Let's Talk about It by Total Wellness Magazine

total wellness

a ucla student wellness commission publication

let's talk about it

answering your questions about taboo topics

teeth whitening brighten your smile

hair removal total wellness â&#x2013;Ş summer 2015

ouch! facts about hair removal

e-cigarettes

understanding e-cigarettes

marijuana

things you wish you knew

a message from the director For most of us, there’s at least one thing that we just don’t feel comfortable talking about. For some of my friends, it’s poop; for others, the dirty details of their last sexual escapade. Or - for those that are proudly in touch with their bodily functions in their entirety - it may be a more emotionally sensitive topic, such as depression or drug addiction. Here at Total Wellness, we know that there are so many things that affect our overall health, even if they aren’t spoken about much. In the making of this issue, our writers had a little fun exploring topics that we know you’ll find very applicable to your life. Join us in discussing some of these uncomfortable topics that we’ve all experienced, but maybe don’t want to talk about. While the majority of this issue is light-hearted, there are many other hushhush subjects that are simply no laughing matter but are essential to our health nonetheless. Many other committees right here within SWC are tackling some of these taboo, but ever-important, subjects. Bruin Consent Coalition (also known as 7000 in Solidarity) works to support sexual assault survivors, educate the UCLA community about consent, and improve campus resources that deal with sexual violence. BCC just completed a number of amazing events for Sexual Assault Awareness month in April, and are making immense progress in spreading awareness about this incredibly important issue that is present on our campus and beyond. Visit 7000insolidarity.org for more info. All of Us, spearheaded by several SWC members, SWC’s Active Minds committee, and other USAC offices, is a campaign to rethink mental health. As the All of Us campaign perfectly communicates, “we don’t all deal with a mental illness, but we all have mental health.” Mental health, one of the most stigmatized and overlooked aspects of our wellbeing, is fundamental to all of us, and everyone should feel comfortable to get the support that they need. All of Us just launched their photo campaign, in which everyone is encouraged to share a bit about their own mental health journey. Visit the All of Us Facebook page to learn more and participate if you are inclined! These are just a couple of examples of the ways that the Student Wellness Commission is working to support your health, and remind us that no topic should be taboo if it affects our health! Please enjoy this issue, and never feel ashamed to be curious, ask questions, and seek support in your personal health journey. Cheers!

total wellness ▪ summer 2015

Anne-Marie Theriault 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.

editors’ notes Let’s face it: we’ve all got that one health issue that only our parents or roommates know about. While we may shy away from talking about these conditions with our friends or even doctors, leaving them untreated can make us miserable. On top of that, sometimes it feels like we’re the only ones with these problems or questions. That’s why we’ve taken it upon ourselves in this issue to cover the topics you might not want popping up in your Google search history. Flip through the issue to find out how to finally get relief from constipation (more common than you think!), methods to remove the hair in all those places you didn’t know hair could even grow, and the reason you might be needing to pee every 5 seconds (you may have a UTI!). Hopefully these articles find you well, and remember, we’re all in the same boat! Wishing you all a healthy and happy summer,

Julia Feygelman Co-Editor-in-Chief

While diet and exercise are frequently mentioned in discussions about health, there are some subjects that for one reason or another, we tend to keep quiet about. For example, despite the prevalence of urinary tract infections (page 9), teeth whitening procedures (page 42), and constipation (page 11), these topics can still be embarrassing to share. Sometimes, the matter is personal or private, like our romantic relationships (page 56), and at other times, the issue is a hot topic, like marijuana use (page 46), juicing (page 17), or electronic cigarettes (page 20). Occasionally, we don’t discuss something because we aren’t even thinking about it! This includes our daily habits, like removing body hair (page 36), as well as things we may not even know exist, like the human microbiome (page 29). No matter how we get there, there are times when we come across aspects of our health and habits that might be a little too uncomfortable to talk about. As much as we might like to hide our surprisingly common secrets and quell our curiosity, Total Wellness aims to address and possibly bring them to the forefront of meaningful, productive conversations with your friends, family, and physicians. Hopefully you read this issue of our magazine with an open mind, so that you can critically evaluate aspects of your health beyond diet and exercise.

total wellness ▪ summer 2015

I commend our hardworking, talented writers, who somehow managed to write about things that I occasionally can’t even talk about. I also thank the designers and leadership, who have once again produced an incredible publication. All previous issues are available at totalwellnessmagazine.org, thanks to Sepideh Parhami, our wonderful Web Designer and the star of our “Meet Our Staff” note this issue. As always, we would love to hear from you, readers and fans! If you have any questions, comments, or ideas, please email us at totalwellnessatucla@gmail.com, or reach out to us on Facebook or Instagram. Wishing you happiness and good health,

Pavan Mann Co-Editor-In-Chief

leadership meet our staff: webmaster There are many things we’d prefer to keep hush-hush about in line with social norms or preventing personal embarrassment. Health issues like constipation and UTIs, commonplace drugs like marijuana and e-cigs, and grooming rituals like hair removal and teeth whitening all drastically change the body and potentially cause discomfort by introducing substances into the body (or, in the case of hair removal or constipation, getting them out). As a health magazine on a college campus, we feel an inclination and responsibility to shed light on these little-discussed but critical topics. While the magazine is our primary means of facilitating the conversation in the UCLA community and beyond, we aspire to continue discussion online. Our newly revamped website at totalwellnessmagazine.org features an archive of our magazine pieces in blog format, making it easier for our readership to interact with us and share individual articles on social media. We always appreciate hearing what you have to say about the topics we’re covering and whether there are other “taboo” health concerns our writers can spare you the awkward task of investigating yourself. Let’s face it, it’s going to be a while before it’s “cool” to talk about things like UTIs. But we may as well answer your burning questions in the meantime as Total Wellness starts to open the conversation.

NATALIE CHONG Art Director

REBECCA TANG Co-Copy Editor

TIFFANY LIN Co-Copy Editor

PETER CHU Managing Editor

cover: yuri/istockphoto

total wellness ▪ summer 2015

Sepideh Parhami Webmaster

total wellness Co-Editor-In-Chief

Co-Copy Editor

Julia Feygelman

Tiffany Lin

Director Annie Theriault

Co-Editor-In-Chief Pavan Mann

Co-Copy Editor Rebecca Tang

Art Director Natalie Chong

Managing Editor

Webmaster

Peter Chu

Sepideh Parhami

Writers Sydnie Bui Sarah Chang Peter Chu Julia Diana Feygelman Catherine Hu Grace Lee Sofia Levy Tiffany Lin Pavan Mann Halee Michel

Design

Omid Mirfendereski Payam Mirfendereski Monica Morucci Sepideh Parhami Christopher Phan Jasmine Sidhu Elsbeth Sites Rebecca Tang Nancy Vu Catherine Wang

Emily White Pauline Yang Danielle Zola

Shana Bird Natalie Chong Alison Jeng Jackie Nguyen Kimberly Rich Molly Sanders Danielle Swenson

Advisory & Review Lin Chang, MD

Eve Lahijani, MS, RD

Professor of Medicine, Director, Digestive Health and Nutrition Clinic, UCLA School of Medicine

Nutrition Health Educator, UCLA Office of Residential Life

Seong Choi, MD

Huiying Li, PhD

Infectious Disease Fellow, UCLA School of Medicine

Assistant Professor, Molecular and Medical Pharmacology

Carolyn Gob, MD

Edward McLaren, DDs, MDC

UCLA Dermatology

Clinical Professor, UCLA School of Dentistry

Dolores Hernandez, MA, RD

Michael Ong, MD, PhD

Nutrition Education Coordinator, UCLA Dining Services

Associate Professor, Department of Medicine, UCLA Comprehensive Cancer Center

Benjamin Karney, PhD

Linda Sarna, PhD, RN, FAAN, AOCN

Professor of Social Psychology, UCLA

Acting Dean, UCLA School of Nursing

Mark Kleinman, PhD, MPP

Miguel Unzueta, PhD

Professor of Public Policy, UCLA Luskin School of Public Affairs

Associate Professor, UCLA Anderson School of Management

total wellness â&#x2013;Ş summer 2015

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. 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 02 ÂŠ 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

Editors’ Notes

In the News

Q&A

63 Credits

ARTICLE COLUMNS Constipation Juicing

11 self-care 17 eat well

E-Cigarettes

20 breathe well

Group Work

24 mind well

Human Microbiomes Omega 3’s & Omega 6’s

29 body in focus 57 decoding the nutrition label

total wellness ▪ summer 2015

FEATURES

cover story 36

A Hairy Situation

Teeth Whitening

Marijuana

Romantic Relationships

meet the

committees of

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!

[Bruin Consent Coalition]

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.

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.

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!

total wellness ▪ summer 2015

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

in the news

by peter chu & sepideh parhami| design by natalie chong

AT UCLA

NEW DISCOVERIES

UCLA SCIENTISTS DEVELOP TECHNOLOGY TO REMOVE CANCER CELLS FROM THE BLOODSTREAM

UK INTRODUCES LAWS TO CREATE BABIES WITH DNA FROM THREE INDIVIDUALS

An interdisciplinary team of scientists from Taiwan, Japan, and China are being led by UCLA researchers to improve the efficiency and cost-effectiveness of extracting tumor cells from the bloodstream. Because cells from cancerous tumors have the ability to break away from one part of the body and create a new tumor in another part of the body, a process termed metastasis, removing these traveling cancer cells from the blood can decrease the likelihood of this process happening. UCLA Professor Hsian-Rong Heng, who heads a lab at UCLA’s California NanoSystems Institute, has invented a device called the NanoVelcro Chip that can recognize tumor cells circulating in the blood. By pairing this device with an improved version of a technique known as laser capture microdissection, scientists are now able to capture and purify circulating cancer cells from blood samples. Scientists are improving purity in extracting tumor cells by controlling the temperature of the blood to be 37°C upon capture and 4°C upon release.

total wellness ▪ summer 2015

MEDITATION MAY SLOW DEGRADATION OF GRAY MATTER IN AGING BRAIN

Starting in a person’s mid-to-late-20’s, the volume of cortical matter in the brain starts to decline in a process that continues throughout the rest of adulthood. This age-related decline is thought to increase risk for issues such as neurodegenerative disease or mental illness. A study conducted at the UCLA Brain Mapping Center and published in Frontiers in Psychology in January found that, compared to individuals who do not meditate, people who meditate on a regular, prolonged basis display a widespread retention of gray matter across many regions of the cortex. This was a pleasant surprise to researchers who expected only small, localized benefits. Gray matter volume was compared between adult human subjects categorized into two groups: a control group with little to no experience with meditation and an experimental group who had practiced meditation regularly for between 4 and 46 years, with an average of 20 years. Because this study merely measured the relationship between long-term meditation practices and cortical volume, one cannot implicate meditation as an immediate cause of gray matter preservation: it is possible that the results reflect effects of other lifestyle differences between the two groups of participants. Nonetheless, meditation therapy may eventually find its way to the clinic as a means of supporting brain health and a diverse range of functions into old age.

Imagine having two moms. In the field of progressive medicine in the United Kingdom, a majority of Parliament members support the notion of creating children using DNA from three individuals instead of the usual two. The technique modifies in vitro fertilization, a procedure that manually combines an egg cell and a sperm cell before placing the embryo in the uterus, such that diseases that would normally be passed from mother to child are avoided. For example, mitochondria, all come from the mother, replacing the mother’s defective mitochondrial DNA with a donor woman’s healthy mitochondrial DNA while keeping the rest of the mother’s DNA can produce a healthy child from the egg fertilized by the father.

SMARTPHONE APPLICATION SCREENS FOR STDs IN MINUTES

Columbia University biomedical engineers have developed a device to test for HIV and syphilis that analyzes and reads out results to a smartphone or computer. Sexually transmitted diseases (STDs) have long been a concern in developing parts of the world, where inadequate resources for screening patients for STDs has meant that infections continue to spread unchecked and can take lives when not detected early on. Their new apparatus for collecting and testing blood samples is 540 times cheaper to produce than machines currently used in clinics. Because the device is lightweight, fast, inexpensive, and powered by computers and smartphones already in use in developing countries, the engineers believe that it will prove an invaluable resource in rural areas that would otherwise not have access to STD testing. Syphilis and HIV both have the potential to be extremely deadly, and early detection will not only help to immediately save lives but also to reduce transmission and prevent future cases. References

“FDA approves new melanoma drug that turns on the immune system to fight deadly cancers.” newsroom.ucla.edu. (2014). 2 “Antioxidant found in grapes uncorks new targets for acne treatment.” newsroom.ucla.edu. (2014). 3 “Accuracy of genetic analyses demonstrated by worldwide study.” medicalnewstoday.com. (2014). 4 “Sequence-specific antimicrobials using efficiently delivered RNA-guided nucleases.” Nat biotechnol. (2014). 5 “Women Spend 30% More Time on Social Web Than Men.” socialtimes.com. (2010). 6 “How Many Calories Do You Burn Each Time You Laugh?” livestrong.com. (2013). 7 “Stress is killing you.” stress.org. 1

NUMBERS

percent lifetime risk of UTI (urinary tract infection) in women

percent of UTIs are diagnosed in men

# of states

that have legalized recreational marijuana, vs. 23 states for medical marijuana (as of press time)

percent of patients request teeth whitening from their orthodontists nationwide (varies by region)

Q: A:

q&a

What is a UTI? UTI stands for “urinary tract infection.” It is a bacterial infection of any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra.1 There are different types of UTIs, depending on which part of the urinary system is infected. Pyelonephritis is the infection of the kidneys. Cystitis refers to the infection of the bladder, and urethritis refers to the urethral infection. The ureters are rarely infected.1 A UTI can also be a symptom of prostatitis, which is the infection of the prostate gland in males.2 by sydnie bui| design by natalie chong

Q: What causes a UTI? A: The most common cause of UTIs is bacteria around the anus that enter the urethral opening, which is where urine leaves the body. The bacteria can move up the urinary tract and infect further areas. The bacterium that usually causes UTIs is Escherichia coli (E. coli). E. coli lives in the large intestine and around the anus and is generally harmless to healthy adults.3 Although less common, UTIs can be caused by viruses, fungi, and parasites. These can be acquired if the immune system is impaired (for example, from cancer) or through sexual intercourse with infected individuals. Individuals who wear a catheter (a tube that is inserted through the urethra to help empty the bladder) also have a higher risk.4

Q: Who can get a UTI? A: Both men and women can get UTIs, although UTIs are more common in women. Around 35 to 40% of women experience a UTI at some point in their lives, and 20 to 25% of women have recurrent, or repeated, UTIs.5,6 Women are more likely to get UTIs because the distance between the anus and urethral opening is shorter than in men. Additionally, the distance from the urethral opening to the bladder is shorter, making it easier for bacteria to migrate to the upper urinary tract.7 As discussed in the next section, some groups of people are more likely to experience UTIs than others.

Q: What are the risk factors for UTIs?

Pregnant women are also susceptible to UTIs because of hormone changes and an enlarged uterus. Certain hormones alter urinary tract function by slowing urine output, while the growing uterus that holds the fetus may block urine from leaving the bladder.10 Q: Does having sex or using a contraceptive increase my chances of getting a UTI? What about circumcision in males? A: The findings regarding sex and UTIs are inconclusive. A 1990 study in the American Journal of Public Health did not find associations between frequency of sexual intercourse or diaphragm use with the incidence of recurrent UTIs in women.11 In contrast, a 1996 study from The New England Journal of Medicine found that sexual activity and use of contraceptives, such as spermicide and diaphragms, increased the risk of UTIs by creating a favorable environment for bacterial growth.12 Sexual intercourse can potentially introduce bacteria from the anus to the urethral opening.13 Additionally, a 1992 study in The Journal of the American Medical Association reported that a lack of circumcision in men may have contributed to their increased risk for UTIs, possibly due to the foreskin providing a moist environment for bacteria to grow.14

Q: What are some typical symptoms of a UTI? A: UTI symptoms include: + a burning sensation when urinating + the urge to urinate + urinating small amounts and feeling like your bladder is not completely emptied + strong smelling or oddly colored urine (cloudy, pink, or red) + fevers + chills + nausea + vomiting + flank pain, or pain around lower stomach or under ribs7 + pelvic discomfort in women

total wellness ▪ summer 2015

Because the muscles of their bladders may be weakened, the elderly might also find it harder to completely empty their bladders, allowing bacteria to grow and stick to the cells that line the urinary tract. Catheterization and the presence of feces in the area between the anus and scrotum/vaginal opening increase the risk of a UTI too. Genetics also influence UTI susceptibility – bacteria stick to proteins on the surface of cells, and some people have genes that code for proteins that bacteria can adhere to more effectively.8

left: original illustration by

______; right: name/istockphoto

A: Diabetes, age, anatomic factors (females vs. males), and genetics can play a role in UTI occurrence. According to one study published in the Journal of Diabetes and Its Complications (2014), people with type II diabetes mellitus (T2DM) were at a 54% increased risk for contracting a UTI and were more than twice as likely to get recurrent UTIs than people without T2DM. The researchers suggested that higher glucose (sugar) concentrations in the urine may provide nutrients for bacterial growth. Additionally, diabetics may have a harder time emptying their bladders because of possible damage to nerves that control the bladder.8,9

Q: What should I do if I have a UTI? A: If you have symptoms that you suspect indicate a UTI, nonprescription dipstick urine tests can be purchased at the drugstore. The dipstick, which is made of material like paper or cardboard, is held under a stream of urine and can test for nitrite (produced during a UTI) or white blood cells and changes color if you have a UTI. Dipstick tests are fairly accurate but are not as detailed and reliable as urine cultures, which are tests that identify the presence of bacteria in your urine.15 Thus, seeing your doctor is recommended for a better treatment. If you suspect you have a UTI, see a doctor. Your consultation may include a medical history, physical exam, and a urine culture. Your doctor may prescribe antibiotics immediately if he or she thinks you have a UTI.7 It is important to complete the antibiotic treatment even if you feel better before the prescription runs out. Otherwise, the remaining bacteria may become antibiotic-resistant. Q: What can I do at home? A: In conjunction with your doctor’s prescription, home treatments include drinking plenty of water and urinating more often to get rid of bacteria, as well as taking nonprescription medications to alleviate symptoms if needed. Not urinating when you have to may also worsen your condition because it gives bacteria the opportunity to colonize. It is also recommended that men and women wipe front to back after using the restroom to avoid spreading bacteria from the anus to the urethral opening.16

Q: Do cranberry products (juice, extract, etc.) help prevent UTIs? A: You may have heard that cranberries, in products like juice or capsules, can help prevent UTIs. Several studies have found that consuming cranberries, such as unsweetened cranberry juice or dried sweetened cranberries, decreases recurrent UTIs.17,18 It is possible that certain compounds with antioxidant properties in cranberries are structurally different from those in other food products, and this difference could be associated with helping prevent bacteria from adhering to urinary tract cells.19,20 In a study published in the Nutrition Journal (2013), the amount of E. coli strains in the intestines of subjects who consumed one serving of dried, sweetened cranberries for 2 weeks decreased as compared to that of the control group. However, the variety of E. coli strains did not change, so potentially harmful bacteria may have still been present.17

There is also evidence that cranberries do not help prevent recurrent UTIs. In a 2012 meta-analysis published in the Cochrane Database of Systematic Reviews, cranberry products did not significantly reduce the occurrence of UTIs as compared to placebos, water, or no treatment at all. Whether the cranberry products were sweetened or unsweetened was not specified.21 Overall, the current body of evidence suggests that cranberry products (either in juice or as capsules or tablets) compared to placebo provides no benefits in most population groups, but cranberry-containing beverages may prevent the recurrence of UTIs in women.21,22

bottom line UTIs are most often caused by bacteria entering the urinary tract and can occur in both males and females. Certain subpopulations, such as the elderly, pregnant women, and diabetics, are more vulnerable to UTIs. UTIs can be treated with antibiotics, and the symptoms can be alleviated at home by staying well-hydrated and taking nonprescription medicine. Evidence concerning the preventive properties of cranberry is inconclusive, as are the associations between UTIs and sexual activity, contraceptive methods, and circumcision. However, it is a good idea to err on the side of caution and practice proper hygiene and bladder evacuation. See a doctor if you notice any UTI symptoms. tw

References

“Urinary tract infection (UTI).” mayoclinic.org. (2012). “Prostatitis and urinary tract infection in men: what’s new; what’s true?” Am J Med. (1999). “Urinary Tract Infection.” medicinenet.com. (2014). 4. “Overview of Urinary Tract Infections.” merckmanuals.com. (2014). 5. “Urinary tract infection.” Medicine. (2011). 6. “Urinary tract infection.” Medicine. (2007). 7. “Urinary Tract Infections in Teens and Adults.” webmd.com. (2013). 8. “What Do We Know about the Urinary Tract Infection-Prone Individual?” J Infect Dis. (2001). 9. “Risk characterization for urinary tract infections in subjects with newly diagnosed type II diabetes.” J Diabetes Complications. (2014). 10. “Urinary Tract Infection Symptoms, Causes and Treatments.” medicinenet.com. (2013). 11. “Recurring Urinary Tract Infection: Incidence and Risk Factors.” Am J Public Health. (1990). 12. “A Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women.” N Engl J Med. (1996). 13. Urinary Tract Infections.” brown.edu. (n.d.). 14. “Lack of Circumcision Increases the Risk of Urinary Tract Infection in Young Men.” JAMA. (1992). 15. “The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy.” BMC Urol. (2004). 16. “Urinary Tract Infections in Adults.” urologyhealth.org. (2013). 17. “Consumption of sweetened, dried cranberries may reduce urinary tract infection incidence in susceptible women – a modified observation study.” Nutr J. (2013). 18. “A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women.” Can J Urol. (2002). 19. “A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity.” Phytochemistry. (2005). 20. “Concentrations of Proanthocyanidins in Common Foods and Estimations of Normal Consumption.” J Nutr. (2004). 21. “Cranberries for preventing urinary tract infections.” Cochrane Database Syst Rev. (2012). 22. “Alternative Medicines for Infectious Diseases.” Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. (2010). 1.

total wellness ▪ summer 2015

2. 3.

self care

constipation:

when you gotta go but your bum says no by nancy vu | design by danielle swenson

total wellness ▪ summer 2015

We’re usually open to talking about health problems like stress, sleep difficulties, allergies, or a sore throat. Bathroom habits? Not so much. Constipation, particularly, is not a topic of everyday conversation. We’re pretty unlikely to share that we haven’t taken a “number 2” in a long time or that we experience pain when trying to take care of our business, but most of us have been there. In fact, 80% of people suffer from constipation at some time in their lives.1 Because it’s such an uncomfortable topic, many people do not know as much about it as they should. Even though “potty problems” are usually not too serious, it’s good to become informed in order to take the proper steps to find relief. This article tackles the basics of this frustrating condition and uncovers simple ways to help you unclog.

what it is Toilet slang includes the terms “backed up,” “blocked up,” or “plugged up” to refer to constipation. Whatever it might be called, constipation is commonly known as a condition in which bowel movements (or, in simpler terms, pooping) become more difficult or infrequent.2 The typical length of time between bowel movements ranges widely from person to person; while some people have to go 3 times a day, others have to do so just 3 times a week.1 However, going 3 days or longer without a bowel movement is normally considered too long since stool becomes hard, dry, and difficult to pass.2 A person is considered to have functional or chronic constipation when they have 2 or more of the following for at least 3 months:3

> straining during bowel movement at least 25% of the time > lumpy or hard stools at least 25% of the time > feeling incomplete evacuation at least 25% of the time > feeling obstruction or blockage in the anus and rectum (last part of the colon before the anus where the body stores stool) at least 25% of the time > using manual maneuvers to help with bowel movements at least 25% of the time (e.g. digital evacuation, or the use of fingers to help remove stool from the anus) > 3 or fewer bowel movements in a week

More severe cases of constipation may include a swollen abdomen, abdominal pain, and vomiting.2

classifications

Constipation can be classified into three broad categories: normal-transit constipation, slow-transit constipation, and defecatory disorders. Normal-transit constipation is the most common type of constipation. This occurs when stool moves through the colon at a normal rate, yet patients may experience other difficulties in stool passage, such as hard stools. Slow-transit constipation is when stool moves at a slower rate and bowel movements are infrequent, leading to more severe symptoms of straining and harder stools. Defecatory disorders, or obstructed constipation, are caused by dysfunction of the pelvic floor (group of muscles that supports the organs within the pelvis and lower abdomen) and anal sphincter (cylindrical muscles that control the closing of the anus). Patients with constipation may experience more than one type.4

causes & prevention methods Constipation typically occurs when stool spends too much time in the colon. The stool becomes hard and dry because the colon absorbs too much water from it, making it more difficult for the muscles in the rectum to push the stool out of the body.5 Here are some common factors that lead to constipation and some ways to avoid stubborn stool from building up in your system:

inadequate fiber intake Dietary fiber is the edible part of plants or carbohydrates that is not digestible by the body. It’s found in all plant foods, including fruits, vegetables, grains, nuts, seeds, and legumes. Most fiber is soluble, which means it can be dissolved in water; others are insoluble, which means they cannot be dissolved in water. Soluble fiber has been mainly studied in constipation as a way to help ease stool passage. It slows digestion and retains water in the stool, keeping your stool soft. Insoluble fiber adds bulk to your stool, helping it pass more quickly.6 Without enough fiber, constipation may occur since your stool may not be able to run smoothly through the colon.

prevention Get your daily dose of fiber! The average American eats 10 to 15 g of fiber per day. However, this is only about half the recommended amount, which is 20 to 35 g.7 Some foods that are especially poop-friendly are whole-grain breads, minimally processed cereals and pastas (whole-wheat cooked spaghetti has about 6.3 g of fiber), raspberries (1 cup has about 8 g of fiber), beans, and peas (1 cup of split peas has 16.3 g of fiber).8 Alternatively, you can take fiber supplements to boost the amount of fiber in your diet. Also, you can stock up on other foods that aid in digestion, including yogurt, peppermint oil, and ginger, which help regulate the functioning of the digestive tract to promote elimination.

cover: nikola spasenoski/istockphoto top right: portugal2004/istockphoto mid right: chictype/istockphoto bottom right: rami_ba/istockphoto

total wellness ▪ summer 2015

how it causes constipation

inadequate fluid intake how it causes constipation Not drinking enough water and other fluids may result in hard stools that are difficult to pass.9 This occurs because the colon will soak up water from food waste to hydrate the body, leaving the remaining stool hard and dry.

prevention Stay hydrated! Get enough fluids from sources like water, fruits and vegetables (they are mostly made up of water), herbal teas, and clear soups. The recommended amount of daily fluid intake is 64 oz from foods and drink (a cup is 8 oz). However, most experts advise to let your body be your guide because the specific amount varies from person to person.9

lack of physical activity how it causes constipation When you’re sedentary, your bowel movements may become irregular because your bowels get less stimulation due to lack of movement. Stool stays in your colon longer and more water is absorbed by the colon, causing constipation. Physical activity may help speed things up in the colon by stimulating the natural contraction of intestinal muscles.10

prevention Get moving! An intense workout is not required; even a regular walking regimen (10 to 15 minutes several times a day) may help the body and digestive system run smoothly. You can also try aerobic exercise (like jogging or swimming), yoga, and stretching.10

ignoring the urge to have a bowel movement how it causes constipation If you ignore the urge to “go,” over time, you may stop feeling like you need to. This habit can lead to constipation since your stool will sit for longer periods of time in your colon.5

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prevention Take time to go to the restroom when nature calls! The longer you ignore the urge to go, the harder it will be to go later on.

the self-care column is sponsored by UCLA Health System: UCLA Center for East-West Medicine

other causes of constipation include

daily routine and diet changes Daily routine and diet changes, a common occurrence when traveling, may often cause constipation for a number of reasons.5 The bodyâ&#x20AC;&#x2122;s circadian clock, or biological clock, may change due to time zone differences or a change in your sleep schedule. As a result, your bowel movements can also become irregular. Additionally, the intake of unfamiliar foods or amounts of food can result in constipation because your system may not yet be adapted to the change, especially if it involves less fiber or fluids.11

pregnancy and age Although constipation can affect anyone of any gender and age, women and the elderly more commonly experience constipation. It is a common occurrence during pregnancy because of hormonal changes and the uterus compressing the intestine, which obstructs the movement of stool. Aging can also affect bowel regularity by reducing the number of nerves that stimulate muscles in the colon.5

medications

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Many medications contribute to constipation as a side effect, each acting on the body in a specific way. These include painkillers, antidepressants, iron supplements, and calcium supplements.1

(science-based) home remedies* Increasing your fiber intake, fluid intake, and exercise are definitely ways to help you unload, but there are additional remedies to help take down constipation. These are strategies that you might not know about that you can do in the comfort of your own home with accessible household items! Here’s the inside scoop to help you poop:

succumb to the power of the prune Try eating 50 g of prunes (equal to 7 medium-sized prunes) twice a day. If you don’t like the wrinkly texture, you can drink 2 glasses of prune juice a day (one in the morning and another at night) to relieve constipation.12 Prunes, or dried plums, have earned the reputation as “nature’s remedy” for constipation. They act as a natural laxative with stool-softening effects as they contain lots of fiber as well as sorbitol, a stool-loosening sugar. In a 2011 study in Alimentary Pharmacology and Therapeutics, patients with chronic constipation consumed 50 g of prunes, providing 6 g of fiber per day for 3 weeks, and maintained a daily symptom and stool diary. Notes included stool consistency, straining, and tolerability. Researchers found that the number of complete spontaneous bowel movements per week and stool consistency scores improved significantly.13

freshen up with lemon juice Squeeze the juice from half a lemon into a glass of warm water. Drink one glass before you sleep and another after you wake up. Lemon juice contains citric acid, which can stimulate your digestive system and cleanse the walls of your colon to help keep things moving.14 However, the efficacy of this method has not been proven by a controlled study.

drink some caffeine (but not too much) Take a cup or two of coffee to relieve constipation, but be sure not to overdo it, otherwise it might have the opposite effect! Caffeine significantly stimulates the release of the hormone gastrin, which triggers the secretion of gastric juice, quickening the digestive process and triggering the contraction of the colon to help combat constipation. However, if taken in excess, caffeine can cause constipation rather than help to cure it. Caffeine is a diuretic, meaning it promotes urination. Frequent urination can be dehydrating, leading to constipation since less water remains in the colon.15

say yes to yogurt

total wellness ▪ summer 2015

Try eating yogurt. It’s a probiotic food which contains good bacteria to keep your digestive tract working properly. In a 2014 study in the American Journal of Clinical Nutrition, adults with constipation were administered probiotics, which decreased the time it took for food to pass through the digestive tract, increased stool frequency, and improved stool consistency.16

left: eutoch/istockphoto top right: alasdair thomson/istockphoto mid right: love_life/istockphoto mid right: floortje/istockphoto bottom right: natikka/istockphoto

empty out with epsom salt Dissolve 2 tsp of Epsom salt (½ tsp for children) in a cup of water or fruit juice. The salt has magnesium sulfate, which is great for absorbing water from its surroundings and softening up stool. Be careful not to take too much— potential side effects include cramping, diarrhea, and nausea.17 Check with your doctor before using this method.

* These are only suggestions; some cases require that you see your doctor.

using drugs to unplug There are different types of nonprescription medicines and products available to help you treat constipation. Like the names suggest, bulking agents are products that add volume to the stool, while stool softeners soften the stool. Osmotic laxatives draw fluids into the colon from surrounding tissue and blood vessels to soften the stool. Stimulant laxatives make stool move more rapidly through the colon by instigating a bowel movement (contraction of the colon). However, use stimulant laxatives with caution: you may also start becoming dependent on them to have a bowel movement.18 This means it can become difficult for you to go naturally on your own, so your body may need laxatives in order to get bowel stimulation every time there’s a code brown.

diagnosis If you notice unexplained or persistent changes in your bowel habits that continue for more than 3 weeks, make an appointment with your doctor. Be sure to do so right away if blood is found in your stool.1 Your healthcare provider may take medical history, perform a physical exam, and order specific tests, including a blood test or other colon-related tests at his or her discretion.2

the bottom line

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Being constipated can be a pain in the butt, but there are many easy, natural solutions to help ease symptoms when you’re backed up. Simple adjustments to your routine can help you find the relief you’ve been looking for, so it’s a good idea to keep tabs on your everyday habits, including diet and exercise. That way, you know what to do to get your bowels moving and how to avoid any complications when you hit the can. tw

References:

“Constipation.” fascrs.org. (2011). “The Basics of Constipation.” webmd.com. (2014). “Functional Bowel Disorders.” Gastroenterol. (2006). 4. “Chronic Constipation.” N Engl J Med. (2003). 5. “Constipation.” nih.gov. (2014). 6. “Dietary Fiber for Constipation.” webmd.com. (2014). 7. “Fiber.” nih.gov. (2012). 8. “Chart of high-fiber foods.” mayoclinic.org. (2012). 9. “Water: A Fluid Way to Manage Constipation.” webmd.com. (2014). “How to Handle Constipation When Traveling.” everydayhealth.com. (2011). 10. “Exercise to Ease Constipation.” webmd.com. (2013). 11. “How to Handle Constipation When Traveling.” everydayhealth.com. (2011). 12. “Recommended Serving of Prunes for Constipation.” livestrong.com. (2013). “How to Relieve Constipation With Lemon & Water.” livestrong.com. (2011). 13. “Randomised clininal trial: dried plums (prunes) vs. psyllium for constipation.” Aliment Pharmacol Ther. (2011). 14. “Split-dose picosulfate, magnesium oxide, and citric acid solution markedly enhances colon cleansing before colonoscopy: a randomized, controlled trial.” Gastrointest Endosc. (2012). 15. “Coffee and gastrointestinal function: facts and fiction.” Scand J Gastroenterol Suppl. (1999). 16. “The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials.” Am J Clin Nutr. (2014). 17. “The management of constipation in adults.” Aliment Pharmacol Ther. (1993). 18. “Nonprescription Medicines and Products - Bulking Agents, Stool Softeners, and Laxatives.” webmd.com. (2014). 1. 2. 3.

eat well

juicing : body cleansing or nutrient depleting? by catherine hu | design by molly sanders

Juicing and juice cleanses are a popular trend, touted for their detoxing, weight loss, and health benefits, which promise to energize you by providing a daily dose of fruits and vegetables. There are a plethora of options, from grab-and-go single bottles to juice cleanses that replace a weekâ&#x20AC;&#x2122;s worth of food. Is this trend really living up to its predicted effects? Is there a difference between juicing and blending? Although juicing may increase intake of vegetables and fruits, it may not really be as glamorous as it sounds â&#x20AC;&#x201C; it may even be dangerous if it becomes a continuous habit.

what is juicing?

total wellness â&#x2013;Ş summer 2015

Juicing is a process where juice is extracted from fruits and vegetables, such as through pressing or squeezing. This is different from eating whole fruits and vegetables or blended drinks because juicing leaves only liquid while discarding the fiber filled pulp.1 Learn more about the importance of fiber in the constipation article of this issue on page 11 of this issue. According to the United States Department of Agriculture (USDA), it is recommended that during meals, half of the plate should consist of fruits and vegetables.2 Juicing provides a way to simplify these daily needs, since one bottle can contain extracts of multiple fruits and vegetables and is fast and easy to consume.

JUICING VS. BLENDING pros of blending

cons of blending

Unlike juicing, blending retains all of the edible portions of the fruit or vegetable in the drink. A 2014 study published in Preventive Nutrition and Food Science found that blended drinks consisting of apples, pears, persimmons, and mandarin oranges exhibited stronger antioxidant activity and greater amounts of phenolic compounds than those prepared by juicing.3 Phenolic compounds are molecules that contribute to antioxidant activity, which have been shown to be inversely correlated with the risk of chronic diseases when abundant in oneâ&#x20AC;&#x2122;s diet.4

Since blended drinks contains all of the fibers of the original fruits and vegetables, these may quickly contribute to excess fiber if oneâ&#x20AC;&#x2122;s diet is not monitored properly. Too much fiber can lead to intestinal gas, abdominal bloating, and cramping. Water intake should also increase alongside increased fiber intake to aid stool formation.5

pros of juicing

cons of juicing

short term: In the 2014 Preventive Nutrition and Food Science

study, results revealed that Vitamin C content was higher in drinks prepared by juicing rather than blending. In particular, the juice of apples, pears, and mandarin oranges contained the most Vitamin C content.3 Thus, nutrient and antioxidant levels, such as Vitamin C, can differ based on juice extraction techniques.

long term: A 2011 study published in Nutrition Journal

found that individuals who drank 16 oz, or 2 cups, of carrot juice every day for 3 months significantly increased total antioxidant capacity in their blood plasma, which means there was increased antioxidant activity throughout their bloodstream (similar to the effects of blended drinks).6

short term: Since juicing removes the rinds of fruits and

vegetables, it also removes fibers but keeps all the sugars.7 For example, consider a fresh, medium sized apple that has 19 g of sugar and 4 g of fiber. In comparison, a glass of apple juice does not contain any fiber and may contain juice from multiple apples, which increases the total sugar content (1 cup of apple juice contains about 24 g of sugar).8 Since fiber is necessary for regulating blood sugar levels, drinking fruit juice may result in blood sugar spikes.9 Furthermore, fiber is also necessary to activate satiety responses, so drinking a cup of fruit juice may not be as filling as eating a piece of fruit.8

long term: The fructose present in fruit juice can be

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problematic as it is associated with increased triglyceride formation in liver cells. Triglycerides are a form of fat that can result from the breakdown of fructose in the liver. Increased triglycerides can impair liver function and build up as plaque inside artery walls when released into the bloodstream. Since higher intakes of fructose are associated with obesity and heart disease, drinking fruit juice in moderation can limit these risks.10 Dietary Guidelines for Americans recommends no more than one serving, or 4 oz, of 100% fruit juice as part of the daily fruit intake.11

juice cleansing what is it? Juice cleansing is a process in which an individual consumes only vegetable and fruit juices for a period of 3 to 10 days.12 However, there are some juice cleanses on the market that last just 1 day as well. Some juice cleansing regimens also suggest that no other additional food items are necessary during the process.

positive: A 2009 study published in the Proceedings of the Nutrition Society found that consumption of the equivalent of 5 servings of fruits and vegetables in the form of puree and fruit juice concentrates in intervals over an 8 hour time period increased dietary phytochemicals, micronutrients, and plasma antioxidant status.7 Similar to antioxidants, phytochemicals have antioxidant-like functions which may help ward off certain diseases.12 Additionally, the micronutrients found in juices are essential for maintaining tissue function.13

negative:

cover: ma-k/istockphoto left: habovka/istockphoto right: mg7/istockphoto

Sometimes a cleanse contains a bottle of nut milk in the regimen that can account for some of the lacking protein, fiber, and healthy fats, but this is usually not enough to meet the recommended daily allowances. Also, nuts are an incomplete protein source, meaning that they lack some of the essential amino acid building blocks necessary for a healthy diet.14 As a consequence, these missing nutrients from a juice cleanse may be responsible for the fatigue and headaches reported by some users.

bottom line

Juicing may be highly promoted by the media, but in reality, drinking a lot of juice or going on a juice-only cleanse may have some adverse effects. The lack of fiber, protein, and the increased sugar consumption during a juice cleanse may lead to sugar crashes and leave you feeling hungry and tired.

Furthermore, drinking fruit juice too frequently may increase blood pressure in the long run. Although drinking fruit and vegetable juices that contain vital nutrients has been shown to increase overall antioxidant activity in the body, it may be considered healthier to consume fruits and vegetables in their original form as part of a balanced intake. tw

References 1. “Juicing for Health and Weight Loss” webmd. (2014). 2. “What Foods Are in the Fruit Group?” choosemyplate.gov. (2014). 3. “Effects of chronic and acute consumption of fruit- and vegetable-puree-based drinks on vasodilation, risk factors for CVD and the response as a result of the eNOS G298T polymorphism.” P Nutr Soc. (2009). 4. “Plant polyphenols as dietary antioxidants in human health and disease.” Oxid Med Cell Longev. (2009). 5. “Antioxidants.” nccam.nih.gov. (2014). 6. “Nutrition and healthy eating.” mayoclinic.org. (2012). 7. “Drinking carrot juice increases total antioxidant status and decreases lipid peroxidation in adults.” Nutr J. (2011). 8. “Habitual intake of fruit juice predicts central blood pressure.” Appetite. (2015). 9. “The Benefits of Fiber: For Your Heart, Weight, and Energy.” webmd.com. (2014). 10. “Is Fructose Bad for You?” health.harvard.edu. (2011). 11. “Healthy Beverage Guidelines.” hsph.harvard.edu. (2009). 12. “Juicing Is Not All Juicy.” Am J Med (2013). 13. “Neuroprotective potential of phytochemicals.” Pharmacogn Rev. (2012). 14. “Why high blood sugar is bad.” mayoclinic.org (2011). 15. “Protein.” cdc.gov. (2012).

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Many juice cleansing companies state that no additional food is necessary to supplement the juice cleanse. However, as mentioned previously, juice can have increased sugar content and does not contain the fibers originally present in whole fruits and vegetables, which can leave you feeling hungry and cause sugar spikes. When blood sugar is high, red blood cells stiffen and interfere with blood circulation, resulting in a buildup of cholesterol within blood vessels over time.14 In addition, a juice cleanse may contain very little protein because fruits and vegetables generally do not contain as much protein as animal meat, legumes, or dairy products. Thus, a full day cleanse may not meet the Center for Disease Control and Prevention’s daily recommended dietary allowances of 46 g of protein for women and 56 g for men.15 While one day probably will not cause any damage, multiple days on a juice cleanse can lead to protein deficiency.

breathe well

understanding e-cigarettes by OMID MIRFENDERESKI | design by KIMBERLY RICH

total wellness ▪ summer 2015

You may have heard about e-cigarettes, or electronic cigarettes, through advertisements that promise users “no smoke, no ash, no tar, no odor” while allowing “the freedom to smoke anywhere.”1,2 These mysterious cigarette-look-alikes, which were first manufactured in China about a decade ago, come in various colors, shapes, and sizes and are sometimes proclaimed as a revolutionary invention.3 But what exactly are they? In this article, we will discuss the nitty-gritty details of e-cigarettes, including their purported safety relative to traditional cigarettes and their potential risks, to get you in the know.

what are e-cigarettes? Electronic cigarettes, also called personal vaporizers or vapes, are claimed to be substitutes for cigarettes and cigarette-quitting devices since they simulate the physical and behavioral sensations of smoking without the use of tobacco. According to a 2014 review in Circulation, electronic cigarettes are devices that deliver a nicotine-containing aerosol by heating a solution consisting of nicotine, propylene glycol, and flavoring agents.3 Nicotine, a potentially addictive chemical found in tobacco leaves, boosts mood, increases heart rate and blood pressure, and stimulates memory.4 Propylene glycol, a chemical found in many pharmaceuticals and cosmetic products, produces a mist that looks very much like tobacco smoke when the e-cigarette solution is vaporized.5,6 Flavoring agents simulate a variety of flavors, including tobacco, menthol, coffee, fruit, and candy.5

how do e-cigarettes work? Electronic cigarettes consist of a battery and an atomizer where liquid is stored and then aerosolized, or converted into a spray, through the generation of heat.7 Puffing by the user activates a battery-operated heating element in the atomizer that causes the liquid in the cartridge to be vaporized into a mist that is then inhaled.8 Although the data are not exact, electronic cigarettes may contain about 0 to 35 μg of nicotine per puff. Traditional cigarettes, on the other hand, generally contain 1 mg of nicotine per whole cigarette. This means that for an e-cigarette containing 30 μg of nicotine per puff, a user would have to puff a little more than 30 times to get the nicotine content of a traditional cigarette.3

what are the different types of e-cigarettes? Electronic cigarettes differ in appearance and size based on their categorization as first g eneration, secondgeneration, or thirdgeneration devices. According to a 2014 article published in Therapeutic Advances in Drug Safety, first generation devices usually look like regular cigarettes and have small lithium batteries that may be disposable or rechargeable.

who uses e-cigarettes?

Second generation devices have higher capacity lithium batteries and atomizers that can be refilled with solution. Third generation devices have very large-capacity lithium batteries with circuits that allow users to change the voltage delivered to the atomizer and thereby control the amount of vapor produced.7

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Although e-cigarettes are a relatively modern phenomenon, their use has been rapidly increasing over the past decade. In statistics obtained from the Centers for Disease Control and Prevention, youth use of e-cigarettes more than doubled from 3.3% to 6.8% from 2011 to 2012.3 The 2014 Monitoring the Future study revealed for the first time that teen use of e-cigarettes had surpassed teen use of traditional cigarettes. The statistics showed that 8.7% of 8th graders, 16.2% of 10th graders, and 17.1% of 12th graders used e-cigarettes, while 4% of 8th graders, 7.2% of 10th graders, and 13.6% of 12th graders used traditional cigarettes.9 It is believed that experimentation may play a part in youth use of e-cigarettes, as the imitation of traditional cigarette sensations, combined with the presence of flavoring agents, may impart a certain appeal.3 Nevertheless, e-cigarette use is still less prevalent than traditional cigarette use among adults. One study found that 6.2% of US adults in 2011 had tried e-cigarettes.3 In comparison, a 2011 study published in the Morbidity and Mortality Weekly Report found that 19.3% of US adults in 2010 were traditional cigarette smokers.10 Similarly, a 2010 UC survey found that 7.9% of undergraduates had used traditional tobacco within the past month.11

how are e-cigarettes regulated? E-cigarettes are not currently regulated by the FDA, but there have been numerous calls for their regulation. According to a 2014 article published in CA: A Cancer Journal for Clinicians, the FDA could potentially require e-cigarette manufacturers to register their products with the FDA, provide a list of ingredients, address impure and untested product additions, and limit marketing and sales only to those 18 years and older.12 This is already the case with traditional cigarettes, as the Family Smoking Prevention and Tobacco Control Act (which became law in 2009) gave the FDA authority to regulate tobacco products and prevent their sales to minors.13 While the FDA proposed a regulation on April 25, 2014 to treat e-cigarettes as tobacco products, thus placing them under the regulation of the Family Smoking Prevention and Tobacco Control Act, the proposal has yet to be finalized.14 Nevertheless, local and state governments have stepped in to regulate e-cigarettes. Some states like California ban the sale of e-cigarettes to minors, while some cities like Los Angeles ban the use of e-cigarettes in indoor public spaces. Other regulatory strategies may include prohibiting free samples of e-cigarettes or levying taxes on the devices and the liquid nicotine they contain.14,15

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what are some claims about e-cigarette use?

relative safety in comparison to traditional cigarettes

use in cessation and abstinence from traditional cigarettes

Given that the conditions caused by smoking kill some 6 million people every year, some evidence suggests that e-cigarettes are theoretically a less harmful alternative to traditional cigarettes.16 Conventional smoking involves combustion, or burning, of tobacco and results in the production of thousands of harmful toxins and carcinogens that may cause cardiovascular disease, cancer, and death.17 According to a 2014 article published in Addiction, e-cigarettes do not contain tobacco, and there is no combustion involved, so many toxic chemicals present in traditional cigarette smoke are avoided.16 It is a misconception that nicotine, which may be present in e-cigarettes as well, is the primary harmful component of traditional cigarettes. Besides, secondhand exposure from e-cigarettes is much less harmful than secondhand exposure from traditional cigarettes. One study found that those exposed to e-cigarette aerosol would be exposed to only 1/10th the level of nicotine found in traditional cigarette smoke.3 Nevertheless, as discussed later, e-cigarette solution still contains a number of chemicals that may have significant health risks.

Studies are at odds as to whether e-cigarettes may be effective devices for smoking cessation. The 2014 article in Addiction noted that subjects who had used e-cigarettes in their last quit attempt were more likely to report not smoking than subjects who had used nicotine replacement therapy or no cessation device at all.16 Similarly, a 2013 study published in PLoS One found that subjects who used e-cigarettes but did not intend to quit traditional smoking showed decreased cigarette consumption and had enduring tobacco abstinence without any significant side effects.7 Nevertheless, many other studies indicate that e-cigarettes are not effective devices for abstinence and that e-cigarette users are no more likely to quit vaping than traditional cigarette users are to quit smoking. One study found that 89% of e-cigarette users are still using e-cigarettes one year later.9 Furthermore, many people who use e-cigarettes continue to use traditional cigarettes, all in all challenging the notion that e-cigarettes are effective for smoking cessation.3

6.2% of US adults reported having tried e-cigarettes in 2011

e-cigarette use among youth more than

doubled

from 3.3% to 6.8% from 2011 to 2012

what are some potential risks of e-cigarette use? Although a comprehensive summary of the effects of e- cigarettes is unknown, research has identified a number of risks that should be taken very seriously.

health effects

Exposure to propylene glycol, which is in the e-cigarette solution, may cause eye and respiratory irritation. Prolonged or repeated inhalation may affect the central nervous system (causing convulsions and seizures), physical behavior (causing muscle contraction or spasms), and the spleen.18 Furthermore, mainstream and secondhand e-cigarette aerosol have been found to contain at least 10 chemicals that are known to cause cancer, birth defects, or reproductive harm, including lead, nickel, and formaldehyde. Nicotine itself is addictive and may also harm brain development. E-cigarette solution may even be lethal for small children who accidentally ingest it.9 Some of the general side effects of e-cigarette use may include throat and mouth irritation, coughing, nausea, and vomiting.3

Other risks of e-cigarettes include their implications for normalizing nicotine use and smoking simply in a different form. Some youth who are not drawn to traditional cigarettes may be drawn to e-cigarettes due to their brand appeal and flavors, starting unnecessary and potentially harmful habits. A study in 2012 found that 20.3% of middle school and 7.2% of high school e-cigarette users had never used traditional cigarettes. E-cigarettes may thus facilitate experimentation with nicotine in youth who do not use traditional cigarettes.3 In addition, people must be aware that companies and their advertisements may be one-sided and may not always give the full picture on their products. E-cigarette companies use some of the same marketing strategies as tobacco companies and may not always have users’ safety as their priority.3 This is important to keep in mind as e-cigarettes are still not standardized or regulated at the federal level.

cover: mauro grigollo/istockphoto top right: ctacik/istockphoto bottom right: thomas lauridsen/istockphoto

e-cigarette aerosole may contain at least

10 chemicals

that are known to cause cancer, birth defects, or reproductive harm

bottom line While some research suggests that e-cigarettes are less harmful than regular cigarettes, other research indicates that they have a number of health risks and potentially dangerous implications for youth. Some evidence suggests that chemicals in the e-cigarette solution may affect respiration, behavior, and brain development and that vaping may have side effects such as throat and mouth irritation, nausea, and vomiting. Other evidence suggests that e-cigarettes may serve as a platform for increased nicotine experimentation in youth, a significant public health concern. Current studies are moreover conflicted as to whether or not e-cigarettes may be beneficial in helping smokers quit. All these findings have been important considerations in the creation of local policies to regulate e-cigarettes thus far. Ultimately, since e-cigarettes are a relatively modern phenomenon, more research is needed to determine their long-term effects and the most effective way to regulate them at the federal level. tw

References 1. “How Safe Are Electronic Cigarettes? Not Everyone Agrees.” blogs.scientificamerican.com. (2013). 2. “E-Cigarettes: A Call for Policy Interventions.” healthequityandpolicy.blogspot.com. (2013). 3. “E-Cigarettes.” Circulation. (2014). 4. “Nicotine and tobacco.” nlm.nih.gov. (2014). 5. “Ethylene Glycol and Propylene Glycol Toxicity: What is Propylene Glycol.” atsdr.cdc.gov. (2007). 6. “E-Cigarettes Under Fire.” webmd.com. (n.d.). 7. “Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review.” Ther Adv Drug Saf. (2014). 8. “Efficiency and Safety of an Electronic Cigarette (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study.” PLoS One. (2013). 9. “State Health Officer’s Report on E-Cigarettes.” cdph.ca.gov. (2015). 10. “Vital signs: current cigarette smoking among adults aged ≥ 18 years -- United States, 2005-2010.” Morb Mortal Wkly Rep. (2011). 11. “Tobacco-Free Campus Policy.” healthy.ucla.edu. (n.d.). 12. “E-Cigarettes and the Future of Tobacco Control.” CA-Cancer J Clin. (2014). 13. “Regulating Electronic Cigarettes and Similar Devices.” publichealthlawcenter.org. (2014). 14. “Overview of the Family Smoking Prevention and Tobacco Control Act: Consumer Fact Sheet.” fda.gov. (2014). 15. “Electronic Cigarette Legislation Prohibiting Sale to Minors in Other States.” law.umaryland.edu. (2012). 16. “Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study.” Addiction. (2014). 17. “Nicotine (Tobacco Addiction and Abuse).” medicinenet.com. (n.d.). 18. “Material Safety Data Sheet: Propylene Glycol MSDS.” sciencelab.com. (2013).

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social implications

mind well

total wellness â&#x2013;Ş summer 2015

the pros and cons of group work by omid mirfendereski | design by natalie chong

total wellness â&#x2013;Ş summer 2015

You may have heard of the term synergy, which means that the whole is greater than the sum of its parts. Bananas, strawberries, and milk may not be very special on their own, but they can be put together to make a delicious fruit smoothie. This same idea explains why you and your friends may get much more work done in a group than by yourselves, even if you are all very diligent individuals. But synergy does not always come about, and you may sometimes feel less effective when you are in a group than when you are solo. Why is this so? Research shows that groups affect judgment and decision-making processes both positively and negatively, depending on how they are structured. Here, we examine the pros and cons of working in groups and offer ways to structure groups with optimal synergy.

group benefits cooperation

Research suggests that group thinking and group discussion increase cooperation, thereby leading to more effective decisions. According to a 2013 article published in the Personality and Social Psychology Review, discussion may enhance cooperation in social dilemmas. This may be because discussion creates common bonds among group members and develops group identity. According to the article, forms of computer-mediated communication such as video conferencing may also produce cooperation, resulting in more socially responsible behavior.1

critical thinking

Group thinking and discussion may also enhance individual critical thinking. A 2009 study published in the Journal of Educators Online found that discussions in online courses were correlated with higher levels of critical thinking in students. Critical thinking was most encouraged when instructor facilitation was less frequent but more purposeful. For the purposes of the study, critical thinking was defined as developing one’s own way of thinking about course materials.2

group drawbacks groupthink

group polarization

Groupthink is probably the best-known distortion of group thinking. Research shows that groupthink may result in improper judgments and decisions. According to a 2011 article published in Emerging Leadership Journeys, groupthink is a mode of thinking in which group members’ desire for unanimity and consensus prevents proper decision-making. Psychologist Irving Janis coined the term groupthink to explain how certain bad government decisions, especially in times of war, came about. According to Janis, groupthink can be caused by factors such as group cohesion (which may cause group members to lean towards unanimity), high stress, and low selfesteem.3

Research suggests that groups may be vulnerable to group polarization, another phenomenon that can result in inappropriate outcomes. According to a 2002 article published in the Journal of Political Philosophy, group polarization occurs when group members shift toward a more extreme position in the direction initially favored before discussion. For example, a few students who all have moderate anti-abortion views may come to have extreme anti-abortion views after having a discussion with one another. This may be because group members adjust their opinions to match the dominant or most persuasive position. It may also be because group members voice their “real” extreme positions only after hearing similar opinions from others.5

> overestimation of the group, including: + illusion of invulnerability: group members think that there are no bad consequences + belief in group’s inherent morality: group members think that they are morally correct

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> close-mindedness, including: + collective rationalization: group members justify what they do + stereotyping out-groups: group members antagonize other teams > pressure toward uniformity, including: + self-censorship: group members do not express their own doubts + illusion of unanimity: group members think that the majority perspective is unanimous + direct pressure on dissenters: group members prevent each other from expressing contrary opinions + self-appointed “mindguards”: certain group members suppress any information that challenges the group’s cohesiveness or the majority perspective

A 1976 study published in the Personality and Social Psychology Bulletin found that group polarization was present in simulated jury settings. After discussing cases with less evidence against the defendants, subjects were more extreme in judgments of innocence and more lenient in recommended punishment, while after discussing cases with more evidence against the defendants, subjects were more extreme in judgments of guilt and harsher in recommended punishment.6

risky shifts Research indicates that group decisions after a discussion may be more risky than individual decisions. A 1965 study published in the Journal of Experimental Social Psychology found that group discussions produced substantial shifts toward risk-taking in hypothetical situations. According to the researchers, face-to-face discussions create emotional bonds among individuals, allowing them to feel linked in a common fate. Diffusion of responsibility allows group members to feel less to blame if a potentially risky decision fails.7 A 1967 study published in the Journal of Experimental Social Psychology found that risk-taking increased even when subjects exchanged initial opinions with one another without further discussion. The study also found that risky shifts were more prevalent in larger groups.8

cover: triloks/istockphoto

The characteristics of groupthink are3,4:

maximizing group benefits and minimizing group drawbacks other recommendations

Groups should follow these guidelines, among those originally set by Irving Janis, to prevent groupthink:

Groups can follow these guidelines to prevent other drawbacks and bring about group synergy:

> group leaders should be impartial

> groups should have face-to-face discussions to maximize cooperation. All group members should directly communicate with one another.1

> group members should critically evaluate the group’s course of action

> outside experts should be invited to talk with the group

> groups should have diverse group members to prevent group polarization and increase creativity + A 1996 study published in the British Journal of Social Psychology found that groups with minority influence agents (individuals with opinions differing from the majority) experienced more divergent thinking (thinking leading to many possible solutions) and originality than control groups with no minority thinkers.9

> group members should play the devil’s advocate, by arguing against their own proposals and generating debate

> groups should have fewer group members to prevent risky shifts

> groups should reconsider their decisions in later meetings to ensure that they are reasonable, before making any commitments

As another example, let’s say you are participating in a group trivia game. When you are forming your group, make sure that it is not so large that you fall prey to diffusion of responsibility and risky shifts. Choose people who do not always think the way you do and who you feel very comfortable brainstorming with.

> smaller groups within the group should assess the group’s proposals > group members should discuss options with trusted people outside the group

As an example, let’s say you and 5 classmates are thinking of a topic for a group project. Instead of sitting in a big circle and thinking of ideas, you can divide yourselves into 2 groups of 3, each of which brainstorms on its own. After each group of 3 comes up with a couple of ideas, you can all get together, share your suggestions, and choose the best proposal. If you are worried about opposing specific people’s suggestions, write all your ideas on pieces of paper and pass these pieces of paper around to preserve anonymity. Choose one person each round to argue against the idea in question.

References “The Group Discussion Effect: Integrative Processes and Suggestions for Implementation.” Pers Soc Psychol Rev. (2013). 2. “Encouraging Critical Thinking in Online Threaded Discussions.” JEO. (2009). 3. “Diverse Perspectives on the Groupthink Theory – A Literary Review.” ELJ. (2011). 4. “What is Groupthink?” psysr.org. (n.d.). 5. “The Law of Group Polarization.” J Polit Philos. (2002). 6. “Group-Induced Polarization in Simulated Juries.” Pers Soc Psychol B. (1976). 7. “The Roles of Information, Discussion, and Consensus in Group Risk Taking.” J Exp Soc Psychol. (1965). 8. “Components of Group Risk Taking.” J Exp Soc Psychol. (1967). 9. “A naturalistic minority influence experiment: Effects on divergent thinking, conflict and originality in work-groups.” Brit J Soc Psychol. (1996). 1.

bottom line Research indicates that working in groups has both pros and cons. While collaborating with others may stimulate cooperation and critical thinking, it may also encourage groupthink, group polarization, and increased risk-taking. With this in mind, boost your group’s synergy by increasing impartiality, increasing direct communication, and decreasing homogeneity.

total wellness ▪ summer 2015

prevent groupthink

total wellness â&#x2013;Ş summer 2015

body in focus

say hello to your little friends bacteria & your body by monica morucci| design by natalie chong

total wellness ▪ summer 2015

The field of microbiology (the study of microorganisms) was spawned in the 17th century when the scientist Antonie van Leeuwenhoek scraped his teeth and discovered organisms that he called “animalcules.”1 These microorganisms, many of which are bacteria, represent only a small snapshot of the many microorganisms on our body. We are so outnumbered by bacteria that we are only 10% human; for every human cell in our body there are 10 microbial cells.1 However, not all of these bacteria in our bodies make us sick. In fact, the bacteria that live on and inside us, called the human microbiota, are important for many processes, from producing vitamins to regulating energy storage.1 Different regions of the body are host to unique communities of bacteria that affect our health in various ways. This article covers some basics of the human-bacteria interaction and zooms in on the bacterial communities of the mouth, the skin, and the gut.

To understand the role of these “animalcules” in our bodies, a few key terms are first defined.

definition A microorganism is an organism of microscopic size.2

example

microorganism

Microorganisms include bacteria (one group of single-celled organisms), protists (predominantly unicellular organisms that resemble plants or animals or both), and viruses (infectious agents that must inhabit a living host in order to reproduce and grow).3,4,5 All three organisms live on and inside the human body, but this article will focus on bacteria.

definition A microbiota is a collection of microorganisms existing in the same place at the same time.1

microbiota

example The human skin microbiota is all the microorganisms currently living on the skin.

definition

total wellness â&#x2013;Ş summer 2015

A microbiome represents the collective genomes (complete sets of DNA) of a community of microorganisms.6

note In publications intended for the general public, microbiota (the community of microorganisms) and microbiome (the genetic information of the microorganism community) are used interchangeably. The scientific and research communities, however, distinguish between the microbiota and the microbiome.

microbiome

bacterial beginnings from birth to bacteria It is thought that babies develop within a bacteria-free environment, but once they are born it doesn’t take long for bacterial colonization to begin.7 Within a few hours of birth babies already have bacteria in their feces. 8 A baby’s microbiota appears to be determined by specific bacteria to which the baby is exposed, both by the mother and from the surrounding environment, starting with the method of delivery. It has been shown that babies delivered through Caesarean-section have different bacterial colonies than those that undergo vaginal delivery. A baby delivered vaginally is exposed to bacteria in its mother’s vagina while a baby delivered through Caesarean section is not, resulting in colonization by different bacteria. 9 After birth, babies’ exposure to bacteria in their mothers’ breast milk and on their mothers’ skin contributes to the development of a unique bacterial community. 9 Additionally, antibiotic use by the infant is associated with decreased amounts of beneficial bacteria. 8

developing beneficial bacteria A 2006 study in Pediatrics collected fecal samples from 1,032 infants and administered questionnaires in order to find the potential determinants of infant gut microbiota. 8 The researchers found that term infants (infants delivered between the 37th and 42nd week of pregnancy) delivered vaginally at home and exclusively breastfed seemed to have the most “beneficial” gut microbiota (highest numbers of bifidobacteria and lowest numbers of Closstridium difficile and Escherichia coli). 10,8 The infant gut microbiota contains species unique to infancy. However, by the age of 2 or 3 the child starts to transition to an adult-like “microbial profile”. 9 This consists of a decrease in infant-specific bacteria and an increase in the amount of bacteria common in adults, due in part to the introduction of solid food. 11

The communities of bacteria can be completely different depending on the part of the body they’re in. According to research compiled in a 2012 Nature Reviews Genetics article, differing body parts such as the hair, nostril, skin, colon, oral cavity, stomach, and vagina have varying percentages of several groups of bacteria.12 The presence of particular bacterial species can control the bacterial composition of certain organs. For example, in the absence of the bacteria Helicobacter pylori, the stomach hosts a diversity of other bacteria. In the presence of H. pylori, however, this diversity drastically decreases and extremely well-adapted H. pylori dominates, making up 93 to 97% of the bacterial species.13 According to a 2009 review article in Gastroenterology, H. pylori

is linked to an increased risk of stomach ulcers, but its absence may be associated with an increase in esophageal diseases and childhood-onset asthma.14 There is also variation between the bacterial composition of the same location in different individuals. For example, the percentages of different bacterial species in the gut can vary from person to person. One study in Nature published in 2011 identified 3 distinct groups of humans (called enterotypes), each characterized by different bacterial ecosystems in the gut.15

total wellness ▪ summer 2015

cover: inok/istockphoto bottom right: zoran kolundzija

communities in the body

mouth bacteria-host interaction

tooth decay

Today, we know that the â&#x20AC;&#x153;animalculesâ&#x20AC;? Antonie van Leeuwenhoek observed were some of the estimated 500 to 700 species of bacteria found in the mouth.1,16 The mouth is a good place to start exploring the idea of the bacteria-host relationship, as it characterizes the interactions of all the different types of bacteria in the human body.

The phenomenon of human tooth decay is the result of the reaction of certain bacteria that live on our teeth with the food that we eat. According to a 2007 publication in The Lancet, the bacteria Streptococcus mutans, Streptococcus sobrinus, and many species of Lactobaccillus have been linked with tooth decay.17 These bacteria live on the surface of our teeth and metabolize carbohydrates like sugar and starch into weak acids. These acids can then deteriorate minerals that make up the bone of our teeth, causing decay and eventually leading to cavities.18 This seemingly simple interaction between the human host and its resident bacteria can have important consequences for oral health, demonstrating the power of the bacteria-host interaction throughout the body.

total wellness â&#x2013;Ş summer 2015

skin skin as an ecosystem

invasion

Skin, the largest organ in the body, provides 1.8 m2 of habitat for microorganisms.19 Bacterial colonization of the skin is driven by the ecology of the skin surface. Much like the geographic features of a landscape determine which organisms live in a certain habitat, the physical features of skin can influence which bacteria colonize particular areas. Drier parts of the skin, like the arms and legs, contain different types of bacteria than moist areas, like the groin and between the toes.19 Factors specific to a person, such as gender, also contribute to differences in bacterial populations. Males and females differ in the amount of sweat, oil, and hormones they produce, which in turn influences the colonization of bacteria.19

In nature, a community can be disrupted by an invasive species, which establishes itself in a habitat and competes with the native organisms for resources.20 The same thing can happen to a bacterial community living on a human, and this often leads to disease. For example, Staphylococcus epidermis usually exists on the skin as a common and harmless bacterial species. When these bacteria enter the body, however, they inhibit the function of the immune system and antibiotics. Because of this, S. epidermis is the leading cause of hospitalacquired infections from internal medical devices like heart valves.19 The concept of bacterial microenvironments as ecosystems is important in understanding the mechanisms of certain diseases.

gut The gut is host to the densest community of microorganisms on the human body, numbering 1012 bacteria per gram.1 This rich community affects many human bodily processes, from the production of nutrients to regulation of the immune system.

nutrient production

obesity

Some of the plant foods we eat contain starches and sugars that our body is unable to break down; the bacteria in our gut do this for us so that we can harvest energy.21 Bacteria not only break down carbohydrates but help to synthesize essential amino acids and vitamins as well.21 Bacteria produce precursors to vitamins B1 and B6, which help the body break down nutrients.21,22 The bodyâ&#x20AC;&#x2122;s main sources of vitamin K are leafy green vegetables and bacterial synthesis. Newborns do not yet have enough bacteria in their bodies to produce the recommended amount of vitamin K, so the CDC recommends newborns get a vitamin K shot at birth to prevent vitamin K deficiencyrelated bleeding.23

Researchers have implicated gut microbiota as a potential factor in the development of obesity, due to the gut bacteriaâ&#x20AC;&#x2122;s role in energy harvest and storage. A 2009 study in the Proceedings of the National Academy of Sciences found that obese and normalweight individuals have distinctly different intestinal communities. The researchers hypothesize that the presence of these distinct bacteria promote an increase in energy uptake from the intestine, which results in obesity.24 Studies of germ-free mice, mice that have been raised in a sterile environment and therefore have no bacteria on or in their bodies, have further tested this hypothesis. A study in Nature in 2006 demonstrated that germ-free mice colonized with the gut microbiota from obese mice gained more body fat than germ-free mice colonized with gut bacteria from lean mice.25

the brain

total wellness â&#x2013;Ş summer 2015

Increasing evidence supports the idea that the gut microbiota influences gut-brain communication. The direct mechanism of communication between bacteria and the brain is unknown, but it is likely that the gut-brain axis (GBA) plays a role.26 The GBA is the bi-directional communication route between the gastrointestinal system and the brain.26 Animal studies have shown that disruption of gut-brain communication can affect stress response and behavior.26 Just as bacteria influence the brain, the brain can also influence gut bacteria. A 2011 study in Brain, Behavior, and Immunity found that rats exposed to social stressors had significant decreases in bacterial diversity compared to unexposed rats.27 There is a need for human studies on the microbiota and the gut-brain axis, but current science suggests that the gut microbiota may play a role in the regulation of anxiety, mood, cognition, and pain.26

future of medicine As more is discovered about the human microbiome, medicine is focusing on addition or cultivation of “good” bacteria, not elimination of “bad” bacteria (through antibiotics), which often results in the elimination of good bacteria as well.

synbiotics A synbiotic is a mixture of probiotics and prebiotics. These mixtures improve the survival of probiotics in the gut by stimulating growth or activating the metabolism of good bacteria using fiber. In the future, synbiotics may be used to control an imbalanced bacterial ecosystem by using good bacteria to outcompete bad bacteria.28

fecal transplants Some infections, like Clostridium difficile, are believed to be caused by an imbalance in the gut bacterial community. C. difficile invades the intestine after the bacterial community has been disturbed, usually by antibiotic use.29 An alternative to the standard treatment of antibiotics is a fecal transplant, also called an intestinal microbiota transplantation (IMT). This involves the transplant of healthy stool (containing good bacteria) into the intestine of the affected patient.29 A 2011 review in Clinical Infectious Diseases found that this addition of healthy bacteria helps restore balance and fight the pathogenic C. difficile bacteria successfully in 92% of cases.29

bottom line The presence of bacteria in humans is often associated with disease, but new research is changing the way we think about these microscopic organisms. The population of bacterial cells on and in our bodies grows and changes as we do, eventually numbering in the trillions. These microscopic inhabitants affect everything from energy storage to mood regulation, and we discover new connections between our bacterial inhabitants and our health each year. With each new discovery, our concept of bacteria grows; soon we may no longer think of bacteria as just a cause of disease, but as a valid treatment for disease. tw

References “From structure to function: the ecology of host-associated microbial communities.” Microbiol Mol Biol Rev. (2010). “Microorganism.” wordcentral.com. (2007). “Bacterium.” wordcentral.com. (2007). 4. “Protist.” wordcentral.com. (2007). 5. “Virus.” wordcentral.com. (2007). 6. “The Human Microbiome Project: Extending the definition of what constitutes a human.” www.genome.gov. (2012). 7. “Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns.” P Natl Acad Sci USA. (2010). 8. “Factors influencing the composition of the intestinal microbiota in early infancy.” Pediatrics. (2006). 9. “Development of the human infant intestinal microbiota.” Plos Biol. (2007). 10. “Term Infant.” medical-dictionary.thefreedictionary.com. (2014). 11. “Developmental microbial ecology of the neonatal gastrointestinal tract.” Am J Clin Nutr. (1999). 12. “The human microbiome: at the interface of health and disease.” Nature Rev Genet. (2012). 13. “Comparative analysis of human gut microbiota by barcoded pyrosequencing.” PLoS ONE. (2008). 15. “Helicobacter pylori in health and disease.” Gastroenterology. (2009). 16. “Enterotypes of the human gut microbiome.” Nature. (2011). 17. “The human oral microbiome.” J Bacteriol. (2010). 18. “Dental caries.” Lancet. (2007). 19. “The Tooth Decay Process: How to Reverse It and Avoid a Cavity.” nidcr.nih.gov. (2013). 20. “The skin microbiome.” Nature Rev Microbiol. (2011). 21. “Invasive species.” britannica.com. (2014). 22. “Metagenomic analysis of the human distal gut microbiome.” Science. (2006). 23. “Food Sources of Vitamins and Minerals.” webmd.com. (2014). 24. “Protect Babies from Life-threatening Bleeding —Talk to Expectant Parents about the Benefits of the Vitamin K Shot for Newborns.” www.cdc.gov. (2014). 25. “Human gut microbiota in obesity and after gastric bypass.” P Natl Acad Sci USA. (2008). 26. “An obesity-associated gut microbiome with increased capacity for energy harvest.” Nature. (2006). 27. “Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour.” Nature Rev Neurosci. (2012). 28. “Exposure to a social stressor alters the structure of the intestinal microbiota: Implications for stressor-induced immunomodulation.” Brain Behav Immun. (2011). 29. “Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era.” Gastroenterology. (2009). 1. 2.

last: eraxion/istockphoto

total wellness ▪ summer 2015

totalwellness ›› on the cover

total wellness ▪ summer 2015

“The important thing is not to stop questioning. Curiosity has its own reason for existing ” – ALBERT EINSTEIN

cover story

A Hairy

Situation

by christopher phan | design and illustration by jackie nguyen

Did you know that the average human has over 100,000 hairs on his or her head alone?1 Whether for practical or aesthetic

types of hair

where does hair come from?

While all hair is made of keratin, (a fibrous protein also found in fingernails and toenails), there are three main types of hair on your body: lanugo, vellus, and terminal hairs.2 Lanugo hair is a very fine, soft, colorless hair found on newborn babies that is shed by around three months after birth. Vellus hair, which is most easily seen in young children and women, is the fine, short, lightly colored hair found all over the body that helps regulate body temperature. In addition to providing thermal insulation by keeping heat near the skin, vellus hair helps wick away sweat and cool skin. Terminal hair is coarser, longer, and darker than vellus hair. It grows on your head and develops in the face, armpits, and pubic regions during adolescence.

Whether growing out of your arms, legs, or head, all hair development begins the same way. Hair starts growing from the follicle, or hair root, beneath the skin. Hair follicles can vary considerably in size and shape depending on their location on the body, but they all have the same basic structure. As hair continues to grow, it pushes out of the follicle where it then becomes visible. According to a 2004 study by the Journal of Investigative Dermatology, hair follicle density is highest in the forehead region (nearly 300 follicles/cm2) compared to the back, chest, upper arm, forearm, thigh, and calf regions (around 20 follicles/cm2).3

cover: ryan lane/istockphoto

total wellness â&#x2013;Ş summer 2015

reasons, hair removal is sometimes desirable or even necessary. With the advance of technology, new treatment options have never been more abundant - so which one is right for you? Though no single method is perfect for everyone, deciding which one personally suits you best can help smooth out your experience. Read on to learn more about the pros and cons of different hair removal options; but first, letâ&#x20AC;&#x2122;s explore the different types of hair.

hair growth cycle Researchers who published a 1971 study in The Journal of the American Medical Association Dermatology observed that hair cells are among the fastest dividing cells in the human body.4 Hair follicles undergo continuous cycles of growth, shedding, and rest - a process referred to as the hair growth cycle. After hair starts to grow, the four-stage hair growth cycle begins (anagen, catagen, telogen, and exogen).5

During the anagen phase (roughly 1000 days or more), hair grows from the root, which determines the length of the hair shaft.

During catagen (about 10 days), the transition phase, the hair follicle shrinks and detaches from the skin.

The hair follicle then goes into a resting phase called telogen (roughly 100 days), during which a new follicle begins development.1

Finally, in the exogen cycle6 (a couple of days), the hair follicle is shed and the new follicle continues to grow.

Similar to programmed cell death, keratinization causes hair cells to transform into keratinized cells which eventually die, forming the visible hair outside of the skin. 7

Ingrown hairs are inflamed pustular formations8 that arise when hair in shaved areas regrows into the skin. Frequency of ingrown hairs can be caused by grooming practices, hair type, and genetic predisposition. This condition is most prevalent in men of Sub-Saharan African descent, though men and women of different ethnicities can get it in body areas where hair is coarse, abundant, and subject to removal.9 The most effective ways to prevent ingrown hairs are to apply depilatory creams, get laser hair removal, and avoid shaving. In extreme conditions when infection arises, medical treatments including topical corticosteroids and retinoids can locally inhibit hair growth.10

total wellness â&#x2013;Ş summer 2015

ingrown hairs

temporary hair reduction how it works

target areas

benefits

depilatory hair removal cream

topical creams such as eflornithine weaken the disulfide bonds and breakdown protein structures within the hair follicle, which helps remove hair11

- face - legs - bikini line11

- at home - quick and easy to apply, especially hard-to-reach areas12 - pain-free without risk of developing nicks and cuts12 - inexpensive

prescription treatments

antiandrogen medications reduce hair growth by blocking production of androgen hormones14

total wellness â&#x2013;Ş summer 2015

method

- upper lip - chin - chest - back - abdomen - arms - thighs15

- targets root source of hair growth - hair becomes softer and lighter

method

how it works

wet shaving

cuts superficial hair shafts off at skin surface level. Blade glides over wet skin to remove hair from view13

electric shaving

a fine screen glides across the skinâ&#x20AC;&#x2122;s surface, trapping hair13

waxing

hot wax is applied to clean, dry skin, followed by fabric strips that are ripped off to lift hair out by its roots13

sugaring

Sugar, lemon juice, water, and essential oils are mixed into a paste which is applied to the skin followed by a cloth that pulls out hair by the roots11

epilating

rotating cylinders with integrated tweezers to remove hairs at the root13

threading

fine threads are twined around each individual hair and then are quickly pulled, lifting hair out from the root11

drawbacks

duration

- can be messy and stinky - might cause allergic reaction on sensitive skin - not as effective on people with coarse hair - visible redness and irritation11

- lasts a few days up to a week13

- can cause skin irritation and acne - often used in conjunction with oral contraceptives to avoid pregnancy as antiandrogens can be harmful to a developing fetus15

- various, depends on how long you take the drug

target areas benefits

drawbacks

duration

- legs - underarms - face13

- cost-effective - convenient - painless - immediate11 - at home - avoids chemicals

- may leave behind stubble - hair regrows quickly - occasional nicks and cuts11

- lasts 1-3 days (men) - lasts 3-5 days (women)

- legs - underarms - face

- good for those with sensitive skin11 - ready for use at home - avoids chemicals

- may leave behind stubble - hair regrows quickly

- lasts 1-3 days

- eyebrows - upper lip - legs - underarms - bikini line13

- can be applied at a salon or at home - leaves area smooth and is long lasting - hair regrowth looks lighter and less noticeable11

- painful - can leave skin temporarily red and bumpy - hair needs to be at least 2 mm for successful removal13 - can lead to ingrown hairs

- lasts 2-4 weeks11

- legs - underarms - bikini line11

- mixtures can be homemade - easy cleanup - more comfortable than waxing - less redness after application - cheaper than waxing11

- self-made preparations are hard to maintain at proper consistency without burning - best when professionally done, which is more costly11

- lasts 2-4 weeks11

- legs - bikini area - underarms13

- pulls out multiple hairs at once - hair grows back finer13

- uncomfortable at first - may lead to ingrown hairs13

- lasts up to 4 weeks13

- facial hair - eyebrows11

- healthier for sensitive skin since no chemicals are used - relatively fast procedure16 - precise13

- hard to find a skilled practitioner - can cause acne breakout for those with severe acne - can cause redness16

- lasts 2-4 weeks16

total wellness â&#x2013;Ş summer 2015

temporary hair removal

permanent hair reduction method

how it works

target areas

laser

a single wavelength of light is directed at the skin to destroy hair follicles or inhibit hair regrowth by thermal damage17

- all body sites including facial hair11

intense pulsed light (IPL)

broad spectrum light beams are pulsed through skin to destroy hair follicles and reduce hair regrowth2

- all body sites including facial hair11

permanent hair removal method

how it works

electrolysis

stops hair growth using electrical currents using a thin probe that is placed in the hair follicle2

body image In addition to affecting physical health, hair removal can negatively impact mental well-being. Broadly defined as a mental image of the body as it appears to others,20 body image can be influenced by images of models portraying “perfect hairless figures”.21 Societal pressures from gender roles and the media often influence how people choose to idealize. According to a 2014 study in the American Journal of Obstetrics and Gynecology, more than 50% of young women aged 18-24 in the United States remove pubic hair, mostly for aesthetic reasons.22 Not only can this result in adverse health consequences such as genital burns from waxing or severe skin irritation, but it can also diminish the self-esteem of those not practicing the norm as they might be stigmatized.

“Goosebumps” occur when a muscle attached to the hair follicle contracts to cause a hair to stand straight up.

fun facts

Oil glands secrete a waxy substance called sebum onto the shaft of a hair follicle which lubricates and protects the epidermis, the outermost layer of skin.

first: terex/istockphoto last: kasiam/istockphoto

total wellness ▪ summer 2015

All around the world men and women commonly adhere to different notions of beauty in their respective cultural traditions. Current trends suggest that hairlessness is becoming more popular among women from underrepresented minorities of diverse backgrounds,22 indicative of the far reaching effect of the media. These hair grooming practices are not exclusive to women though; a 2013 report claims that between 60-70% of men remove at least some hair from the pubic area.23 Despite the increase in social pressures, the decision to remove hair should be a personal choice and well thought out.

benefits

drawbacks

duration

- large areas of skin can be treated at once

- not for all skin types and hair colors13 - expensive - thermal burns can occur

- after a series of treatments, hair reduction may be permanent for some people - usually lasts 6 months to a year13

- large areas of skin can be treated at same time - lower cost than laser treatments - less painful than laser17 - less pain during treatments18

- not always thorough - thermal burns can occur if misused - complications include pigment alteration2 - less effective than laser17

- after a series of treatments, hair reduction may be permanent for some people - usually lasts 6 months to a year13

target areas benefits

drawbacks

- all body sites including facial hair11

- expensive and time consuming - reduction may be - potential infection from an unsterilized permanent for needle some people11 - scarring11

- intended to be permanent, but some people experience hair regrowth11

duration

additional considerations health implications According to a 2013 study in the American Journal of Men’s Health, hair removal may increase the risk of potentially contracting infectious diseases as well. Researchers found that shaving body hair with a razor leaves the skin more susceptible to these diseases due to skin irritation, nicks and cuts. Another finding reported that 16% of participants would be disturbed if they were hypothetically unable to depilate and an additional 18% would have anxiety if they did not depilate for a few weeks.18 Clearly, hair can affect more than just the appearance of one’s body. While hair removal can sometimes be detrimental to health, it can also be helpful in treating particular conditions. A 2007 study published in the Journal of the European Academy of Dermatology and Venereology details a case in which laser hair removal serves as a treatment option for trichotillomania, a compulsive hair pulling disorder. After 3 cycles of IPL treatment, a woman with trichotillomania overcame the habit of pulling out hairs, a testament to the therapeutic benefits of hair removal.19 References “The Hair Growth Cycle.” pgbeautyscience.com. (2013). “Laser hair removal.” Dermatol Ther. (2011). 3. “Variations of Hair Follicle Size and Distribution in Different Body Sites.” J Invest Dermatol. (2004). 4. “Methotrexate for Psoriasis.” JAMA Dermatol. (1971). 5. “Clock genes, hair growth and aging.” Impact J: Aging. (2010). 6. “Improving stable isotopic interpretations made from human hair through reduction of growth cycle error.” Am J Phys Antro. (2011). 7. “Outer root sheath keratinization in anagen and catagen of the mammalian hair follicle. A seventh distinct type of keratinization in the hair follicle: trichilemmal keratinization.” J Anat. (1981). 8. “To grow or not to grow: Hair morphogenesis and human genetic hair disorders.” Semin Cell Dev Biol. (2014). 9. “Pseudofolliculitis Cutis: A Vexing Disorder of Hair Growth.” Brit J Dermatol. (2014). 10. “An overview of unwanted female hair.” Brit J Dermatol. (2011). 11. “Shaving Versus Depilation Cream for Pre-operative Skin Preparation.” Indian J Surg. (2011). 12. “Female Hair Removal Options.” pgbeautyscience.com. (2013). 13. “Treatment options for polycystic ovary syndrome.” Int J Womens Health. (2011). 14. “Therapy of Endocrine Disease: Treatment of hirsutism in the polycystic ovary syndrome.” Euro Soc Endoc. (2013). 15. “Body Hair Removal: Threading.” pamf.org. (2013). 16. “Photoepilation with a diode laser vs. intense pulsed light: a randomized, intrapatient left-to-right trial.” Brit J Dermatol. (2012). 17. “Correlates of Body Depilation: An Exploratory Study Into the Health Implications of Body Hair Reduction and Removal Among College-Aged Men.” Am J Men’s Health. (2013). 18. “Laser hair removal as an option for treatment of trichotillomania: a case report.” JEADV. (2007). 19. “Body, Image and Affect in Consumer Culture.” Body & Soc. (2010). 20. “Tips for Maintaining a Healthy Body Image.” pamf.org. (2013). 21. “Complications related to pubic hair removal.” Am J Ob Gyn. (2014). 22. “To let hair be, or to not let hair be? Gender and body hair removal practices in Aotearoa/New Zealand.” Body Image. (2013). 1.

bottom line From medical-grade laser treatments to homemade sugaring pastes, there are many different ways to remove hair. People around the world have varying ideas of beauty, and styling hair (or the lack thereof) is just one of the ways cultural standards are expressed. There are many additional considerations to ponder before deciding to remove hair or not, but most importantly it is a matter of personal preference. So whether you are trying to be functional or going for the latest fashion trend, consider the various options that can help you look and feel great. t w

total wellness ▪ summer 2015

feature

brighten your SMILE! by payam mirfendereski | design by shana bird

total wellness â&#x2013;Ş summer 2015

Over the last two decades, increasing numbers of individuals have taken advantage of tooth bleaching in order to enhance and beautify their smiles. Tooth bleaching and tooth whitening are often used interchangeably, both colloquially and in dental practice, but according to the International Organization for Standardization, the two have slightly different definitions. While both are cosmetic dental procedures designed to whiten and polish teeth, tooth bleaching is more specific. Tooth bleaching is in fact a form of tooth whitening that decolorizes teeth via chemical processes, and it is what millions of people refer to when they say they got their teeth â&#x20AC;&#x153;whitened.â&#x20AC;?1 Read on to learn how tooth bleaching actually works and how you can maintain a beautiful smile without damaging your teeth!

how is tooth whitening different from tooth bleaching? While “tooth whitening” and “tooth bleaching” seem to be interchangeable, it is useful to make a scientific distinction between the two. Tooth bleaching entails the removal of tooth discolorations through oxidation. The oxidation of pigment molecules in the teeth, in particular, is what leads to the increased perception of whiteness in the teeth. Tooth whitening comprises a wider range of interventions, including purely mechanical ones such as polishing and brushing with disease-preventive pastes that only remove surface stains. Tooth bleaching is therefore a chemical

procedure designed to alter the inherent coloration of the teeth, while tooth whitening is any set of chemical or mechanical procedures designed to polish the teeth for aesthetic reasons.1 Tooth whitening can be used in order to remove both extrinsic and intrinsic tooth stains, which may be caused by smoking, poor oral hygiene, drinking colored substances such as coffee or tea, and even aging. Intrinsic stains, such as those caused by aging, can be removed only through bleaching and not through mechanical procedures.2

how does tooth bleaching work? The active chemical ingredient in most tooth bleaching products is hydrogen peroxide, although chlorine dioxidebased and carbamide peroxide-based products are also available. Hydrogen peroxide, chlorine dioxide, and carbamide peroxide are all molecules that commonly engage in oxidation. Bleaching products contain anywhere between 3% and 40% hydrogen peroxide by concentration, with at-home products typically containing lower hydrogen peroxide concentrations than their in-office counterparts.1,3

Although the chemical mechanisms of tooth bleaching are not yet fully understood, it is believed that free radicals (highly reactive ions) produced by hydrogen peroxide interact with pigment molecules in the teeth to produce a whitening effect. These interactions cause changes in the light-absorbing properties of the teeth, thereby making them appear less colored and thus “whiter” to the eye. The temporary dehydration of the enamel surface is another side effect of the bleaching procedure that visibly reduces the shade of the teeth.1

how can I get my teeth bleached? Though originally practiced mainly in dental offices, tooth bleaching has expanded and diversified greatly over the last two decades. Individuals today may get their teeth bleached at a variety of locations via an even wider range of products. In addition to purchasing over-the-counter tooth bleaching products to apply at home, consumers can get their teeth bleached at malls, in beauty salons, and even on cruise ships.1 The types of bleaching products are also diverse, and include brushes, strips, and trays.1 Most brushes and strips are over-the-counter products, purchasable without a dentist’s prescription and applied by patients themselves. Individuals can choose to attach strips coated with bleaching gel to their

teeth for several hours per day for a couple of weeks until their teeth achieve the desired whiteness. Similarly, they may opt to apply hydrogen peroxide-containing gels directly to their teeth using special brushes. Trays, also called mouthguards, are personalized dental molds typically prescribed by dentists for at-home use. At-home tray bleaching typically involves applying a bleaching gel to the inside of the tray and wearing the tray either overnight or twice a day for 2 to 4 days per week.4 Tray bleaching is also common in dental offices themselves, where trays containing high concentrations of bleaching agent are applied for 30 minutes to 2 hours, producing an immediate whitening effect.3

what new methods of tooth bleaching can I use?

total wellness ▪ summer 2015

More creative methods of tooth bleaching are also patented and being perfected, but more research needs to be conducted in order to determine their effectiveness. One of these is the light-emitting toothbrush. Theoretically, this product would allow consumers to brush their teeth with hydrogen peroxide-containing paste while shining light onto their teeth from the same toothbrush, thereby harnessing the power of photobleaching in addition to the oxidative processes described above5. Another recent invention is the dry patch, which overcomes the weak adhesion exhibited by wet, gel-coated patches and strips as well as the possibility of swallowing and ingesting some of the gel. The dry patch would sidestep this complication by containing the bleaching gel within a matrix rather than on the external surface of the strips.4

which bleaching method is most effective? Many factors play a role in the effectiveness of the bleaching process, the two most influential of which are the concentration of the active ingredient and the length of time that the bleaching material has contact with the enamel, the hard white tissue that covers the visible portion of the teeth.6 For convenience, many patients use daytime or nighttime bleaching trays. Comparing the results of nighttime trays, daytime trays, in-office hydrogen peroxide products, and over-the-counter hydrogen peroxide products, a 2009 review published in Operative Dentistry found that dentist-prescribed nighttime tray bleaching is the most effective of the four. According to the review, the whiteness achieved by nighttime trays surpasses that achieved by the other three systems.6 While in-office procedures may induce a white appearance immediately after bleaching, the necessarily shorter contact time of the active agent appears to make them less effective in providing long-term results. In comparison to over-the-counter strips, moreover, trays are also less likely to allow hydrogen peroxide to get into the saliva, therefore decreasing the likelihood of adverse effects.3 For these reasons many dental offices tend to recommend tray systems as a follow-up to in-office procedures.6

how safe is tooth bleaching? hydrogen peroxide products

oral cancer

The presence of free radicals in bleaching materials has sparked a fair deal of concern throughout the years. While oxidative processes involving free radicals have been shown to be associated with aging, stroke, and other degenerative diseases (diseases which progress over time), hydrogen peroxide-based tooth bleaching is not known to produce these effects. Indeed, only very low concentrations of hydrogen peroxide are released into the mouth during the bleaching process, and the bodyâ&#x20AC;&#x2122;s natural defense mechanisms resist the little hydrogen peroxide that is swallowed and ingested during the process.1

While tooth bleaching has been claimed to be associated with an increased risk of oral cancer, research has not provided much evidence in favor of this assertion. A 2004 study published in Food and Chemical Toxicology determined that hydrogen peroxide-based tooth bleaching products are not correlated with oral cancer in either children or adults. According to the study, hydrogen peroxide is only genotoxic, or able to cause mutations in genes and thereby cancer, in vitro (within test tubes or petri dishes), and not in vivo (within the body). Moreover, due to the negligible contact of hydrogen peroxide with the mouth tissue throughout the bleaching process, bleaching products are highly unlikely to pose an increased risk for oral cancer.7

It is important to note, nonetheless, that high hydrogen peroxide concentrations may cause burns to gingival (gum) tissue upon contact. While hard enamel tissue protects the surface of the teeth from such burns, the soft tissue of the gums are quite vulnerable to ulcers, or sores on the tissue. If these burns are immediately detected (the gingival sores typically appear as white, swollen areas), water can be applied to the ulcerated area to bring the tissue color back to normal. If the bleaching gel remains in contact with the enamel for a longer period of time, though, the ulceration takes much longer to resolve. Vitamin E, rather than mere water, must then be applied to aid in the healing process.1

Nonetheless, other research is less inclined to dismissing the oral cancer debate. A 2006 review published in the British Dental Journal concluded that until further clinical research is conducted to address the question of possible carcinogenicity (ability to cause cancer), patients should not use toothbleaching products containing concentrated hydrogen peroxide without gum protection, and those with already damaged or diseased gums should avoid hydrogen peroxidecontaining products. Patients using trays should also avoid high concentrations of hydrogen peroxide (i.e. greater than 30%) and prolonged exposures to the bleaching material.3

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chloride dioxide products Tooth bleaching products containing chlorine dioxide are known to be more harmful than other bleaching products. Chlorine dioxide products are much more acidic than their hydrogen peroxide or carbamide peroxide counterparts and therefore tend to erode the enamel. Chlorine dioxide products may cause not only an irreversible reduction in enamel luster, but also increased sensitivity, irritation, and roughness in the teeth, and a greater susceptibility to restaining.1,8

gingival irritation With a reported incidence of between 5 and 50%, gingival irritation is commonly due to an ill-fitting tray, high concentrations of hydrogen peroxide, and possible contact of the hydrogen peroxide with the gums. Thus, trimming the ill-fitting tray and applying gels with lower concentrations of hydrogen peroxide should be able to reduce the risk of gingival irritation.1, 3 tooth sensitivity Tooth sensitivity, which has an incidence of up to 50%, may be caused by the penetration of the hydrogen peroxide into the pulp. The pulp constitutes the interior tissue of the teeth, and as it contains nerves and blood vessels, is particularly sensitive to hydrogen peroxide. Nonetheless, tooth sensitivity may also be prevented to some extent by using lower concentrations of hydrogen peroxide.1, 9

bottom line While often accompanied by mild adverse effects such as tooth sensitivity and gingival irritation, tooth bleaching can be a safe and relatively comfortable way of whitening one’s teeth. High concentrations of hydrogen peroxide in the bleaching material may lead to complications such as burns in gingival tissue, but the more minor side effects of tooth bleaching may often be reduced through proper application and care. The effectiveness and safety of tooth bleaching depend on many factors, including application time, active agent concentration, and the type of bleaching product. Whether performed by the dentist or by patients themselves, tooth bleaching requires regulation and monitoring. New methods of tooth bleaching are being continuously invented and promoted, and it is very likely that this simple way of enhancing one’s smile will continue to be sought after by the millions. .tw References 1. “Safety issues of tooth whitening using peroxide-based materials.” Brit Dent J. (2013). 2. “Tooth-bleaching procedures and their controversial effects: A literature review.” The Saudi Dental Journal. (2014). 3. “Hydrogen peroxide tooth-whitening (bleaching) products: Review of adverse effects and safety issues.” Brit Dent J. (2006). 4. “Patches for teeth whitening.” patft.uspto.gov. (2004). 5. “Light-emitting toothbrush and method of whitening teeth.” patft.uspto.gov. (2003). 6. “Review of the Effectiveness of Various Tooth Whitening Systems.” Oper Dent. (2009). 7. “Tooth whitening products and the risk of oral cancer.” Food Chem Toxicol. (2006). 8. “Influence of bleaching agents on surface roughness of sound or eroded dental enamel specimens.” J Esthet Restor Dent. (2010). 9. “Incidence of tooth sensitivity after home whitening treatment.” J Am Dent Assoc. (2003).

total wellness ▪ summer 2015

what are the more common side effects of tooth bleaching?

feature

the lowdown on the

high of marijuana by sarah chang | design by alison jeng

total wellness â&#x2013;Ş summer 2015

As the most popular illegal drug in

the United States, marijuana and its legalization have been hot topics in the past few years.1 On the UCLA campus, the presence of marijuana can be found from fraternity houses to apartment parties, and even in dormitory rooms. But we arenâ&#x20AC;&#x2122;t alone - according to a national sample of 1,100 students, 51% of full time university students have used the illicit drug in their lifetime.2,3

Although marijuana surrounds us, the biological effects of marijuana remain a mystery to many students. In this article, weâ&#x20AC;&#x2122;ll delve into what marijuana is, how it works in our brains and bodies, what its short and long term effects are, and some common myths about marijuana use.

Marijuana, also known as pot, hemp, cannabis, hash, weed, grass, and dope, refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa, indigenous to Central and South Asia. The main biologically active component of marijuana is delta-9-tetrahydrocannabinol (THC).3 THC is responsible for marijuana’s pharmacological effects such as reduced cognition, impaired memory, inaccurate time perception, and euphoria.4 The brain and its different parts react to THC thereby producing the psychiatric effects commonly associated with marijuana.

is marijuana safe? Research suggests that marijuana does not have significant, irreversible long term effects for overall healthy individuals unless users smoke daily and at least 5000 times in their lives. However, pre-pubescent adolescents, pregnant women, the elderly, and those with addictive disorders are more severely affected by marijuana. Furthermore, no deaths due to THC alone have been reported.4,5 However, marijuana is also associated with lung problems such as chronic bronchitis, chronic obstructive pulmonary disease, cancer, and exposure to infectious organisms such as molds and fungi. Moreover, tobacco smokers and marijuana users who were 10 years younger had a similar extent of respiratory problems.6

schizophrenia and psychosis

Cannabis is the most common illicit drug used by patients with schizophrenia, a mental disorder that causes hallucinations and an inability to distinguish between reality and fantasy. However, using marijuana can worsen the course of illness in schizophrenics.7 Increasing dosages also increase the risk for psychosis, or the loss of reality as in hallucinations, paranoia, and depersonalization (feeling of detachment from one’s body and thoughts).8 This relationship varies depending on several factors such as family history, genetics, and the age at which marijuana use began.

how does marijuana work? THC

Neurons, specialized cells in the nervous system, communicate with one another by releasing signals called neurotransmitters. The brain’s network of 100 billion neurons sends extremely fast signals, and the interconnectivity of these neurons impacts our behavior. THC can ultimately affect long term memory by mimicking the naturally-occurring neurotransmitter anandamide. Both THC and anandamide activate cannabinoid receptors.9 Cannabinoid receptors contribute to the reward pathway, which “rewards” us for carrying out activities essential to our survival, such as eating and having sex. In addition, cannabinoid receptors are found in areas of our brain that control pleasure, thinking, memory, coordination, and time perception, which are all affected by smoking marijuana. More specifically, THC interferes with the neurons’ abilities to communicate with one another. Marijuana use increases the chance that a neuron’s message will fail, a basis for uncoordinated, “sedated” behavior while experiencing a “high.” After a neuron sends a signal to the next neuron, it usually exhibits a refractory period during which it can no longer send signals. Normally, this mechanism prevents a neuron from overreacting to stimuli and encourages calmer responses to the environment. While under the influence of marijuana, the brain’s neurons lose their refractory period and repeatedly fire neurotransmitters. The neurons’ constant signaling heightens perception and imagination, causing extreme fixation on an idea. In addition, THC decreases the user’s sensitivity to certain neurotransmitters like dopamine, which induce euphoria, pleasure, relaxation, and sometimes anxiety.10 Reduced sensitivity contributes to drug craving, increased stress reaction, and aggression.

what is CBD? Cannabidiol (CBD) is another major component in the Cannabis sativa plant. However unlike THC, CBD does not cause any psychoactive effects such as memory deficits and impaired movement control. 11 Moreover, CBD may antagonize the psychoactive effects of THC and activate central nervous system regions that reduce feelings of anxiety and autonomic arousal. Cannabis strains that lack CBD result in a much higher rate of psychotic episodes. Because of this property and its similarity to THC, CBD has potential as a therapeutic medicine. However, CBD is not widely available for oral consumption by humans, and has a narrow therapeutic dose range in animal test subjects.12

total wellness ▪ summer 2015

what is marijuana?

one brain,div i ded Our brains are divided into different parts, and the interactions between these parts are complex and not fully understood. Marijuana significantly affects these labeled areas of the brain. 13

marijuana’s effect Structures comprising the amygdala play an important role in reinforcing aspect of dependence. In brain scans of young adult recreational marijuana smokers, the surfaces of right amygdala are caved inwards. Moreover, the amygdalas of long-term users were decreased in volume.14

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prefrontal cortex

> part of the limbic system and temporal lobe > is involved in memory, emotion, and fear

marijuana’s effect

Marijuana addiction involves prefrontal cortex dysfunction, which decreases the ability to stop an addiction.11 cover: foosion/istockphoto middle: illsutration/istockphoto last:tinydevil/istockphoto

normally responsible for higher cognition, decision making, goal-oriented behavior

amygdala

hippocampus important for learning and memory, specifically for converting short term memory to more permanent memory, and for recalling spatial relationships in the world about us

marijuana’s effect Heavy users performed more poorly than controls on tests of processing speed and immediate and delayed memory. However, whether or not marijuana contributed to or caused these defects is uncertain.15

grey matter

marijuana’s effect

composed of cell bodies, dendrites, axon terminals of neurons. On the other hand, white matter contains axons connecting the different parts of grey matter next to each other16

In a dose-dependent manner, adolescent marijuana use is associated with adverse academic, cognitive, behavioral, and psychiatric outcomes. A 2010 study published in Current Drug Abuse Reviews found that adolescent marijuana use was associated with decreased IQ, memory abilities, and processing speed that persisted at least 6 weeks; however, no deficits were found among users that had discontinued marijuana use for at least 3 months.

basal ganglia and cerebellum associated with regulating and coordinating movement, posture, and balance19

total wellness ▪ summer 2015

On average, adolescents who smoked at least 5 joints a week had a 4 point IQ reduction between assessments at ages 9-12 and again at 17-21. Male and female users who started marijuana before age 17 had smaller whole brain and cortical grey matter volumes and larger white matter volumes.17 The variation of grey and white matter volumes is particularly relevant to intelligence and serves to predict certain aspects of life success.18

marijuana’s effect

Learning, completing complicated tasks, participating in athletics, and driving are affected.

short and long term health effects Marijuana affects both short-term and long-term users physically and psychologically. However the interaction between genetic variables and environmental factors such as the amount used, its potency, and age of first consumption all contribute to marijuana’s overall effect on the user.

short term effects physical symptoms

The acute effects of smoking marijuana are generally calming and pleasurable. One example is increased sensory perception. Other physical effects can also include tiredness, dizziness, increased resting heart rate, dry mouth, muscle relaxation, and increased appetite.4

psychological symptoms

Sometimes marijuana usage leads to anxiety or panic. Impairment of memory, coordination, and inaccurate perception of time represent the short-term effects of marijuana.4 Because marijuana impairs coordination, smoking cannabis while driving vehicles puts drivers, passengers, and other bystanders at risk. Deficits in cognitive control, attention, learning and memory can remain within a few days of use.1 High doses of marijuana can produce temporary psychotic reactions including hallucinations and paranoia, but not everyone loses touch with reality.20,21

long term effects addiction and withdrawal

addiction: A 2006 study published in Synapse showed that in contrast to the rest of the brain, the nucleus accumbens, located in the subcortex of the brain, showed growth in length and number of dendrites in rats injected with escalating amounts of THC over time. This central part of the brain processes motivation and pleasure, and it plays an important role in addiction to the euphoria produced from drugs and reward processing. When this area of the brain is enlarged, it may become overactive and increase addictive behaviors for the rewarding and pleasing sensation. Therefore, decreased size and activation of the nucleus accumbens enhances control over addiction.14 withdrawal: In a 2012 study found in PLOS One, dependent marijuana users reported severe withdrawal symptoms. The data suggest that cannabis withdrawal is clinically significant because in heavy users, marijuana smoking is associated with functional impairment during everyday activities and relapse into usage.22 Higher levels of dependence on cannabis were associated with more severe functional impairment, but withdrawal symptoms only occurred after heavy users abruptly stopped smoking.4 The symptoms of such users are similar to those of cigarette smokers and include irritability, insomnia, uneasiness, and loss of appetite. However, withdrawal symptoms can usually subside after 2 to 12 weeks of cannabis abstinence.6

pulmonary effects

Heavy users may experience lung symptoms similar to those of heavy smokers such as airway inflammation, chronic cough, and pulmonary infections. Moreover, the methods of smoking marijuana lead to more tar and carbon monoxide in the lungs than cigarette smoking. Sharing of cannabis water pipes can also lead to pulmonary tuberculosis.11 However, a 2012 study in the Journal of the American Medical Association showed that occasional and low levels of marijuana smoking did not have adverse effects on pulmonary function. The researchers measured the lung function of tobacco smokers against that of marijuana smokers. Although maximum lung capacity decreased during the lifetimes of chronic tobacco smokers, the results of marijuana smokers did not follow a straightforward pattern. Some evidence even suggested that marijuana use increased maximum lung capacity.5

total wellness ▪ summer 2015

what are the medical uses of marijuana? Firstly, a medical marijuana card is necessary for acquiring medical marijuana. Doctors prescribe marijuana for patients with a serious medical condition such as AIDS, cancer, chronic pain, severe nausea, and other illnesses.24 In principle, medical marijuana and recreational marijuana do not differ greatly, but medical marijuana may have a higher amount of CBD to obtain more of CBD’s therapeutic effects. However, a higher CBD concentration in marijuana leads to weaker psychoactive effects, which may be less desirable for users.5

chronic pain

cancer

Medical marijuana can greatly alleviate chronic neuropathic pain and pain associated with multiple sclerosis, an autoimmune condition in which the flow of information between the brain and the spinal cord is disrupted. Neuropathic pain is a state of chronic pain in which damaged nerve fibers send unwarranted pain signals. These nerve impulses cause a change in nerve function both at the site of injury and areas around the injury. However, marijuana has little effect on people with acute pain.4

Cancer is the uncontrolled multiplication of cells in the body and lack of cell death, as well as the spread of this defect to other tissues and organs. Because cannabinoids interfere with communication throughout the body, researchers have considered the future therapeutic role that cannabis could play in treatment. One of the major advantages of cannabis in regards to cancer is the drug’s ability to target and possibly prevent tumor growth in breast, prostate, lung, pancreatic, and other cancers.25

marijuana myths and truths 1. “marijuana is a gateway drug” A gateway drug is a drug (such as alcohol or marijuana) that is thought to often lead to the use of more dangerous drugs (such as cocaine or heroin).27 Though the progression to using illegal drugs often follows the “gateway sequence” from beer and alcohol to nicotine to marijuana to hard drugs, researchers have not discovered the underlying reasons for this pattern. However, the regular or heavy cannabis use is associated with an increased risk of using other illicit drugs, abusing or becoming dependent upon other illicit drugs, and using a wider variety of other illicit drugs. In a 2006 study found in The American Journal of Psychiatry, researchers compared the “gateway sequence” to its reverse sequence (cocaine, then to marijuana). The data suggest that the occurrence of these two patterns depends on the circumstances of the marijuana user, such as proneness to delinquency and availability of the drug.27 For example, in communities with high drug availability, adolescents with lower adult supervision are more likely to smoke marijuana before alcohol or tobacco. Moreover, this reverse gateway sequence occurred in 20% of the study’s sample.25

myth

2. “smoking marijuana and driving is safe” Increased blood THC concentrations and driving within an hour after smoking were strongly associated with higher risk of an automobile accident. This effect is dose-dependent, meaning that higher doses of marijuana were correlated with higher number of crashes. Combining marijuana and alcohol use exacerbated the effect of increased crashes. In a 2013 study found in Clinical Chemistry, low and medium marijuana doses combined with 0.04% blood alcohol content (BAC) created an impairment similar to 0.09% BAC.4 The legal limit of BAC is 0.08%.

myth

the takeaway Marijuana use is associated with impaired short-term memory, and processing speed is correlated with lower IQ. Short term effects may include pleasurable relaxation, decreased coordination, decreased memory, and anxiety. Long-term effects of heavy marijuana use in adolescents could be significant, but researchers must study them further. However, research suggests that marijuana does not have significant, irreversible long term effects on adults. tw

References 1 “The Influence of Marijuana Use on Neurocognitive Functioning in Adolescents.” Curr Drug Abuse Rev. (2010). 2 “The State of Legal Marijuana Markets.” static.squarespace.com. (2014). 3 “Governor Hickenlooper’s Amendment 64 and Proposition AA Implementation Budget Request.” colorado.gov. (2014). 4 “The Therapeudic Potential of Cannabis and Cannabinoids.” Dtsch Arztebl Int. (2012). 5 “Medical Marijuana Program Frequently Asked Questions.” cdph.ca.gov. (2015). 6 “Association between Marijuana Exposure and Pulmonary Function Over 20 Years.” J Am Medical Assoc. (2012). 7 “What is Schizophrenia?” nimh.nih.gov. (n.d.). 8 “Mental Health and Depersonalization Disorder.” webmd.com (n.d.). 9 “Non-acute (residual) neurocognitive effects of cannabis use: A meta-analytic study.” J Int Neuropsychological Society. (2003). 10 “Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity.” Proc Natl Acad Sci. (2014). 11 “Marijuana: Current Concepts.” Front Public Health. (2013). 12 “Multiple mecahnisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders.” Philos Trans R Soc Lond B Biol Sci. (2012). 13 “Brain Structures and their Functions.” brynmawr.edu. (2012). 14 “Cannabis Use is Quantitively Associated with Nucleus Accumbens and Amygdala Abnormalities In Young Adult Recreational Users.” J Neurosci. (2014). 15 “Neurocognitive consequences of Marijuana -- a comparison with pre-drug performance.” Neurotoxicol Teratol. (2005). 16 “Grey Matter and White Matter.” indiana.edu. (n.d.). 17 “Functional Consequences of Marijuana Use in Adolescents.” Pharmcol Biochem Behav. (2009). 18 “Relationships between IQ and Regional Cortical Gray Matter Thickness in Adults.” Cerebral Cortex. (2006). 19 “The Basal Ganglia.” utexas.edu. (n.d.). 20 “Cannabis use and risk of psychotic and affective mental health outcomes: a systematic review.” Lancet. (2007). 21 “Cannabis affects people differently: inter-subject variation in the psychotogenic effects of Δ9tetrahydrocannabinol: a functional magnetic resonance imaging study with healthy volunteers.” Psychological Medicine. (2013). 22 “Quantifying the Clinical Significance of Cannabis Withdrawal.” PLoS One. (2012). 23 “Association between Marijuana Exposure and Pulmonary Function Over 20 Years.” J Am Medical Assoc. (2012). 24 “Neuropsychological performance in long-term cannabis users.” Arch Gen Psychiatry. (2001). 25 “Cannabinoids as therapeutic agents in cancer.” Oncotarget. (2014). 26 “Gateway Drug.” merriam-webster.com. (n.d.). 27 “Drug Abuse and Addiction.” drugabuse.gov. (2014).

3. “marijuana isn’t addictive”

total wellness ▪ summer 2015

Marijuana addiction actually occurs in 9% of users.9,12 Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.26 Heavy, regular marijuana users can develop a physiological addiction and a withdrawal syndrome comparable to heroin addiction in severity. Severe marijuana use activates cannabinoid receptors through neural mechanisms similar to those by which other drugs induce drug addiction. Furthermore, marijuana is associated with prefrontal cortex dysfunction, which inhibits marijuana users’ ability to stop the addiction.6

myth

feature

romantic relationships in modern america: dynamic and diverse total wellness â&#x2013;Ş summer 2015

by jasmine sidhu| design by natalie chong

Single and young. Same sex and married. In college and dating. Committed and living together. Because the face of relationships is diverse and ever-evolving, these relationship statuses only encompass a few of the potential combinations that Americans identify with. This makes it hard to generalize what the meaning or importance of a relationship is because many Americans change their relationship statuses and viewpoints over a lifetime. In fact, new trends in relationships are getting attention from research centers and the US government. Read on to discover what characterizes modern day relationships.

college students: what you should know College is a time for individuals to further their education so they can build a career for the future, but you never know when love may or may not hit. However, there are a few facts that every college student should be aware of regardless of whether or not they want to be in a relationship.

what does the relationship atmosphere for people of about college age (20-25) look like?

In 2013, a study published in the Journal of Developmental Psychology estimated that 33% of young adults between the ages of 20 and 25 were in a committed relationship (married or cohabiting), 27% were dating, and 40% were not in any romantic relationship.1

what are the possible benefits of a committed relationship?

Being in a relationship can possibly have beneficial effects on your health. A 2010 study published in the Journal of the International Association for Relationship Research studied 1,621 students and found that those in a relationship experienced fewer mental health problems and were less likely to be overweight or obese. In addition, those in a relationship had fewer sexual partners and thus did not encounter issues related to STDs (sexually transmitted diseases) as frequently.2

what are the three most common ways potential partners meet?

In 2012, a study published in the American Sociological Review found that potential couples were most likely to meet through mutual friends. Public locations were the second most likely way to meet, followed by the Internet (Facebook, online dating, etc.).3

how many sexually active Americans age 1524 are likely to acquire sexually transmitted diseases (STDs)?

According to the Center of Disease and Prevention, half of the 20 million new STD cases (54,000 cases a day!) diagnosed each year are among young people aged 15â&#x20AC;&#x201C;24 years, who make up only 27% of the sexually active population. Additionally, 26% of all HIV cases in America come from this age group.4

total wellness â&#x2013;Ş summer 2015

Discover what being single, homosexual, or in a long term relationship looks like in America!

single It turns out that many Americans are single these days. Personal choice, financial strain, changing lifestyles, higher education, and career commitments are some of the many potential factors that help explain why there are currently fewer relationships in America now than there were in previous decades.

how many single people are there?

At 50.2%, a record number of Americans have reported that they are single in comparison to 36% in 1976. This means that approximately 124.6 million Americans are single.5

at what age did singles report the greatest level of happiness and why?

A 2005 article published in the Review of Social Economy studied singles of various ages. The study found that singles experienced greatest overall happiness when they were in their twenties. These individuals stated that their primary sources of happiness were their independence, career, and ambitions.6

which 3 cities have the most employed single men?

+ San Jose, CA + Denver, Colorado + San Diego, CA7

what percentage of one-person households are there in America?

Based on studies conducted by the U.S. Census Bureau, there are currently about 27% one-person households in America compared to 17% in 1970.5

the rise in reported same sex couples

how many documented same sex couples are there in America?

726,600

which region of America has the most same sex couples?

District of Columbia

which state has the lowest number of same sex couples?

Wyoming

what percentage of same sex couples are unmarried?

74%

what percent of same sex couple households have children?

approximately 20%

how many people identified being in a same sex marriage in 2013?

According to the U.S. Census Bureau, in total 251,403 of all reported same sex couples were married.

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total wellness â&#x2013;Ş summer 2015

With a majority of U.S. states legalizing same sex marriage, more same sex couples have the opportunity to take a long term relationship to the next level. Consequently, the U.S. Census Bureau has documented a rise in the number of same sex couples, both married and unmarried.5

the deal about marriage While marriage is on the cards for some individuals, new research finds that many Americans are marrying later or rejecting the idea of marriage altogether. Whatever your stance on marriage may be, there is no doubt that its role in American society is being redefined.

According to a 2014 study conducted by Pew Research Center, 46% of the public believes that society is better off if people make marriage and having children a priority. 50% of the public believes that society is just as well off if people have priorities other than marriage and children. The remaining 4% are indifferent.7

how many Americans 25 or older have never been married?

1 in 5 Americans 25 or older have never been married. This is a historic high. The marriage rate has been cut in half since 1960.7

what is the average age of marriage for men and women?

Based on studies conducted by the US Census Bureau, the average age people get married in the United States is at a historic high: 27.6 for men and 25.9 for women.

history Lesson: What was the average age of marriage for men and women in the 1960s?

+ 20 years old for women + 23 years old for men7

what’s the average age difference between spouses?

77% of married couples are within 5 years of each other’s age

what is the couples’ biggest concern?

Researchers concluded in a 2011 study published in the Journal of Marriage and Family that a lack of financial stability was the main reason couples fell apart. In some cases, it was correlated with increased violence and abuse within the relationship.8

total wellness ▪ summer 2015

what is the public perception regarding marriage?

cohabitation: a growing alternative Although Americans are not getting married at the rates that they used to, cohabitation has become a popular option for many young Americans. Some see it as a way to test the strength of a relationship while others find it to be a useful way to deal with rising financial costs in the midst of a downhill economy.5,7

what percent of never-married Americans from ages 25 to 34 live with a partner?

According to the March 2013 Current Population Survey, about 24% live with a partner.

what percentage of cohabitation relationships led to marriage after one year?

Based on the National Center for Health Statistics, 30% of cohabiting partners married while 68% continued to cohabitate.

what percentage of cohabitors have partners whose ages were within 5 years of one another?

68%

what is the main problem young couples who cohabitate face?

In 2010, the Journal of Family Psychology found that young couples living together were especially sensitive about finances. In fact, money troubles were found to be a potential source of physical violence, insecurity, and infidelity.8

bottom line Love is an unpredictable but integral part of life. It’s important for individuals to realize that there is no perfect time to find romantic love and there is no ideal way to express it because relationship dynamics are constantly changing. Since the 1960s, more Americans have chosen to remain single, pursue same-sex marriage, postpone marriage, and live together. Remember that love comes in many different forms: patience is key, and no one can predict when a relationship might happen! In the meantime, be the best you!

References “Romantic Relationships in Young Adulthood and their Developmental Antecedents.” Dev Psychol. (2013). “Romantic relationships and the physical and mental health of college students.” J of Int Ass. of Rel Research. (2011). “Searching for a Mate: The Rise of the Internet as a Social Intermediary.” Amer Soc Rev. (2012). 4. “Sexually Transmitted Infections Among Young Americans.” cdc.gov. (2014). 5. “America’s Families and living Arrangements.” census.gov. (2013) 6. “Happiness Research: State and Prospects.” Rev of Soc Econ. (2005). 7. “As Values, Economics, and Gender Patterns Change.” pewresearch.org. (2014). 8. “Economic Factors and Relationship Quality Among Young Couples: Comparing Cohabitation and Marriage.”J Marriage Fam. (2011). 1. 2.

total wellness ▪ summer 2015

decoding the nutrition

by catherine wang| design by natalie chong

When was the last time you had salmon, kale, or flaxseed in a meal? How about sunflower seeds, pistachio nuts, or chicken? Although many people commonly ingest these foods, their impact on oneâ&#x20AC;&#x2122;s health and the reasons behind their significance are often overlooked. These foods are rich in omega 3 and omega 6 fatty acids, but which foods are rich in which fatty acid? And why does it matter? Many people confuse omega 3 fatty acids with omega 6 fatty acids. This article will help clear up the difference between the two, and uncover why the ratio of one to another is so important.

total wellness â&#x2013;Ş summer 2015

all you need to know about omega 3's & 6's

what are omega 3’s and 6’s? Omega 3’s are essential fatty acids (EFAs) that are important for good health in a variety of ways. It is a polyunsaturated fatty acid (PUFA), which means that it has more than one doublebond in its chemical structure. The body obtains from food because it cannot synthesize omega 3’s on its own.1

Omega 6’s are also EFAs that are important for good health. It is also a polyunsaturated fatty acid that the body cannot synthesize on its own, differing from omega 3’s in its structure.2 While both are PUFAs, each fatty acid plays a unique role in helping you maintain a healthy body.

what they do and how

total wellness ▪ summer 2015

When omega 3’s and 6’s are consumed, they are incorporated into cell membranes and affect a number of cell functions, such as membrane transport across cells, enzyme properties, phagocytosis (cell engulfs particles), exocytosis (cell secretes particles), etc.3 Omega 3’s and 6’s are also important precursors for the synthesis of cell signaling molecules. These cell signaling molecules are often involved in cell growth & development and modulating inflammation.3 The ratio of omega 3: omega 6 is important because these two PUFAs compete for incorporation into cell membranes, as both incorporate into cell membranes of all tissues in the body.4

omega 3

benefits

risks

Omega 3’s can help lower triglyceride levels in the blood by decreasing lipogenesis, the formation of fat.5 This is beneficial because higher triglyceride levels lead to higher risk of heart disease.

As beneficial as omega 3’s are to your health, ingesting too many omega 3’s comes with risks. A study published in the Journal of the National Cancer Institute found a link between omega-3 fatty acid consumption and increased risk of prostate cancer in men.7 The study, which compared 834 men with prostate cancer to a group of 1,393 men randomly selected from 35,000 participants, found that men had a 43% higher risk of developing prostate cancer with the highest levels of omega 3 fatty acids. They also found that men had a 71% chance of developing high-grade prostate cancer, which is more likely to be fatal.7 Another finding from the study was that omega 3’s can convert into compounds that can damage DNA, which is a possible connection as to why ingesting omega 3 fatty acids can increase the risk of prostate cancer in men.

Omega 3’s also help reduce inflammation responses by serving as precursors for anti-inflammatory lipids. Because of this anti-inflammatory property, omega 3’s can help arthritis patients by alleviating joint pain. A small number of studies have found that omega 3’s can help lower the risk of developing depression. These studies have suggested that when omega 3’s are incorporated into cell membranes, serotonin, the “happiness neurotransmitter,”, can more easily pass through the cell membrane.14 Additionally, omega 3’s are important for normal brain development and function by supporting the plasticity of neuronal connections.6

benefits

risks One risk omega 6’s present is that omega 6 fatty acids can increase triglyceride levels, which increases the risk for heart disease. One doctor, who is the chairman of Cleveland Clinic’s Wellness Institute, stated that omega 6’s cause inflammation in the arteries and the immune system, increasing the risk of cancer and atherosclerosis (plaque buildup in arteries). Omega 6 supplements are not recommended if one has high triglyceride levels.4

omega 6

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Like omega 3’s, omega 6’s also provides the body with many benefits. Like omega 3’s, omega 6’s also play a role in brain function and normal growth and development. They also help stimulate skin and hair growth, maintain bone health, regulate metabolism, and maintain the reproductive system in a healthy state. A metabolically important omega-6 PUFA is arachidonic acid. Arachidonic acid is the precursor for the synthesis of eicosanoids. Eicosanoids activate platelets and leukocytes, which are important for clotting and immune system activation. These eicosanoids are also involved in the signaling of pain and the regulation of gastric secretions.4 Omega 6’s may also alleviate arthritis pain, reduce allergy symptoms, ADHD, eczema symptoms, and hypertension.

the importance of the omega 3: omega 6 ratio A study published in Biomedicine and Pharmacotherapy found that excessive amounts of omega 6 PUFAs and a low omega 3: omega 6 ratio promote the development of many diseases, such as inflammatory diseases, cardiovascular disease, and cancer. A low omega 3: omega 6 ratio is common in today’s Western diets. The study also showed that increased levels of omega 3 PUFAs and a high omega 3: omega 6 ratio had disease suppressing effects.8

So what is the ideal omega 3: omega 6 fatty acid ratio?

Several sources suggest that humans evolved with a diet of a 1:1 ratio of omega 3: omega 6 fatty acids.8 The American Heart Association (AHA) does not have an ideal ratio published, but they recommend higher levels of omega 3 fatty acids and lower levels of omega 6 fatty acids. AHA recommends 1.6 grams/day for men and 1.1 grams/day for women of omega 3 fatty acids. For omega 6 fatty acids, AHA recommends at least 5-10% of daily calories from omega 6’s.9

other ways to incorporate a healthy omega 3: omega 6 ratio into your diet Fish oil supplements are rich in omega 3 PUFAs, which are important in preventing and managing heart disease.10 They also might help lower blood pressure, reduce triglyceride levels, slow the development of plaque in arteries, reduce likelihood of a heart attack and stroke, and lower the chance of sudden death for those with heart disease. AHA recommends up to 3 grams of fish oil supplements daily, but a doctor’s advice should still be seeked out before starting a daily fish oil supplement regimen. Fish oil supplements are a main source of omega 3 PUFAs, but may not be completely suitable for vegetarians. Ingestion of micro-algae oil can lead to significant increases in red blood cells and DHA, an omega 3 fatty acid.11 More research is needed to conclude the optimal amount that should be incorporated into vegetarian diets, but algae oils appear to be promising.

conclusion

References “Omega-3 fatty acids.” nlm.nih.gov. (2011). “Understanding the Omega Fatty Acids.” webmd.com. (2011). “Membrane lipid composition and cellular function.” J of Lipid Research. (1985). 4. “Polyunsaturated Fatty Acids, PUFAs.” supplementscience.org. (2013) 5. “Why do omega-3 fatty acids lower serum triglycerides?” Current Opinion in Lipidology. (2006). 6. “Scientists Learn How Food Affects the Brain: Omega 3 Especially Important.” sciencedaily.com. (2008). 7. “Omega-3 Fatty Acids Linked to Increase in Prostate Cancer Risk.” cancer.org. (2013). 8. “The importance of the ratio of omega-6/omega-3 essential fatty acids.” Biomedicine and Pharmacotherapy. (2002). 9. “Omega-3 and Omega-6 Fatty Acids.” ianrpubs.unl.edu. (2010). 10. “Omega-3 Fish Oil Supplements for High Blood Pressure.” www.webmd.com. (2013). 11. “Bioavailability and Potential Uses of Vegetarian Sources of Omega-3 Fatty Acids: A Review of the LIterature.” Crit Rev in Food Sci and Nutr. (2013). 1. 2. 3.

cover: oytun karadayi/istockphoto middle: luknaja/istockphoto last:juefraphoto/istockphoto

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Omega 3 and omega 6 fatty acids are essential for one’s diet, as the body cannot synthesize these fatty acids on its own. The most common sources for omega 3’s are fish, such as salmon and tuna, leafy green vegetables, such as kale, and seeds, such as flaxseed. The most common sources for omega 6’s are borage seed oil, pine nuts, pistachio nuts, and olive oil. Omega 3’s can help lower blood pressure, while omega 6’s can activate cells for blood clotting. Aim to consume more omega 3’s than 6’s. Some common places to acquire omega 3 and omega 6 fatty acids are health food stores, farmer’s markets, and even dining halls like Bruin Plate. tw

total wellness â&#x2013;Ş summer 2015

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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:

a hairy situation

Seong Choi, MD, Infectious Diseases Fellow, UCLA David Geffen School of Medicine

Carolyn Goh, MD, UCLA Dermatology

constipation: when you gotta go but your bum says no

Edward McLaren, DDS, MDC, Clinical Professor, UCLA School of Dentistry

Lin Chang, MD, Professor of Medicine, Director, Digestive Health and Nutrition Clinic, UCLA David Geffen School of Medicine

juicing: body cleansing or nutrient depleting?

Eve Lahijani, MS, RD, Nutrition Health Educator, UCLA Office of Residential Life

understanding e-cigarettes

Michael Ong, MD, PhD, Associate Professor, Department of Medicine, General Internal Medicine and Health Services Research, UCLA Jonsson Comprehensive Cancer Center Linda Sarna, PhD, RN, FAAN, AOCN, Acting Dean, UCLA School of Nursing

the pros and cons of group work Miguel Unzueta, PhD, Associate Professor of Management and Organizational Behavior, UCLA Anderson School of Management

brighten your smile

the lowdown on the high of marijuana

Mark Kleinman, PhD, MPP, Professor of Public Policy, UCLA Luskin School of Public Affairs

all you need to know about omega 3’s and 6’s

Dolores Hernandez, MA, RD, Nutrition Education Coordinator, UCLA Dining Services

romantic relationships

Benjamin Karney, PhD, Professor of Social Psychology, UCLA

copy-edits and review

Julia Feygelman, Tiffany Lin, Pavan Mann, Rebecca Tang, Annie Theriault

layout revisions Natalie Chong

cover & table of contents Designed by Natalie Chong

say hello to your little friends: bacteria and your body Huiying Li, PhD, Assistant Professor,

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