Healthy Everywhere

total wellness a ucla student wellness commission publication

healthy here, healthy there...

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healthy everywhere

the scoop on

traveler’s diarrhea the secret to avoiding

motion sickness how much is total wellness â–Ş fall 2015

too much sugar?

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a message from the director Dear reader, Welcome to Total Wellness magazine, UCLA’s student-initiated health and wellness publication. A committee within the Student Wellness Commission (SWC), Total Wellness was initially instituted to care for the needs of students at UCLA’s campus, but has since expanded to encompass the greater Los Angeles community and beyond. Created by students, for students, Total Wellness is here to help you achieve your health-related goals and make the healthy choice, the easy choice.

In this issue, we explore how healthy options exist everywhere. Although seemingly “healthy” alternatives such as diet sodas can be found on almost every supermarket aisle, how truly healthy are they—do they live up to their name? Making healthy decisions can be difficult, so we’ve searched through scientific literature and worked with UCLA healthcare professionals to translate what the research says into more understandable language.

While you may not always be able to have a green salad or work out at the gym, developing a lifestyle of healthy habits can go a long way in keeping you well. Staying on top of your wellness means making small healthy decisions often, which leads to beneficial changes in your lifestyle. So whether you are staying in the dorms or are traveling abroad to study, being mindful of your decisions can help you take better care of your health.

To conclude Volume 15, we present Issue 4, an assortment of health topics to take with you no matter where you go. Be sure to take a look at our cover story “Traveler’s Diarrhea.” From motion sickness (page 18) and skin hydration (page 11) to prediabetes (page 28) and foot health (page 37), this issue is dedicated to reminding you that good health can be found anywhere, but it starts with you.

By taking charge of your health and wellness, you can improve your mind, body, and soul wherever you go. So wherever you are, we hope that you can be Healthy Everywhere.

Cheers to your health, Chris Phan Director

editor’s note

total wellness ▪ fall 2015

Hello everyone!

It is with great excitement that I begin my role as the new editor-in-chief of Total Wellness magazine. It’s truly an honor to be a part of an initiative dedicated to spreading awareness on health issues and trends relevant to all facets of the UCLA community.

This issue—Volume 15, Issue 4—focuses on health topics you may come across anywhere and anytime in your life. Whether you’re right here on campus, far away on another continent, in a car, on the plane, or even in the pool, you have to be on the lookout and take care of your health. In this issue, you can find information on prediabetes (page 28), traveler’s diarrhea (page 24), motion sickness (page 18), and more.

Sometimes, it is difficult to see how health matters on a moment-to-moment or place-to-place basis. We often neglect the steps of the journey and focus on the final goal or destination. Hopefully, these articles, written and designed by our hard-working and motivated staff, can show you that you can truly be healthy everywhere and anywhere. Always stay alert and take control of your health.

Wishing you a healthy school year,

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Omid Mirfendereski Editor-in-Chief

leadership

PAYAM MIRFENDERESKI Copy Editor

RUCHI DESAI Finance Director

NANCY VU Managing Editor

NEGIN AMINIAN Co-Outreach Director

TALIN MARKARIAN Co-Outreach Director

ALISON JENG Assistant Art Director

total wellness â–Ş fall 2015

cover: unsplash/pixabay

JACKIE NGUYEN Art Director

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 wellbeing, 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.

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total wellness director

editor-in-chief

Chris Phan

Omid Mirfendereski

finance director

managing editor

Ruchi Desai

assistant art director

art director

Nancy Vu

Jackie Nguyen

co-outreach director

co-outreach director

Negin Aminian

Alison Jeng

writers Sydnie Bui Ruchi Desai Shriya Didwania Katie Farr Momoko Ishii Yoon Syuk Jun Omid Mirfendereski Payam Mirfendereski Masumi Padhye Sepideh Parhami

copy editor

Payam Mirfendereski

Jamie Shin Jasmine Sidhu Sabrin Sidhu Richa Vakharia Natalie Vawter Nancy Vu Jefferey Yeung

Talin Markarian

design

outreach

web

Sophia Fang Jenna Le Amir Ljuljanovic Jackie Nguyen Nezia Rahman Edith Ramirez Kimberly Rich Molly Sanders Eun Ji Song Kandice Tsoi

Negin Aminian Talin Markarian

Alyssa Herman Rachelle Juan Harold Kim Jia-Tern Ng Mahir Shah Erika Yoon

advisory & review Babak Baravarian, DPM

Susan Davis, MD

Chief of Podiatric Surgery, UCLA Medical Center

Assistant Clinical Professor, UCLA School of Medicine

Agatha Berger, MD

Claire Panosian Dunavan, MD, FIDSA Professor Emeritus, UCLA School of Medicine

Clinical Instructor, UCLA School of Medicine

Jenny Hu, MD, MPH

Yoon-Hee Cha, MD

Assistant Clinical Professor, UCLA School of Medicine

Associate Adjunct Professor, UCLA School of Medicine

Eve Lahijani, MS, RD

Angela Chen, MD, MPH, FACOG

Nutrition Health Educator, UCLA Bruin Resource Center

Associate Clinical Professor, UCLA School of Medicine

Total Wellness is a free, student-run publication and is supported by advertisers, the Student Wellness Commission (SWC), the Undergraduate Students Association (USAC), the Arthur Ashe Student Health and Wellness Center, UCLA Healthy Campus Initiative (HCI), UCLA Recreation, and UCLA Health System: Center for East-West Medicine.

total wellness â–Ş fall 2015

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 Subscription, back issues, and advertising rates available upon request Volume 15, Issue 04

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Š 2015 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} 02

message from the director editor’s note

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in the news

08

Q&A

43

credits

ARTICLE COLUMNS skin hydration

11 self-care

summer fruits

14 eat well

motion sickness

18 mind well

foot health

37 move well

FEATURES traveler’s diarrhea

28

prediabetes

33

chlorine chemistry

total wellness ▪ fall 2015

cover story 24

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meet the

committees of

Aids Awareness works to increase campus awareness and knowledge of HIV/AIDS and promote safe sex practices.

The Body Image Task Force’s mission is to spread self acceptance and positive body image, which encompasses mental, physical, and emotional health. Love yourself and be confident in who you are!

BCC’s goal is to promote consensual sex, effective bystander intervention, and access to University resources that support survivors of sexual assault.

HNF is devoted to hosting fun and educational events that promote proper nutrition, an active lifestyle, and overall wellbeing.

Active Minds holds workshops and events to educate students and the surrounding Los Angeles community on the importance of mental health.

SEARCH (Student Education And Research of Contemporary Health) researches health topics pertinent to the UCLA student body to create interesting and educational events.

The Sexperts committee is dedicated to increasing the awareness of genderrelated health issues, stigmas, and identity at UCLA and beyond.

EARTH is committed to promoting student awareness about the dynamic relationship that exists between individual health and the health of the environment.

“SHA”s are trained to educate other students about various health issues including relationships and communication, stress management, body image, and alcohol harm reduction.

total wellness ▪ fall 2015

BRUIN RUN/WALK

know your resources!

Bruin Run/Walk puts on an annual 5K charity run to raise awareness and funds to support the Chase Child Life Program at the Mattel Children’s Hospital UCLA.

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The CPR and First Aid Program offers low-cost American Heart Association CPR and First Aid courses to the UCLA community ($10 for UCLA students, $15 for community members).

Each committee within SWC holds health-related programs throughout the year for the UCLA student body. Like us on Facebook or visit swc.ucla.edu to learn more, and never miss an opportunity to improve your health!

in the news

breaking news

AT UCLA

NEW DISCOVERIES

THE FDA APPROVES IMMUNOTHERAPY DRUG AS TREATMENT FOR LUNG CANCER

SCIENTISTS ESTABLISH METHOD TO CREATE AGE-REFLECTIVE CELLS

An international study spearheaded by UCLA’s Jonsson Comprehensive Cancer Center has shown Pembrolizumab to be a breakthrough therapy for small-cell lung cancer. Already approved for melanoma treatment, Pembrolizumab was just recently approved by the FDA for treating the world’s leading cause of cancer deaths, lung cancer. Marketed under the name Keytruda, Pembrolizumab is an antibody that targets immune system “breaks,” or certain proteins that reduce the immune system’s ability to attack cancer cells.

Specifically, the drug prevents PD-1 from binding PD-L1, a protein often expressed in tumor cells. The PD-1/PD-L1 complex weakens T-cells that would normally be active in cancerous tissue. Results have been promising, revealing shrinkage of tumors in 41% of patients. More studies are under way to assess Pembrolizumab’s potential to treat yet other types of cancer.1,2

Traditionally, stem cells have been used to study various diseases. Skin cells taken from patients can be induced into pluripotent stem cells, which can be prompted to become any type of cell in the body. The difficulty in using stem cells to study neurodegenerative diseases arises from the fact that stem cells do not reflect age-related epigenetic signatures in the brain. Indeed, stem cells undergo a reprogramming of gene expression such that their gene expression mirrors that of younger cells. Scientists at the Salk Institute for Biological Studies in La Jolla have developed a method of bypassing the stem cell state in order to convert skin cells directly to neurons.

Remarkably, these “induced neurons” reveal epigenetic signatures that reflect the age of the patients from which they were derived. By creating age-reflective neurons, scientists may be able to make progress in studying not only aging but also neurodegenerative diseases such as Alzheimer’s and Parkinson’s.4

UCLA SCIENTIST RECOGNIZED FOR RESEARCH ON HOW THE BRAIN IS WIRED

TRIO AWARDED NOBEL PRIZE FOR MAPPING OUT MECHANISMS OF DNA REPAIR

Columbia University has awarded the 2015 Louisa Gross Horwitz Prize, the university’s top honor in biological and biochemical research, to UCLA’s Dr. S. Lawrence Zipursky. Dr. Zipursky’s research on the genetic and molecular basis of how neuronal connections form has triggered a breakthrough in understanding brain development. Dr. Zipursky’s team has pinpointed the gene Down Syndrome Cell Adhesion Molecule (Dscam) to be responsible for enabling neurons to choose the correct paths as they branch out to other neurons. Dscam encodes thousands of different variants of a protein that can be expressed on neuronal surfaces. In fact, the very set of Dscam-encoded proteins on a neuron serves as that neuron’s “identification badge,” which helps the neuron recognize itself and avoid making connections with its own branches. The neuron can therefore make connections with branches of distinct neurons in order to construct a highly complex yet miraculously efficient wiring system that is responsible for the brain’s advanced functions.3

The 2015 Nobel Prize in Chemistry was awarded to Tomas Lindahl, Paul Modrich, and Aziz Sancar for having traced out the molecular foundations of how cells repair damaged DNA and thereby preserve the stability of the genetic code. On a daily basis, DNA is subject to errors made in replication as well as to potentially dangerous mutations induced by UV radiation, free radicals, and various other carcinogens. These mutations, often the result of damage to the cell’s innate repair mechanisms, may indeed initiate various types of cancer.

Lindahl, Modrich, and Sancar have mapped out the molecular repair mechanisms responsible for maintaining the integrity of DNA and countering the effects of mutagens: base excision repair, nucleotide excision repair, and mismatch repair. The detailed molecular outlines provided by Lindahl, Modrich, and Sancar may prove particularly useful in developing drugs that specifically target the repair systems in cancer cells.

Such innovative drugs would prevent cancer cells, rather than normal cells, from proliferating.5

References 1.

“After UCLA-led tests, immunotherapy drug approved by FDA to treat lung cancer.” newsroom.ucla.edu. (2015).

2.

“FDA approves Keytruda for advanced non-small cell lung cancer.” fda.gov. (2015).

3.

“Horwitz Prize Awarded for Research Revealing How the Brain is Wired.” newsroom.cumc.columbia.edu. (2015).

4.

“Researchers learn how to grow old brain cells.” sciencedaily.com. (2015).

5.

“The cells’ toolbox for DNA repair.” nobelprize.org. (2015).

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total wellness ▪ fall 2015

by payam mirfendereski | design by jackie nguyen

q&a

cyclic hormonal methods of birth control: patch, pill, and ring which one is right for me? by masumi padhye|design by sophia fang

Q: how are the patch, pill, and ring used?

A: The birth control pill is an oral contraceptive that is taken once a day for either 21 or 28 days. The only difference between the 21-day and 28-day pills is the 7 days of placebo pills. The 28-day pills include the 7-day placebo pills, which are to be taken during one’s period (the last 7 days of the 28 days). Placebo pills are used to maintain a schedule, by serving as a reminder to start the new set of 28-day pills the day after menstruation is complete. Since these placebo pills do not have a chemical effect on contraception, 21-day pills are also available. 21-day and 28-day pills of similar make do not differ in terms of chemical composition. There are two types of actual pills, the combination pill and the minipill, which differ based on their hormone compositions.1

total wellness ▪ fall 2015

The birth control patch is a transdermal contraceptive which sticks to the skin and is replaced every week for three weeks and is not worn in the fourth week (during menstruation).

The patch is usually stuck onto the thigh or stomach and prevents pregnancy by continuously delivering hormones into the bloodstream through the skin.2 The vaginal ring is a small flexible ring that is inserted to provide contraception protection by slowly releasing hormones. The ring is replaced every month and is not worn in the fourth week (during menstruation). The ring can be easily inserted and removed and is held in place by the vaginal walls close to the cervix.3

Q: how do these methods of birth control work?

A: The birth control patch, pill, and ring are cyclic hormonal methods of birth control. Cyclic hormonal methods of birth control chemically alter hormone levels in the body in order to prevent pregnancy, and are repeated after every menstrual cycle (which is why the term “cyclic” is used). The hormonal changes act as a barrier to conception by inhibiting the release of ova from the ovaries, thickening cervical mucus (mucus that lines the part of the uterus leading to the vagina) to prevent sperm penetration, and preventing embryo implantation by causing the endometrial lining (the inner tissue layer of the uterus) to shed.4 The two hormones present in hormonal methods of birth control are progestin and estrogen. Progestin is a synthetically produced hormone that mimics the function of progesterone, which is naturally produced by the body. Progestin, like progesterone, makes the uterine lining inhospitable to a fertilized egg, limits the sperm’s potential to penetrate the egg, and immobilizes sperm by thickening the cervical mucus.

Estrogen prevents the release of ova from the ovaries by inhibiting luteinizing hormone (LH) and follicle stimulating hormone (FSH) production by the pituitary gland. LH and FSH regulate the menstrual cycle and the production of eggs by the ovaries. The amounts of LH and FSH vary throughout a woman’s menstrual cycle and are highest just before ovulation.

In the absence of LH and FSH, the release of an ovum does not take place, thereby preventing conception.5 The birth control patch, combination pill, and ring contain both estrogen and progestin. The minipill on the other hand, contains only progestin. While the minipill is less effective because of this, many do prefer this alternative if they experience strong side effects due to estrogen.5

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Another long-term side effect from hormonal methods of contraception is depression. Although it has been proven that hormonal methods of birth control can cause depression, a cross-sectional study conducted by the Iranian Journal of Nursing and Midwifery Research in 2011 concluded that there was no correlation between a specific type of hormonal birth control and depression.9 216 women were selected through random sampling of 10 health care centers in Iran and depression was observed in 47.8% of the participants.9 The findings of this study indicate that depression caused by birth control is a multifactor issue that varies on a case-bycase basis, and cannot be directly linked to a specific method of contraception.9

Q: what’s the bottom line?

Q: which method is most popular among women?

A: In 2006 to 2010, 12,279 sexually-active women (aged 15 to 44) from the United States were interviewed as part of the National Survey of Family Growth (NSFG).6 About 4 of every 5 sexually active women had used the pill, and this proportion remained stable since 1995, despite the introduction of additional highly effective methods such as the intrauterine device (IUD), a small T-shaped device that is inserted into the uterus to prevent pregnancy.6 According to the NSFG, the usage of the patch increased from 0.9% in 2002 to 10% in 2006 to 2010. The vaginal ring (which was first considered by the NSFG in the 2006 to 2010 survey) had been used by 6.3% of the women. The usage of the pill increased from 76% in 1982 to 81.9% in 2006 to 2010, making it the most popular of the three methods.6

A: This ultimately varies from person to person. According to the Center of Young Women’s Health, the success rate with typical use of the birth control pill, patch, and ring is 91%.10 Since each method is equal in terms of success rate, it is important to look into which method of contraception is most suitable for your body in terms of minimal side effects.

In addition to the cyclic methods of hormonal birth control, there are also other methods of hormonal birth control one can consider such as the Depo Provera shot, the Nexplanon implant, and the Mirena IUD (refer to chart 1 for more info).

Many women prefer other hormonal methods of birth control because they do not need to be replaced/repeated as often as cyclic methods of birth control. With the help of a physician, most women are able to find a method of birth control that causes the least side effects and works best for them.

To learn more, refer to helpful guides such as bedsider.org, plannedparenthood.org, or birth control phone apps such as MyPill and My True Cycle. However, keep in mind that these tools do not substitute a physician’s advice and it is important to consult a physician when making decisions about birth control. t w

A 2013 study published in BMC Women’s Health asked 18,787 European women why they use the birth control they use. “Nondaily administration” was one of the main reasons women selected the patch and ring. The main reasons for not choosing the patch included “not discrete, visible” and “can fall off,” while the primary reasons for not selecting the pill were “saily use” and “will forget to take it.” In a few cases, the ring was rejected because some women didn’t want to use a “foreign body.” 7

A: According to a survey conducted in 2006-2010 by the NSFG, side effects were the most common reason for discontinued use of the pill and the patch. 30% of women stopped using the pill while 49% of women stopped using the patch.6 While most women deal with milder side effects such as headaches and nausea, the pill, patch, and ring can also cause more intense ones such as blood clotting. Estrogen present in contraceptives can promote a state of hypercoagulability which can increase the risk of clot formation.8

total wellness ▪ fall 2015

Q: are there any harmful side effects from these contraceptive methods? If so, how prevalent are they?

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additional hormonal methods of birth control to consider

brief description

pros

depo-provera shot

An injection that contains a sustained level of medroxyprogesterone acetate, which suppresses ovulation in the majority of women. It also renders cervical mucus impenetrable to sperm and induces a thin endometrium, which is unsuitable for implantation.

- Injection is administered every three months - No estrogen-related side effects - Highly effective form of contraception

Studies show decreased bone density11

nexplanon implant

The implant is a thin flexible piece of plastic that is inserted under the skin of the upper arm. It continuously releases progestin, keeping the egg from being released from the ovaries and prevents sperm from reaching the egg.

- It is replaced every three years - Easy insertion of implant - Highly effective form of contraception

Cost. You may have to pay about $600 or more for an exam and the implant, and $100 or more to have it removed.12

mirena intrauterine device (IUD)

total wellness ▪ fall 2015

cons (apart from general side effects*)

hormonal birth control method

The mirena IUD is a T-shaped plastic frame that slowly releases levonorgestrel, a form of progestin. It is inserted into the uterus.

- Replaced every 5 years - Highly effective form of contraception

An IUD works best in women who have had at least one child, making it less effective for women who haven’t had children.

The cost for the medical exam, the IUD, the insertion of the IUD, and follow-up visits to the physician can range from $500 to $1,000.13

*headaches, nausea, changes in mood, potential weight gain References: 1.

“Comparing Birth Control Pill: Pros and Cons of Different Types and Brands.” wedmd.com. (n.d.).

2.

“Birth Control Patch.” wedmd.com. (n.d.).

3.

“Vaginal Ring.” birth-control-comparison.info. (2015).

4.

“Implants, Injections, Rings, and Patches: Hormonal Birth Control Options.” acog.org. (n.d.).

5.

“Hormonal Contraception.” courses.washington.edu. (n.d.).

6.

“Contraceptive Methods Women Have Ever Used: United States, 1982–2010.” cdc.gov. (2013).

7.

“Women’s perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling.” BMC Women’s Health. (2013).

8.

“Coagulation effects of oral contraception.”Am J Obstet Gynecol. (1987).

9.

“The association of contraceptive methods and depression.” Iran J Nurs and Midwifery Res. (2011).

10.

“Contraception: Pros and Cons of Different Contraceptive Methods.” youngwomenshealth.org. (2009).

11.

“Injection (Depo-Provera).” sexualityandu.ca. (2012).

12.

“What is Nexplanon.” nexplanon.com. (2013).

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self care

quench the skin you’re in

Dry, peeling, scaly skin—not a pretty picture. Now imagine soft, glowing, supple skin. That’s a much nicer image, isn’t it? As days get longer and the weather gets hotter, chances are that you’re going to show off more of your skin. Who wouldn’t want it to look flawless?

We’re all born with different skin, of course, but anyone can achieve the great look of hydrated skin if they are willing to put the work into it.

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total wellness ▪ fall 2015

right: volodymyr krasyuk/istockphoto

by richa vakharia | design by jackie nguyen

how to measure skin hydration

but what exactly is “dry skin?”

Dry skin can range from fine lines and cracks all the way to severely flaky, itchy skin. It’s caused by a lack of hydration to the outermost layer of skin, or the epidermis, which is made up of cells that absorb and retain moisture. The way to keep our skin hydrated is to make sure that those cells are constantly replenished with enough water.1

Skin hydration is measured through something called transepidermal water loss, or TEWL. In other words, as water moves through different layers of skin to reach the epidermis, some of it evaporates and gets lost. The more water that is lost, the drier the skin becomes. Transepidermal water loss is a way to quantify that amount, meaning the higher the TEWL, the drier the skin. It’s not a statistic that is well known to the common person, but it’s just the way dermatologists and researchers can assess how dry your skin is. For the curious: two moisture sensors and two thermometers are used to measure the water vapor flow density, a value that is then converted into the TEWL number.2 The average TEWL number is 5, meaning water is lost at a rate of 5 grams per meters squared per hour (5g/h•m2).1,2,3

how to keep skin hydrated The greater the number of water-regulating cells in the skin, the more moisturized the skin. Drinking water is a great way to accomplish this, but there are other things you can do along with drinking water to hydrate your skin. Here are some different factors to take into consideration.

total wellness ▪ fall 2015

dry skin and weather Though it’s true that overexposure to the sun can cause dehydration, a recent study published in Nutrients in 2012 found that lack of vitamin D is also correlated with dry skin. It seems that a healthy level of vitamin D is needed for better skin hydration, though the exact amount has not yet been identified.4 Interestingly, a study published in Dermatologic Therapy in 2004 found that intensely humid climates are correlated with scalier skin than drier climates are. In drier climates, the skin has to produce more water-absorbing cells to make up for the lack of water. Those in more humid climates have not had to adapt in the same way, and so their bodies aren’t as naturally hydrated. In other words, those in humid climates have to make sure their skin is hydrated even more than those in drier climates.5

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However, researchers have found that moving from a humid climate to a dry climate can cause the skin to become less scaly. For those here in gorgeous Southern California, you must remember that staying indoors all day will actually make your skin more susceptible to dryness. Of course, it is important to remember that an excess of anything has detrimental effects, and the American Academy of Dermatology recommends that you get most of your vitamin D through diet to avoid overexposure to the sun. However, a small, healthy amount of sun exposure is necessary to maintain hydrated skin.

helpful ingredients Glycerol: a natural, water-absorbing ingredient that is widely used in pharmaceuticals and moisturizers because of its demonstrated capabilities. A 2008 study published in the Journal of Cosmetic Dermatology Research found that when used with hydrolyzed jojoba esters, glycerol works better than usual in decreasing water loss and increasing skin moisturization for the long-run.

Jojoba is a plant whose oil is commonly used in cosmetics, and hydrolyzed esters simply refer to certain chemical compounds that are mixed with water and broken down.

These are common ingredients in cosmetics. However, it was only a preliminary study, and more research needs to be done to see if these combinations will in fact lead to the most hydrated skin.6 Hyaluronan: another natural, water-absorbing ingredient that has been highlighted in its ability to moisturize skin. A 2004 study published in the Journal of Drugs in Dermatology showed that hyaluronan-based creams significantly decreased wrinkles by increasing the elasticity in the skin of 30 to 60 year-old women.5

quick tips According to the American Academy of Dermatology, here are a few simple tips to soothe dry skin: ❯ ❯ ❯ ❯ ❯

❯ ❯ ❯

take 5 to 10 minute showers use warm, rather than hot, water use ointments rather than creams or lotions, as ointments are more effective and less irritating use gentle, unscented skincare products wear gloves during cold, dry weather, when performing tasks that will get your hands wet, and when working with chemicals, grease, and other harsh substances use hypoallergenic laundry detergent, which causes relatively fewer allergic reactions wear soft clothes under rough materials such as wool add moisture to the air by using a humidifier8

Dead Sea Salt: though not always found in moisturizers in America, salt extracted from the Dead Sea has been shown to hydrate skin well. It is thought to be the magnesium in the salt that really does the job. Magnesium salts are known to enhance skin elasticity and hydration by replenishing water-absorbing skin cells, and the Dead Sea is rich in them.7

There you have it! Studies on skin hydration are constantly being done and still need to be done, but the tips above are what the scientific world has produced so far. Soft, glowing skin doesn’t just make a pretty picture, it’s a sign of healthy skin. So try to get your TEWL numbers down, moisturize with the ingredients described above, drink water, and enjoy your time outside! t w

total wellness ▪ fall 2015

left: volodymyr krasyuk/istockphoto; right: portugal2004/istockphoto

bottom line

References 1.

“Skin Hydration: a review on its molecular mechanisms.” J Cosmet Dermatol. (2007).

2.

“TEWL- transepidermal water loss.” dermatest.de. (2015).

3.

“Stratum Corneum Lipids and Water.” Exogenous Dermatol. (2004).

4.

“Assessing the Relationship between Vitamin D3 and Stratum Corneum Hydration for the Treatment of Xerotic Skin.” Nutr. (2012).

5.

“Moisturization and Skin Barrier Function.” Dermatol Ther. (2004).

6.

“Evaluation of additive effects of hydrolyzed jojoba (Simmondsia chinensis) esters and glycerol: a preliminary study.” J Cosmet Dermatol. (2008).

7.

“Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin.” Int J Dermatol. (2004).

8.

“Dermatologists; top tips for relieving dry skin.” Am Acad Derm. (2015).

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eat well

healthy snacking:

the truth about fruit by sabrin sidhu | design by kimberly rich

total wellness ▪ fall 2015

When it comes to indulging in sweet and tasty treats, delicious in-season fruits can be a great option. With fruits ranging from coconuts to kiwis to mangos, it can become challenging to know which fruits provide us with the greatest amount of nutrients.

Before taking a look at which delicious fruits might be the best for you, let’s establish the fruity basics. While we usually think of fruits as sweet from a culinary standpoint, this isn’t always the case. In fact, something is considered a fruit if it is derived from the flowers of a seed-bearing plant. This means that even foods like avocados classify as fruits!1 Vegetables, on the other hand, are made of the other parts of a plant including the stems, leaves, and roots.1 As you can see, there’s a wide variety of fruits, and there are also numerous ways to eat them.

Whether your one serving of fruit is a classic medium sized apple, 8 ounces of 100% fruit juice, or ½ a cup of canned fruit, the USDA recommends that you get 3 to 4 such servings of fruit per day. 2 That may seem like a lot of servings—find out what you could be snacking on right now as this article takes you through the basics of popular fruits!

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the power of fruit did you know?

monitoring your fruit intake Although fruits in general are beneficial for our health, it is important to take into account portion sizes. Fruits like mangos are relatively high in sugar when compared to other fruits. Eating fruits high in sugar and fat in large quantities can increase the risk of developing type 2 diabetes and obesity.

left: volodymyr krasyuk/istockphoto; right: istockphoto

As you choose which fruits you want to indulge in, be careful to watch out for frozen fruits like frozen strawberries, mangos, and blueberries. These frozen fruits may contain added sugar, preservatives, and

❯ ❯ ❯ ❯ ❯ ❯ ❯

Bell peppers are fruits.

Bananas are berries.

Avocados are fruits.

Figs are high in calcium and one serving has as much calcium as a glass of milk!

Kiwis beat oranges in Vitamin C! Apples are cousins of roses.

Coconuts contain more saturated fat than butter!3

additives that will take away from the natural fresh fruits’ benefits and nutrition.24 Likewise, while fresh fruits are associated with improved health, a 2014 study found that canned fruits (often containing sugary syrups) did not show the same benefits.25 In contrast, however, fruit juices show many of the same benefits as regular fruits. When shopping for juices, however, make sure to buy 100% fruit juice, as other juices may contain added sugar and flavors. Either way, remember fresh is best!

bottom line Seasonal fruits like watermelon, kiwi, and blueberries have many health benefits that make them prime snacking options. Although fruits have a multitude of health benefits, it’s important to eat everything in regulated portions. After all, some fruits like mangos and coconuts are rich in sugar and fat, so overconsumption can lead to health risks. Nonetheless, with so many healthy options, tw make sure to get your share of fresh fruits this year!

total wellness ▪ fall 2015

Eating fruits is a great way to satisfy your sweet tooth and still get nutritional benefits. It’s common to have been told since childhood that fruits and veggies are necessary and important for good health, but what exactly makes fruits so power-packed? The different nutrients and minerals found in fruits contribute to healthy functioning across the body. A 1992 study published in the Journal of Nutrition and Cancer found that individuals who had a high intake of fruit and vegetables when compared to the general population were two times less likely to develop any type of cancer.4 These individuals typically met or exceeded the suggested 3 to 4 servings of fruit per day. Another 2014 study published in the British Medical Journa had similar results and found that increased fruit consumption was correlated with a lower risk of mortality, especially in regard to cardiovascular-related death.5 In fact, in the population examined, each serving of fruit reduced mortality risk by about 6% and this positive decrease continued for up to 5 servings.5 Similarly, studies have shown that a consistent, daily intake of fruit can decrease the likelihood of stroke and can reduce the risk of coronary heart disease by 4 to 7%.6-7

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types of fruit: benefits and drawbacks

guava

benefit 1: Guava is a tropical fruit that has been shown to be high in antioxidants and dietary fiber which can help decrease overall cholesterol levels while increasing HDL levels and overall metabolism.16 benefit 2: It has also been found to reduce blood pressure and cholesterol through its high levels of soluble fiber and vitamins.16

total wellness â–Ş fall 2015

coconut

benefit 1: While coconuts are a delicious tropical fruit on their own, coconut oil is becoming popular as well. Many studies have suggested that coconut and its derivatives have antioxidant, antistress, and antidepressant effects. These positive effects can be attributed to the special types of fatty acids found in coconuts which assist in reducing depression, especially when given in the form of an oil.22

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cantaloupe

benefit 1: Cantaloupes are tasty treats rich in antioxidants. As in other fruits, many of these antioxidants help prevent a variety of conditions, from the common cold to cancer. Some of the prominent vitamins and minerals found in cantaloupes include vitamin C and potassium.20

strawberries

benefit 1: Strawberries have high antioxidant capacities because they are rich in vitamin C, folate (a type of B vitamin), and phenolic constituents.15 benefit 2: A 2012 study published in the Journal of Nutrition found that the nutrients in strawberries contribute to overall improved metabolism, which can help with weight loss.15

watermelon

benefit 1: Even though watermelon is 92% water, it is loaded with antioxidants that can help prevent the onset of cancer.11 benefit 2: Because watermelon is rich in an amino acid called l-citrulline that assists in providing relief to sore muscles, it is a helpful and healthy option for athletes. In fact, one 2013 study in the Journal of Agricultural and Food Chemistry found that muscle soreness was partially relieved within 24 hours of watermelon juice consumption.12

figs

benefit 1: Figs have many beneficial vitamins and minerals.

One serving of 3 to 5 figs provides 30% of the suggested daily value of iron, 14% of potassium, and 7.1% of vitamin B1.9 These minerals/vitamins in addition to the soluble fiber found in figs are useful in controlling weight, blood sugar, and blood cholesterol.9 benefit 2: Figs are high in calcium and have no sodium, fat, or cholesterol, making them a good option for people with health problems.9

blueberries

avocado

benefit 1: Avocados are rich in “heart healthy fats.” In particular, “heart healthy fats” are unsaturated and are known to benefit your heart. Because avocados are associated with fats that benefit the body, consumption of avocados can help with weight loss.10 benefit 2: Numerous phytochemicals, or biologically active compounds like carotenoids, and essential nutrients found in avocados have been linked to cancer prevention, good skin health, good eye health, and arthritis relief.10

kiwi

benefit 1: A 2011 study published in the Asia Pacific Journal of Clinical Nutrition found that kiwi has the ability to improve sleep quality in adults with issues like chronic insomnia because it is rich in serotonin and folate.8 These two compounds are associated with REM sleep (sleep that helps with learning and memory). benefit 2: Kiwi is also a fruit with beneficial antioxidants.

Antioxidants are vitamins and nutrients that are known to remove harmful oxidizing agents in the body. In fact, studies have shown that the numerous antioxidants present in kiwi can help detoxify the body by fighting oxidative damage. benefit 3: Kiwi also reduces the chance of getting the flu because it is rich in nutrients that foster a strong immune system.8 Some of the many beneficial nutrients found in kiwi include vitamin C, vitamin E, vitamin K, folate, iron carotenoids, potassium, and fiber.8 caution! Kiwis are an allergenic fruit meaning they are known to induce allergic reactions in some individuals. Typically, the reactions are only mild, but it is important to avoid kiwi and see your doctor if you feel any adverse side effects after consumption.8

mango

benefit 1: Mangos are sweet, juicy, and almost too good to be considered healthy. Nonetheless, they are beneficial for the immune system because they are full of vitamin A, vitamin C, and 25 other nutrients that boost immune health.17 benefit 2: Because mangos are rich in vitamin A, they also support eye health and help prevent dry eyes.17 Additionally, the antioxidant found in mangos, zeaxanthin, is known to play a protective role in eyesight. benefit 3: Though widely unknown, in addition to mangos, mango peels can also be eaten and studies suggest that the peels may be beneficial.17 In fact, a 2015 study published in the Journal of the Science of Food and Agriculture found mango peel powder beneficial for diabetic patients.18 caution! Whole large mangos can contain up to 46 grams of sugar per serving.19 Additionally, some individuals may be allergic to the compounds found in mango peels.

References 1.

“Fruit or vegetable — Do you know the difference?” mayoclinic.org. (2012).

2.

“Dietary Guidelines.” health.gov. (n.d.).

3.

“Fun Facts About Fruits and Vegetables.” wedmd.com. (2014).

4.

“Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence.” Nutr Cancer. (1992).

5.

“Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.” BMJ. (2014).

6.

“Fruit and vegetable consumption and stroke: meta-analysis of cohort studies.” Lancet. (2006).

7.

“Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies.” J Nutr. (2006).

8.

“Kiwifruit: our daily prescription for health.” Can J Physiol Pharmacol. (2013).

9.

“Antioxidant Activities and Anthocyanin Content of Fresh Fruits of Common Fig.” J Agric Food Chem. (2006).

10.

“Hass Avocado Composition and Potential Health Effect.” Crit Rev Food Sci Nutr. (2013).

11.

“Fruit of the Month: Watermelon.” webmd.com. (2006).

12.

“Watermelon juice: potential functional drink for sore muscle relief in athletes.” J Agric Food Chem. (2013).

13.

“Blueberries: Nutritious Things Come in Small Packages.” webmd.com. (2010).

14.

“Neuroprotective effects of berry fruits on neurodegenerative diseases.” Neural Regen Res. (2014).

15.

“The strawberry: Composition, nutritional quality, and impact on human health.” J Nutr. (2012).

16.

“Effects of guava intake on serum total and high-density lipoprotein cholesterol levels and on systemic blood pressure.” Am J Cardiol. (1992).

17.

“Mad About Mangos.” webmd.com. (2006).

18.

“Anti-diabetic effect of dietary mango (Mangifera indica L.) peel in streptozotocin-induced diabetic rats.” J Sci Food Agr. (2014).

19.

“Basic Report: Raw Mangos.” USDA. (2015).

20.

“What are the Health Benefits of Cantaloupe?” livestrong.com (2013).

21.

“Daily Polyphenol Intake in France from Fruits and Vegetables.” J Nutr. (2006).

22.

“Antistress and antioxidant effects of virgin coconut oil in vivo.” Exp Ther Med. (2015).

23.

“Coconut Oil and Health.” webmd.com. (2011).

24.

“Nutrition.” cdc.gov. (n.d.).

25.

“Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data.” J Epidemiol Community Health. (2014).

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total wellness ▪ fall 2015

left: volodymyr krasyuk/istockphoto, picturepartners/istockphoto, joxxxxjo/ istockphoto; infographik/istockphoto, alexstar/istockphoto; jill111/pixabay, azzurrodesign/pixabay

benefit 1: Blueberries are rich in antioxidants. One cup of blueberries delivers 14% of the recommended daily dose of fiber and 25% of the recommended daily intake of vitamin C.13 Fiber plays an important role in digestive health and vitamin C aids in healing wounds and maintaining healthy teeth and bones. benefit 2: According to multiple studies, blueberries have antineurodegenerative properties because they modulate pathways involved in inflammation, cell survival, and neurotransmission.14 This means that they support brain health and promote good mental and physical health.

mind well

a cruise through motion sickness by ruchi desai | design by alison jeng

total wellness ▪ fall 2015

Breaks from school and work are highly anticipated and are often filled with exciting vacations, cruises, and trips to exotic locales. But while the final destination sounds fantastic, the journey to there may be fraught with a few discomforts. If you’ve ever found yourself sweating, vomiting, and feeling dizzy on what was supposed to be a relaxing plane ride, you may have had a bout of motion sickness. Motion sickness is quite common and the majority of individuals will experience motion sickness at some point in time. So let’s discover what motion sickness is, uncover ways to ease your travel discomforts, and hopefully make the journey in your vacations just as enjoyable as the final destination!

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what it is Motion sickness, or kinetosis, is the uncomfortable and often debilitating feeling that many people encounter while traveling. It is also known as carsickness, airsickness, and seasickness. It usually starts as a feeling of uneasiness, dizziness, and sweating and progresses to nausea and maybe vomiting.1

is all dizziness the same?

Vertigo and dizziness are commonly associated with motion sickness. All three are related to a person’s equilibrium and sense of balance. However, there are a few differences among the three ailments. Motion sickness is specific to traveling and uneasiness caused by motion. Vertigo is a sensation of spinning and is generally triggered by problems with the inner ear.2 Dizziness is a general feeling of spatial disorientation and can be associated with other causes such as dehydration, allergies, head/neck injuries, infections and other illnesses.3

science behind motion sickness how normal conditions are disrupted Your sense of balance gets disrupted when your vestibular system and visual system send conflicting messages to the brain. There are three major types of motion sickness: motion that is felt by the vestibular system but not seen, motion that is seen by the visual system but not felt, and motion that is detected by both systems, but the signals do not correspond.5 The motion sickness that occurs while traveling in a car, boat, or plane is motion that is felt but not seen. In other words, your inner ear is telling the brain that you are moving but your eyes say that you are not. As a result, your brain receives conflicting information. It is interesting to note, that although it is referred to as “motion sickness”, it is not a true sickness in the strict sense of the word, but is actually just “a normal response to an abnormal situation”.5

total wellness ▪ fall 2015

left: ceneri/istockphoto

vestibular system and balance The vestibular system is the sensory system that helps your body balance and understand your physical position in relation to your surroundings. Motion sickness occurs when this system is disturbed or “confused.” The vestibular system is found in the inner ear and is composed of three semicircular canals, interconnecting fluid filled tubes, and certain structures called the otolith organs. The semicircular canals detect rotational movements of the head; when your head moves, the fluid in the canals also moves. The otolith organs determine when your body is moving in a straight line and tell your brain where your head is with respect to gravity (whether your are standing, sitting, or lying down). The vestibular system works with your visual system (eyes) and musculo-skeletal system (joints and muscles) to help you balance. These three systems work as a team by relaying information amongst each other.4

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who is affected

symptoms and diagnosis

Unfortunately, having a functioning vestibular system means that you have the potential to develop motion sickness.

However, certain individuals may be more susceptible to the illness than others:

Symptoms of motion sickness include:1

• Children between the ages of 2 and 12 • Women who are pregnant, menstruating or who are undergoing hormone treatments • People who suffer from migraines, especially while traveling • Sleep-deprived individuals • Individuals taking certain types of medications such as antidepressants, antibiotics, and asthma medications6

• dizziness • cold sweat • nausea • vomiting • headache • increased salivation • fatigue Motion sickness does not need to be diagnosed with lab tests.

A person is considered to have motion sickness if they exhibit any of these symptoms while traveling.8

In addition, research has found that motion sickness is linked to genetics. The first genome-wide study on motion sickness, published in Oxford Journal’s Human Molecular Genetics in 2015, looked at 80,094 individuals and found 35 genetic associations with motion sickness. While the study was specific to carsickness, the findings suggest that motion sickness in general may be heavily linked to genetics.7

prevention and treatment when you are traveling by car

total wellness ▪ fall 2015

when you are travelining by plane

when you are travelining by boat

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• Try to sit in the front seat or near the front of the vehicle.

• Increase air ventilation by opening a window, turning on the AC, and turning the vents to blow the air towards your face. The reason this may be helpful is that it helps provide fresh air to make breathing easier. A 1999 study published in the journal of Aviation, Space, and Environmental Medicine found that continuous slow deep breathing, which decreases anxiety, helped reduce motion sickness symptoms.9

• Ask for a seat near the front or over the wings.

• Direct the vent airflow towards your face.

• Sit in the front or middle of the ship near the water level.

• Face the direction in which the boat is moving.8

Regardless of which mode of transportation you are using, there are a few general behavioral changes that can help you avoid getting sick.

• For all travel forms, reduce sensory conflict by avoiding reading. Insead keep your eyes on the horizon, or close your eyes.

• Try to rest your head against something (i.e. the back of the seat) and avoid major movements.

• Avoid eating greasy, spicy, or heavy foods before traveling.

• Don’t smoke.

• If you do start to get nauseous, eating dry saltine crackers and drinking a carbonated beverage can help to alleviate an upset stomach.10

medications scopolamine what it is Scopolamine is a drug that is often used by individuals who suffer from motion sickness. Scopolamine is generally administered via a prescription transdermal patch that is placed behind the ear several hours before you plan to travel.

Scopolamine works to reduce nausea, which is one of the major symptoms of motion sickness.11 is it effective?

A review study published in The Cochrane Library in 2011 evaluated 14 controlled studies on the effectiveness of scopolamine for sea or lab-induced motion sickness. The results demonstrated that scopolamine is more effective than a placebo in the prevention of nausea and vomiting induced by motion sickness.12

side effects Side effects of scopolamine include drowsiness, dry mouth, rashes, disorientation, confusion, and dilated pupils. More serious side effects include hallucinations, dizziness, eye pain, and rapid pulse. You should also wash your hands thoroughly after touching the patch as medication can be transferred from your hands to your eyes or mouth after handling the patch.

If you experience any of the serious side effects, you should contact a doctor right away.11

antihistamines what they are Antihistamines for motion sickness are over the counter medications that are taken about half an hour to an hour before you travel. The most common antihistamine taken for motion sickness is meclizine, which is marketed as Antivert, Bonine, and the low drowsy formulation of Dramamine.10 Dimenhydrinate, another popular antihistamine, is found in the regular form of Dramamine.

side effects The majority of antihistamines will cause drowsiness and may put you to sleep. So if you are driving, you should not take an antihistamine, unless it specifically states that it is nonsedative. However, the non-sedative antihistamines do not seem to be as effective. Sleeping is often considered another good way to avoid motion sickness.14

are they effective?

total wellness ▪ fall 2015

A clinical trial reviewed in the American Family Physician concluded that dimenhydrinate, the generic name for the brand name drug Dramamine, was effective in reducing nausea.13 The 2011 The Cochrane Library study on scopolamine found that dimenhydrinate was as effective as scopolamine and that meclizine was less effective. Nevertheless, both dimenhydrinate and meclizine were effective in reducing nausea and both are available without a prescription.12 Overall, antihistamines are an effective medication to use before traveling to reduce symptoms of nausea.

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popular treatments ginger what it is Ginger is a popular natural medication for motion sickness.

It is commonly used in Asian medications to reduce nausea, stomach aches, and diarrhea.15 is it effective?

Studies have confirmed that ginger is effective in reducing nausea during pregnancy, but the results are mixed when it comes to motion sickness. Ginger can be consumed by drinking gingerale, ginger tea, or taking a powdered ginger capsule. Some people even eat ginger candies!16 Dramamine Naturals provides 1000mg of ginger, the typical effective dose found in studies. A 2003 study published in the American Journal of Physiology evaluated 13 individuals and found that pretreatment with ginger reduced nausea, prolonged the onset of nausea, and reduced the recovery time from motion sickness.17 However, two other studies reviewed in the American Family Physician did not find ginger to significantly reduce nausea in comparison to a placebo.18

conclusion It may seem odd that an herb can be used to prevent nausea, but scientists believe that ginger contains certain chemicals that work in the intestines and stomach to reduce nausea. The chemicals may also work in the brain and nervous system.19 When taken in small doses ginger is relatively safe, however some minor side effects include heartburn, diarrhea, and general stomach discomfort.19 While the scientific evidence may not fully support the effectiveness of ginger, there is little harm in trying it out, as it is considered safe for most individuals.

acupressure and acustimulation bands what they are You might have heard of acupressure and acustimulation bands that reduce motion sickness. The theory behind these bands is that they consistently apply pressure to the P6 point, an acupressure point on your wrist, and this continued pressure is supposed to reduce motion sickness symptoms.

These bands use the theories in the ancient practice of acupressure and acupuncture, which maintain that stimulating particular points on the body can restore balance and harmony to the system.20

total wellness ▪ fall 2015

are they effective?

While a wristband that reduces motion sickness sounds cool in theory, the scientific evidence does not seem to back it up.

A 2004 study published in Aviation, Space, and Environmental Medicine examined two types of acupressure bands and a placebo.The researchers found that the bands did not reduce motion sickness in patients.21

conclusion Even though more research needs to be done to understand how effective these bands are, the current research is not very positive. In addition, the amount of pressure that needs to be applied to the P6 point to effectively stimulate it can be uncomfortable to some people and even cause numbness and tingling in the hands. However, you can always try them out as some individuals do seem to experience relief when using these bands, and there do not appear to be any major side effects for most people from using the bands.

bottom line Motion sickness can put a damper on your travel plans, but simple behavioral changes, medication options, and even some popular natural treatments like ginger may help to alleviate some of the discomfort you feel while traveling. Whatever you decide to use, try to relax and reduce your anxiety about motion sickness. You never know, the journey might even become more exciting than the final destination! t w

References 1 “Motion Sickness-Topic Overview.” webmd.com. (2015).

2 “Dizziness and Motion Sickness.” entnet.org. (2015).

3 “Dizziness and Motion Sickness.” pehni.com. (2015).

4 “Balance Disorders.” medicinenet.org. (2015).

5 “Neuronal Mechanisms and Treatment of Motion Sickness.” Pharmocology. (2013).

6 “Motion Sickness.” cdc.gov. (2013).

7 “Genetic variants associated with motion sickness point to roles for inner ear development, neurological processes, and glucose homeostasis.” Hum Mol Genet. (2015).

8 “Motion Sickness.” umm.edu. (2013).

9 “Slow deep breathing prevents the development of tachygastria and symptoms of motion sickness.” Aviat Space Environ Med. (1999).

10 “Motion Sickness: First Aid.” mayoclinic.org. (2014).

11 “Scopalamine Transdermal Patch.” nih.gov. (2013).

12 “Scopalamine (hyoscine) for preventing and treating motion sickness.” The Cochrane Library. (2011).

13 “Treatment of Motion Sickness.” Am Fam Physician. (2012).

14 “Motion (Travel) Sickness.” patient.info. (2015).

15 “Ginger.” nih.gov. (2012).

16 “Ginger for Motion Sickness.” webmd.com. (2013).

17 “Effects of Ginger on Motion Sickness and gastric slow-wave dysrhythmias induced by circular vection.” Am J of Physiology. (2003).

18 “Ginger an Overview.” Am Fam Physician. (2007).

19 “Ginger.” webmd.com. (2015).

20 “Acupressure points and Massage Treatments.” webmd.com. (2015).

21 “Efficacy of acupressure and acustimulation bands for motion sickness.” Aviat Space Environ Med. (2004)

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totalwellness ›› on the cover

total wellness ▪ fall 2015

“Certainly, travel is more than the seeing of sights; it is a change that goes on, deep and permanent, in the ideas of living.”

right: jackie nguyen

– MIRIAM BEARD

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cover story

when you gotta go: traveler’s diarrhea by sepideh parhami | design by eunji song

total wellness ▪ fall 2015

You’ve spent months saving your money, doing your research, and preparing for the international getaway of a lifetime. But just days after arriving abroad, you realize you don’t feel so good… and instead of lazing by the beachside, you’re lounging within crawling distance of a restroom. Traveler’s diarrhea (TD) can make a crappy situation out of an otherwise perfect vacation. TD, also familiarly called Montezuma’s revenge, Delhi belly, or Turkey trots,1 actually refers to a collection of gastrointestinal infections caused by bacteria, viruses, and protozoa found in dirty food and water.

Although not life-threatening and generally benign, traveler’s diarrhea can lead to complications. Learn about why it happens, how to avoid the bummer in the first place, and how to ensure a smooth recovery.

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what it is TD is a condition that affects 20 to 50% of international travelers.2 Especially at risk are young adults (who may take fewer precautions when traveling), people with decreased immune defense (children, the elderly, and the chronically ill) and those visiting high-risk travel destinations such as: • • • •

most of Asia, including the Middle East Africa Mexico Central and South America3

The onset of symptoms can occur anytime during travel, even after returning home.2 Symptoms include: • • • • •

3 or more loose stools in a day urgent need to defecate abdominal cramps nausea or vomiting fever4

how it happens

where it happens See “high-risk travel destinations” above for a list of regions of the world where traveler’s diarrhea is commonly acquired.

These are generally places with: • No indoor plumbing. Sewage can contaminate water sources and pathogens can get deposited in soil.

• Inadequate clean water supply. Washing hands poorly when preparing food, growing food with contaminated irrigation systems, or washing produce in unclean water are all possible consequences of water shortage.

• Few regulations on safe food handling.3

All forms of traveler’s diarrhea are caused by exposure to microbes or viruses in contaminated water and food sources (described in “Why it happens”). When a person consumes water or food infected by traces of animal or human feces, disease-causing pathogens get transferred. Common dietary means of exposure are:

Several studies since the 1980s have shown that where you eat is more of a factor than what you eat when it comes to TD. Those who eat home-cooked food are much less likely to get sick than restaurant-goers.3

total wellness ▪ fall 2015

left: mzube/iflickr, nikola spasenoski; right: robert prosak/freeimages, karimala/istockphoto

• Water or other unheated beverages. Even if the water is not known to cause illness in locals, it can still be harmful to visitors. Locals get repeated exposure to organisms in the supply and build immunity over time.4 • Fruits or vegetables grown and washed in contaminated water.

• Undercooked meat.

• Unsanitary food handling by restaurants or street vendors.2

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health effects TD can lead to serious complications if the patient gets dehydrated, symptoms of which include dry mouth, intense thirst, and little or no urination. Other possible complications are colitis or irritable bowel syndrome, both of which are chronic conditions.4 Rest assured, TD is usually harmless in the long term and is mostly just unpleasant during the course of the illness. Around 90% of cases are resolved without medical attention within one week and often within just a couple of days.

However, because of the possibility of serious complications, it is extremely important to know when to seek medical attention. Severe abdominal pain, bloody stool, and/or significantly high fever require medical attention and may indicate something more serious than TD.2

personal preventative measures avoid contaminated water by: • Drinking water sold in a bottle or, in high-risk countries, boiling water for 10 minutes and refrigerating.

• Using a combination water filtration and purification system if drinking from the tap. Learn the difference between filtration and purification in the quick reference chart.

• Avoiding ice made from unclean water.

• Brushing your teeth with clean water.

• Sticking to hot beverages like coffee or tea or bottled, carbonated drinks. The boiling process (in the factory in the case of soda or at home for heated drinks) kills bacteria, protozoa, and viruses.2,3

prevent person-to-person transfer by: • Washing your hands frequently and before meals. Carrying an alcohol-based hand sanitizer can encourage this habit.

• Watching the hygiene and sanitation practices of the place where you’re buying prepared food.

• Being careful not to ingest water while swimming and staying out of the water if you have open wounds or diarrhea.2,3

regulate your diet by: • Eating raw fruits and vegetables sparingly, since they may be grown in contaminated water. If you must eat them raw, rinse produce in a mild bleach solution before peeling items yourself.

• Eating only thoroughly cooked meat and seafood. Make sure that the juices run clear, there is no pink left in the middle, and the inside gives off steam.8 • Avoiding unpasteurized dairy products.2,3

total wellness ▪ fall 2015

Antibiotics should not be used as a preventative measure.

The CDC warns against it because if you are not actually sick, antibiotics deplete beneficial bacteria in the gut and actually leave you more susceptible to drug-resistant bacteria.

Antibiotics may also give a false sense of security because they do not protect against viruses or protozoa. However, your doctor may give you a supply of TD antibiotics to pack in your luggage in case of illness, but do not use them until you show symptoms.2

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what to do if you get TD • Drink lots of (properly treated!) water (see chart) or other clear liquids that are easily digested such as broth, juice without pulp, or tea.9 • Replace lost electrolytes with sports drinks and salted crackers. Electrolytes are charged particles essential to many body processes.

• Take medication with bismuth subsalicylate (Pepto-Bismol is the most common brand) to promote water absorption and kill bacteria.2 • If symptoms are severe and last for more than a few days, a doctor can prescribe antibiotics or antimotility agents that reduce the urge to defecate, depending on the combination of symptoms.2 • Seek immediate medical attention in the case of severe abdominal pain, bloody stool, and/or significantly high fever.

Purification

Protozoa and bacteria only

Protozoa, bacteria, and viruses

Mechanisms of action

Mechanically separate out particles and single-celled organisms from water molecules

Use chemicals, heat, or light energy to inactivate or kill even the smallest pathogens

Devices and techniques

-Membrane filters (exclude particles by size) -Depth filters (trap particles in porous material)

Drawbacks

Will not destroy viruses

• Boiling (kill with heat) • Mix-in iodine or chlorine drops (kill chemically) • Ultraviolet light (stop DNA reproduction)10 • Adsorption (trap smaller particles than depth filtration)10 Will not eliminate physical debris

the bottom line

References 1.

“Traveler’s Diarrhea - Topic Overview.” webmd.com. (2013).

2.

“Disease Listing, Travelers’ Diarrhea.” cdc.gov. (2006).

3.

“Travelers’ Diarrhea - Chapter 2 - 2014 Yellow Book.” cdc.gov. (2014).

4.

“Diseases and conditions: Traveler’s diarrhea.” mayoclinic.org. (2013).

5.

“Pathophysiology of Diarrhea.” vivo.colostate.edu. (2006).

6.

“Types of Microbes.” microbeworld.org. (2014).

7.

“OA Guide to Water Purification.” princeton.edu. (1999).

8.

“Cooking meat safely.” safefood.eu. (2006).

9.

“Clear liquid diet.” mayoclinic.org. (2014).

10.

“Low Cost Water Quality Interventions for the Prevention of Diarrheal Disease.” d-scholarship.pitt.edu. (2008).

total wellness ▪ fall 2015

left: llmicrofono oggiono/flickr; right: webiliz/flickr, fabian franke/flickr, fep cdt/flickr, julian kücklich/flickr

Filtration Organisms targeted

Getting traveler’s diarrhea while on vacation is not the end of the world, but it certainly is not a pleasant experience. There are many preventive measures that international voyagers can take to limit exposure to the diverse illness-causing microbes present in food and water. Enjoy your trip, but remember to exercise caution when it comes to matters of sanitation and consumption... because vacations are much better spent out and about than in the bathroom.

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feature

too much sweetness in your life?

total wellness â–Ş fall 2015

by jasmine sidhu | design by jackie nguyen & molly sanders

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Everyone craves a sweet treat once in a while, but how do you know when your love for sugar has gone too far? The numbers say it all: since 1975, sugar consumption has risen from a yearly average of about 121 pounds of sugar per person to 155 pounds of sugar per person.1 This increase, in combination with poorer diets and lack of exercise, has contributed to the escalating health problems of America.

❯❯

One health problem that’s gotten a lot of media attention is diabetes. According to the Center for Disease Control (CDC), the estimated number of diagnosed diabetics is 20.9 million and the number of undiagnosed diabetics is 8.1 million.2 This number, however, does not include the people who are on the verge of developing diabetes or, in other words, people who are prediabetic. The number of prediabetics is much more alarming, at 86 million people. In other words, one-third of the U.S. population has prediabetes3. This is a condition that has been rising across all ethnicities and ages and, unfortunately, 15 to 30% of prediabetics will develop type 2 diabetes within 5 years.4 The worst part? 9 out of 10 people don’t even know they have prediabetes.4 Find out how you can know if you’re at risk.

what is diabetes?

Diabetes is a metabolic disorder in which the pancreas produces little or no insulin. Insulin is responsible for allowing glucose, a sugar that is the body’s main source of energy, to enter cells. There are two types of diabetes: Type 1 Diabetes: this type of diabetes is an autoimmune disease in which the immune system attacks cells that make insulin.

Type 2 Diabetes: this type of diabetes is not as sudden as type 1 diabetes and usually occurs gradually.

Type 2 diabetes has numerous associated risk factors. This is the type that we are concerned with when discussing prediabetes. While type 1 diabetes cannot be controlled without insulin injections, type 2 diabetes can be treated with medications and better lifestyle choices. Additionally, type 1 diabetes typically occurs during childhood.5

While most people know about diabetes, fewer people are aware of prediabetes. Individuals with prediabetes have a blood sugar level higher than what is considered normal but not high enough to be diagnosed as type 2 diabetes.6 Prediabetes is also known as impaired glucose tolerance.

The beta cells found in the pancreas produce an essential hormone called insulin that maintains normal blood glucose levels. Insulin resistance occurs when the body does not respond as effectively to the insulin produced, resulting in insulin insensitivity.7

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left: sebastian mary/flickr; right:cupcakes cubed/flickr

what is prediabetes?

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signs and symptoms: listen up college students!

79 million individuals 20 or older have prediabetes, making this a relevant problem for college-aged students.8 In fact, a 2011 study in the journal Diabetes Spectrum showed that about 70% of college students gain weight during their first few years and about 23.3% do not exercise at all.8 Even college students with normal BMIs are at risk because insulin resistance can result from poor nutritional choices and a diet of saturated fats, excess sugar, and processed/junk food as well. Since elevated body mass index (BMI, which measures a person’s weight with respect to their height), a bad diet, and physical inactivity are risk factors for prediabetes, it is important that college students look into preventative measures and educate themselves about diabetes in general.

Interestingly, prediabetes usually does not exhibit any symptoms and can only be detected with a blood glucose test. That’s the reason why many people may have prediabetes and not even know it.

risk factors

symptoms of diabetes Even though prediabetes displays no symptoms, here are the tell-tale signs of diabetes: ❯ ❯

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❯ ❯ ❯ ❯ ❯

hypertension or history of cardiovascular disease previous elevated blood glucose level or HbA1C (a measurement of average blood glucose levels over the course of a few months) increased thirst frequent urination blurred vision fatigue9 weight gain, especially in the stomach region

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In addition to potential symptoms, there are also many risk factors that affect an individual’s likelihood of becoming prediabetic: ❯

If you have a family member who is a type 2 diabetic, you are genetically more prone to becoming a prediabetic or a future type 2 diabetic yourself. Even those who are not overweight or obese can be genetically susceptible to high blood sugar levels.

❯

Associated metabolic diseases like hypertension and high cholesterol put you at increased risk for diabetes.

Obesity is a major risk factor in developing prediabetes and type 2 diabetes.

❯

African Americans, Hispanics, American Indians, Asian Americans, and Pacific Islanders are at greater risk of developing prediabetes.9

diagnosing prediabetes

1

Hemoglobin Average Blood Test (A1C Test) Your blood is taken and your sugar levels from the past 3 to 4 months are assessed. A normal level would be 5.6% or less, prediabetes would be from 5.7% to 6.4%, and diabetes would be 6.5% or above.

2

Fasting Plasma Glucose Test You won’t eat for 8 hours prior to taking the test. Your blood sugar is normal if you get a value of less than 100. You have prediabetes if your sugar is 100 to 125, and you’re diabetic if your blood sugar value is 126 or higher.

3

Oral Glucose Tolerance Test First, you will take the fasting glucose test and then you will drink a sugary solution. Two hours later, you will take another blood test. Your blood sugar is considered normal if the value is less than 140 after the second test. You are considered prediabetic if the value is 140 to 199 after the second test, and you are considered diabetic if your blood sugar is 200 or higher.6

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left: jean-marie guyon/istockphoto; right: bodytel/flickr

Many doctors encourage young individuals to get annual blood tests done to ensure that they are in good health. While many individuals may consume a healthy diet, their ethnic and genetic backgrounds may put them at an increased risk of developing prediabetes. The following are three diagnostic options:

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the outcome of prediabetes—why should you care?

Diagnosing prediabetes early on is important because if left unnoticed, because prediabetes can lead to an increased likelihood of developing type 2 diabetes.

Development of type 2 diabetes can further lead to blindness, kidney failure, heart disease, stroke, and feet problems which may lead to the amputation of toes, legs, and feet,4 A 2012 review published in the Journal of the American College of Cardiology similarly confirmed that prediabetics are also at an increased risk of developing microvascular disease which includes eye and kidney diseases and macrovascular disease which includes heart disease and dysfunctional peripheral nerves.10 In addition, diabetes can lead to pregnancy complications for women and impotence in men.

preventative measures It’s always better to stay on the safe side and there are three key methods that can help you avoid or control prediabetes: weight control: If your BMI is higher than normal, losing 5 to 10% of your body fat can help prevent the onset of prediabetes. It can also help those who are prediabetic to avoid becoming full-fledged

eating healthy: A diet that is low in sugar, calories, and carbohydrates, but rich in fiber, is desirable. When shopping for food, be careful because 80% of foods sold in grocery stores have added sugar (including items like lowfat yogurt, fruit juices, and granola bars). It is also best to avoid “white” foods including white bread, white rice, etc.

Suggestion: Lentils and beans are a great option for a healthy and balanced meal! For liquids, try to opt for water!

being more active: It is recommended that prediabetics or those at risk of prediabetes exercise for 30 minutes every day. Alternating between aerobic exercise and weights is most preferable and sedentary habits should be reduced or avoided.

Aerobic exercises, which usually involve sustained activity, are particularly preferable and improve the body’s utilization of oxygen and support the heart and lungs.

Suggestion: Try going hiking, skiing, or swimming for a fun way to stay active!6

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bottom line While type 2 diabetes is traditionally seen as a disease that is developed later on in life, many young adults face the risk of developing prediabetes. Obesity, poor nutritional choices, ethnicity, and genetics all influence an individual’s likelihood of developing prediabetes. It is important to recognize that each individual has a different level of susceptibility to the disease.

While it’s always helpful to live a healthier lifestyle, finding a way to tackle prediabetes and diabetes can best be discussed with your doctor.

Taking precaution early on in life will pave a healthy road to the future! t w

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References 1.

“Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease.” Am J Clin Nutr. (2007).

2.

“Number (in Millions) of Civilian, Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2011.” cdc.gov. (2013).

3.

“Identifying prediabetes—Is it beneficial in the long run?” Maturitas. (2015).

4.

“Prediabetes.” cdc.gov. (2014).

5.

“Diabetes Guide.” webmd.com. (2015).

6.

“What is Prediabetes?” webmd.com. (2014).

7.

“Insulin and Insulin Resistance.” Clin Biochem Rev. (2005).

8.

“Toward Reducing the Diabetes Pandemic: College Students’ Perspectives of Type 2 Diabetes.” Diabetes Spectrum. (2011).

9.

“Prediabetes Symptoms.” mayoclinic.org. (2015).

10.

“Pre-Diabetes, Metabolic Syndrome, and Cardiovascular Risk.” J Am Coll Cardiol. (2012).

feature

swimming in saltwater solution:

chlorine chemistry by christopher phan | design by nezia rahman

Have you ever gone swimming and wondered what’s in the water? Depending on the environment – be it an indoor swimming pool, outdoor swimming pool, or even a lake or ocean – it could be a number of different things. Nonetheless, it is probably composed of a mixture of solutes dissolved in water in addition to a host of byproducts and microorganisms. In this article, we will take a deeper look into the differences between the two main methods of pool sanitation: chlorination and saltwater systems. Keep on reading to discover the chemistry of swimming pool water before you take a dip and have a healthy and swimmingly time.

why are there chemicals in my water?

total wellness ▪ fall 2015

left: aluxum/istockphoto; right: dennis skley/flickr

Virtually any type of water you encounter on a daily basis is not completely pure. Tap water from a sink, for instance, is treated with chlorine dioxides to disinfect the water1.

Even crystal clear bottled water contains minerals for enhanced taste2. More than just for aesthetic purposes, chemicals in pool water function to help sanitize from algae and bacteria as well as balance pH, a measure of how acidic or basic a solution is.

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From steeping an aromatic hot cup of coffee to diluting sugary apple juice to your desired sweetness level, solutions chemistry is a part of everyday life. Before we dive in too deep, let’s take a moment to define some terms:

crash course in solutions chemistry solutions chemistry Solution:

Solute:

Solvent:

A liquid mixture composed of a solute uniformly distributed in a solvent For instance, lemonade is a solution of lemon juice, sugar, and water.

A solid substance such table salt (NaCl) which dissolves in a solvent.

Saline water, for example, is made from adding table salt to water.

A liquid substance added to dissolve other substances Substances are said to be miscible if they mix to form a homogenous solution. For example, water and ethanol are polar substances and mix well whereas water and oil are immiscible and separate into distinct layers since oil is a nonpolar substance.

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Solubility: The degree to which one substance dissolves in another expressed as grams of solute per volume of solvent at a specific temperature.

The Solubility Product Constant (Ksp) is an equilibrium constant quantitatively describing how soluble a substance is.

Ksp varies with temperature; the higher the temperature, the more soluble a substance is. That’s why hot cocoa powder mixes better in hot water than cold water.

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acid-base equilibrium pH Scale: A logarithmic scale ranging from 0 to 14, measuring the acidity of a solution. The lower the pH value, the more acidic and the higher, the more basic.

Distilled water (pH≈7), for instance, is considered neutral whereas lemon juice (pH≈2) is acidic and bleach (pH≈12) is basic.

In a swimming pool, an optimal pH level is between 7.2 and 7.8.7 A chemical substance that donates protons (H+) Vinegar or acetic acid (C2H4O2) is a strong acid that contains antioxidants which can help protect against free radical damage.

Base: A chemical substance that accepts protons (H+) Bleach or sodium hypochlorite (NaClO) is a strong base that acts as a reducing agent which can remove stains in clothing.

Neutralization: When an acid and base react to form salt and water HCl(aq) + NaOH(aq) -> NaCl(aq) + H2O(l) acid + base -> salt + water Acid:

how it works Chlorination is a common disinfection method that is often used in swimming pools due to its low cost, convenience of application, and sanitary effectiveness.3 However, when humans swim, sweat and urine are produced, which react with the chlorine to produce disinfection by-products (DBPs). DBPs are toxic chemicals that arise from chemical reactions between natural organic matter and the disinfectant. While these chemicals are in the water, some DBPs are volatile, meaning they can evaporate into the air. Indoor swimming pool facilities with poor ventilation can aggravate the problem if the air is not properly filtered. Despite its setbacks though, chlorination is an effective way to reduce contaminants in swimming pool water.

left: louish pixel/flickr; right: viktor hanacek

Whether introduced as a solid, liquid, or gas, chlorine, when added to water, reacts to form hypochlorous acid (HOCl) and hypochlorite ions (OCl-) in the simplified reaction: Cl2(g) + H2O(l) -> HOCl(aq) + HCl(aq) Hypochlorous acid (HOCl) is the active chemical that functions as a sanitizer and oxidizer whereas the byproduct hypochlorite (OCl-) remains inactive.4 Sanitation is the process of destroying harmful microorganisms while oxidation helps remove dissolved impurities in the water, much like how the active carbon in Brita water filters works.

short-term health effects hair Chlorinated water can cause hair to dry out. Some people with fair-colored hair even report their hair turning green. Contrary to popular belief, chlorine does not cause blonde hair to turn green. The culprit is rather dissolved copper, which is added to pools to help control algae, that is absorbed by the hair.5 skin Water treated with chlorine can also be harsh on the skin. In addition to drying out skin, chlorinated water can irritate skin and cause redness as chlorine is harsher than saltwater.6 eyes Although chlorinated water may irritate your eyes, the concentration of chlorine is diluted (~1.0 to 3.0 parts per million) and is generally not intrinsically harmful.7 Wearing goggles can help limit the stinging effects of treated water.

long-term maintenance costs While cost-efficient, treating pool water with chlorine is generally more expensive than purchasing saltwater.8 Chlorine tablets are often used to cleanse pool water by adding them to a pump unit that dilutes the tablets in the water over time. This method requires more maintenance as owners must test the pH with a kit regularly, as frequently as twice a week, and adjust the pH to between 7.2 to 7.8.7

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total wellness â–Ş fall 2015

chlorine swimming pools

saltwater swimming pools how it works Saltwater swimming pool systems actually use the same chlorine-cleansing principle, but implement it in a more effective way, using salt in a process called saltwater chlorination. This method differs from regular chlorination in that salt is added to the water until its salinity reaches around 5,000 to 9,000 parts per million (ppm) before anti-corrosive plates in a chlorination cell electrolyze the salt water. Upon electrolysis the salt solution is chemically transformed into chlorine gas, which incorporates into the water just like regular liquid chlorine.9 The electrolysis of aqueous salt yields chlorine gas (Cl2(g)) and sodium hydroxide (NaOH) in the simplified reaction: 2NaCl(aq) + 2H2O(l) -> Cl2(g) + 2NaOH(aq) + H2(g) Cl2(g) + H2O(l) -> HOCl(aq) + HCl(aq) Chemically speaking, once chlorine gas is produced from the salt water electrolysis, the reaction proceeds nearly identically to the regular chlorination method. The added benefit of this two-part reaction is that it requires less maintenance and is more environmentally safe to use since you are not directly handling large volumes of chlorine and potentially introducing it to nearby plants.

which reaction is favored?

Chlorination and saltwater systems are equally viable options for sanitizing the swimming pool, but which is right for you? If you plan on swimming for years to come, saltwater is generally a better option for most people since in addition to a lower price tag, there is less maintenance required and there are more health benefits.

Regardless of what pool you swim in, take a shower before jumping in the pool to reduce the number of DBPs.10 This is especially important in indoor swimming conditions since the contaminant trichloramine (NCl3) can pollute the air and cause respiratory irritations.11 Wear a swimming cap to keep hair from drying out, shower after swimming with a gentle cleanser, and moisturize after showering to prevent dry skin. Also test often for pH values and calcium hardness levels, a measure of how much dissolved calcium is present in solution, to keep within health standard regulations.

the bottom line short-term health effects

Whether swimming in a chlorinated or saltwater pool, being aware of how these chemicals affect the water you are swimming in can help you decide which option is right for you. In either case, rest assured that as long as they are properly monitored, chemicals in your swimming pool water do more help than harm and will keep you swimming safer.

hair Similar to chlorine, salt can dry up moisture, leaving hair brittle and prone to split ends. To counteract this problem, try adding leave-in moisturizer to keep your hair healthy. skin The softening effect of salt electrolysis reduces the dissolved alkali minerals in water, leaving a soft, gentle feel. eyes Since the saline concentration and chlorine levels are relatively low, there is less sting in salt water than in water treated with chlorine.

References

long-term maintenance costs

“Water on tap: what you need to know.” water.epa.gov. (2009).

“Bottled Water Quality Report.” fijiwater.com. (2011).

“Seasonal dynamics of water and air chemistry in an indoor chlorinated swimming pool.”

Water Res. (2015).

4.

“Swimming Pool and Spa Water Chemistry.” health.mo.gov. (2015).

5.

“A Teenage Girl with Green Hair.” Pediatr Dermatol. (2014).

6.

“Quantification of continual anthropogenic pollutants released in swimming pools.” Water Res. (2014).

7.

“Your Disinfection Team: Chlorine & pH.” cdc.gov. (2013).

8.

“Chlorination and pH control system” Patent ID: US4767511 A. (1988).

9.

“Field Testing of Photovoltaic Electro-chlorination Application in Salt Water Swimming Pools.” solar.org.au. (2002).

10.

“Swimming facilities and work-related asthma.” J Asthma. (2014) 11.

“Investigation of Air Quality Problems in an Indoor Swimming Pool: A Case Study.” Ann Occup Hyg. (2015).

1.

2.

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3.

While having a steeper initial set-up price, saltwater swimming pools are generally less expensive to maintain than traditional chlorine swimming pools and are economically better investments over time.

Since saltwater chlorination systems need to be monitored less frequently, they are easier to maintain than the traditional chlorination method.

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move well

off on the wrong foot: foot health by sofia levy | design by jackie nguyen

left: airman magazine/flickr

needs to be seen by a doctor. Is that hard area on your foot a callus or a bunion? Is your foot itchy because it’s dry or because there’s a fungal infection? Read on to find out what might be causing that pain or itching in your foot and what to do about it!

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Foot conditions such as bunions and athlete’s foot are very common. However, it can be confusing whether or not a foot

skin issues

athlete’s foot Athlete’s foot (tinea pedis) is the most common fungal skin infection. The fungus that causes most athlete’s foot conditions is Trichophyton mentagrophytes,which grows in or on the top layer of the skin of the foot and is prone to growing in wet, warm areas (i.e. athletic equipment, areas where people are barefoot, public pools and showers, between the toes).1

causes

Athlete’s foot is contagious and can spread easily, via direct contact or by contact with skin particles left on towels, shoes, and floors. The fungus grows in tight shoes with little air circulation. Once you have athlete’s foot, you are more likely to get it again.2 Although the reasons for this are unknown, males, older adults, residents in a warm, damp climate, and ones with weak immune systems are at higher risk of getting athlete’s foot.1,3

signs and symptoms There are 3 types of athlete’s foot , each of which has its own progression of symptoms: Toe web infection: scaly, peeled, and cracked skin between the toes, often occurs between the fourth and fifth toes.

Moccasin type infection: begins with skin soreness, then the skin on the heel or bottom of the foot becomes thickened and cracked. The toenails can also become thickened and fall out.

Vesicular type infection: begins with fluid-filled blisters usually on the bottom of the foot that can lead to bacterial infection.2

prevention

Keep feet dry and clean, let shoes air dry for 24 hours before wearing them again, and wear socks that absorb sweat.

Use talcum or antifungal powder, use prescribed antifungal cream for the entire prescribed time, wear shower sandals in warm, wet places, and use hot water and bleach to kill fungi in clothes.4

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treatment

Nonprescription and prescription antifungal medications are used to treat athlete’s foot.5 Natural remedies have not been proven to treat athlete’s foot, but include tea tree oil, an antifungal and antibacterial agent, and garlic, which contains an antifungal compound called ajoene. Burow’s solution is a liquid solution made of water and aluminum acetate.6 and may be beneficial for blister-like infections; it dries out the blister before treatment with antifungal medication7 Call a doctor for severe skin cracking, peeling, or scaling, blistering, or signs of bacterial infection (fever, red streaks on skin, pus discharge, or increased redness, swelling, pain, or heat). Call if the infection spreads or if symptoms persist after 2 weeks of prescribed treatment and 4 weeks of non-prescribed antifungal medication.8

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ingrown toenails The toenail grows into the flesh instead of over it. This condition often occurs in the big toe and is more common with curved and/or thicker toenails.

causes Ingrown toenails can be caused by hosiery or ill-fitting shoes that push the nail into the toe, by toenails that are not caused straight across, or by injury.

signs and symptoms Symptoms include pain, swelling, and even infection.11

prevention

Toenails must be cut straight across, not too short or rounded.

Avoid wearing hosiery, wear footwear that is not too tight, or wear open toe shoes for a few days.

Injuries such as surgery, jamming one’s toe, or stubbing one’s toe can cause an ingrown toenail.11

treatment

A doctor can partially remove an ingrown toenail or permanently remove part of the nail at the root; a chemical is used to prevent the nail from growing back and into the skin again. In the case of infection, an antibiotic may also be prescribed.12

calluses and corns Calluses and corns refer to abnormally thickened areas of skin.

Calluses are hard, and often form on the hands and feet. Corns have an inner core that can be hard or soft. Soft corns are hard corns that are softened by sweat between the toes and hard corns are found on top of the toes.9

causes

plantar (foot) warts

Pressure or friction on the foot, often from shoes or walking barefoot, causes a hard, protective layer to form. Sports, an odd way of walking, or abnormal foot structure can also cause calluses and corns. Calluses and corns not contagious and do not occur from viruses or fungi. Corns are a product of ill-fitting shoes and can go away with correctly-fitting shoes.9

Plantar warts develop in a cluster on the soles of the feet.

While walking or standing, the warts are pressed into the feet, which can cause them to grow underneath a callus and cause pain. Calluses also form to prevent the spread of these warts, which can cause pain.13

signs and symptoms

causes

A callus may be less sensitive to touch than surrounding skin and appear grey or yellow. A hard corn is firm, thick, and may have a yellow ring with a grey center. A soft corn looks like an open sore. Calluses and corns are not painful, but shoes or pressure on calluses and corns may cause pain.9

Plantar warts can be caused by human papilloma virus (HPV) strains 1, 2, and 4 (other strains of HPV cause other types of warts), which can be difficult to treat, according to a 2011 study published in the Indian Journal of Dermatology.15 These viruses are contagious, spreading easily in warm, moist environments.

Most people build an immunity to plantar warts over time, but individuals with weak immune systems and prior exposure to plantar warts are still susceptible.13-14

prevention In shoes, a wider toe box (part that surrounds the toes) prevents toes from squeezing against each other. Deep toe boxes prevent toes from pressing against the top of the shoe.

There is also protective padding for feet such as toe pads, caps, and sleeves.

signs and symptoms The warts look like black pinpoints, which are clotted blood vessels. They are also rough, hard, grainy, and often painful.16

treatment treatment Plantar warts are harmless and can go away without treatment.

However, they are usually too painful not to treat. See a doctor if plantar warts change in color, will not go away with treatment, and are increasingly painful and uncomfortable.

Those with weak immune systems, diabetes, or decreased sensation in their feet must be supervised by a doctor.16 Prescription-strength salicylic acid gradually peels the layer of the skin with the warts and cryotherapy freezes warts with liquid nitrogen. Other treatments include vaccination, minor surgery, immune therapy, and laser treatment.17

total wellness â–Ş fall 2015

Calluses and corns do not need treatment unless they are painful, for which you can wear shoes that have more room.

You can soak your feet in water or use salicylic acid only on the callus or corn, to soften it and file it off with a pumice stone.

Salicylic acid makes the skin shed, but it can cause irritation and must be used as instructed.10 A doctor can trim a callus or corn.9

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structure and pain issues

bunion Otherwise known as hallux valgus, bunion is an enlargement of bone and tissue in the joint at the base of the big toe. This enlargement is caused by excessive pressure. A bunion on the little toe is called a bunionette or a tailor’s bunion. causes Genetic factors, flat feet, feet that roll inward, feet that are naturally shaped to press on the big toe, and tight shoes can all cause bunions. Over time, these factors cause the toe to be misaligned. Additionally, bunions can be caused by injury to the foot, arthritis, hammertoe (see below), removal of the second toe, abnormal development of the foot, or loose ligaments in the foot. signs and symptoms The affected toe points inward toward the other toes and there can be pain, swelling, and red or irritated skin over the bunion.

These symptoms can be confused with symptoms of gout.18-19 treatment

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Painless bunions do not require treatment. Non-surgical treatment includes wearing pads, moleskin, or arch supports.

Roomy, comfortable shoes also help treat and prevent bunions.

Medication and ice can help alleviate pain and reduce swelling.

If non-surgical treatment is unsuccessful, bunion surgery can realign the toe joint to relieve pain.20 However, bunions can cause ingrown nails, hammer toe, osteoarthritis, and corns and calluses.21

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plantar fasciitis A common cause of heel pain, plantar fasciitis involves the plantar fascia, a thick band of tissue that runs along the bottom of the foot, supporting the arch of the foot and connecting the heel bone to the toes.22,23 causes Too much tension on the plantar fascia can cause stretching or tears. This leads to swelling, inflammation, and irritation.23 Activities such as running can lead to early onset of plantar fasciitis. Other risk factors include age (ages 40 to 60), obesity, not wearing supportive shoes, being on one’s feet a lot, and flat and highly arched feet.2,4 signs and symptoms One indicator of plantar fasciitis is stabbing pain in the bottom of the foot near the heel. The pain tends to be worse during the first steps after waking up, but it also happens after standing for a long period of time and/or getting up from a sitting position. The pain then decreases as the plantar fascia becomes more flexible.22 treatment Treatment includes medication, therapy, and surgical procedures. Medication and therapy usually resolve plantar fasciitis in a few months. Pain relief medications treat pain and reduce inflammation. Therapies include physical therapy, night splints (which stretch the calf and arch of the foot during sleep, keeping it limber), and orthotics. Other treatments include steroid shots (which temporarily relieve pain) and extracorporeal shock wave therapy (in which sound waves are used for heel pain and to facilitate healing). Surgical treatment involves detaching the plantar fascia from the heel.

It is important to treat plantar fasciitis, as the pain can become chronic and impede activities.25 One may alter one’s walking to relieve the pain from plantar fascitis, but this can lead to new foot, knee, back, or hip problems.26

tips for buying shoes

hammertoe and mallet toe

❯

Buy shoes later in the day, as feet are small in the morning and swell throughout the day

❯

Know your shoe size, especially the width, as your shoe size can change

❯

You can get your shoes worn in and stretched at a shoe repair store33

abnormally bent joints in one or more of the toes. A hammertoe involves the middle joint of the toe, whereas mallet toes affects the joint that is closest to the nail.27 cause shoes that are too tight, or shoes with small toe boxes, as these shoes push the toes towards the front of the shoe, causing them to bend.27 Risk factors include injury to the toes such as stubbing them, breaking them, or jamming them, nerve damage in the feet, increased age, being female, and having a second toe that is longer than the big toe.28,29 signs and symptoms both hammertoe and mallet toe most commonly affect the toe that is second to the big toe.27 Toes tend to curl when in shoes and lie flat when one is barefoot. However, the tendons in the toes tighten and contract, causing them to be permanently stiff 30 and remain curled even when one is barefoot.28 Moving the toes can be painful and calluses and corns can occur from the toes rubbing against shoes.31

bottom line Since feet are complex structures that are commonly kept in warm, compact shoes, conditions such as athlete’s foot, ingrown toenails, and more are likely to arise. Thus, it is helpful to prevent and treat these conditions by wearing well-fitting supportive shoes, keeping the feet clean and dry, and getting help from a doctor as needed.

treatment References 1.

“Athlete’s Foot - Cause.” webmd.com. (2014).

2.

“Athlete’s Foot - Topic Overview.” webmd.com. (2014).

3.

“Athlete’s Foot - What Increases Your Risk.” webmd.com. (2014).

4.

“Athlete’s Foot - Prevention.” webmd.com. (2014).

5.

“Athlete’s Foot - Treatment.” webmd.com. (2014).

6.

“Burow’s Solution.” webmd.com. (2014).

7.

Athlete’s Foot - Other Treatment.” webmd.com. (2014).

8.

“Athlete’s Foot - When to Call a Doctor.” webmd.com. (2014).“ 9.

“Calluses and Corns - Topic Overview.” webmd.com. (2014).

10.

“Salicylic Acid Topical.” webmd.com. (2014).

11.

“Understanding Ingrown Nails--the Basics.” webmd.com. (2014).

12.

“Understanding Ingrown Nails -- Treatment.” webmd.com. (2014).

13.

“Plantar warts: definition.” mayoclinic.org. (2014).

14.

“Understanding Plantar Warts -- The Basics.” webmd.com. (2014).

15.

“Plantar Warts Treated with Topical Adapalene.” Indian J Dermatol. (2011).

16.

“Plantar Warts: symptoms.” mayoclinic.org. (2014).

17.

“Plantar Warts: treatment and drugs.” mayoclinic.org. (2014).

18.

“Bunions - Topic Overview.” webmd.com. (2013).

19.

“Bunions - Cause.” webmd.com. (2013).

20.

“Bunions - Treatment Overview.” webmd.com. (2013).

21.

“Bunions - What Happens.” webmd.com. (2013).

22.

“Plantar Fasciitis: Definition.” mayoclinic.org. (2014).

23.

“Plantar Fasciitis: Causes.” mayoclinic.org. (2014).

24.

“Plantar Fasciitis: Risk Factors.” mayoclinic.org. (2014).

25.

“Plantar Fasciitis: Treatment and Drugs.” mayoclinic.org. (2014).

26.

“Plantar Fasciitis: Complications.” mayoclinic.org. (2014).

27.

“Hammertoe and Mallet Toe - Definition.” mayoclinic.org. (2013).

28.

“Hammertoe and Mallet Toe - Causes.” mayoclinic.org. (2013).

29.

“Hammertoe and Mallet Toe - Risk Factors.” mayoclinic.org. (2013).

30.

“Hammertoe and Mallet Toe - Complications.” mayoclinic.org. (2013).

31.

“Hammertoe and Mallet Toe - Symptoms.” mayoclinic.org. (2013).

32.

“Hammertoe and Mallet Toe - Treatments and drugs.” mayoclinic.org. (2013).

33.

“Hammertoe and Mallet Toe - Prevention.” mayoclinic.org. (2013).

34.

“Hammertoe and Mallet Toe - Lifestyle and Home Remedies.” mayoclinic.org. (2013).

35.

“Hammertoe and Mallet Toe - Tests and Diagnosis.” mayoclinic.org. (2013).

total wellness ▪ fall 2015

Pain and pressure from hammertoe and mallet toe can be relieved by wearing different shoes27 or wearing shoe inserts, orthotics, or pads, which can reposition the toe and relieve pressure and pain.32 Adjustable (lace-up) shoes with a low heel, deep toe box (avoid shoes with a pointed toe), or flexible material covering the toes are best; there should be half an inch of space between the big toe and the inner tip of the shoe.33,34 See a doctor when hammertoe or mallet toe cause enough pain to make it difficult to walk.31 Doctors can diagnose the conditions by examining the foot or via x-rays of the foot.35 A doctor may suggest doing foot exercises to strengthen and stretch the toes. If this is ineffective, surgery can remove bone or the contracted tendon and straighten the toe.32

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total wellness â–Ş fall 2015

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Angela Chen, MD, MPH, FACOG, Fellowship Director, Division of Family Planning, Associate Clinical Professor, Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine

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:

Agatha Berger, MD, Fellow, Division of Family Planning, Clinical Instructor, Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine

quench the skin you’re in

Jenny Hu, MD, MPH, Assistant Clinical Professor, Division of Dermatology, UCLA David Geffen School of Medicine

healthy snacking: the truth about fruit

Eve Lahijani, MS, RD, Nutrition Health Educator, UCLA Bruin Resource Center

motion sickness

Yoon-Hee Cha, MD, Associate Adjunct Professor, Department of Neurology, UCLA David Geffen School of Medicine

when you gotta go: traveler’s diarrhea

Claire Panosian Dunavan, MD, FIDSA, Past-President, American Society of Tropical Medicine and Hygiene, Professor Emeritus of Medicine and

Infectious Diseases, UCLA David Geffen School of Medicine

too much sweetness in your life?

Susan Davis, MD, Assistant Clinical Professor of Medicine, Division of Endocrinology, Diabetes, and Hypertension, UCLA David Geffen School of Medicine

chlorine chemistry

Jenny Hu, MD, MPH, Assistant Clinical Professor, Division of Dermatology, UCLA David Geffen School of Medicine

off on the wrong foot: foot health

Babak Baravarian, DPM, Chief of Podiatric Surgery, UCLA Medical Center, Santa Monica, Assistant Clinical Professor, UCLA David Geffen School of Medicine

copy-edits and review

Payam Mirfendereski, Omid Mirfendereski, Christopher Phan, Nancy Vu

layout revisions

Alison Jeng, Jackie Nguyen

cover & table of contents

Designed by Alison Jeng, Jackie Nguyen

43

total wellness ▪ fall 2015

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