD Q&A in this very magazine!)

total wellness ▪ summer 2013

Over the course of the 2013-2014 academic year, my commissioner letters will serve as updates for SWC as a whole, such as with upcoming events, fairs, programs, and campaigns.

Currently, SWC is working on 7000 in Solidarity: A Campaign Against Sexual Assault. The 7000 in Solidarity Campaign seeks to create a safe, inclusive campus for students of all gender expressions and sexual orientations by educating our campus community about sexual assault. Our goal is to promote consensual sex, effective bystander intervention, and access to UCLA resources that support survivors of sexual assault.

The campaign is based on the statistic that 1 in 3 women, and 1 in 6 men will have survived sexual assault in college, meaning that at UCLA, 7000 individuals will have experienced some form of sexual violence by the time they graduate. With 7000 survivors at UCLA, we seek to engage our campus community to take a stand against sexual assault. We realize the potential for us to shift the campus climate to one where sexual assault is not tolerable. To join the fight against sexual assault, please visit usac.ucla.edu./7000insolidarity/.

For now, I hope you enjoy this latest issue and take away from it new information and tips to help you lead a healthy lifestyle!

Best,

total wellness Director and Editor-In-Chief Assisstant Editor-In-Chief Co-Art Director Co-Art Director Managing Editor Copy Editor Finance Director Assistant Finance Director Outreach Director Webmaster

Shannon Wongvibulsin Chalisa Prarasri Barbara Wong Karin Yuen Cindy La Julie Escobar Nabeel Qureshi Angela Hao Annie Theriault Kevin Sung

Staff Writers Ryan Babadi, Savannah Badalich, Leslie Chang, Julia Duong, Julia Diana Feygelman, Samantha Leslie Fong, Sally SooHyun Kim, Harini Kompella, Sofia Levy, Lawrence Liem, Tiffany Lin, Josephine Liu, Pavan Mann, Halee Michel, Samantha Mojica, Allison Newell, Lillie Luu Nguyen, Jaclyn Portanova, Anahit Poturyan Design Natalie Chong (intern), Karen Chu, Emily Hsu (intern), Jocelyn Kupets, Coco Liu, Ally Lucchi (intern), Allison Newell, Keziah Pagtakhan, Catrina Pang, Kristen Sadakane, Mary Sau, Jessica Sun, Annie Theriault, Alexandria Villanueva (intern), Barbara Wong, Shannon Wongvibulsin, Karin Yuen Advisory & Review William Aronson, MD

Professor, UCLA School of Medicine

Susan Bowerman, MS, RD, CSSD

Assistant Director, UCLA Center for Human Nutrition

Leah FitzGerald, RN, FNP, PhD

Assistant Professor, UCLA School of Nursing

Dena Herman, PhD, MPH, RD

Adjunct Assistant Professor, UCLA School of Public Health

Eve Lahijani, MS, RD

Nutrition Health Educator, UCLA Bruin Resource Center

Melissa Magaro, PhD

Clinical Psychologist, UCLA Counseling and Psychological Services

Lilia Meltzer, RN, NP, MSN

Lecturer, California State University, Long Beach

William McCarthy, PhD

Adjunct Professor, UCLA School of Public Health

Rena Orenstein, MPH

Assistant Director, Student Health Education

Allan Pantuck, MD, MS, FACS

Associate Professor, UCLA School of Medicine

Raffi Tachdjian, MD, MPH

Assistant Clinical Professor, UCLA School of Medicine

Elisa Terry, NSCA-CSCS

FITWELL Services Program Director, UCLA Recreation

Alona Zerlin, MS, RD

Research Dietitian, UCLA Center for Human Nutrition

Total Wellness is a free, student-run, publication and is supported by advertisers, the Arthur Ashe Student Health and Wellness Center, the On Campus Housing Council (OCHC), the Student Wellness Commission (SWC), UCLA Recreation, and the Undergraduate Students Association (USAC).

Contact 308 Westwood Blvd., Kerckhoff Hall 308 Los Angeles, CA 90024 Phone 310.825.7586, Fax 310.267.4732 totalwellnessatucla@gmail.com www.totalwellnessmagazine.org www.swc.ucla.edu Subscription, back issues, and advertising rates available on request Volume 13, Issue 5

Savannah Badalich SWC Commissioner

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© 2013 by Total Wellness Magazine. All rights reserved. Parts of this magazine may be reproduced only with written permission from the editor. Although every precaution has been taken to ensure the accuracy of the published material, Total Wellness cannot be held responsible for the opinions expressed or facts supplied by authors. We do not necessarily endorse products and services advertised. The information in Total Wellness is not intended as medical advice and should not replace the advice of your physician.

Always consult a health care provider for clarification.

contents IN EVERY ISSUE 2 Editor’s Note 4 Words From the Commissioner 6 In the News 7 Q&A 46 Decoding the Nutrition Label 47 Credits

DEPARTMENTS get active 8 Running Outdoors vs.

Running on a Treadmill body in focus 10 A Study on Bloody Noses 12 Ways to Wake Up eat right 17 Salad Savvy: A Guide to “Green” Eating mythbusters 22 Hear This: How to Properly Clean Your Ears

total wellness

ON THE COVER

26 The Nail Files: Preventing and Decoding Your Nails’ Puzzling Appearance 31 Clear Waters: Filters to Purify Your Water 34 Mindful Running 40 Delightful Desserts

total wellness ▪ summer 2013

cover: kais tolmats/istockphoto; right: tacojim/istockphoto

FEATURES

a ucla student wellness commission publication

health in your

+

hands

your guide to salad greens

ways to wake up from

daytime sleepiness

nutritious & delicious

tasty treats

12 17 26 40

Ways to Wake Up Salad Savvy Nail Health Delightful Desserts

summer 13 | vol 13 | issue 5

5

in the news

what’s happening in health? by shannon wongvibulsin

| design by barbara wong

RESEARCH AND NEW FINDINGS Tylenol: Potential for Liver Failure and Death

A recent study conducted by the University of Texas Health Sciences Center and published in Cancer Prevention Research concluded that poor dental health is an independent risk factor for human papillomavirus (HPV) infections, which can contribute to oral cancers. Through the analysis of approximately 3,400 participants (ages 30 to 69) from the 2009-2010 National Health and Nutrition Examination Survey, the researchers found that individuals who reported poor oral health exhibited a 56% higher rate of HPV infection compared with those with good dental health. For this study, oral health data was determined based upon the following factors: self-rating of overall oral health, presence of gum disease, use of mouthwash, and number of teeth lost.

Although the authors of this study recognize that further research is still necessary, they indicate that bad oral health could result in a potential “entry portal” for HPV since mouth ulcers, mucosal disruption, and chronic inflammation can provide the wound site necessary for HPV infection.

total wellness ▪ summer 2013

Microbes for Health

New evidence recently published in Nature from research conducted at the National Institute for Agricultural Research in France suggests that the microbes in our digestive systems are important for functions beyond simply aiding in food digestion. In fact, these researchers found that individuals with less diverse microbes are more likely to gain weight and develop conditions, such as insulin resistance and inflammation, which are risk factors for health problems like type II diabetes, heart disease, and cancer. These findings support the notion that consuming a poor diet or antibiotics regularly can be associated with health problems and the obesity epidemic through the impact of these practices on our gut microbes.

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30

percent of adults get six or less hours of sleep per night

AT UCLA

80

thousand deaths in the US annually result from excessive alcohol use Kidney Tests and Smartphones

A recent development at UCLA Henry Samueli School of Engineering and Applied Science and California NanoSystems Institute makes it possible to conduct kidney tests with a lightweight portable device and transmit data through a smartphone attachment. Because patients with kidney disease must regularly provide fluid samples to labs or health centers in order to monitor their health, this requires the patient to make a substantial number of office visits. In fact, many patients make multiple visits over the course of one day. The new device, based on the detection of albumin in the urine and the transmission of test results in seconds, has the potential to significantly decrease the need for office visits by patients with diabetes or chronic kidney ailments. t w

90

percent of Americans consume more sodium than the recommended intake cdc

left (in order): mohamed sadath/istockphoto; henrik jonsson/ istockphoto; right: roel smart/istockphoto

More than Cavity Prevention: Brushing Your Teeth and Cancer Prevention

Soon, Tylenol caps will have warning labels indicating that the pain reliever has the potential to cause liver failure and death.

Although similar warnings are already printed on the product’s label, the purpose of the cap label is to inform consumers who may not read the medication’s fine print. Since acetaminophen, Tylenol’s active ingredient, is estimated to result in approximately 500 deaths and 55,000 to 80,000 emergency room visits annually, health officials aim to decrease these numbers by alerting consumers through this new warning label.

NUMBERS

q&a

Q: A:

What is an IUD? How does it work? by savannah badalich | design by barbara wong

The “intrauterine device” or IUD is a small T-shaped device inserted into the uterus to prevent pregnancy. There are currently three types of IUDs available in the United States: ParaGard, Mirena, and Skyla.

› paragard is a copper IUD and does not affect hormone levels, thus avoiding potential symptoms and side effects associated with hormonal forms of birth control. The US Food and Drug Administration (FDA) has approved ParaGard for ten to 12 years of use. › mirena is an IUD that releases a small amount of progestin-

like hormone (Levonorgestril) locally into the uterus. Progestin is a hormone that prevents egg release, makes the uterine lining unfavorable for implantation, limits the sperm’s ability to fertilize the egg, and thickens the cervical mucus to further hinder the sperm’s movement. Mirena is FDA approved for use for five years.

› skyla, the newest IUD, was approved by the FDA in February of 2013. It is essentially a mini-Mirena; it is smaller and good for three years. what are the benefits over the traditional birth control pill?

what are the cons?

IUDs provide no protection from sexually transmitted infections and may cause irregular bleeding in the early months after insertion and cramping and pain at insertion.

Also, there is a two to ten percent chance of expelling the IUD within the first year after insertion. In extremely rare cases - one in one thousand - the IUD can puncture/perforate the uterus as stated in a 2013 article in the journal Human Reproduction; however, this is usually associated with the procedure of placing/inserting the IUD.

resulting in anemia. › Mirena can cause development of ovarian cysts, but these generally resolve without treatment. About 12% of women become amenorrheic (do not have any periods) while using Mirena; thus, Mirena can be used as a form of treatment for women who have heavy, irregular periods. › There is not enough data yet to detail Skyla.

how soon after getting an IUD can I have sex?

It depends on the IUD type and your menstrual cycle. With the ParaGard IUD, it is immediately effective after insertion.

IUDs can be used as a form of emergency contraception, if they are placed within 120 hours (5 days) of sexual intercourse.

how is an IUD inserted?

An IUD is inserted into the uterus through the vagina and cervix. It is inserted using specialized tools by your healthcare provider. This is an office procedure and can be done during any time of the menstrual cycle once a pregnancy has been excluded. However, placement of an IUD during menses has been associated with a higher incidence of expulsion.

how is an IUD removed?

IUD removals are done in the office and are usually a simple procedure. This should only be performed by your healthcare provider. You cannot remove the IUD by yourself, and attempts to do so may cause injury and other complications.

how much does it cost?

IUDs are the least expensive long-term and reversible form of birth control. The total cost for the medical examination, the cost of the IUD, insertion of the IUD, and any office follow-up visits can range from $500 to $1,000, depending on your insurance policy. However, keep in mind that the total cost of the IUD is spread out for three, five, or ten years, depending on the type of IUD. t w

got a question? We love curious readers. Send

your question over to totalwellnessatucla@gmail.com and the answer may appear in a future issue.

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total wellness ▪ summer 2013

According to a 2012 article published in the New England Journal of Medicine, IUDs are 21.8 times more effective than the birth control pill, patch, or ring. Compliance is not an issue because once the IUDs are inserted in the physician’s office, there is no need to “remember” to take the pill daily, change the patch weekly, or change the ring every three weeks. An added benefit specific for the Mirena and Skyla IUDs is decreased menstrual bleeding. Additionally, IUDs are completely reversible. Once you decide you want to get pregnant, the IUD can be removed to restore fertility.

specific cons for each iud: › ParaGard can cause pelvic cramps and heavier periods,

get active

running outdoors by josephine liu | design by annie theriault

Running USA reported that there were 4,600,000 road race finishers in 1990. In 2011, almost 14,000,000 Americans signed up and finished countless 5Ks, 10Ks, half marathons, and marathons. There is no doubt that running has quickly grown to become a popular form of exercise and recreation in the US. There has also been increasing debate on whether it is better to run outdoors or to run on a treadmill. Although treadmills are becoming more advanced in simulating the experience of running on a track, die-hard longdistance runners still swear by running on the terrain of the great outdoors. So, is there really a difference?

It turns out where you run may not only affect you physically but psychologically as well. Running overground may lead to faster speeds and heightened positivity. However, running on a treadmill may help a runner avoid injuries that running on a track or on concrete can cause. Read on for a detailed breakdown of how the styles compare.

total wellness â–Ş summer 2013

Some studies suggest that running outdoors may lead to faster speeds. Higher involvement of sensations from the environment, such as vision, auditory noise, and thermal senses can cause a reduction of relevant sensory input, such as exhaustion or pain. This may lead the runner to run faster outdoors without feeling as tired as he or she would on a treadmill. In a 2004 study published in Psychology of Sport and Exercise, 60 individuals who ran an average distance of at least 15 miles per week were randomly placed into groups running on a treadmill or an outdoor route. Researchers found that running on the treadmill resulted in significantly slower 5-km times than on the outdoor route, with a mean time of 29.60 minutes for treadmill runners and 25.56 minutes for outdoor runners.

Similar results were previously found in a study published in 1991 in Medicine and Science in Sports and Exercise, in which subjects consistently ran faster on the field than on a treadmill even when tested at light, medium, and difficult levels of intensity.

Researchers hypothesized that these results may be due to the environmental effect of running outdoors.

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left: bholland/istockphoto; right: donnichols/istockphoto

running performance

vs. running on a treadmill mood

The environment in which people run can also affect their mood afterwards. In a study published in 1995 in Psychophysiology, the outdoor run subjects were found to feel less anxious, less depressed, less hostile, less fatigued, and more invigorated after running while indoor runners felt the exact opposite. Researchers concluded that because the environment of the treadmill lacked the visual, auditory, and thermal stimulation that the outdoors provided, subjects might have experienced some physical and emotional stress, causing the subjects to report more fatigue, depression, and anxiety after their run.

injury

Several studies have shown that how the body is positioned when running overground can lead to more injuries than when running on a treadmill. A 2003 study in the British Journal of Sports Medicine concluded that due to differences in running form, compressive strain and tension strain rates were 48% to 285% higher during overground running than during treadmill running. In a study published in 1976 in Medicine and Science in Sports, researchers found that the length of the runners’ strides shortened when subjects ran on a treadmill as compared to running overground. Another study published in 1995 in Medicine and Science in Sports and Exercise discovered that subjects systematically planted their feet in flatter positions, allowing more surface area of their feet to make contact on the treadmill than overground. Because treadmill runners experience lessened compression and tension strain from running with shorter strides and flatter feet, treadmill runners are at a lower risk for developing tibial stress fractures, more commonly known as “shin splints.”

air pollution

total wellness ▪ summer 2013

Air quality also plays a key factor in the benefits or downsides of running outdoors. Because runners are more likely to take deeper inhalations and to breathe through their mouths instead of their noses, the air they breathe bypasses the filters of the nasal passages which normally blocks airborne pollutants from entering the body. While the South Coast Air Quality Management District deems most of the West Los Angeles and Santa Monica region “good,” make sure to check the most recently updated air quality map before heading out. Also make sure to avoid areas with high traffic congestion or outdoor smoking areas. For those living in areas where the air quality is less than “good” or “moderate,” such as in Downtown Los Angeles, the best way to avoid damage to the lungs may be to run indoors.

For the runner whose main goal is aerobic fitness or burning calories, treadmill running may be preferable to overground running, as it offers less risk of developing tibial stress fracture and is insusceptible to weather changes or low air quality.

However, for the runner whose major concern is speed improvement or a mood lift, running outdoors may be the most profitable option. t w

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body in focus

a study on

bloody noses by leslie chang| design by jessica sun

Nosebleeds are common problems for many individuals.

In fact, a retrospective study published in 2005 in the American Family Physician found that 60% of the population has suffered from nosebleeds at least once during their lives. Nosebleeds occur more often in males, children less than ten years old, and adults 50 and over. Most cases do not require medical attention; but it is important to know how to prevent and treat common nosebleeds and when it is necessary to seek medical attention.

what are the different types of nosebleeds? at the front of the nose is broken, which results in blood leaking through the nostrils. This type of bleeding is easily treated at home and usually does not require medical attention.

total wellness ▪ summer 2013

posterior nosebleeds: This type of nosebleed is rare and mostly found in elderly patients. Posterior nosebleeds occur when blood vessels in the back of the nose are broken and require admission to the hospital to stop the bleeding. This is dangerous because the blood moves to the back of the throat and can cause suffocation (when blood enters the windpipe).

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cases where nosebleeds should be seen by a healthcare provider:

› If bleeding does not stop after 20 minutes while using the measures described on page 11

under how to treat nosebleeds, it would be safer to seek medical treatment rather than tend to the nosebleed yourself. The healthcare provider may need to cauterize the blood vessel (seal the source of the bleeding) or put in nasal packing to put pressure inside the nose to stop the bleeding.

› If the nosebleed is caused by trauma to the head, the healthcare provider may choose to check for a skull fracture or a broken nose by taking an x-ray.

cases where nosebleeds are frequent, it is also important to see a healthcare provider as they may › Inneed to cauterize a blood vessel or prescribe medications such as blood thinners.

main image: talaj/istockphoto; bottom left: jusun/istockphoto; bottom right: dny59/istockphoto

anterior nosebleeds: This is the most common type of nosebleed. Anterior nosebleeds occur when a blood vessel

what causes nosebleeds? medical conditions: High blood pressure can increase the risk for nosebleeds because blood vessels can burst from inside the nose due to pressure in the veins. Less commonly, genetic disorders such as hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu disease) can also increase the likelihood of nosebleeds as it is difficult for people with this condition to naturally stem the bleeding with abnormal blood vessel formation. drugs: A 2008 retrospective study of nosebleeds, published in the Israeli Journal of Emergency Medicine, found that drugs such as aspirin and warfarin, which thin the blood and prevent clotting, may increase the frequency of nosebleeds and make them more difficult to stop.

trauma: The most common cause of nosebleeds is trauma to the nose. Trauma to the outside of the nose, such as an injury to or near the nose, can break blood vessels. It is also possible to injure the inside of the nose through nose picking, repeated irritation from the cold air, strong nose blowing, and particles in the air, such as cigarette smoke. nostril formation: If you are born with a deviated septum (when the cartilage in your nose leans to one side) or perforated septum (when the cartilage develops a hole) the possibility of a nosebleed increases. unknown: There are also instances where there is no apparent cause for bleeding. However, infrequent, mild nosebleeds should not provoke concern.

how to treat nosebleeds? nosebleeds can often be addressed with simple first aid.

here are some things you can do:

› › › › ›

Gently compress the soft tissue of the nose (the nostril area) with your fingers for at least five minutes and up to 20 minutes.

Plug the affected nostril with gauze or cotton.

Tilt the head forward to prevent blood from going into the throat and avoid nausea and airway obstruction.

If blood has traveled to the mouth, spit it out as swallowing may cause nausea.

After bleeding has stopped, use a humidifier or vaporizer to keep the nose from drying out and bleeding again.

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Using an ice pack on your neck: In a 2003 study published by Clinical Otolaryngology & Allied Sciences, researchers reported that using ice to treat nosebleeds had no significant difference in the amount of blood flow as compared to participants who did not use ice.

2

Being exposed to dry air (such as in a heated home): Your nose is more sensitive during and after nosebleeds. Exposure to a dry environment may irritate the nose and increase the chance of re-bleeding.

3

Blowing your nose after the bleeding has stopped: Blowing the nose increases stress on the blood vessels and the risk of loosening coagulants. This can lead to re-bleeding. t w

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total wellness ▪ summer 2013

common mistakes made when treating nosebleeds:

body in focus

ways to wake up by pavan mann | design by jocelyn kupets and barbara wong

left: ariwasabi/istockphoto; right: antagain/ istockphoto; maridav/istockphoto

total wellness â–Ş summer 2013

Sometimes, getting plenty of sleep is enough to start the day, but it is not always enough to get through the day. Though caffeine can provide a quick fix for afternoon fatigue, according to a 2008 publication in Sleep Medicine Reviews, it can also disrupt normal sleep schedules, reduce sleep quality, and further induce daytime sleepiness. Although a 2007 study in the American Journal of Physiology: Endocrinology and Metabolism correlated two-hour long midafternoon naps to an increase in alertness and performance, napping is not always a reasonable solution for students in class or employees at work. Without a pick-me-up coffee or a rejuvenating nap, it may seem that no force within can restrain the urge to doze off into daydream-land. Fortunately, some shortterm triggers of daytime sleepiness are resolvable, and their effects may be reversible. For further information on long-term causes of persistent fatigue, check out Fixing Fatigue in Issue 4, Volume 11.

Read up for a few ways to wake up!

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triggers of daytime sleepiness

solution: Stick to one sleep schedule! Any imbalance in these metabolic molecules caused by a change in circadian rhythm may lead to insufficient energy allocation throughout the day and can warrant unwanted sleepiness. A good way to keep the circadian rhythm in check is to align it with the environmental rhythm by making a regular schedule of sleeping at night when it’s dark, waking in the morning when it’s light, and eating at the same times. This way, outputs and inputs of energy can be regulated and utilized for maximal alertness throughout the day.

People who experience continual changes in their daily cycle, such as night shift workers, often take melatonin supplements to induce sleep or reset their circadian cycles with bright light.

However, supplements should always be properly discussed with a doctor prior to usage.

circadian rhythm upset The circadian rhythm is roughly a 24-hour cycle of changes in physical and behavioral state. For diurnal animals like humans, this cycle is normally aligned with the environment so that the pattern of sleep and wakefulness corresponds to dark and light, respectively. Altering a regular sleep schedule may misalign the arrangement of the circadian and environmental cycles, causing sleep disorders. A 2009 article in Sleep Medicine Reviews revealed that people with irregular sleep-wake rhythms such as shift workers (night workers), late-night studying students, and those who experience jet lag, are often afflicted by daytime sleepiness and other sleep problems like insomnia.

Desynchronizing sleep and biological cycles may in turn induce sleepiness and wakefulness at inappropriate times, and these factors can also alter normal release of energyrelated hormones in the body.

thyroid stimulating hormone: In 2005, a study in Medscape Neurology revealed that the release of thyroid stimulating hormone (TSH), which is essential to maintaining the body’s metabolic rate (energy usage rate), is significantly decreased in those who received only four hours of sleep for six days compared to the same people when they received 12 hours of sleep for six days. Lower TSH levels due to a dramatic shift in sleep cycle can decrease the amount of energy that is available, inducing lethargy at abnormal times.

A 1993 study published in Human Relations defines boredom as “an unpleasant, transient affective state in which the individual feels a pervasive lack of interest in and difficulty concentrating on the current activity.” Thus, boredom can actually decrease cognition and increase the sensation of sudden sleepiness. how it happens: disinterest: A tedious task at work or a monotonous lecturer in class can trigger boredom, which in turn reduces brain stimulation and alertness. In fact, a 1994 study in the British Journal of Psychology revealed that temperature effects on alertness were minor in comparison to the effects of an individual’s interest. A bored participant was more likely to have slower reaction times and to report feeling sleepy.

Additionally, the afternoon “dip” in alertness was found to be between three o’clock and three thirty, during which boredom was particularly potent in inducing daytime sleepiness. solution: Take a break, yawn, or do both! In a 2008 article in Medical Hypotheses, yawning was proposed to increase arousal, alertness, and wakefulness by mechanical stimulation of the carotid body, which detects oxygen and carbon dioxide levels in the blood. Thus, if a yawn is coming on, it may be better to let it carry out! Another way to increase oxygen to the brain and become more alert is to do some type of physical activity, such as stretching in place or taking a walk around the office or classroom. If the issue is with disinterest, finding ways to increase alertness and decrease sleepiness is crucial.

Writing notes in different colors or working to music might just do the trick. Even taking a quick break can help refresh the mind.

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total wellness ▪ summer 2013

how it happens: melatonin and melanopsin: In 2013, the Handbook of Experimental Pharmacology discussed the effects of molecules that help regulate the circadian rhythm and control sleep.

Melatonin, a chemical that facilitates sleep, is produced naturally at night, but its production is halted when the eyes detect light. Upsetting this balance with light at night and dark in the day can cause wakefulness and sleepiness at irregular times of the day. Additionally, light can activate a light-absorbing pigment in the eye called melanopsin, which in turn causes arousal from sleep. A 2013 Proceedings of the Royal Society: Biological Sciences study revealed that melanopsin is most sensitive to wavelengths of blue light, meaning blue light is most effective in waking up the body.

boredom

showed that low GI breakfast meals significantly reduced the glucose and insulin response compared to high GI and high protein meals, meaning that post-meal blood glucose remained high, and energy level was sustained. Low GI meals can be better providers of energy after a meal and can help prevent post-lunch doziness compared to high GI, high fat, high meat, or even low fat meals. Thus, finding a Glycemic Index of foods online may be helpful in choosing energyefficient foods throughout the day. However, seemingly similar foods can have different GI values, so it is important to check a GI chart before chowing down.

high glycemic index meals

total wellness ▪ summer 2013

how it happens: insulin response: Foods high in certain simple carbohydrates, such as white bread, have a high GI and rapidly increase blood glucose levels. In response, the pancreas releases excess insulin, which in turn dramatically decreases blood glucose levels a few hours later, leading to tiredness. Glucose is a molecule that the body uses for energy, and a lack of it after a high GI meal may cause the urge to nap. A clinical trial published by the Public Library of Science in 2013 revealed that significantly less energy was available 180 to 300 minutes after a low fat meal than after a low GI meal. A corresponding study found that low fat, high carbohydrate meals may have caused subjects to feel more awake two to three hours after eating than high fat, low carbohydrate meals did. This study, published in 1997 in Physiology and Behavior, thus related high fat intake to less energy availability and high carbohydrate intake to relatively more energy. fat digestion: Similarly, in a 2010 study published in Sleep Medicine, women who had a high fat or meat intake during a meal reported feeling the need to nap afterwards, indicating that these types of meals may induce sleepiness.

In Physiological Genomics, a 2007 publication discovered that during sleep, more enzymes involved in cholesterol synthesis and more proteins used in lipid transportation are produced.

Though this study was done in rats, it may reveal that digestion of fat and cholesterol is linked to sleepiness and may be causing the urge to nap. solution: Try eating low GI! Low GI foods, including beans, whole grains, and vegetables, contain complex carbohydrates that are harder to break down and last longer as an energy source in the body. A 2011 study in Obesity

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poor indoor lighting A 2012 publication in Physiology and Behavior revealed that brighter indoor light conditions increased alertness, attention to tasks, and heart rate, regardless of the time of day or duration of light exposure. The participants in the study reported feeling less sleepy and more energetic in the high versus the low light conditions. They also had shorter reaction times on a vigilance task in high light, indicating higher physiological arousal. However, the computers that students and workers often use provide a bright and close source of light, significantly increasing the prevalence of eye strain, burning, and itching after six hours of use, as revealed in the Journal of Clinical and Diagnostic Research in 2013. how it happens: melatonin and melanopsin: As discussed in detail in the How it Happens: Circadian Rhythm Upset section on page 13, light has been shown to suppress melatonin and activate melanopsin. These may affect wakefulness and provide the power to fight the urge to doze off. Nevertheless, light that is too bright or intense can tire the eyes, making the eyelids feel heavy and inducing overall tiredness. solution: Turn up the right lights! Creating a good balance of indoor lighting includes turning on ambient light and dimming focused light. For example, dimming the computer screen and turning on the main light may help to reduce eye strain, and the bright surrounding light may induce wakefulness. If an individual desk light must be used to spare a roommate or co-worker from disruption, aiming it slightly to the side of the project at hand can reduce the intensity of the light. For more information about computer lighting and its effect on eyes, read iStrain in Issue 3, Volume 13!

left: chelnok/istockphoto; blackjack3d/istockphoto; right: rouzes/istockphoto; hiro-pm/istockphoto

The glycemic index (GI) is a measure of how quickly blood sugar (glucose) levels rise after eating a certain food containing different kinds of carbohydrates. Research released in 2007 in The American Journal of Clinical Nutrition found that a high GI meal significantly reduced the time required for onset of sleepiness compared to a low GI meal, and that high GI meals are more likely to induce sleepiness four hours after ingestion. For example, if an individual eats a high GI lunch of a white bread sandwich and a soda at 11 o’clock, he or she may feel the need to nap about four hours later, around three o’clock. In comparison, a low GI meal of kidney bean soup and grapefruit juice may be less likely to lead to dozing off.

reported feeling more tired than when fluids were permitted.

Thus, it is crucial to drink water regularly and to stay adequately hydrated and awake. For more information on dehydration and sleepiness, see Fixing Fatigue in Issue 4, Volume 11. Prolonged and repeated exposure to sunlight can also create a high risk of skin cancer, so avoiding excessive outdoor activity and applying sunscreen regularly are important habits to form.

lack of sunlight Sunlight is an excellent source of vitamin D, an essential nutrient that can be absorbed through the skin. Vitamin D deficiency can sometimes cause excessive daytime sleepiness. The sun also helps to set the natural circadian rhythm because it decreases production of melatonin, which is released during sleep. Simultaneously, it provides light that triggers the activation of melanopsin, which works to wake up the body, as described in How it Happens: Circadian Rhythm Upset on page 13 and How it Happens: Poor Indoor Lighting on page 14. how it happens: vitamin d: In 2012, research published in the Journal of Clinical Sleep Medicine demonstrated a significant correlation between decreased vitamin D levels and a subsequent increase in sleepiness. The study also revealed that members of different racial groups, particularly AfricanAmericans, may be more susceptible to sleepiness due to vitamin D deficiency than others.

solution: Soak up some sun! This is one way to ensure that sunlight can do its job in regulating melatonin, serotonin, and vitamin D in the body. If the majority of the day is spent indoors in class or at work, try eating lunch outdoors or going for a walk to get adequate sun time. Too much unprotected sun exposure, however, can be counterproductive and harmful. The heating effects of the sun dry the body’s water supply, sometimes leading to dehydration, which causes fatigue. In fact, a 2004 study in the British Journal of Nutrition found that subjects dehydrated for just 24 hours experienced reduced alertness, greater difficulty concentrating, and

Though exercise may seem tiring, it can actually keep the body awake and active throughout the day, if executed correctly. Too little exercise can induce a persisting inactive state that decreases the amount of energy the body has to stay awake and alert. Surprisingly, exercise that is too strenuous may also have a negative effect on alertness. how it happens: cognitive function: Brain Research published a 2010 study that emphasized the effects of the complex, positive correlation between exercise and cognition, or alertness (which can be defined as the opposite of sleepiness). The study found that steady-state cycling exercise and fatiguing running exercise were both shown to increase cognitive function as well as enhance memory storage and retrieval after a workout. In contrast, this mental performance significantly improved during and after cycling, but running on a treadmill decreased mental performance during the activity and had little positive effect afterwards. response time: Other studies, such as one conducted in 2011 for Physiology and Behavior, have concluded that acute, intermediate intensity exercise has a strong, beneficial effect on reducing the time of response in memory tasks, but a low or possible detrimental effect on accuracy of response.

Additional research from Brain and Cognition in 2012 had coinciding results, finding that moderate intensity exercise increases mental arousal and a faster speed of processing, though the effect on accuracy is indeterminable. solution: Get physical, but not too much or too little!

Exercising regularly may improve cognitive function, but it does not have to be intense in order for it to make a difference. Simply taking the stairs up to the office or classroom may be just what is needed to get through a particularly tiring time of day. Biking instead of driving to work may not always be practical, but it can be a three-in-one situation: a workout, transportation, and a way to beat traffic!

If gym time cannot be scheduled, trying small exercises like stretches can be beneficial. Anything that will get the heart rate going might be the key to keeping unwanted daytime sleepiness away.

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total wellness â–Ş summer 2013

melatonin and serotonin: Environmental Health Perspectives released an article in 2008 that discussed the beneficial effects of sunlight on the regulation of sleep hormones such as serotonin and melatonin (previously discussed in the How it Happens: Circadian Rhythm Upset on page 13 and How it Happens: Poor Indoor Lighting on page 14). In this study, those exposed to sunlight or very bright artificial light in the morning were found to produce melatonin earlier the following night, making the transition to a sleep state easier. The 2008 article revealed that serotonin, another sleep hormone, is produced by mammalian skin cells during the daytime and converted to melatonin at nighttime to aid the onset of sleepiness. It found that moderately high serotonin levels may result in a more positive mood and a calm, focused mental outlook.

lack of exercise

solution: Stay warm! Since warmth and coldness have been correlated to wakefulness and sleepiness respectively, a good way to prevent a daytime nap is to keep the cold at bay.

If the lecture hall or office is often chilly, bring a sweater or wear layers. Though bundling up can feel cuddly and bed-like, it may have the opposite effect and it could prevent drowsiness from taking over the afternoon.

food and sleep: energy compensation

low temperature Body temperature, as a part of the circadian rhythm, also follows a daily pattern of highs and lows. The body’s temperature is highest during the active times of day because the body produces heat as it creates and uses energy. When the body is resting, there is less activity and therefore less heat production, causing a decrease in body temperature that has been correlated to sleepiness. how it happens: thermoregulation: The Journal of Physiological Anthropology released an article in 2012 detailing the effects of the thermal environment on sleep stages, which were shown to be linked to thermoregulation (how our bodies maintain temperature homeostasis), a mechanism that also helps to control sleep.

It revealed that when bedding is used and clothing is worn in bed, heat and humidity exposure increases wakefulness and decreases deep sleep. Cold exposure was not found to affect a specific sleep stage, but it was shown to decrease heart rate and thus, physiological activity. decline in body temperature: In 1993, a study published in Sleep provided information that body temperature drops more rapidly during sleep onset and remains lower than the temperature during wakefulness. Accordingly, results from research published in 2009 in Sleep Medicine Reviews are summarized in the figure below, graphing how body temperature decreases at nighttime during sleep.

core body temperature throughout the day & night 37.4

temperature in °C

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37.0 36.8 36.6 36.4 36.2 36.0 7PM

9PM 11PM

1AM

3AM 5AM 7AM

time

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9AM 11AM 1PM 3PM

5PM

graph adapted from: sleep medicine reviews; volume

13, issue 1, 2009

37.2

A busy student’s or employee’s routine can be characterized by at least one, if not several, sleep-inducing activities: falling out of the circadian rhythm, not getting enough sunlight, working in bright light, eating heavy meals, exercising infrequently, fighting boredom, and even freezing room temperatures. Although these various daily triggers can cause undesirable drowsiness, the tips and tricks listed above may help to reverse their effects. However, these solutions may not be as effective on long-lasting, chronic fatigue that is caused by more serious factors, such as a persistent lack of adequate sleep. Before reaching for a cup of coffee or nestling into a nice nap, dozy daydreamers should try to assess their surroundings and daily habits to look for sources of sleepiness. t w

left: malerapaso/istockphoto; right: creativeye99/istockphoto

Research from the Proceedings of the National Academy of Sciences in 2013 provided evidence that increased food intake after disruption of the circadian rhythm is a physiological adaptation to provide the energy required to sustain wakefulness. A 2005 Medscape Neurology article proposed that sleep restriction may reduce leptin levels (appetite suppressant) and elevate ghrelin levels (appetite stimulant). This means that sleep deprived people may be more likely to overeat.

On the other hand, as summarized in a 2012 article in Molecular and Cellular Endocrinology, levels of glucose, a food energy molecule, may actually rise during sleep. Researchers attributed this counterintuitive phenomenon to lower brain and muscle activity during sleep, causing the unused, excess glucose to be stored rather than utilized for energy.

eat right

salad savvy:

a guide to “green” eating written & designed by allison newell

Whether you are standing in line at the dining hall’s salad bar or wandering the produce aisle at the grocery store, you may notice the variety of lettuce options awaiting you. And you may be thinking: which kind of lettuce do I want? The iceberg lettuce? The classic romaine? It may seem that a salad is a salad, no matter what type of lettuce is used. But think again! It is true that all lettuce types belong in the vegetable group, and that incorporating vegetables into one’s diet provides numerous health benefits. According to a 2000 literature review published in the Journal of the American Dietetic Association, consuming

vegetables can provide essential vitamins, minerals, and protective benefits against some chronic diseases like heart disease, diabetes, obesity, and certain types of cancer such as stomach, breast, and prostate cancer. However, not all lettuce types are created equal when it comes to nutritional content. Despite the general health benefits of lettuce, some types pack more nutritional punch than others. The main types of lettuce are looseleaf, romaine, butterhead, and crisphead. Read on to learn more about these four types of greens and how to maximize the nutritional content of your salad!

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basic nutrients & dietary benefits of lettuce Incorporating a salad into one’s diet is a good way to reach the recommended daily intake of vegetables. According to the United States Department of Agriculture (USDA), the daily-recommended intake of vegetables is two to two and a half cups for women and two and a half to three cups for men. Two cups of raw salad greens, whether it’s romaine or iceberg lettuce, are equivalent to one cup of this daily-recommended intake of vegetables. Before diving into the specifics behind each type of lettuce, here is a general overview of the nutrients that lettuce can provide:

beta carotene: naturally occuring form of vitamin A, which helps maintain skin, eye, and immune system health potassium: helps maintain blood pressure, fluid balance, electrolyte levels, and muscle contraction vitamin c: aids in immune functioning and healing, in addition to keeping teeth and gums healthy vitamin e: antioxidant that protects cell membranes vitamin k: allows blood clots to form when needed and helps synthesize proteins calcium: promotes strong bones and teeth, helps muscles contract and blood vessels dilate iron: aids in the formation of red blood cells and transportation of oxygen to tissues folate: helps the body form red blood cells and is important in prenatal care during pregnancy fiber: aids in digestive functioning, can help reduce cholesterol levels and reduce risk of heart disease Note: Knowing the definitions behind nutrient claims is key to understanding a product’s nutritional content. › Claims such as “excellent source,” “rich source,” or “high amounts” mean the product contains 20% or more of the daily value per serving. › Claims such as “good source” or “good amounts” mean the product contains ten to 19% of the daily value per serving.

the guide ›› the four types of lettuce crisphead lettuce The most common type of crisphead consumed is iceberg lettuce. The name “iceberg” was coined because California growers in the 1920’s shipped the lettuce covered in crushed ice!

characteristics: The crisphead consists of a solid

nutritional content: Of the four types of lettuce, crisphead is ranked the lowest, which can be attributed to its structure. According to a 2009 study published in Current Nutrition and Food Science, synthesis and absorption of nutrients is dependent on exposure to light. The more the surface area of the lettuce is exposed to light, the more nutrients there will be. Because crisphead lettuce leaves are tightly wrapped together, the leaves receive less light exposure and thus are lighter in color. This is why it provides less nutrients compared to the other types. It also contains the least amount of beta carotene in addition to low amounts of fiber and vitamin K compared to the other types. A redeeming quality? Iceberg lettuce beats out looseleaf lettuce for potassium content.

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left: suzifoo/istockphoto; right: fotogal/istockphoto; suzifoo/istockphoto; creativeye99/istockphoto

total wellness ▪ summer 2013

head of tightly wrapped leafs. It is crisp (hence the name “crisphead”), light in color, and has a bland, watery taste.

looseleaf lettuce Green leaf lettuce (such as oak leaf) and red leaf lettuce are two subtypes of looseleaf.

characteristics: Its head consists of loosely gathered leaves. Green leaf lettuce is considered to be the greenest and darkest of the lettuces, which explains why it is a great source of beta carotene. The more green in color the lettuce is, the more beta carotene it contains.

nutritional content: In addition to beta carotene, looseleaf lettuce is high in vitamin K. It also contains a good amount of vitamin C.

romaine lettuce Also known as cos lettuce, romaine is often the main ingredient in Caesar and garden salads.

characteristics: This lettuce grows in a vase-shaped head and is often characterized by its long leaves and thick, white center rib down the center. This rib carries most of the plant’s water and fiber and gives it its characteristic crunch.

nutritional content: An excellent source of beta carotene and vitamin K, romaine also contains the highest amount of fiber, vitamin C, and folate compared to the other three types. These qualities make romaine one of the healthiest lettuce options you can choose.

butterhead lettuce total wellness ▪ summer 2013

Also known as Boston or Bibb lettuce.

characteristics: Identified by its “buttery” textured leaves, this type has small, round leaves that form loosely around the head. This structure makes a head of butterhead lettuce look like a green, blooming rose.

nutritional content: Butterhead reigns supreme in vitamin K content. It is an excellent source of beta carotene and a good source of folate. Also, compared to the other types, butterhead has the most calcium and potassium.

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other types of leafy greens you can find In addition to the four main types of lettuce, there is a range of other options available that continue to grow in popularity.

These days the produce shelves at the grocery store are teeming with a variety of baby greens, microgreens, and prepared salad mixes.

“Baby greens,” such as baby spinach, are leaves that are picked before they are fully grown. “Microgreens,” which are seedlings of edible vegetables and herbs, are even younger than baby greens. Both are often served as a garnish to soups, sandwiches, and salads to enhance flavor, color, and texture. In fact, baby greens and microgreens generally contain more nutrients than their full-grown counterparts! In a 2012 study published in the Journal of Agricultural and Food Chemistry, researchers analyzed nutrient levels of 25 different microgreens and found that almost all of the microgreens were more dense in specific nutrients than the mature leaves of the same plant!

radicchio

Known as Popeye’s “leaf of choice,” this leafy green is oval or triangular in shape, typically dark green in color, and ranks highest (even above romaine lettuce!) in beta carotene, vitamin K, iron, and calcium.

This deep red/purple leaf is often found in mesclun salad mix and is typically sold as a round, compact head. It also is characterized by its thick, white-veined leaves and bitter to spicy taste. This unique leaf is an excellent source of vitamin K.

arugula

kale

This leafy green is classified as a cruciferous vegetable (meaning it belongs to the cabbage family) and originated in the Mediterranean. According to a 2004 study published in Integrative Cancer Therapies, cruciferous vegetables contain many nutrients, particularly glucosinolates, which are sulfur-containing chemicals that are currently being studied for their protective effects against cancer. Arugula has a peppery, bitter taste and is often found in mesclun salad mix. It is a good source of beta carotene and vitamin K.

Also classified as a cruciferous vegetable, this chewy and fibrous plant comes in a variety of colors (green, dark green, and purple) and is rich in antioxidants. Its leaves are typically ruffle-edged. Out of all the cruciferous vegetables, kale is richest in vitamins C and K and beta carotene, with one cup providing 134%, 684%, and 206% respectively of the daily value for these nutrients.

Not only that, but it provides a good amount of folate and potassium. Along with Swiss chard and spinach, kale is one of the most nutrient packed greens out of this whole list.

total wellness ▪ summer 2013

spinach

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left: victorburnside/istockphoto; matka_wariatka/ istockphoto; eyewave/istockphoto; ockra/istockphoto; right: tomboy2290/istockphoto; alasdair thomson/ istockphoto; alasdair thomson/istockphoto

One popular salad mix, mesclun, consists of a variety of different salad leaves. Mesclun salad traditionally consists of a “mescla” or “mixture” of looseleaf lettuces along with more exotic, leafy greens like arugula, frisée, mizuna, and radicchio. Read on to learn more about some of these exotic, trending additions that can spice up your salad!

swiss chard This antioxidant rich leaf is characterized by its shiny, green leaves. Its stem can range in color, from red to yellow to white. Not only is one cup of Swiss chard an excellent source of vitamin C and beta carotene, but it also contains extremely high amounts of vitamin K, providing 374% of the daily value for this important nutrient.

salad tips & tricks Choosing a healthy type of lettuce as your base is one thing, but what you put on it is a whole other story. Toppings can either enhance or diminish the nutrient content of the salad greens. Here are some tips to keep in mind:

avoid creamy and saturated fat dressings.

Try opting for healthy oil dressings (like olive or canola oil) or vinaigrette, a dressing that consists of a mixture of oils that are often flavored with herbs or spices. Oil-based dressings provide a healthy dose of essential unsaturated fats, as long as they are used in moderation.

yea or nay on fat-free dressings?

mizuna This Japanese mustard green is known for its small jagged-edged leaves and its strong flavor. It is often found in prepared salad mixes, particularly mesclun salad. It is high in vitamin C and A and glucosinolates, which help to prevent cancer.

frisĂŠe Also known as curly endive and often used in mesclun salad mix, this leafy green consists of curled leaves with a yellow and green coloring. It is slightly bitter in taste and adds a nice crunch and texture to a salad.

Nutritionally, it is an excellent source of vitamin K and A.

Opt for fat-based dressings over fat-free ones! This may seem a bit counter-intuitive, since fat-free dressings are typically low in calories and are assumed to be healthier for you. But according to a 2012 study published in the Journal of Molecular Nutrition & Food Research, using fat-based dressings actually enhances nutrient absorption of salad and vegetables, and having a dressing with no fat can actually diminish the benefits of the greens you are eating!

Using dressings made with monounsaturated fat required the least amount of fat to get the most carotenoid absorption into the bloodstream compared to saturated and polyunsaturated dressings. Carotenoids are phytochemicals found in plantbased foods and act as antioxidants for the body. Estimates are that you only need a teaspoon or so of these fat-based dressings to aid in the uptake of healthy carotenoids. Using too much dressing can undermine these benefits.

types of toppings:

total wellness â–Ş summer 2013

Avoid putting croutons, bacon bits, and mounds of cheese on top of a salad because these ingredients can add carbohydrates, fats, and calories that may be unnecessary.

Using these in moderation is fine, but excessive quantities can diminish the nutrient benefits of the lettuce. Try putting sunflower seeds or walnuts as a source of protein and texture. Lean meats such as chicken and turkey can add protein to a salad. Fruits and vegetables are always excellent options for toppings that can add even more nutritional punch. Since dressings with monounsaturated fat enhance nutrient absorption, toppings with this type of fat have a similar effect. Such toppings include avocado and nuts (such as cashews and macadamia nuts). A 2005 study published in The Journal of Nutrition found that adding avocado to a salad enhanced carotenoid absorption compared to a salad with no avocado. For this reason, avocado is one of the best additions you can make to a salad.

the bottom line Lettuces that are more green and dark in color (romaine, green leaf, red leaf, and butterhead) provide more nutritional punch than lighter colored and tightly packed lettuces (such as crispheads like iceberg). The same goes for the more non-traditional leafy options, particularly the greenest ones such as kale, swiss chard, and spinach. So the next time you hit the salad aisle or make a trip to the dining hall, keep this in mind when looking for a salad that will give you the biggest nutritional bang for your buck or swipe! t w

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mythbusters

hear this:

how to properly clean your ears

total wellness â–Ş summer 2013

People clean their ears for several reasons: better hearing, comfort, hygiene, and more.

However, these individuals might be using harmful tools or employing dangerous methods to keep their ears squeaky clean. So the question is, what is the proper way for people to clean their ears? Well, contrary to popular belief, commonly practiced methods such as using Q-tips and candling are NOT the answer!

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left: stock shop photography llc/istockphoto; right: design56/istockphoto; cveltri/istockphoto

by sofia levy| design by barbara wong

what not to do: There are commonly practiced, but risky ways to clean out the ears:

q-tip: Using a Q-tip not only puts one at risk for perforating the eardrum, but it can also just push the wax further into the ear and make it more impacted. Also, the cotton tip can increase the chance of bacterial infection.

› A 2004 study in the International Journal of Pediatric first of all, what is wax?

Wax, also known as cerumen, forms in the ear as a result of skin cells, dust, and secretions from ceruminous glands.

Ceruminous glands are structures in the ear canal that secrete lipids and other substances in the ear.

what is wax for?

Secretions from the ceruminous glands are part of the ear’s self-cleaning mechanism. These secretions protect the ear from bacteria by: 1. Keeping the skin in the auditory canal lubricated.

2. Protecting the skin’s protective acid mantle which helps kill bacteria. › According to a 2011 study published in Lipids, the study found over one thousand compounds in ear wax that help protect the skin by producing a low pH in the ear and providing a hostile environment for bacteria.

Otorhinolaryngology concluded that using cotton-tip applicators for cleaning ears seems to be the leading cause of otitis externa in children, otherwise known as swimmer’s ear, an infection or inflammation of the external auditory canal.

› As with using Q-tips, using hair pins and other small objects

to remove ear wax can break the eardrum and/or push the ear wax deeper into the ear canal. *However, it is okay to clean ears using a Q-tip as long as one is cautious and aware of the risks.

candling: Candling is another method used to remove ear wax. Paraffin, beeswax, and cloth are rolled into a cone shape with the small end in the ear. An assistant lights the edges of the other end on fire and the burning supposedly draws the ears wax out of the ear and into the tube. *However, a 2009 study published in The European Journal of General Practice showed that ear candling is not effective and can actually cause injury.

3. Trapping dust, bacteria and other foreign particles to prevent them from entering further into the ear canal. › Movement also helps with this self-cleaning process because actions such as speaking or eating move the lower jaw, which gradually pushes the wax out.

what determines how much ear wax you have?

total wellness ▪ summer 2013

The amount of ear wax that one has may be determined by genetics or age. People of older age may produce more ear wax since the ceruminous glands shrink with age, causing the ear wax to be dry. Dryness keeps the ear from cleaning itself well, so skin particles may accumulate as a consequence and result in greater amounts of wax in the ear.

when should I clean my ears?

It is important to remember that ear wax is beneficial and is not a sign of poor hygiene, so one should not clean his or her ears too often. However, when too much wax builds up, it can become impacted and form a plug. This can also happen when someone wears a hearing aid, uses earplugs, or does not use the right ear-cleaning tools. One might want to remove a blockage of impacted ear wax to improve comfort and hearing.

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how do I safely remove ear wax? irrigation: Streaming water in the ear can soften the wax and make it easier to remove. Irrigation is not advisable for people who currently have, or have a history of, ear infection, ear surgery, eardrum injury, permanent ringing in the ears (tinnitus), or hearing in only one ear.

› It is important not to attempt removing ear wax if experiencing ear pain or discharge. These are signs that a doctor should be seen. oil: Olive oil, almond oil, baby oil, mineral oil, sprays, or ear

drops can also lubricate and loosen the ear wax. The number of drops that should be used depends on the brand and a doctor’s recommendations. With this method, tilt the head side to side for five minutes to let the drops settle.

› A 2009 study published in The Cochrane Library showed that there may not be a difference between various ear drops and how effective they are. Therefore, while using ear drops for removing ear wax is better than doing nothing at all when ear wax builds up, there are no particular types of ear drops that are recommended. see a physician: One can see a physician who uses special

here is how to use irrigation to remove ear wax: 1. Use body temperature water (any cooler or warmer can cause dizziness or vertigo, where you feel as if you are spinning or moving or that the world is spinning around you).

2. Hold your head upright and gently pull the outside of your ear upward to straighten the ear canal.

3. Use a syringe (can be bought at the store) and gently direct a small stream of water at the wall of the ear canal next to the wax.

tools such as a vacuum to safely remove ear wax. It is a good idea to call a physician if the ear wax is tough, if the wax cannot be removed, or if ear pain, fever, or hearing loss occurs.

4. Tip your head to allow the water to drain. Then, you may need to repeat the irrigation.

which way is the best way to clean your ears?

5. When the wax is removed, the ear must be dried thoroughly. This can be done with a hairdryer on a low setting. However, when irrigating, it is important not to irrigate with a tool for cleaning teeth, or if there is another possible ear condition. Also, it is not good to irrigate too much.

A 2010 study published by the National Institute for Health Research (NIHR) compared the different ways of removing ear wax. While it was shown that softeners such as olive oil and sodium bicarbonate being used before irrigation might be helpful, the study was inconclusive in regards to which specific softeners are better and whether mechanical removal or irrigation was more effective in removing ear wax.

Overall, it may be risky to clean ears using a Q-tip or the candling method. However, the ears can be cleaned safely by using lubricants, applying the irrigation method, or seeing a doctor or professional. tw

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left: surabky/istockphoto; right: kutaytanir/istockphoto

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bottom line

total wellness ›› on the cover

total wellness ▪ summer 2013

“Take care of your body; it’s the only place you have to live.”

– Jim Rohn

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features

the nail files:

preventing and decoding your nails’ puzzling appearance by julia feygelman | design by mary sau | illustration by kristen sadakane

left: merzavka/istockphoto; right: original illustration by kristen sadakane

total wellness ▪ summer 2013

Fingernails, the keratinous skin appendages growing at the tips of our fingers, are often mistreated and ignored. Chewed on, broken, painted – they go through a lot. Paying attention to fingernail appearance can provide insight on what’s going on inside our bodies, and may reveal previously undiagnosed health issues. A 2010 study in Clinics in Dermatology found that nail disorders comprise approximately ten percent of dermatological conditions. Addressing them can prevent underlying issues from going unnoticed and worsening. While fun, a manicure isn’t always the cure! Find out what’s causing your nail weirdness and how to prevent it in the future.

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quick nail guide: the major parts distal edge: the part of the nail extending beyond the finger, also called “free edge” nail plate: the “hard part” which most people simply refer to as “the nail”; it is made up of keratin, the

same substance that hair and the top layer of skin are made of nail grooves: the areas of skin on each side of the nail in which it is embedded lunula: the moon-shaped visible portion of the matrix above the cuticle

cuticle: formally known as the eponychium, the cuticle is the small band of epithelium (skin) extending onto the base of the nail

nail root: the base of the embedded nail below the skin, originating from the matrix matrix: the tissue upon which the root of the nail (and slightly beyond) rests, containing nerves, lymph,

and blood vessels nail bed: the surface upon which the nail itself rests

minor conditions beau’s lines (the mild type)

onycholysis

what it looks like: Beau’s lines appear as horizontal indents

what it looks like: Onycholysis causes gradual, painless

or depressions across t he length of the fingernail.

underlying cause: Beau’s lines may be caused by injury

directly to the nail. Injuring the nail causes it to temporarily stop producing nail cells, leading to grooves that are visible on the nail. The hiatus of nail cell production can also be caused by illness, infection, or high fever.

solution: Soak nails in warm salt water or simply warm water two to three times a day to reduce the lines. Using an emollient (or ‘soothing’) cream after washing or after the above soaking procedure may also help. Lastly, apply a mild antiseptic solution to nails. According to The Center for Podiatric Care and Sports Medicine, this keeps the nails from becoming dried out and minimizes discomfort which may result from the aforementioned dryness and irregularity in shape.

separation of the nail from its nail bed.

underlying cause: Non-medical onycholysis can actually be caused by slight or moderate trauma to the nail, such as repetitive tapping or impact. It can also be caused by improperly using tools that clean under the nail or over moisturizing the fingertips or nails.

solution: For minor cases of onycholysis not caused by systemic medical conditions, waiting for the nail to grow back is the most viable solution. Because the condition is not caused by a distinct source, there is nothing to treat holistically and the nail must simply repair itself.

chromonychia what it looks like: “Chromonychia” is a Greek term meaning

acute paronychia what it looks like: This condition makes the nail fold (area

where the nail edge meets the finger) inflamed, painful, red, and swollen. Sometimes, yellow pus appears under the cuticle.

by bacterial infection. The cold sore virus or yeast (a fungus naturally found in our bodies which can grow out of control under certain circumstances) may also be at fault.

solution: Bacterial cases can be treated with oral antibiotics, while viral infections are treated with oral antifungal medications such as fluconazole and topical creams, both of which can be prescribed by a doctor. These kill off the bacteria or virus causing the infection, in turn relieving the symptoms of paronychia. An antiviral drug called valaciclovir is usually prescribed for viral cases because it can cure the infection within seven days.

underlying cause: Vitamin B12 deficiency is likely a root

cause of black bands, while white marks can be caused by direct trauma to the nail. The orange staining is usually due to overuse of nail polish without a protective base coat.

solution: Consume a diet rich in vitamin B12 by including more seafood, beef, and eggs. A good vegan option is fortified cereals or energy bars.

As for the issue of staining: 1. Combine equal parts three percent hydrogen peroxide with warm water and soak for five minutes. Hydrogen peroxide has “been found to be effective in bleaching or lightening” discolored nails according to a 2000 U.S. patent titled “Process for bleaching chemically tanned skin and discolored nails.”

2. After soaking, scrub with a toothbrush using baking soda paste (equal parts warm water and baking soda).

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underlying cause: Acute paronychia is usually caused

“color nail.” It can refer to any type of nail discoloration, but symptoms of the less critical forms include black bands on the nails, white marks, or an orange-ish tint. The black bands can range from thin lines to amorphous splotches. If the marks are white, they usually appear as thick horizontal bands.

critical conditions nail pitting

koilonychia

what it looks like: Nail pitting appears as small, numerous

what it looks like: Meaning “spoon nails” in Greek, nails

underlying cause: A 2004 study published in American

underlying cause: Most commonly, koilonychia points

Family Physician reported that nail pitting could be a sign of multiple systemic conditions including psoriasis (genetic skin condition), Reiter’s syndrome (bacterial arthritis), incontinentia pigmenti (a genetic skin disease), and alopecia areata (hair loss).

solution: As these are wide-ranging and complex diseases, treatment is varied. If you suspect having any of these conditions, seeking medical attention as soon as possible is the best way to go.

to hypochromic anemia (paler than normal red blood cells), which is usually caused by iron deficiency, according to a 2003 publication in Fitzpatrick’s Dermatology in General Medicine.

solution: Treating this issue from the inside is essential.

Consume more foods rich in iron, such as meat, eggs, seafood, spinach, string beans, broccoli, whole grains, watermelon, strawberries, beans, and lentils, which are all excellent sources.

Avoid caffeinated beverages as they may slow iron absorption.

Taking vitamin C and iron supplements can help nails grow healthily. Look for supplements that are non-constipating, as this is a common side effect of iron supplementation.

Finally, try not to bite nails as this may cause irritation and inflammation in the nail bed.

nail clubbing

hutchinson sign and nail dystrophy

what it looks like: According to a 2001 study published

in The Journal of the American Medical Association, symptoms include but are not limited to: an angle of more than 165° between the nail bed and cuticle, increased roundness of the surface of the nail, general thickening of the end of the finger, and shiny, linear streaks on the nail.

what it looks like: This condition usually begins as a vertical pigment band the length of the nail plate. As the condition develops, the band becomes wider, especially towards the cuticle. Pigmentation may range from light to dark brown.

Bleeding and thinning, cracking, or distortion of the nail plate are more severe sign.

underlying cause: The European Journal of Internal

underlying cause: If you notice any of these symptoms, do

Medicine found in 2008 that 60% of nail clubbing cases were idiopathic, meaning “not having an underlying medical cause.”

However, 40% are associated with various lung, heart, and gastrointestinal diseases, among others.

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affected with koilonychia are thin, flat, or even concave.

solution: Because this nail deformity can have so many different causes, see a dermatologist to make sure your case is not disease-related. The dermatologist will ask about medical history and may perform additional tests such as chest X-rays or a CT scan to rule out lung and heart disease.

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not ignore them as they may indicate subungual melanoma, a type of skin cancer that appears under the nail.

solution: If diagnosed as subungual melanoma, the site of the cancer is surgically removed to treat the disease, and the surgical defects can be repaired using skin grafting.

left: illustration by kristen sadakane

dents or “pits.”

and the more commonly encountered... onychomycosis (aka nail fungus)

onychoschizia (aka nail splitting)

what it looks like: According to a 2012 review

what it looks like: Visible symptoms include splitting

by UK’s National Health Service, the most common symptom of a fungal nail infection is thickening and discoloration. The nail may turn white, black, yellow, or green. The condition is initially painless, but if left untreated, it can become uncomfortable and in rare cases, painful. The infection can cause difficulty writing and leave the nails brittle and fragile, eventually resulting in the nail falling off. The skin under and around the nail can become inflamed, painful, and scaly. The nail bed sometimes presents white or yellow patches.

underlying cause: Onychomycosis is caused by

three main classes of organisms: dermatophytes (fungi that feed on nail tissue), yeasts, and nondermatophyte molds. All three cause similar symptoms which is why onychomycosis must be properly diagnosed by laboratory tests before being treated, suggests Charles Davis, MD and PhD clinical professor at the University of Texas Health Sciences Center at San Antonio.

solution: Recently, triazole and allylamine have

become the drug standards as they provide shorter treatment courses and higher cure rates than former treatments, with fewer relapses. According to a 2011 article by the American Society for Microbiology, triazole, during in vitro (test tube) experimentation, has shown potent activity against dermatophyte pathogens (fungal agents causing the disease) of onychomycosis.

Allylamines kill the fungus by inhibiting the production of an enzyme that constitutes a component of the fungus’ membrane. A 2011 article in American Family Physician reports that terbinafine, fluconazole, and itraconazole have replaced the more traditional topical treatments because they penetrate the nail and nail bed more quickly and are generally safer as well. They work in a similar way to triazole, by secreting a substance called squalene which decreases production of ergosterol, a component of fungal cell membranes.

(layering), brittle, soft, or thin nails. The condition is more common in women.

underlying cause: Nail splitting is rarely caused by a

systemic disease. If toenails are healthy but fingernails present onychoschizia, the factors are most likely external. The nails are either being dehydrated or over moisturized. Repeated wetting and drying may also be at fault. Too much moisture can weaken the nails and soften them which can lead to peeling, while dehydration causes brittleness. Brittleness, in turn, can contribute to splitting.

solution: The American Osteopathic College of Dermatology recommends applying lotions that contain alpha-hydroxy acids or lanolin after soaking nails in water for five minutes to restore them to a sustainable texture. A 1998 study published in Cutis found that these substances improve the appearance of splitting nails and reduce symptoms such as unusual dryness, rough texture, and advanced flaking and scaling.

subungual hematoma what it looks like: According to a 2009 entry in Mosby’s

Medical Dictionary, subungual hematoma is a collection of blood beneath the nail. Throbbing pain can be a symptom.

The nail will appear black or dark purple, either partially or entirely.

underlying cause: Subungual hematoma is most commonly caused by trauma to the nail. The British Journal of Sports Medicine reported in 2004 that “jogger’s toe” can cause the condition as well, due to repeated impact of the longest toe with the front of the shoe.

bottom line If home remedies do not lead to improvements in the condition, or if the condition appears to be one of the more serious described above, seek professional help from a dermatologist.

As a gold standard, eating a balanced, healthy diet and avoiding the five major nail mistakes (read about these top nail care mistakes on page 30) will help keep nails in tip top shape.

Always keep an eye out for any nail abnormalities because they are tell-tale indicators of overall health.

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solution: The nail is usually treated by trephination, or drainage of the trapped blood. A 1991 study by the American Journal of Emergency Medicine reports little to no complications with this procedure. The journal elaborated in a 2006 article that this quick and convenient method, performed by a physician, provides substantial pain relief by controlled release of the trapped blood under the nail plate.

top nail care mistakes 1. filing nails back and forth

› why it’s a no-no: This method can cause splitting, breakage, and peeling. › instead: File from each edge of the nail to its center for a smooth nail tip.

2. forgetting to moisturize the cuticle

› why it’s a no-no: Dry cuticles can lead to hangnails and cracking skin surrounding cuticles. › instead: Moisturizing once every 24 hours is vital

Nut ritio n

to keeping surrounding skin neat and healthy. Most drugstores sell moisturizers specifically formulated for the cuticle.

•M ind -Bo dy •

3. cutting cuticles back

› why it’s a no-no: ine This may lead to infection, dic Me redness, and inflammation. se e n hi •C arch avoid these discomforts, push cuticles › instead: eseTo e•R r a C Health back Wellness • gently with a cuticle pusher after showering, when they are soft.

4. getting “gel polish” manicures

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5. improper trimming and nail biting

› why it’s a no-no: According to a 2009 article by the American College of Foot and Ankle Surgeons, trimming nails too short can lead to ingrown toenails (this applies to fingernails as well). › instead: Always trim nails straight across, and avoid making them too short. There should be enough room that you can place your fingernail under the front and sides of the nail being trimmed. t w

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Pick up a copy!

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Read our previous issues online at http://issuu.com/totalwellnessmagazine visit our website totalwellnessmagazine.org like us on facebook!

right: jameslee1/istockphoto.

› why it’s a no-no: Five subjects reported in a 2012 study published by the Journal of Cosmetic Dermatology that their nails became weak, brittle, and thin after receiving gel manicures. While this new trend is popular because of its long-lasting results, it may not be worth it. Pseudoleukonychia (nail discoloration) and onychoschizia lamellina (horizontal splitting) were found in the subjects. › instead: Use natural nail polish which can be bought online. According to a 2012 article by Abra Pappa, a holistic nutrition expert, the chemicals in nail polish can seep through our nail pores and be absorbed by the bloodstream right below. She recommends avoiding toluene, dibutyl phthalate, and formaldehyde. Look at the ingredients on polish bottles when shopping to avoid these three chemical villains.

features

clear waters: filters to purify your water by tiffany lin | design by karen chu

Therefore, water filters are extremely important in water sanitation, which affects the overall health quality of the population. There are several types of water filters available with various structures and functions. Read on to learn more about the categories of water filters and how each filter purifies your water differently.

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total wellness â–Ş summer 2013

According to the U.S. Environmental Protection Agency (EPA), Americans spend billions of dollars every year on home water treatment units. Why? In 2009, The New York Times compiled hundreds of thousands of water pollution records to create a comprehensive national database of water pollution violations; this revealed that laws intended to protect our water supplies were not being properly enforced, and thus, tap water may contain dangerous chemicals. This database shows that water in Los Angeles contains one contaminant above legal limits and five other contaminants below legal limits, but above health guidelines.

what do water filters do?

where are water filters placed?

People use different types of filters depending on the specific composition of contaminants in the local water. Possibilities include harmful environmental runoff composed of pesticides, herbicides, and fertilizers. Fertilizers may contain nitrates, calcium, magnesium, and arsenic. There are also additives in water; chlorine is added to control microbes, and fluoride is added to promote stronger teeth. However, chlorine can react with organic compounds in water to form byproducts that are hazardous to health, and overfluoridation can have long term negative effects on bones and teeth. The pipes that water travels through before reaching your tap may also add dirt, rust, slime, sand, mud, copper, lead, and bacteria. No single type of water filter is able to remove all of the impurities mentioned above, and thus, different types of filters exist.

Two main categories of water filters are point-of-entry units and point-of-use units. units treat water before it gets distributed › Point-of-entry throughout the entire house or building. These include water softener tanks for entire houses.

units treat water right before it is about to be › Point-of-use consumed. These include common countertop filters, faucet filters, and under the sink units.

types of water filters what is it?

activated carbon filter

An activated carbon filter has a filter made of granulated carbon or solid carbon filtrate. The carbon particles have a large surface area and have been processed to be very porous.

The porous surface attracts and traps dirt and impurities, and the liquid water is repelled and travels through the filter.

distillation

Distillers boil water to create steam, which cools and condenses to form pure, mineral-free water droplets, which are then collected for use.

ion exchange

Ion exchange filters remove dissolved salts in water by exchanging the mineral ions in water with its own ions.

ultraviolet disinfection

An ultraviolet light may be installed to kill bacteria and other microorganisms.

reverse osmosis

In this filter, water is pushed through a fine semi-permeable membrane, which separates the liquid and the concentrate. top: airyelf /istockphoto.

total wellness â–Ş summer 2013

name

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are they effective?

for filters labeled as meeting NSF (National › Look Sanitation Foundation) standard 53. These filters have

been independently tested to prove that they can reduce levels of health-related contaminants. NSF International is a nonprofit organization that tests and certifies certain products to ensure that they meet public health and safety standards.

out what’s in your water to determine what type of › Find filter to use. Local drinking water information can be found here: http://water.epa.gov/drink/local/index.cfm/drink/local/ index.cfm. If a report cannot be found online, you can contact your water supplier for more information.

common mistakes to avoid

sure to follow directions in the installation and use of › Make water filters.

the timeline for replacement. For example, the › Follow smaller activated carbon filters in water bottles should be

replaced every two months or 40 gallons. A water filter used for longer than intended may actually start to negatively affect water quality by harboring bacteria.

what’s in your water so you can purchase the › Know corresponding filter and correct system.

what it filters

Activated carbon filters are used in countertop filters, faucet filters, and under the sink units. They are the most commonly used type of filter.

This filter removes bad tastes and odors, including the smell of chlorine. Some may also reduce the amount of heavy metals, disinfection byproducts, parasites, pesticides, and volatile organic chemicals found in water. According to a 1995 study in Applied and Environmental Microbiology, point-ofuse powdered activated carbon filters significantly reduced bacterial density in rural domestic groundwater supplies after running water through the filter for two minutes.

This type of filtration is used in countertop or whole house point-of-entry units and can be combined with an activated carbon filter for further purification.

Distillation removes heavy metals, arsenic, fluoride, and other salts.

It is used in house point-of-entry units and removes calcium, magnesium, and fluorides.

This filter “softens” hard water. Hard water contains calcium and magnesium, which may harm pipes and decrease the effectiveness of cleaning agents, such as soap. The ion exchange filter trades these minerals with strong positive charges for those with smaller charges, such as sodium and potassium. According to a 2005 study in Water Environment Research, the ion exchange filtration technique was highly effective in reducing ammonia concentrations and bacterial populations of lake water, resulting in improved health of the overall ecosystem and habitat.

It is used in under the sink units and is usually combined with an activated carbon filter for further purification.

This type of filter removes bacteria and parasites from water. A 2013 study published in Environmental Science and Pollution Research International indicated that point-of-use ultraviolet disinfection systems used for 20 to 50 minutes were able to inactivate E. coli and eliminate their disease-producing capabilities.

These are commonly used in under the sink point-of-use units in combination with activated carbon filters. Water is stored in a pressure tank after reverse osmosis and treated with an additional activated carbon filter to further remove impurities.

A 2002 study published in Water, Science, and Technology suggests that there is a higher removal of microbes with the combined system than with reverse osmosis alone. The largest drawback of this filter is that it wastes lots of water; every purified gallon wastes two gallons, so in order to obtain one gallon of purified water, three gallons must be filtered.

This type of filter removes most contaminants, including certain parasites, heavy metals, and other environmental pollutants. t w

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common places of use

features

mindful running

total wellness â–Ş summer 2013

Love to run? Or not a big fan but run for the exercise?

You are not alone. Over 50 million people run or jog at least once a day, according to Sporting Goods Manufacturers Association’s 2012 national survey.

Additionally, 19 million individuals run or jog 100 or more days a year. However, because running is a highimpact sport, running-related injuries are prevalent. The side effects of this popular exercise may affect all types of runners from beginners to marathon champions.

According to a study published in the 2012 International Journal of Sports Physical Therapy, about 19% to 79% of runners may experience at least one injury each year.

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The good news for runners is that injuries from running can often be prevented and have very similar treatment methods when caught early.

Since most running injuries are caused by recurring factors, recognizing and paying attention to the first sign of sudden or persistent pain can greatly shorten a runner’s rehabilitation time and prevent future injuries.

original illustrations by kristen sadakane

by sally soohyun kim | illustration and design by kristen sadakane

when are you most prone to running injuries?

According to the American Orthopaedic Society for Sports Medicine, there are four periods of time when runners are most vulnerable to injury:

1

During the initial four to six months of running

2

Upon returning to running after an injury

3

When the quantity of running is increased (distance)

4

When the quality of running is increased (speed)

s

m

t

w

r

f

s

common causes of running injuries: training errors: According to the American Orthopaedic Society for Sports Medicine, training errors, such as inadequate stretching and insufficient rest between training sessions, are the most common cause of running-related injuries. minor deformities or areas of weakness: It is also important to pay attention to any anatomic abnormalities that may affect the body while running. Some runners may have minor deformities or weaknesses in specific areas that may cause increased pain while running. For example, ankle laxity can lead to frequent ankle sprains and pain.

> take a well deserved break: Taking a break from running until the pain resolves is the first step to a speedy recovery. Depending on the type of injury, the resting period will vary, but generally one can gradually return to runnning when there is no pain in the targeted area. > consider over-the-counter medication: In addition to rest, taking medications such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil, Motrin) can help reduce pain and inflammation. > treat your body by stretching and massaging: Stretching targeted areas to strengthen specific muscles is a way to prevent future injuries and managing soreness. Massaging the injured area with ice is another general method to relieve pain. > try alternative forms of exercise: Consider alternative forms of exercise! Running injuries, if not severe, do not stop one from exercising entirely.

There are other ways to be active without straining one’s injury. For example, cycling is a great alternative that is less likely to cause injuries. It also may speed one’s recovery time by strengthening the quadricep muscles. Swimming is another non weight-bearing activity that runners can do to maintain their cardiovascular fitness. Even going on brisk walks, if possible, is a great way to stay active while recovering.

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foot problems: In addition, an individual’s foot type can be related to foot problems. There are three basic foot types: normal arch, flat arch, and high arch. The types are based on the height of the foot arch and affects the pronation of the foot. Pronation is when the outside part of your heel makes initial contact with the ground. A normal pronation is when the foot rolls inward about 15% which causes the foot to fully contact the ground when you step. This allows your foot to support your body weight and helps you push off evenly from the front of the foot. It is also critical to proper shock absorption. Not everyone has the perfect pronation. The size of the runner’s arch can affect its ability to roll, causing either underpronation (foot rolls inward less than 15%) or overpronation (foot rolls inward more than 15%). Those who have flat feet tend to be overpronators. Overpronators have problems stabilizing the body and shock is not absorbed efficiently. The foot pushes off the ground using mainly the big toe and second toe. Those who have high-arched feet tend to be underpronators.

Underpronators also are affected by unequal force distribution. The foot pushes off the ground using the smaller area of the foot such as the smaller toes on the outside of the foot. Choosing the right running shoes may help alleviate over and under pronators. Overpronators are recommended to wear a motion-control shoe that controls pronation and underpronators do best in a neutral-cushioned shoe that allows for a natural foot motion.

general treatment methods of common running injuries

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Running is a high-impact exercise that primarily puts stress on the lower body and can result in a number of injuries. Below is a list of the most common injuries both novice and advanced runners may come across. It is important that at the first sign of pain, one pays attention to where the pain occurs and takes action to prevent further injury. While many types of pain may feel and seem minor, do not ignore them as these injuries can become more serious over time if not properly treated. Most of the common running injuries can be relieved with proper rest. Common lower body areas that are prone to running injuries:

at risk area: leg chronic external compartment syndrome (CECS)

what causes it? This syndrome occurs when there is increased pressure within a muscle compartment (muscles and neurovascular structures bound by soft connective tissue and bone). During exercise, the blood supply to the working muscles increases, which in turn makes the muscles expand. However, if the muscles swell greater than they can expand, pressure builds up in the compartment. When this happens, the pressure cuts off some of the muscle’s blood supply which leads to CECS. According to Cathy Fieseler, MD, director of Sports Medicine in the Trinity Mother Frances Health System and member of the Board of Directors of the American Medical Athletic Association, once exercise has stopped, the swelling and pain also stops. Thus, usually when a runner meets with a physician about this problem, X-rays, bone scans and MRIs show normal results. If the history is suggestive of CECS, measuring the pressure within the compartments confirms the diagnosis, states Fieseler. Although anyone can develop CECS, runners are more likely to experience CECS due to the repetitive impact from running. symptoms: CECS is characterized by an aching, burning, or cramping pain in the affected limb. The affected area may feel tight or numb. The pain typically follows a pattern: 1) it begins soon after you start exercising the affected limb, 2) it progressively worsens as long as you exercise, 3) it stops within 30 minutes after the affected limb comes to rest, and 4) over time, it may begin to persist longer after exercise, possibly lingering for a day or two. additional treatment tips: According to a 2012 study published in Sports Health, the only evidence-based treatment is activity modification and rest. If the pain is still persistent, surgical measures may be taken.

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original illustrations by kristen sadakane

total wellness â–Ş summer 2013

what is it? CECS is an exercise-induced muscle and nerve condition that causes pain and swelling. If severe, CECS can cause disability in the affected leg or arm muscles.

at risk area: thigh/knee iliotibial band syndrome (ITBS) what is it? When you flex and extend your knee, the iliotibial band, which runs along the outside of the thigh, can become irritated from repetitive rubbing over the outside of the knee. what causes it? There are several causes of this syndrome, including weak gluteal muscles, over-pronation (excessive inward rolling of the foot), and running on uneven surfaces. According to a 2012 study published in Sports Medicine, ITBS is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between five percent and 14%. symptoms: There is pain or aching on the outside of the knee, usually occurring in the middle or at the end of a run. additional treatment tips: In addition to decreasing your running mileage, try stretching the outer thigh and strengthening the hip abductors with lateral side steps, side leg lifts, and one-legged squats. Unlike some of the common running injuries, bicycling can aggravate ITBS. Try swimming or using an elliptical machine to exercise while recovering.

at risk area: knee patellofemoral pain syndrome (PFPS) (runner’s knee) what is it? Runners put heavy stress on their knees, areas that are very sensitive. The kneecap, or patella, is a small bone in the front of your knee that moves with the knee as it flexes. The patella protects the other bones in the knee against collisions and falls.

Runner’s knee involves pain around the front of the knee (patellofemoral pain).

According to a 2012 review published in Sports Medicine, PFPS is most common in runners who participated in ultramarathon races. what causes it? Patellofemoral pain may be the result of irritation of the soft tissues around the front of the knee. Overuse, muscle imbalance, and inadequate stretching are other contributing factors to patellofemoral pain. Furthermore, pain that begins in another part of the body, such as the back or hip, may cause pain in the knee. It should be noted that in some people with runner’s knee, the kneecap may be out of alignment. If this is the case, running on it may cause excessive stress and wear on the cartilage of the kneecap leading to pain and irritation around the area. symptoms: The most common symptom is a dull ache (think of a constant ache, not a sharp pain) underneath the kneecap while walking down stairs, squatting or getting up after sitting for long periods of time.

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total wellness ▪ summer 2013

additional treatment tips: Relative rest and stretching and strengthening to correct for the muscle imbalance is important. Try stretching your hip flexors. Also, performing lateral side steps and squats can strengthen your knees’ support muscles such as the quadriceps and glutes. In addition, ice should be applied to the knees after running. Light running is okay if this injury is mild, and Bryan Heiderscheit, PhD, PT, director of the University of Wisconsin Runners’ Clinic, recommends shortening your stride length and landing with the knee slightly bent, a practice which can take up to 30% of the load off the knee joint. In addition, uphill running can be beneficial as it works the glutes. Gluteal muscles help control hip and thigh movement and prevent the knees from turning inward. However, running downhill should be avoided because it can exacerbate pain because it puts extra stress on your knee.

at risk area: feet plantar fasciitis what is it? Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. According to a 2012 study published in Sports Medicine, plantar fasciitis is one of the main general running-related musculoskeletal injuries. what causes it? Long distance runners and runners who have foot arch problems such as flat feet and high arches may experience this injury. Plantar fasciitis is commonly known as an injury that causes small tears in or inflammation of the tendons and ligaments that extends from a runner’s heel to his or her toes. However, according to a 2006 review published in Physical Medicine and Rehabilitation Clinics of North America, studies have suggested that plantar fasciitis is more of a degenerative process rather than inflammation. symptoms: Plantar fasciitis typically presents itself as heel pain from weight bearing actions. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The worst pain is experienced with the first steps in the morning or early in running. However, the pain often lessens with activity. additional treatment tips: Try heel and foot stretching exercises before getting out of bed. For example, stretch your foot by flexing it up and down ten times before standing. Stretching or massaging before standing up can often reduce the pain.

Also try to stretch before running to warm the foot and arch, which can help reduce discomfort early in the activity.

achilles tendinitis what is it? Achilles tendinitis is when the Achilles tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. what causes it? Achilles tendinitis may be more likely to occur if one is running on hard surfaces such as concrete, running too often, or wearing shoes with improper support while running.

addition treatment tips: Stretching should be incorporated to improve the flexibility of the calf muscles. For example, try a “wall stretch” where you stand facing a wall from several feet away. First, stagger your stance, placing one foot forward.

Second, lean forward and rest your hands on the wall, keeping your heel, hip and head in a straight line. Attempt to keep your heel on the ground. Hold for ten to 20 seconds and then switch sides. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Surgical treatment is frequently needed in the event of complete rupture. It may take at least two to three months for the pain to go away. original illustrations by kristen sadakane

total wellness ▪ summer 2013

symptoms: Achilles tendinitis is characterized by pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. In addition, moving or touching the tendon may be painful. The area may also be swollen and worn. Standing up on one toe may be difficult to do.

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at risk area: shin medial tibial stress syndrome (shin splints) what is it? According to a 2012 study published in Sports Medicine, medial tibial stress syndrome is one of the main general running-related musculoskeletal injuries. what causes it? Shin splints occur when there is pain along or just behind the tibia (shinbone), which is the large bone in the front of your lower leg. This injury can result from repetitive activtity on hard surfaces because of forceful, excessive use of the foot flexors and too much force being placed on one’s shinbone and connective tissues that attach your muscles, such as your flexor digitorum longus and soleus muscles, to the periosteum (lining of the bone) and to the bone itself. As you continue to run without giving your tissues time to repair, inflammation of the periosteum and the tendon insertions into the bone and its lining occurs. Furthermore, shin splints are frequently associated with runners who use worn-out shoes or have suddenly changed running surfaces or distance. In addition, weak leg muscles can contribute to shin splints. symptoms: You may feel tenderness, soreness, or pain along the inner part of your lower leg. There can also be mild swelling in the lower leg. In the early stages, the pain may cease when you stop running or exercising; however, if left untreated, the pain may be continuous. additional treatment tips: Remember RICE: Rest for seven to ten days, Ice on the injured area, Compress the muscle with an elastic bandage, Elevate the injured leg as often as possible. Shin splints can be relieved with rest but stretching and performing certain exercises are good for both recovery and prevention. In a chair, try tracing the alphabet on the floor with your toes. Do this with each leg. Other methods such as physical therapy to stretch and strengthen the calf muscle can also be beneficial. Furthermore, rigid orthotics, which are personalized shoe inserts, may help to correct foot hyperpronation. In a 2010 study published in Foot and Ankle Specialist (FAS), a group of runners with medial tibial stress syndrome treated with calf stretching and off-the-shelf orthoses resulted in 15 of the 23 patients showing a 50% reduction of their symptoms after three weeks intervention. As a result, they concluded that orthoses may be used as part of the treatment in shin splints but should be combined with other methods. If you are suffering from shin splints, consider consulting your doctor to see if orthotics is an option for you.

total wellness â–Ş summer 2013

Although running is a popular activity for health benefits, the risk for running injuries should not be neglected. Knowing how to spot, treat, and prevent running injuries, especially for beginners, will promote running consistency. It is best to catch and address injuries early. This will prevent runners from having to stop running for long periods of time. Additionally, a preventative technique can maintain strength and flexibility in the muscles and reduce risk for injuries. Remember that more is not always better. Moderation is key. Decreasing mileage and taking breaks will not only prevent injuries but improve one’s running experience overall in the long run. tw

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features

delightful

desserts by halee michel | design by annie theriault

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the effect of desserts on mood Desserts have a potential mood boosting effect.

In a 2011 study in the Journal of Biological Regulators and Homeostatic Agents, the emotional status and digestive process of one hundred individuals who consumed a coffee-flavored iced dessert was examined. A psycho-emotional questionnaire, which measured the subject’s base emotional pattern, showed an association between an increase in mood and pleasant digestibility and palatability. The results found in this study showed a positive correlation between pleasure from consuming an agreeable product and the subject’s emotional status. In all, this study unsurprisingly suggests that eating something you find delicious can improve your mood. In addition to a possible mood improvement related to the mind, the body can obtain nutrients from the consumption of a healthy dessert.

left: shorrock/istockp; right: mariuszblach/istockphoto

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Deliciously crafted, healthy dessert options can satisfy the vanilla lovers, the fruity flavored fanatics, and even the chocoholics. Healthy and gratifying ingredients can be combined to satiate consumers’ taste buds and raise consumers’ spirits. Although desserts can provide nutrients, they shouldn’t replace meals or snacks.

Alona Zerlin, MS, RD, and dietitian II at the UCLA Department of Medicine, Center for Human Nutrition, stresses the importance of eating desserts only after substantial meals like dinner. The meal consumed prior to the dessert can help lower the sugar load of the dessert while preventing the consumption of too much dessert. The key to consuming sweets is to eat them in moderation and to incorporate healthy ingredients when doing so.

dark chocolate Dark chocolate is typically composed of cocoa, sugar, vanilla, and lecithin, a fatty substance. Dark chocolate, unlike milk and white chocolate, usually doesn’t have any added milk products. Some dark chocolate bars show a percentage of cocoa on their wrappers indicating the amount of ingredients that actually stem from the cocoa bean. This percentage is important to consider. Typically, the higher the percentage of cocoa in the bar, the healthier the bar is.

why choose dark chocolate?

It’s loaded with antioxidants: cocoa’s antioxidant capacity and flavanoid content were found to be greater than those of red wine, green tea, black tea, milk chocolate, apples, and cranberry juice, according to a 2003 study published in the Journal of Agricultural and Food Chemistry, a 2006 systematic review published in Nutrition and Metabolism, and a 2008 study published in the Journal of Thrombosis and Thrombolysis. In fact, it was found that cocoa’s flavonoid content and antioxidant capacity was about:

› › › › ›

two times that of red wine. two to three times that of green tea. four to five times that of black tea. equivalent to that of vitamin C. two and a half times that of milk chocolate.

BENEFITS: antioxidants

Cocoa beans are a natural sinkhole for flavanols, a natural antoxidant compound found in plants. Like other antioxidants, they aid in repairing damage to the body and protecting the body from environmental toxins.

According to a 2008 study published in the Journal of Thrombosis and Thrombolysis, the positive effects of dark chocolate on cardiovascular disease (CVD) may be due to its large antioxidant capacity and flavonoid concentration.

Some potential mechanisms involved in the prevention of CVD include antioxidants’ antihypertensive (prevention of high blood pressure) and antithrombotic (prevention of blood clotting) effects.

anti-inflammatory effects

Dark chocolate may have antiinflammatory effects, which can be protective against certain diseases related to chronic systemic inflammation such as obesity, diabetes, digestive system diseases, and Alzheimer’s disease.

According to a study conducted from 2005 through 2007 and published in The Journal of Nutrition, the percentage of adult subjects with blood concentrations of C-reactive

protein (CRP), a protein within the blood that rises in response to inflammation, was found to be higher in subjects that did not consume dark chocolate compared to those who did. This suggests that dark chocolate may play a positive role in modulating inflammation in the body.

TYPES TO LOOK FOR: When shopping for chocolate, go dark. Scoping out the less commercialized, natural dark chocolates high in cocoa is important when trying to maximize nutrients. According to the University of Michigan’s health system, consumers should look for dark chocolate that contains at least 60% cocoa. It is also suggested that consumers look for cocoa made from cocoa butter instead of palm and coconut oils.

According to the University of Michigan Health System, the saturated fat within cocoa butter has been shown to have a neutral effect on cholesterol unlike the saturated fat found in both palm and coconut oils. I f a chocolate bar meets these requirements and also contains nuts, then this is just an added benefit.

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why not milk chocolate?

According to a 2006 systematic review published in Nutrition and Metabolism, milk is thought to inhibit the absorption of flavanoids in the intestines, so selecting dark chocolate over milk chocolate may lead to better flavonoid absorption.

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BENEFITS: According to the Arthritis Foundation, strawberries are high in folic acid, a type of vitamin B that helps form healthy, new cells. As for vitamin C, one cup of strawberries contains more vitamin C than a medium orange. Vitamin C helps with the growth and repair of body tissues along with the maintenance of healthy teeth and gums.

according to a 1994 study published in The American Journal of Clinical Nutrition, dietary fiber helps to regulate digestion and prevent constipation. Fiber has also been associated with reduced blood pressure and a lower risk of coronary heart disease. According to the Arthritis Foundation, blackberries, raspberries, and boysenberries contain eight grams of fiber per cup.

antioxidants

TASTY TIPS:

folic acid and vitamin C

According to the Arthritis Foundation, blueberries contain anthocyanin, an antioxidant that gives fresh fruits their vibrant colors. Whereas other fruits typically contain fewer types of anthocyanin, blueberries have 20 different types. More anthocyanin means more antioxidants and potentially more antioxidant-related benefits.

According to a 2008 review published in the Journal of Agricultural and Food Chemistry, these compounds may positively influence human health.

According to this review, these compounds may also metabolize enzymes and counteract DNA oxidative damage.

berry bowls Berries can be paired with a sweet topping of honey, low fat or nonfat milk, or yogurt to make for a tasty, nutritious dessert. These fruits are sinkholes for many essential nutrients like potassium, dietary fiber, vitamin C, and folic acid.

In order to receive the ideal health benefits from berries, the Arthritis Foundation recommends consuming two to three types of fresh, dried, or frozen berries every day.

Drizzling berries with antibacterial and anti-inflammatory honey can add taste and health benefits to a fruit bowl. Soaking berries in a bowl full of low-fat or nonfat milk with a natural sweetener like honey, makes a tasty concoction. For a crunchy addition, add low-fat granola.

fiber

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left: angiephotos/istockphoto; right:kirin_photo/istockphoto

total wellness â–Ş summer 2013

Berries supply dietary fiber that can help with bowel function as well as aid in the reduction of blood cholesterol and help keep individuals full. Additionally,

yogurt The grocery store offers an immense amount of yogurt options. In order to keep your consumption of saturated fat low while still receiving the benefits of dairy, low-fat or non-fat dairy products are optimal. Low fat yogurt contains less saturated fat and cholesterol, with the same amount of nutrients as regular yogurt.

BENEFITS: calcium and protein

Calcium is a mineral needed to maintain strong bones, enable muscle movement, and help send molecular signals throughout the body. Protein is a macromolecule essential for the structure, function, and regulation of the body’s cells.

Both calcium and protein can be found in yogurt. According to WebMD one cup of nonfat “lite” raspberry yogurt contains 350 mg of calcium and eight grams of protein.

This provides a third of one’s dailyrecommended calcium intake as well as 17% of one’s protein intake.

cholesterol-lowering effect

immunity

A 2006 study in International Microbiology investigated the effects of different probiotic strains on immunity and found that standard yogurt and a fermented product containing two new probiotic strains enhanced the immune system. Both products increased the activity and number of phagocytes, cells that play an essential role in the immune response.

CUSTOMIZE: To customize yogurt, pair it with a favorite fruit or high-fiber breakfast cereal. Other tempting toppings include fresh-cut strawberries combined with vanilla extract, pineapple, shredded coconut, and orange slices mixed with natural orange marmalade. For a crunchy topping, add low-fat granola or dark chocolate bits.

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A 2009 study in the Annals of Nutrition and Metabolism dealing with mildly to moderately hypercholesterolemic subjects suggested that probiotic yogurt may reduce cholesterol levels. This study found that the consumption of probiotic yogurt showed a substantial decrease in total cholesterol in comparison to standard yogurt.

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trail mix Trail mix can provide protein, flavonoids, and vitamins in the form of nuts, dried fruits, and dark chocolate morsels. Many flashy varieties exist on the grocery store shelves, but the healthiest products contain the ingredients listed below. When shopping for a healthy trail mix go natural and raw.

NUTS:

A 2010 study in Circulation looked at the relation between main protein sources and the risk of cardiovascular heart disease (CHD). Out of several proteins, including poultry, fish, and nuts, nut consumption was associated with the lowest risk for CHD when compared to red meat consumption.

For those fearing weight gain associated with the frequent consumption of nuts, this same 2009 review shows that clinical and epidemiological evidence doesn’t suggest a connection between frequent nut consumption and obesity.

A 2009 review published in the American Journal of Clinical Nutrition found strong evidence for the protective effect of nuts on an individual’s risk for cardiovascular heart disease.

nutrients and phenol antioxidant content

potential effects on diabetes

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frequent nut consumption not associated with weight gain

This 2009 review also found evidence that nuts might lower the risks of diabetes in women. The benefits are attributed to the magnesium, fiber, monounsaturated fat, and polyunsaturated fat found within nuts.

However, the effect of nuts on diabetes in men remains unknown.

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DRIED FRUIT:

Phenol antioxidants are thought to be the agents contributing to protective effects against heart disease and cancer. In a 2005 study published in The Journal of the American College of Nutrition, the nutrients and quality of

phenol antioxidants in dried fruit were compared to those in fresh fruit. The study found the quality of the phenol antioxidants to be the same within fresh and dried fruit. Additionally, the study showed that dried fruits have a longer shelf life, a higher nutrient density, and a higher phenol antioxidant content compared to their fresh counterparts. These findings suggest that it can be beneficial to consume dried fruit.

DARK CHOCOLATE: Dark chocolate within trail mix provides both unsaturated fats and antioxidants in the form of flavonoids as discussed on page 41.

The above ingredients can be consumed separately or together to create healthy and subtly sweet treats. These healthy, fresh desserts can aid your intake of daily nutrients while completing your food pyramid recommendations. Overall, when consumed in moderation, these desserts can help keep you feeling satiated, mentally content, and guilt-free. tw

svanhorn/istockphoto

protective effects against cardiovascular heart disease

The HEALTHY CAMPUS INITIATIVE supports TOTAL WELLNESS…

The HEALTHY CAMPUS INITIATIVE supports TOTAL WELLNESS…

For 24/7 health information and events on campus, check out our website: www.healthy.ucla.edu

total wellness ▪ summer 2013

For 24/7 health information and events on campus, check out our website: www.healthy.ucla.edu 45

DECODING THE NUTRITION LABEL

stevia

by samantha fong | design by catrina pang

how do stevia-based sweeteners taste?

Although Reb A is the most preferred among the steviol glycosides for its sweetness potency and least off-taste, it can be bitter at high concentrations. Thus, stevia based sweeteners are often blended with other non-caloric sweeteners such as aspartame, sucralose, and saccharin, as well as caloric sweeteners such as sugar alcohols.

what is it?

There are at least eight sweet components in the stevia leaves, collectively known as steviol glycosides. Glycosides are molecules composed of a sugar and a non-sugar substance.

These glycosides are extracted through a process similar to steeping tea leaves. Two of the known components found in stevia leaves, stevioside and rebaudioside A (Reb A), are the sweetening compounds found in stevia-based sweeteners used today. Stevioside can be 100 to 300 times sweeter than sucrose (cane sugar), and Reb A can be 250 to 450 times sweeter than sucrose. The US Food and Drug Administration announced in 2009 that the use of highly purified stevioside and Reb A is “Generally Recognized as Safe (GRAS)” when consumed in proposed amounts.

health effects of steviol glycosides

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Stevioside has been studied for its possible health effects in hypertension, type II diabetes, and obesity.

› A 2003 study published in Clinical Therapeutics found that when given 500 mg of stevioside three times daily for two years, adults with mild hypertension showed a significant decrease in blood pressure compared with those given a placebo. While this amount is large compared to what a typical consumer would use as a tabletop sweetener, stevioside’s possible health effects may instigate further studies to investigate its use in potential treatments for high blood pressure. › In a 2005 study published in Hormone and Metabolic Research, diabetic rats given three doses of 0.2 mg/kg stevioside per day for ten days showed an improvement in insulin sensitivity. An increase in sensitivity to insulin allows glucose to be used and stored more efficiently. › In a 2010 study published in Appetite, when three groups of subjects were given pre-meal snacks sweetened with either stevioside, aspartame (a synthetic non-nutritive sweetener), or sucrose, there was no significant difference in degree of hunger at their next meal. Since both stevioside and aspartame are calorie-free, subjects who consumed snacks containing these compounds consumed fewer calories than subjects in the sucrose group, and had the same level of hunger at the next meal as the sucrose group. Thus, stevioside may be beneficial in reducing calorie intake and aiding in weight loss.

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health concerns Although there have been some health concerns regarding the genotoxicity (measure of a substance’s ability to cause genetic mutation) of steviol glycosides, a recent 2013 review published in Food and Chemical Toxicology has evaluated the validity of studies that have posed these concerns and also of more recent studies determining the safety of steviol glycosides. The review concluded that studies that found positive results in causing mutation were either poorly summarized or performed using high concentrations of steviol glycosides that are atypical of an average person’s consumption.

The review also evaluates several laboratory analyses performed after 2008 that contributed to the FDA’s approval and follow the Organization for Economic Co-operation and Development (OECD) guidelines. In a 2009 comprehensive study published in Food and Chemical Toxicology, Reb A was found to be non-mutagenic (did not show the ability to cause mutation). The 2013 review states that one can confidently apply this study to stevioside because all steviol glycosides are metabolized in a similar manner.

Therefore, the FDA does not object to consumption of stevioside and Reb A so long as consumers yield to the acceptable daily intake (ADI) of 0 to 4 mg/kg bw/d (milligrams per kilogram of body weight per day) or about 29 packets of stevia-based tabletop sweeteners such as Truvia or PureVia for a 150 lb person.

In a 2010 review published by the Yale Journal of Biology and Medicine, non-caloric sweeteners were shown to falsely activate reward systems in the brain and contribute to increased appetite and an increased craving for sweets. This, in turn, may contribute to weight gain. Thus, there is concern in using artificial sweeteners because repeated exposure increases one’s preferences and cravings for sweetness.

Stevia is commonly used as an alternative sweetener with both potential health benefits and risks.

Although there have been some health concerns, the FDA has deemed stevia-derived products as GRAS. A key requirement in the testing of stevia derived products is the percent purity (percentage of pure stevioside or Reb A) of the product. In the GRAS notices, the products were deemed generally safe for consumption so long as the highly purified stevioside and/or Reb A composed at least 95% of the product.

You can make sure the stevia-derived product you use is on the GRAS list by visiting the FDA website. tw

left: adamsunny/istockphoto; right: chrisgramly/ istockphoto

There is increased interest in finding sugar substitutes that do not pose the same risk of excess calories as sugar does. One source of interest is the stevia plant, which is native to South America and has been used there as a sweetener for food and beverages throughout history.

credits We would like to acknowledge the following people for their contributions to this edition. We would also like to make special mention of the following UCLA physicians, professors and faculty members who donated their time and expertise to ensuring the accuracy of content published in the following articles:

R q&a

Michelle Hoh, MD, Associate Clinical Professor of Medicine, UCLA Family Medicine Practice, Iris Cantor/UCLA Women’s Health Center

running outdoors vs. running on a treadmill Elisa Terry, NSCA-CSCS, FITWELL Services Program Director, UCLA Recreation

a study on bloody noses

Leah FitzGerald, RN, FNP-C, PhD, Assistant Professor, UCLA School of Nursing

ways to wake up

Talin Babikian, PhD, ABPP Clinical Neuropsychologist and Assistant Clinical Professor, David Geffen School of Medicine at UCLA

salad savvy: a guide to “green” eating

Susan Bowerman, MS, RD, CSSD Assistant Director, UCLA Center for Human Nutrition

clear waters: filters to purify your water Hannah Landecker, PhD, Associate Professor, Institute for Society and Genetics, Department of Sociology, UCLA

mindful running

Elisa Terry, NSCA-CSCS, FITWELL Services Program Director, UCLA Recreation

copy-edits and review

Julie Escobar, Chalisa Prarasri, and Shannon Wongvibulsin

layout revisions

Barbara Wong, Shannon Wongvibulsin, and Karin Yuen

cover & table of contents Designed by Barbara Wong & Shannon Wongvibulsin

delightful desserts Alison Grimes, AuD, Head of Audiology Clinic at UCLA Medical Center, Assistant Clinical Professor in Head and Neck Surgery

the nail files: preventing and decoding your nails’ puzzling appearance Leah FitzGerald, RN, FNP-C, PhD, Assistant Professor, UCLA School of Nursing

Alona Zerlin, MS, RD, Research Dietitian, UCLA Department of Medicine, UCLA Center for Human Nutrition

total wellness ▪ summer 2013

hear this: how to properly clean your ears

decoding the nutrition label Susan Bowerman, MS, RD, CSSD Assistant Director, UCLA Center for Human Nutrition

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