Peace of Mind

total wellness

a ucla student wellness commission publication

peace of mind

+

loving your body

ways to boost your

brain health overcoming

social anxiety how to improve

communication in relationships

spring 14 | vol 14 | issue 3

a message from the director In our pursuit of total wellness, we are often reminded to eat well, move well, and keep our body in focus. However, mental health typically remains in the background since it is a topic most people prefer not to discuss. With the stigma commonly associated with mental diseases, those who think they may be suffering from these conditions are often hesitant about seeking help due to concerns that their friends, family, classmates, coworkers, etc. will find out. Other times, people do not know where they can go for help.

Nevertheless, according to the Centers for Disease Control and Prevention, about 1/4 of US adults suffer from a mental illness.1 Furthermore, the World Health Organization (WHO) estimates that globally more than 450 million people have mental disorders.2

total wellness ▪ spring 2014

In recognition of the prevalence of mental illnesses and the importance of mental health in overall wellness, Total Wellness consistently makes an effort to inform our readers on topics relating to mental wellbeing through our mind well column. We further expand our dedication to mental health education through this issue’s theme on achieving a peace of mind. With this issue, we strive to make resources on mental wellbeing more accessible and to also emphasize the importance of tending to our mental health needs. As Active Minds (our fellow committee in the Student Wellness Commission) states, “Not everyone has mental illness, but everyone has mental health.”

What exactly is mental health? According to WHO, mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”2 However, the US Department of Health and Human Services reports that only approximately 17% of US adults are in a state of optimal mental health.3 This data suggests that about 83% of adults in the US can benefit from embracing lifestyle practices that can help promote mental health. As a result, we dedicate this issue to resources for a peace of mind so that our readers can gain the tools necessary to work towards improved mental wellbeing and overall wellness.

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In this issue, you’ll uncover a wide array of article topics – from social anxiety and how to calm your nerves (pages 20-23) to games for boosting brain health (pages 16-19). You’ll also find a guide to depression and how to beat the blues (pages 44-48).

Additionally, because mental health problems are often related to body image issues, our cover story focuses on the dangers behind the pursuit of bodily perfection, the science behind why these “ideals” are unattainable, and steps for a new perspective to loving your body (pages 30-37).

If you’re suffering from a mental illness or just working towards improving your mental health in general, we hope that this issue of Total Wellness provides you with the foundation you need to get started. To learn more about mental health, we invite you to check out workshops and additional educational materials through UCLA Counseling and Psychological Services (CAPS), Healthy Campus Initiative (HCI): Mind Well, and Student Wellness Commission: Active Minds.

Cheers to your health and your peace of mind,

Shannon Wongvibulsin Director and Editor-in-Chief References 1.

“CDC Mental Illness Surveillance.” cdc.gov. (2013).

2.

“Mental health: strengthening our response.” who.int/en. (2010).

3.

“Mental Health: A Report of the Surgeon General.” National Institute of Mental Health. (1999).

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.

editor’s note

leadership

In this issue, we focus on what I think is the most important aspect of wellbeing: mental wellness. Total Wellness covers a wide variety of topics, typically centered on taking care of the body, but it’s hard to bother with good physical health if you don’t have the peace of mind necessary to appreciate it!

But it’s not a dichotomy – it turns out that, in many cases, taking good care of your body is synonymous with taking good care of your mind. And it makes sense, doesn’t it?

Your mind is a part of the body, after all. Many articles in this issue illustrate how things known to help general bodily wellness, such as good nutrition and adequate exercise, can improve mental wellbeing as well. For example, check out how exercise can promote happiness on pages 13-14. Learn about some lifestyle factors that can influence depression symptoms on pages 44-48. And finally, see how dietary factors can help maintain healthy levels of dopamine in our Q&A section on page 7.

While traditional healthy habits can maintain or improve mental wellbeing just by positively influencing the body, the mind requires some specific care as well. Check out how to nurture your relationships using science-backed communication techniques on pages 24-28. See how road rage could have a medical cause on pages 39-43. Exercise your mind with some information from our mind games article on pages 16-19. And finally, learn about social anxiety disorder, an extreme form of shyness (pages 20-23), and the rising tide of prescription drug abuse (pages 49-53).

JULIE ESCOBAR Co-Copy Editor

TIFFANY LIN Co-Copy Editor

BARBARA WONG Co-Art Director

KARIN YUEN Co-Art Director

LESLIE CHANG Managing Editor

ANNIE THERIAULT Outreach Director

HARINI KOMPELLA Finance Director

KEVIN SUNG Webmaster

To finish, I wanted to introduce you all to our amazing cover story, titled In Pursuit of Bodily Perfection, which is an overview of just how ridiculous our concept of “the perfect body” is, and what kinds of problems it can cause for the mind.

This article also reports some surprising potential harms of dieting and explains why it’s important to diet healthily.

With that, I hope you enjoy this issue!

Wishing you physical health as well as peace of mind,

total wellness ▪ spring 2014

Chalisa Prarasri Editor-in-Chief

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total wellness words from the commissioner Hello Bruins!

I hope your Spring Break was relaxing and refreshing! With spring quarter already underway, we here at the Student Wellness Commission have a jam-packed quarter filled with events! Besides our usual weekly CPR and First Aid classes, we have our biggest week of the year this quarter: Bruin Health Week. Bruin Health Week is a SWC tradition, and this year we’ve made it bigger than ever. Throughout fourth week (April 21st-27th), we will have new and exciting programming every day dedicated to a specific health topic.

Bruin Health Week’s themes are as follows: Monday is sexual health, Tuesday is mental health, Wednesday is EARTH Day, Thursday is Wellness & Physical Health, Friday will feature student health organizations that are a part of our Student Health Network, Saturday is our annual Super CPR event, and Sunday is our 15th annual Bruin Run/Walk 5K! Whew, with so many events throughout the week, we are enlisting the help of our fellow student health organizations, campus resources (such as Counseling & Psychological Services, the Ashe Center, the Community Programs Office, etc.), and other student government (USAC) offices!

Director and Editor-In-Chief Editor-In-Chief Co-Art Director Co-Art Director Managing Editor Co-Copy Editor Co-Copy Editor Finance Director Outreach Director Webmaster

Shannon Wongvibulsin Chalisa Prarasri Barbara Wong Karin Yuen Leslie Chang Julie Escobar Tiffany Lin Harini Kompella Annie Theriault Kevin Sung

Staff Writers Peter Chu, Julia Diana Feygelman, Sally Kim, Grace Lee, Sofia Levy, Tiffany Lin, Pavan Mann, Halee Michel, Jennifer Miskabi, Allison Newell, Lillie Luu Nguyen, Sepideh Parhami, Vesta Partovi, Elsbeth Sites, Rebecca Tang, Emily White, Pauline Yang Design Shana Bird, Nicole Chang, Natalie Chong , Emily Hsu, Chika Matsumoto, Allison Newell, Catrina Pang, Mary Sau, Jessica Sun, Annie Theriault, Alexandria Villanueva, Barbara Wong, Helena Wong, Shannon Wongvibulsin, Karin Yuen Web Erik Jue, Mary Sau Outreach Shana Bird, Sydnie Bui, Nicole Chang, Sarah Chang, Peter Chu, Michelle Do, Catherine Hu, Alyssa Lok, Pavan Mann, Zoë Merrill, Omid Mirfendereski, Payam Mirfendereski, Monica Morucci, Allison Newell, Brian Khoa Nguyen, Niyati Patel, Christopher Phan, Jasmine Sidhu, Rebecca Tang, Nancy Vu, Emily White, Danielle Zola Advisory & Review William Aronson, MD

Professor, UCLA School of Medicine

Susan Bowerman, MS, RD, CSSD

Assistant Director, UCLA Center for Human Nutrition

Leah FitzGerald, RN, FNP, PhD

Assistant Professor, UCLA School of Nursing

Dena Herman, PhD, MPH, RD

Adjunct Assistant Professor, UCLA School of Public Health

Eve Lahijani, MS, RD

Nutrition Health Educator, UCLA Bruin Resource Center

Melissa Magaro, PhD

Clinical Psychologist, UCLA Counseling and Psychological Services

total wellness ▪ spring 2014

In addition to Bruin Health Week, we are collaborating with CAPS’ Campus Assault Resources & Education (CARE), the Clothesline Project, 7000 in Solidarity: A Campaign Against Sexual Assault, and SWC’s own Gender Health committee to bring you events throughout April, which is Sexual Assault Awareness Month. With 1 in 3 women and 1 in 6 men experiencing sexual violence throughout their lifetime, the Student Wellness Commission is dedicated to educating the student body on sexual consent, bystander intervention, and what sexual assault resources are available to students.

We hope you’ll come to at least one event throughout the month!

Those are just some of the events the Student Wellness Commission is hosting this quarter. To check out the rest of them – and there are many, many more – please visit our website at swc.ucla.edu!

Stay Happy & Healthy, Savannah Badalich

William McCarthy, PhD

Adjunct Professor, UCLA School of Public Health

Rena Orenstein, MPH

Assistant Director, Student Health Education

Allan Pantuck, MD, MS, FACS

Associate Professor, UCLA School of Medicine

Julie Skrupa, AADP, CHHP

JWellness101, Owner and Health Coach

Raffi Tachdjian, MD, MPH

Assistant Clinical Professor, UCLA School of Medicine

Elisa Terry, NSCA-CSCS

FITWELL Services Program Director, UCLA Recreation

Alona Zerlin, MS, RD

Research Dietitian, UCLA Center for Human Nutrition

Total Wellness is a free, student-run, publication and is supported by advertisers, the 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 www.swc.ucla.edu Subscription, back issues, and advertising rates available on request

Savannah Badalich SWC Commissioner

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Volume 14, Issue 3 © 2014 by Total Wellness Magazine. All rights reserved. Parts of this magazine may be reproduced only with written permission from the editor. Although every precaution has been taken to ensure the accuracy of the published material, Total Wellness cannot be held responsible for the opinions expressed or facts supplied by authors. We do not necessarily endorse products and services advertised. The information in Total Wellness is not intended as medical advice and should not replace the advice of your physician.

Always consult a health care provider for clarification.

contents IN EVERY ISSUE 02 03 04 06 07 55

A Message from the Director Editor’s Note & Leadership Words from the Commissioner In the News Q&A Credits

DEPARTMENTS

16

08 self care Breathe Easy: Your Guide to Air Purifiers

49

10 eat well Seeds in Our Diets 13 move well The Science Behind Happiness and Exercise 16 mind well Mind Games 20 mind well Taking Nerves to the Next Level: Social Anxiety Disorder 24 body in focus “You Said What Now?” Communication and Relationships

08

54 decoding the nutrition label Carrageenan

30 cover story In Pursuit of Bodily Perfection 39 The Biological Basis of Road Rage 44 Beating the Blues 49 Prescription Drug Abuse

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ON THE COVER 16 20 24 30

total wellness ▪ spring 2014

cover: aleksandarnakic/istockphoto; right(in order): ineskoleva/istockphoto; firina/istockphoto; serts/istockphoto; nico_blue/istockphoto; hadel productions/istockphoto

FEATURES

Brain Health Social Anxiety Communication Loving Your Body

10 5

in the news

what’s happening in health? by chalisa prarasri| design by barbara wong

RESEARCH AND NEW FINDINGS Most common and scientific sources claim that the human nose can tell the difference between 10,000 different odors, but according to a study published recently in Science, this number is off by a lot. Apparently, the number 10,000 was never tested scientifically – so these scientists decided to measure how well people can tell smells apart. It was found that the human nose can distinguish between at least 1 trillion (that’s 1,000,000,000,000) different smells.

Since human eyes can distinguish between up to 7.5 million colors, and human ears can hear around 340,000 different tones, the researchers concluded that the nose may actually outperform our other senses by a good margin.1

AT UCLA

total wellness ▪ spring 2014

UV EXPOSURE MAY HELP SKIN CANCER CELLS MIGRATE

A recent study published in Nature suggests that exposure to UV light may activate certain immune cells, thus improving the ability of melanoma cells to move along blood vessels and spread to other parts of the body. While it is well-established that unprotected exposure to UV radiation can contribute to the development of melanoma, a type of skin cancer, this study explored the effects of repeated UV exposure on mice engineered to have melanoma. It was found that the UV-damaged skin cells released a chemical that activates immune cells, thus producing an inflammatory response. This inflammatory response somehow enhanced melanoma expansion along blood vessels and increased the likelihood that the cancer would spread to the lungs. This coincides well with observations in human models in which people with ulcerated melanoma tumors (with a lot of inflammation near them due to the ulceration) have a higher risk for also having melanoma in their blood vessels, as well as a higher risk for metastasis (the spread of cancer to the other parts of the body).2

MUSCLE MASS FOR LONGEVITY?

Muscle mass may be a viable predictor of longevity, according to a recent study published in The American Journal of Medicine. There is inconsistent evidence suggesting that having a higher Body Mass Index (BMI) can increase the chance of death from any cause in older adults.

BMI is a measure of body fat composition that takes into account a person’s weight and height.

However, this measure may be flawed because a person’s weight is made up of both muscle and fat, each of which can have different effects on the body. Thus, this study analyzed the effect of muscle mass index (a measure of total muscle mass that takes height into account) on longevity in 3,659 older adults who were followed between 1988 and 2004. It was found that the older adults with the highest muscle mass index scores (top 25%) were 19% less likely than the group with the lowest scores (lowest 25%) to die of any cause. This study suggests that it may be useful to look at more than weight when assessing an older adult’s health.3

CIGARETTE SMOKING RELATED TO BRAIN CHANGES IN YOUNG SMOKERS

A recent article published in Neuropsychopharmacology found evidence suggesting that just a few years of smoking can lead to changes in brain structure. Previous studies have shown that there may be a difference in brain structure between longtime smokers and non-smokers, but this study aimed to see how short-term smoking (a few years’ worth) in young adults aged 16 to 21 can affect brain structure. They focused on the insular cortex, a part of the brain that monitors internal states and contributes to decisionmaking – and which is also considered a key player in smoking behavior and dependence.

Despite the relatively little time that the young adults tested had spent smoking, more time spent smoking, as well as an increased urge to smoke, were each correlated with thinner insular cortices on the right side of the brain.

However, the researchers warned that this study shows correlation, not causation, and the insular thickness could be related to genetic factors leading to smoking, rather than being the result of smoking.4 t w References 1.

“Humans Can Discriminate More than 1 Trillion Olfactory Stimuli.” Science. (2014).

2.

“Ultraviolet-radiation-induced inflammation promotes angiotropism and metastasis in melanoma.” Nature. (2014).

3.

“Muscle Mass Index as a Predictor of Longevity in Older-Adults.” Am. J. Med. (2014).

4.

“Cigarette Exposure, Dependence and Craving are Related to Insula Thickness in Young Adult Smokers.” Neuropsychopharmacology. (2014).

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NUMBERS

26

approximate percentage of US adults with depression

28.8 estimated percentage of US adults who have had an anxiety disorder

36.2 million

americans paid for mental healthcare in 2006

cdc, nih

left: spxchrome/istockphoto; right: original illustrations by mary sau

THE HUMAN NOSE IS BETTER THAN WE GIVE IT CREDIT FOR

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q&a

Q: A:

what is dopamine?

what does dopamine do?

Dopamine relays messages across cells of the reward system. Psychology has identified 2 components to the reward circuitry: 1) anticipation of positive stimulation and 2) experiencing the pleasure post-action.5 With this duality of pleasure, dopamine is partially to blame when it comes to why we're so easily addicted to that which society warns us to do in moderation – things like drugs, gambling, alcohol, sex, junk food, and social media, which all stimulate the reward circuitry.6 Aside from its role in reward, dopamine is also involved in motor control: research has traced certain mechanisms behind movement like motor learning, inhibition, and error detection to brain regions targeted by dopamine.6

first, the bad news what happens when there is a dopamine deficit in the brain?

Parkinson's disease (characterized by extreme loss of motor control and stiffness, usually after the age of 50) and attention deficit hyperactivity disorder (ADHD, usually diagnosed in children with difficulty inhibiting thought processes or movements) are both associated with low dopamine concentrations in the brain.6

what about overproduction of dopamine?

Too much dopamine flooding the brain can result in psychosis (e.g. schizophrenia), compulsive behavior, or addiction.3,6

what are common causes of improper dopamine levels?

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and now the good news how does one support healthy levels of dopamine?

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you are what you eat: The European Food Safety Authority (EFSA) gathered a panel of scientists who confirmed that a diet with adequate levels of tyrosine correlates to normal dopamine production.8 In the body, tyrosine can be synthesized from phenylalanine,1 another amino acid found in meat.9 Look for foods like soy, eggs, cheese, seaweed, fish, and turkey to boost tyrosine intake4 and pork, beef, fish, and turkey to increase phenylalanine concentrations in the body.9 › keep an eye on dietary saturated fat levels: Over the long term, a high-fat diet may make the brain less responsive to dopamine surges.10 A 2013 study published in PLOS ONE demonstrated that rats fed with a diet dominated by fat showed mild responses to high doses of cocaine.10 This suggests that saturated fats can blunt sensitivity to dopamine, making the brain crave more and more of a substance or behavior to feel the reward. The experiment used only saturated fats (e.g. those in lard and butter) to come to this conclusion, so further research is needed to study the role of unsaturated fats in dopamine reabsorption. › prescription medication: In the case of schizophrenia, Parkinson's, ADHD, or drug addiction, dopamine agonists (which activate signaling pathways in the absence of bodyproduced dopamine) or antagonists (which block receptor activation)11 can sway the balance of dopamine in the desired direction (see First, the Bad News mentioned previously in this article).

how is dopamine being studied in interdisciplinary fields (like neuroeconomics)?

Neuroeconomics applies economic principles to explaining how humans allocate brain function. A 2012 study in Behavioral and Brain Sciences proposed that dopamine levels associated with an action may correlate to the perceived worth of that activity, much like a cost-benefit analysis in economics.12

in short

Dopamine is a neurotransmitter involved in reward, pleasure, and motor control. Genetics, aging, or drug abuse can result in deficits in the dopamine circuitry, but medication and proper nutrition can restore healthy functioning. t w

References 1.

“Dopamine – Compound Summary.” pubchem.ncbi.nlm.nih.gov. (2013).

2.

“Dopamine, learning, and reward-seeking behavior.” Acta Neurobiol. Exp. (2007).

3.

“Dopamine – A Sample Neurotransmitter.” utexas.edu.

4.

“Foods highest in Tyrosine.” nutritiondata.self.com. (2013).

5.

“Variation in dopamine genes influences responsivity of the human reward system.” PNAS. (2008).

6.

Linden, D. J. The Compass of Pleasure. New York City: Penguin Group (USA) Inc. (2011).

7.

“DrugFacts: Stimulant ADHD Medications -- Methylphenidate and Amphetamines.” drugabuse.gov. (2014).

8.

“Scientific Opinion on the substantiation of a health claim related to L-tyrosine and contribution to normal synthesis of dopamine pursuant to Article 13(5) of Regulation (EC) No 1924/2006.” EFSA J. (2011).

9.

“Foods highest in Phenylalanine.” nutritiondata.self.com. (2013).

10.

“Prolonged High Fat Diet Reduces Dopamine Reuptake without Altering DAT Gene Expression.” PLOS ONE. (2013).

11.

“Pharmacological Glossary.” tocris.com. (2014).

12.

“An opportunity cost model of subjective effort and task performance.” Behav. Brain Sci. (2012).

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total wellness ▪ spring 2014

genetics: Variation in genes can cause problems with the receptors that receive dopamine’s signals. Research suggests that up to half of the risk factor in developing these disorders comes down to heredity.6 › aging: Certain late-onset disorders like Parkinson’s, propelled by the loss of dopamine from 2 key brain regions, are considered degenerative. This means that symptoms get worse and worse as time progresses, and in the case of Parkinson’s, both dopamine levels and motor control fall off irreversibly.6 › drug abuse: A class of drugs known as stimulants (which includes cocaine, amphetamines, and caffeine) delivers an energizing “hit” by blocking dopamine reuptake, leaving it to build up among brain cells.3,6 Dependence on stimulants can be exacerbated by genetic factors.6 However, in controlled doses, amphetamines can correct symptoms of ADHD by increasing dopamine to proper levels.7

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by sepideh parhami | design by mary sau

Dopamine is a neurotransmitter, a molecule that sends chemical signals among nerve cells.1 It is one of the main neurotransmitters of the reward system,2 a collection of brain regions responsible for pleasure and pain, motivation, addiction, and muscular control.3 Dopamine comes from chemical modification of the amino acid tyrosine,1 which is either produced in the body1 or introduced via certain protein-rich foods.4

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self-care

breathe easy: your guide to air purifiers by emily white| design by catrina pang

Many air purifiers available claim to relieve a whole spectrum of respiratory woes, and while that sounds great, how useful are they really? With so many types to choose from, how do you decide which one is right for you? And even then, what should you look for? In this guide to air purifiers, all these questions are answered to help you start breathing a little bit easier. what’s the point?

According to the Environmental Protection Agency, indoor air pollution is among the top 5 environmental health risks in the US.1 It is also estimated that nearly 60 million Americans suffer from allergies or asthma due to airborne particles like dust, pet dander, mold, pollen, or smoke.1-2 Although most homes and buildings are equipped with ventilation systems to combat indoor air pollution, personal air purifiers can further remove these pollutants (also known as particulate matter) that may contribute to asthma or allergies.1 By removing floating triggers from indoor air, allergy and asthma symptoms may be managed more effectively.3

what is there to consider?

There are generally 3 critical attributes to keep in mind when selecting the best purifier:4

efficiency: Can the filter catch a wide range of particle sizes? capacity: How much can the filter effectively hold? airflow: What is enough for proper ventilation?

A balance of these 3 traits will help find the device with the longest life and greatest effect. Other things to consider include the filter’s size, noise level, cost, and maintenance level. Many varieties available advertise a range of features to increase efficiency and safety, so it is important to choose the best for your particular situation. Moreover, the only rating system in place for air purifiers was created by the manufacturers, so there are no independent health ratings or standards monitored by the FDA that judge a purifier’s usefulness.2 This makes it difficult to distinguish between more than just technical aspects of filters, but more effective filters are likely to improve health the most. Consumer Reports urges buyers to weigh all features carefully in order to have the most success purchasing an air purifier.6

The 2 most common types available are HEPA filters and ionizing electrostatic devices, which both remove particulate matter from indoor air.4

total wellness ▪ spring 2014

high-efficiency particulate air (HEPA) filters: HEPA filters work by mechanically fanning particles through the device, trapping them in an internal filter.1

ionizing electrostatic devices: Ionizers work by charging particles as they enter the filter, causing them to stick to a metal plate.5

plants: Even plants can remove various harmful compounds from indoor air. Read Living Air Purifiers in Issue 4, Volume 13 for more information about these all-natural air purifiers.

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left: firina/istockphoto; milea/istockphoto; right: karammiri/istockphoto; karammiri/istockphoto; cynoclub/istockphoto

what kinds are there?

are they even useful?

Maybe. Some filters are better than others. HEPA filters are generally the most efficient at removing airborne pollutants that may contribute to allergies and asthma. A number of studies suggest that HEPA filters may relieve asthma symptoms when placed in the bedroom, combined with air conditioning and frequent cleaning.5,7 They may also help to manage asthma symptoms in households with pets by minimizing dander.4 It is still unclear as to whether air filters alleviate symptoms of respiratory diseases, but they could be a helpful component of indoor air quality improvement to minimize respiratory stress. A number of other studies also suggest that portable air cleaners (both HEPA or electrostatic) can greatly reduce indoor pollutants and dust concentration, though the exact benefit this reduction has on respiratory health is unclear.3,8 Furthermore, some air cleaners may be able to protect against certain airborne disease pathogens like tuberculosis, chicken pox, and measles.9

how can you use a purifier safely? follow all maintenance guidelines: Understanding the

filter’s technology and procedures will ensure the purifier’s safe use as recommended by the Ontario Health Technology Assessment Series in 2005.9 Be sure to change or clean the filter often to ensure it is working in top condition.

know the risks: Ionizing purifiers are more likely to release

harmful byproducts like ozone, a reactive relative of oxygen, which can damage respiratory tissues and make asthma symptoms worse, as seen in a study by the Journal of Allergy and Clinical Immunology in 2010.5 According to the Journal of Toxicological Sciences in 2010, models of air purifiers that release reactive oxygen species (like ozone) into the air were specifically linked to DNA damage in the lungs after prolonged exposure.10

When used correctly and maintained appropriately, air purifiers are an effective way to remove pollutants from an indoor environment. Whether or not the removal of these pollutants actually helps with the symptoms of allergies or asthma is unclear. However, the use of an air purifier in conjunction with other techniques to reduce indoor air pollution may be a good step to alleviate respiratory stress and allergic symptoms. tw References 1.

“Guide to Air Cleaners in the Home.” epa.gov. (2012).

2.

“Allergy Facts and Figures.” aafa.org. (2010).

3.

“Control of asthma triggers in indoor air with air cleaners: a modeling analysis.” Environ Health. (2008).

4.

“Effectiveness of Air Filters and Air Cleaners in Allergic Respiratory Diseases: A Review of the Recent Literature.”

Curr Allergy Asthma Rep. (2011).

5.

“Air filters and air cleaners: Rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee.” J Allergy Clin Immunol. (2010).

6.

“Air purifier buying guide.” consumerreports.org. (2014).

7.

“Environmental Issues in Managing Asthma.” Respir Care. (2008).

8.

“The effects of intervention with local electrostatic air cleaners on airborne dust and the health of office employees.” Indoor Air. (2005).

9.

“Air cleaning technologies.” Ont Health Technol Assess Ser. (2005).

10.

“Air purifiers that diffuse reactive oxygen species potentially cause DNA damage in the lung.” J Toxicol Sci. (2010).

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

total wellness ▪ spring 2014 9

eat well

seeds in our diets by elsbeth sites | design by helena wong

prevent heart disease and diabetes Chia seeds are an excellent source of unsaturated fat. Many studies note the correlation between high saturated fat and low unsaturated fat intake with health issues such as heart diseases and diabetes. A balanced diet that contains fats mainly from unsaturated sources (such as the ALA found in chia seed) and that is low in saturated fat-rich foods (like whipped cream or butter) may have cardioprotective benefits.2

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increase fullness after eating Incorporating chia seeds into one’s diet may also promote satiety after a meal. In a study conducted by the University of Florida in 2012, control subjects ate plain muffins while another group ate muffins baked with 40% of the flour replaced with ground chia seeds. After monitoring the hunger of the subjects every 10 minutes for a total of 90 minutes, the researchers found that the majority of the participants who ate the chia muffin felt fuller when compared to the control group, suggesting that chia in food products may keep post-meal hunger at bay.5

chia seeds

total wellness ▪ spring 2014

what nutrients do they contain?

The seed of the Salvia hispanica plant (part of the mint family) is more commonly known as the chia seed. In 2012 the Journal of Biomedicine and Biotechnology reported that it is a rich fiber source as each seed is 18 to 30% fiber.

Chia is made of about 15 to 25% protein and 26 to 41% carbohydrate. Minerals, vitamins, and dry matter constitute 90 to 93% of the seed. It also contains many antioxidants, is gluten free, and is an excellent source of omega-3 fatty acids.2 Chia seeds are one of the best sources of an essential fatty acid, alpha-linolenic fatty acid (ALA), which is believed to treat and prevent blood vessel and heart diseases.3

what can they do?

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reduce blood sugar A study by the European Journal of Clinical Nutrition in 2013 assessed whether ingesting seeds of the Salvia hispanica plant may attenuate the effects of carbohydrates in raising blood sugar levels in healthy people. Preliminary data suggest that eating Salba (a very purebred Salvia hispanica seed) when baked into bread can decrease the after-meal blood sugar spikes.4

how to incorporate them into your

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baked goods Chia seeds can be baked into cookies or muffins with little change to the original recipe.

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toppings Their crunchy texture makes them a popular choice for yogurt and oatmeal toppings.

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smoothies and beverages When blended into a smoothie, their very subtle flavor doesn’t detract from the sweetness of the fruits. Chia seeds can absorb up to 9 times their weight in liquid and are easily suspended in liquids, making them an interesting add-in to beverages for their texture and substantial volume.

left: hadel productions/istockphoto; right: pepifoto/istockphoto; riverlim/istockphoto

In the past decade, seeds have been touted as being small vessels of bountiful nutrients – sprinkle-able ways to nutritionally enhance any meal. They are often considered ‘functional foods’, or foods that may provide additional health benefits, reduce disease risk, or promote good health.1 In particular, chia, flax, and hemp seeds have vastly increased in popularity. These seeds are rumored to increase fullness after eating, reduce food cravings, prevent heart disease, lower cholesterol, and much more.

Can such tiny things be so powerful?

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flax seeds what nutrients do they contain?

Flax seeds are derived from the Linum usitatissimum plant and are often called linseeds. They contain soluble fiber and carry all 9 essential amino acids. Like chia seeds, flax seeds are one of the richest sources of ALA. For this reason, they have been advocated to combat heart disease.

According to a 2000 article published in Poultry Science, adults are recommended to consume daily 2.22 g of ALA based on a 2000 kilocalorie diet, but the typical North American diet provides only about 1.4 g of ALA per day.6 Getting the daily recommended amount of ALA could help to treat or prevent heart and blood vessel diseases.

Flax seeds also contain lignans, which are estrogen-like chemicals produced by plants (phytoestrogens). Containing 85.5 mg lignan per 1 oz, flax seeds are by far the richest natural source of plant lignans. Though diets rich in foods containing plant lignans have been consistently associated with reductions in risk of cardiovascular disease and cancer, exactly how they aid the human body is not clearly understood.7

what can they do? reduce cholesterol A study by The British Journal of Nutrition in 2008 found significant reductions in total blood cholesterol (22%) in subjects with high cholesterol after an 8-week dietary supplementation with 600 mg per day of chemicals derived from flax seed.8

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prevent atherosclerosis Atherosclerosis is the hardening and thickening of the arteries through a build up of cholesterol and triglycerides within the arterial walls. Severe atherosclerosis may result in a total or partial blockage of blood flow, or a piece of the clot may break off and travel down the bloodstream.

This makes atherosclerosis a serious condition, as it can lead to heart attack or stroke.9 Flax seeds have shown to reduce the development of atherosclerosis caused by cholesterol by 46% in rabbit models, according to a 2009 study published in the Journal of Cardiovascular Pharmacology. Flax lignans appear to slow the progression of atherosclerosis, but have no effect in its regression. Overall, suppression of atherosclerosis is associated with lowering the amount of lipids in the blood.10

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may reduce risk of breast cancer It is thought that lignans may play a role in preventing estrogen-dependent cancers, such as breast cancer. The lignans function as antioxidants and through mechanisms not yet fully understood, may slow cell growth and thus suppress tumour growth. A 2013 study in Cancer Causes & Control claims to be the first study to report an observed association between women’s flax seed intake and breast cancer occurrence, and has found that flax seed consumption could be correlated with a reduction in breast cancer risk.11

how to incorporate them into your diet

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baked into snacks Flax seeds are used similarly to chia seeds in baked goods and toppings but are also often incorporated into store bought cereals and crackers.

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egg substitute in baking Grind seeds in a food processor (or purchase already ground seeds), and replace each egg with a tablespoon of ground seeds mixed well with 3 tablespoons of water. Let sit at room temperature for 10 minutes or in a refrigerator for 20 minutes to an hour. It is ready to use when it has the gooey consistency of an egg white.

total wellness ▪ spring 2014

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note: beware of spoilage They have a shorter shelf life than chia seeds, especially when ground, and can spoil in 1 week in the pantry or 1 month if refrigerated.12

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hemp seeds

conclusion

what nutrients do they contain?

The hemp plant is a variety of cannabis that is grown for its seed and fiber. Its seeds are perfectly safe and legal to eat as they contain very little tetrahydrocannabinol (the psychoactive compound of marijuana). Like flax, each seed contains all 9 essential amino acids. According to a 2010 article published in Nutrition & Metabolism, about 25% of a seed’s dry weight is protein and about 28% is fiber.

Hemp seeds are one of nature’s best plant-based sources of essential fatty acids. Like the aforementioned seeds, they are also a great source of ALA.13

what can they do?

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antioxidant properties According to a 2000 study published in The Journal of Nutraceuticals, Functional & Medical Foods, hemp seeds contain tocopherols (vitamin E compounds) which have both antioxidant and possibly anticancer properties and are present in sufficient quantities in hemp seed oil. However, this has not been widely studied.14

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anti-inflammatories Hemp seeds contain a particularly beneficial fatty acid called gamma linolenic acid (GLA). Ingested hemp seeds deliver a healthy dose of GLA which is a direct building-block of anti-inflammatory hormones that may reduce inflammation in arthritis and possibly allergic reactions.14

The nutritional properties of these seeds are quite similar, especially chia and flax, as they are abundant sources of the essential fatty acid ALA and fiber. They can be great supplements to a balanced diet and likely offer fantastic health benefits, though further research is needed.

With active ingredients that can increase the nutritional value of daily meals, they can be considered handy functional foods that easily add an interesting and healthy boost to many meals. tw

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hemp seed oil Hemp seed oil is produced by pressing the seeds.

Some people use hemp seed oil as a dietary supplement rather than taking fish oil capsules.

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hemp milk Hemp milk is produced by grinding hemp seeds that have been soaked in liquid. This can be used as a dairy substitute, such as for cereal or in cooking.

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a crunchy topping The taste of the raw seeds is often compared to the flavor of pine nut, allowing the seed to be sprinkled onto nearly anything as they have a very unobtrusive flavor. They frequently appear blended into smoothies and sprinkled on hot cereals.

References 1.

“What are Functional Foods?” eatright.org. (2013).

2.

“The Promising Future of Chia, Salvia Hispanica L.” J Biomed Biotechnol. (2012).

3.

“Alpha Linolenic Acid.” webmd.com. (2009).

4.

“Effect of whole and ground salba seeds on postprandial glycemia in healthy volunteers.” Eur J Clin Nutr. (2013).

5.

“Influence of Chia Seed on Satiety.” University of Florida. (2012).

6.

“Human Requirement for N-3 Polyunsaturated Fatty Acids.” Poult Sci. (2000).

7.

“Lignans” lpi.oregonstate.edu (2005) 8.

“Dietary flaxseed lignan extract lowers plasma cholesterol and glucose concentrations in hypercholesterolaemic subjects.” Br J Nutr (2008).

9.

“Atherosclerosis” heart.org (2013).

10.

“Flaxseeds and Cardiovascular Health” J Cardiovasc Pharmacol. (2009).

11.

“Consumption of Flaxseed, a rich source of lignans, is associated with breast cancer risk” Cancer Causes & Control.

(2013).

12.

“Shelf Life of Flaxseeds.” eatbydate.com. (2012).

13.

“The cardiac and haemostatic effects of dietary hempseed.” Nutrition & Metabolism. (2010).

14.

“The Composition of Hemp Seed Oil and Its Potential as an Important Source of Nutrition.” J Nutraceut Function Med Foods. (2000).

left: kjekol/istockphoto; thebroker/istockphoto; right: ariwasabi/istockphoto

total wellness ▪ spring 2014

how to incorporate them into your diet

move well

the science behind

happiness and exercise by grace lee | design by shana bird

Most of us are already familiar with the fact that exercising regularly can have benefits such as maintaining a healthy weight and improving cardiovascular health. As if we need yet another reason to exercise, there is also the suggestion that physical activity may also improve one’s mood and increase feelings of happiness. Here are several ways exercising can positively affect our emotions.

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exercise can lower instances of depression

In 2014, the European Archives of Psychiatry and Clinical Neuroscience1 released a study focusing on a group of individuals being treated for Major Depressive Disorder (MDD), a medical condition that includes symptoms such as feelings of hopelessness, insomnia, fatigue, and suicidal thoughts.2 They found that exercising 3 times a week may help improve the patients’ moods. However, a regular exercise program may be a more effective way of helping a patient overcome depression, according to an article by Harvard Health Publications. Though antidepressants cause the swiftest response in helping depression, studies show that the effects of exercise lasted longer than antidepressants, and that patients who regularly exercised were less likely to relapse.3

exercise can help manage stress

The Journal of Sports Medicine and Physical Fitness released a study in 2001 that demonstrated that aerobic exercise may decrease tension, fatigue, and anger.4 Another study in 2004 by Behaviour Research and Therapy found that both high and low intensity aerobic exercise may reduce anxiety sensitivity.5 Besides reducing the symptoms of stress, exercise in general can also help boost one’s self confidence as well as improve one’s sleep – all of which can ease stress levels. On a more personal level, exercise may distract people from the daily worries of life, boosting their energy and helping them feel that they are more in control over their lives.6

exercise can cause the release of “happy” brain chemicals According to a 2004 article by Psychiatria Polska, the positive effects of exercise on an individual’s mood may be because of how exercise causes the brain to release endorphins and monoamines.7

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Endorphins are neurotransmitters, or brain chemicals, released into the body after exercising. They primarily combat feelings of pain and stress. They can also have other positive effects, such as improving the immune system, modulating the appetite, and creating a feeling of euphoria.8

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Monoamines are also neurotransmitters but their functions are less clear.9 However, an article published by Brain Sciences in 2013 suggests that monoamines may play a role in helping the brain recover from mental disorders. It can also protect the brain against stress and relieve anxiety, as well as improve one’s memory and ability to learn.10

the bottom line Overall, while exercise can have long-term health effects on the body, its mood boosting effects are almost instantaneous, as it occurs while you are working out.

Next time you need an incentive to hit the gym, don’t forget that exercise is not just good for your physiological health, but for your mental health as well! tw

For instance, Preventative Medicine published a study in 2000 that claimed that exercise not only enhanced psychological wellbeing, but that it also helped ease feelings of anger and cynical distrust while helping participants maintain stronger feelings of social integration.11 Moreover, the American Psychological Association has been encouraging exercise as a way of combating depression and anxiety. It is believed that through exercise, people can achieve a sense of accomplishment that can help them return to meaningful activity.12 Focusing on physical activity can also help them forget about the negative aspects of life by focusing on the movements required for physical activity, putting the participant in a meditative state.6

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References 1.

“Effects of acute exercise on mood and well-being in patients with major depressive disorder.” Med Sci Sports Exerc. (2005).

2.

“Major Depressive Disorder.” mentalhealth.com. (2011).

3.

“Exercise and Depression.” health.harvard.edu. (2014).

4.

“The effects of exercise on mood changes: the moderating effect of depressed mood.” J Sports Med Physical Fitness. (2001).

5.

“Effects of aerobic exercise on anxiety sensitivity.” Behav Res Ther. (2004).

6.

“Exercise and stress: Get moving to manage stress.” mayoclinic.com. (2014).

7.

“Effects of exercise on anxiety, depression and mood.” Psychiatr Pols. (2004).

8.

“Endorphins: Natural Pain and Stress Fighters.” medicinenet.com. (2014).

9.

“Function and pharmacology of monoamine neurotransmitters.” ucl.ac.uk. (2014).

10.

“Exercise Benefits Brain Function: The Monoamine Connection.” Brain Sci. (2013).

11.

“Exercise enhances creativity independently of mood.” Br J Sports Med. (1997).

12.

“The Exercise Effect.”apa.org. (2014).

left: phildate/istockphoto

total wellness ▪ spring 2014

exercise can be psychologically beneficial

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total wellness ▪ spring 2014

• • • •

mind well

mind games

games on the rise In the 1990’s, as science and technology advanced, exercising the brain to improve cognition and memory became a new hot topic. Now, there are numerous websites, smartphone applications, and even retail stores (for example, Marbles: The Brain Store) dedicated to brain fitness! The question is, what exactly do these brain exercises do and are they effective?

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so what are these brain games?

As a normal part of aging, our brains, like our bodies, get tired and can atrophy and degenerate.1 However, it is thought that brain exercises may slow our brains’ aging by promoting brain cell growth, nerve cell connections and communication, and growth of brain tissue.2 Subsequently, it is thought that this growth might improve cognition, accelerate information processing, improve memory and reasoning, prevent Alzheimer’s and dementia, and maintain neuroplasticity (brain elasticity). Overall, these brain games might strengthen and broaden a healthy, uninjured brain’s “cognitive reserve”, also known as the brain’s capacity for cognitive processes.3

left: jamtoons/istockphoto; ineskoleva/istockphoto

total wellness ▪ spring 2014

by sofia levy | design by chika matsumotoa and barbara wong

cognition While some research shows that playing brain games is a potentially beneficial activity, much more research needs to be done on brain workouts to see their effect on common cognitive processes and the brain’s cognitive reserve. However, it is difficult to measure cognitive ability, improvement, or decline. Nevertheless, here some studies indicating that being cognitively active and stimulated does not hurt, especially for older adults: A 2006 study published

by The National Academy of Sciences of the USA showed that, with an intensive training program meant to maintain brain plasticity and cognitive function, mature adults showed great improvement in their memory and cognitive ability.4

A 2013 study for The Public Library of Science revealed that Brain Age, a brain training game, may improve executive functions (such as problem solving and planning) in the brain, working memory, and processing speed in young adults.5

A 2012 study published in The Public Library of Science showed that Brain Age could also help the elderly with shortterm cognitive functions such as executive functions and processing speeds, although the long-term effects and benefits regarding daily activities is unknown.6

However, despite these studies, other studies currently conflict in their results regarding computerized brain games and their effects. A 2012 study for The Public Library of Science claimed that computerized cognitive training is an effective alternative to traditional pencil-and-paper cognitive training for older adults.7 However, a 2012 study in Frontiers in Human Neuroscience, showed that online games meant for training aging brains only slightly improved cognitive control in healthy older adults.8

alzeheimer’s and dementia Other topics in need of research include brain exercises and their impact on Alzheimer’s disease and dementia. Several studies show that brain stimulation can slow down the onset of symptoms of Alzheimer’s and dementia, which tend to appear after age 60,9 while other studies cannot prove that it prevents or delays dementia.3 As previously mentioned, it is suggested that brain exercises improve general brain processes such as memory, reasoning, and processing information; these improvements are also reckoned to aid individuals with daily life activities and can last for different amounts of time depending on the training and tasks performed.2 On the contrary, researchers have not yet been able to identify specific activities or combinations of brain exercises that have provided measurable effects on Alzheimer’s disease and dementia.3 *** Although these studies are not conclusive, it seems to be better to strengthen the brain through cognitive exercises rather than not exercise the brain at all. In other words, brain stimulation is a good idea, but not a guarantee for improving or preventing anything within the brain. ***

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let the games begin...

It turns out there are tons of ways to stimulate our brains with tangible exercises or with conceptual workouts:1,10

› Testing your memory and recall

› Engaging all of your senses

› Working on a puzzle

› Playing a board game

› Learning something new

› Doing math in your head

› Listening to or studying music

› Paying close attention

A 2012 study conducted for Trials displayed that although certain cognitive functions decrease with age, cognitive training, specifically learning therapy which includes reading out loud and solving simple math problems, can improve various cognitive functions that are used daily such as executive functions, working memory, episodic memory, short-term memory, and processing speed in healthy elderly adults.11

The following may also be good ways to stimulate your brain:

› sleep: A study published in the World Journal of

› exercise: A 2008 study published in the

Biological Psychiatry in 2010 claims that slowwave sleep (a part of the sleep cycle) can help long-term memory and learning.12

Cochrane Database of Systemic Reviews shows that exercise, which brings oxygen to the brain, is likely to improve cognition in older adults.13 Additionally, exercise can help improve cognition by helping the growth of new brain cells. Check out Exercise: Can It Improve Cognition? in Issue 1, Volume 14 for more information.

› meditation and limiting stress: A 2012 study

in Neuroimage found that long-term meditation practitioners had a thicker corpus callosum (the part of the brain that joins the two hemispheres), which might increase brain connectivity and hemispheric integration.14

Although more research needs to be done, avoiding passive activities (such as watching TV or boredom) and instead engaging in activities such as laughter and enjoyable social interactions may stimulate the brain.1,10

a game for the brain

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in order: jamtoons/istockphoto; aldo murillo/istockphoto

total wellness ▪ spring 2014

Try completing this word search to give your brain a challenge!

other ways to possibly boost your brain health A healthy-brain diet can be helpful, consisting of less fat and cholesterol1 and more fruits and vegetables, water, and omega-3 fatty acids.10 There are some studies that suggest that these eating habits can lead to a healthy brain:

1 2 3 4 5

A 2013 study in Ageing Research Reviews showed that omega-3 fatty acids can possibly help delay brain deterioration, as they can strengthen the connections between brain cells, decrease inflammation in the brain, and promote the growth of brain cells. Thus, omega-3 fatty acids are a potential aid in maintaining memory and cognitive functioning.15 A 2000 study in the Journal of the American College of Nutrition and a 2012 study in Central Nervous System Agents in Medicinal Chemistry both showed that eating foods that are rich in choline (a compound similar to vitamin B) such as eggs helps promote healthy brain and memory development, especially during pregnancy and lactation when the mother’s choline levels are lower.16-17 A 2012 study in The Journal of Nutrition, Health & Aging showed that eating vegetables is associated with a delayed cognitive decline.18

It is also known that lack of a healthy diet can lead to diabetes and obesity, which can disrupt the central nervous system, peripheral organs, and,higher brain functions, according to a 2012 study for the Japanese Journal of Psychopharmacology.19

A 2013 study in AGE also found that certain compounds in coffee may reduce cognitive deficit in aging.20

in conclusion While more information is needed on whether or not brain games and exercises are effective in improving or simply maintaining cognitive function, some research has shown that they might be beneficial.

Hence, go ahead and do the exercises since they certainly are not detrimental to your brain! tw

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total wellness ▪ spring 2014

References 1.

“Brain Exercises That Boost Memory.” everydayhealth.com. (2014).

2.

“Brain Exercises and Dementia.” webmd.com. (2014).

3.

“Healthy Brain Aging: Role of Cognitive Reserve, Cognitive Stimulation, and Cognitive Exercises.” Clin Ger Med. (2010).

4.

“Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study.” PNAS. (2006).

5.

“Brain training game boosts executive functions, working memory, and processing speed in the young adults: A randomized controlled trial.” PLoS One. (2013).

6.

“Brain training game improves executive functions and processing speed in the elderly: A randomized controlled trial.” PLoS One. (2012).

7.

“Computerized cognitive training with older adults: A systematic review.” PLoS One. (2012).

8.

“Online games training aging brains: limited transfer to cognitive control functions.” Front Human Neurosci.

(2012).

9.

“Alzheimer’s Disease Fact Sheet.” nia.nih.gov. (2014).

10.

“How to improve your memory.” helpguide.org. (2014).

11.

“Beneficial effects of reading aloud and solving simple arithmetic calculations (learning therapy) on a wide range of cognitive functions in the healthy elderly: study protocol for a randomized controlled trial.” Trials.

(2012).

12.

“Slow wave sleep and the consolidation of long-term memory.” World J Biolog Psych. (2010).

13.

“Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.” Cochrane Database Syst Rev. (2008).

14.

“Bridging the hemispheres in meditation: thicker callosal regions and enhanced fractional anisotropy (FA) in long-term practitioners.” NeuroImage. (2012).

15.

“Omega-3 fatty acids and brain resistance to ageing and stress: Body of evidence and possible mechanisms.”

Age Res Rev. (2013).

16.

“Choline: Needed for normal development of memory.” J Am Coll Nutr. (2000).

17.

“Choline nutrition programs brain development via DNA and histone methylation.” Cent Nerv Syst Agents Med Chem. (2012).

18.

“Fruits, vegetables and prevention of cognitive decline or dementia: a systematic review of cohort studies.”

J Nutr Health Ageing. (2012).

19.

“Coffee, but not caffeine, has positive effects on cognition and psychomotor behavior in aging.” AGE. (2013).

20. “[Effects of diabetes and obesity on the higher brain functions in rodents].” Japanese J Psychopharmacol.

(2012).

mind well

taking nerves to the next level: social anxiety disorder by halee michel | design by annie theriault

If you have social anxiety disorder, the world is a stage and you’re constantly the center of attention.

The butterflies in your stomach rarely leave.

In fact, these feelings of nervousness and fear dictate your life to the point where you avoid social interactions to prevent these feelings from reoccurring. Social anxiety disorder (SAD) is an extreme level of shyness. Read on to learn more about this disorder as well as its causes, implications, and current methods of treatment.

Social anxiety disorder (SAD) is the overwhelming fear and avoidance of social situations. It is a common anxiety disorder found in about 7% of the population in America.1 This fear can be so strong that it impairs individuals from carrying out everyday tasks. People with this disorder usually obsess over social scenarios weeks before they occur. Some social situations that seem completely normal to most people appear daunting to those with SAD. Examples of these situations include eating in front of

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prevalence others, speaking to others, making eye contact with others, and using public restrooms. Other general examples that may lead to anxiety include initiating conversations, meeting new people, giving presentations, and dating. Any public scenario can give individuals with SAD anxiety.2 Interestingly enough, most people with SAD realize that they shouldn’t be as afraid as they are. However, in most situations, they’re usually unable to control their fears without help from a doctor.3

According to a 2008 review from Neuropsychiatric Disease and Treatment, 7 to 13% of the general population will develop SAD at some point in their lives.

Sometimes people with SAD don’t realize they have this disorder.

Other times this condition is recognized but never fully cured.

Like any anxiety disorder, SAD takes time to cure and can last a lifetime.

This review also states that females, younger adults, and those of lower socioeconomic standing tend to demonstrate higher rates of SAD.4

left: andreaskermann/istockphoto; right: alxpin/istockphoto

total wellness ▪ spring 2014

what it is

potential chronic effects According to the aforementioned 2008 review, people with SAD will often avoid everyday activities in work or school situations. In these contexts they avoid asking questions, feel uncomfortable refusing requests, and/or may be afraid to socialize. They are also more likely to misuse drugs and alcohol and are less likely to marry compared to those without SAD. In addition to the previous setbacks, patients with SAD often have additional disorders. Other conditions that co-occur with SAD include depression, substance abuse, and other anxiety disorders. Furthermore, patients with SAD and an additional disorder typically experience a lower quality of life and more impairment than those with SAD alone.4

types of SAD The severity of this disorder varies from person to person. According to a 2013 review in the Clinical Practice and Epidemiology in Mental Health, there are 2 types of SAD.

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specific SAD People with specific SAD experience symptoms when confronting certain social situations, like public speaking.2

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generalized SAD People with generalized SAD, the more serious subtype, experience symptoms when confronting a wide array of social situations. According to the 2008 review mentioned previously, patients with this subtype tend to have a family history of SAD.4

signs and symptoms:3

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Anxious before talking with others Self-conscious in front of other people Embarrassed in front of other people Afraid of judgment from other people Avoid public places Difficult time making and maintaining friends Experience nausea when talking with other people Sweat, tremble, and/or blush around others

According to Michael Treanor, PhD, a post-doctoral fellow at the UCLA Anxiety Disorders Research Center, numerous factors contribute to the development and maintenance of SAD. These factors are not only limited to neurobiological ones. Other factors that can contribute to SAD include genes, examples of social anxiety in others, negative social experiences, and any other experiences that may reinforce social anxiety.

Doctors are looking at regions of the brain related to fear and anxiety in order to expand their knowledge on the causes and potential treatments of SAD.3 A 2001 study in the American Journal of Psychiatry used positron emission tomography (PET) scans to explore brain areas that are activated in response to anxiety in people with and without SAD during public and private speaking incidents. The study showed that increased levels of anxiety in those with SAD correlated with an increase in blood flow to the amygdala, a region of the brain associated with fear. This study suggests that SAD could be occurring because people with this disorder have unusually high activation in fear-related brain areas during social activities.5

diagnosis Doctors generally diagnose a patient with SAD if the individual experiences these symptoms for at least 6 months. After a patient reports these symptoms, a doctor conducts a physical exam to make sure that another condition isn’t causing the aforementioned symptoms.3 During this physical exam the doctor may check vital signs, take a complete blood count, test the chemistry panel, conduct thyroid tests, and/or carry out other laboratory tests.6 Without diagnosis and treatment, this condition can last a lifetime. Sometimes patients are referred to a mental health specialist to treat their specific conditions.3

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› › › › › ›

causes

Because of the wide range of contributors to SAD, various treatments are prescribed based on the individual’s needs.

Psychotherapy, specifically cognitive behavioral therapy, and medication are the 2 main treatments. According to Treanor, cognitive behavior therapy is the first line of treatment recommended prior to medication or medication and psychotherapy. A medical consultation is recommended since the most effective treatment varies per individual and in each specific case.3 PSYCHOTHERAPY what it is: A specific type of psychotherapy called cognitive behavior therapy is used for treating SAD. It teaches patients different ways of behaving, thinking, and reacting to social situations so that they feel less anxiety, embarrassment, and stress.3

total wellness â–Ş spring 2014

what it does: This type of therapy encourages patients to test out their fears and reinforces the formation of realistic thoughts. The goal of psychotherapy is to lessen the anxiety that SAD patients experience. To do this, patients are exposed to their fears in a comfortable, controlled surrounding. Their fears are then identified and discussed in an attempt to modify them and to decrease the anxiety associated with them.7 In addition to altering their thought processes, this form of therapy can help patients develop social skills.3

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MEDICATION Besides psychotherapy, doctors may prescribe medication for treatment. anti-anxiety medications and anti-depressants what it is: Anti-anxiety medications and antidepressants may be used to treat SAD. Anti-anxiety prescriptions come in varying forms and are generally very strong. They typically take a few weeks to a couple of months to start working.8 However, it is not recommended that people remain on anti-anxiety medications for extended periods of time.3

what it does: The anti-depressants increase the availability of neurotransmitters such as serotonin. It is thought that these brain chemicals improve emotional stability.

They do, however, take a few weeks to start working.3 beta-blockers what it is: Beta-blockers are a type of medication prescribed for a wide range of health conditions, from hypertension to arrhythmia. what it does: Beta-blockers block the effects of adrenaline at beta-receptor sites. They also slow down the nerve impulses traveling through the heart. For these reasons they reduce some symptoms of social phobia, like sweating and shaking.9

left: pixalot/istockphoto; right: devonyu/istockphoto

treatment

REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS): what it is: rTMS is an alternative method of treatment currently being developed and researched. According to the 2013 review mentioned above, 25% of patients with SAD do not respond to conventional treatment methods. This review investigated the use of rTMS as a potential form of treatment.2 what it does: This non-invasive treatment stimulates electrical activity in the brain and activates brain cells. It has the effect of altering the function of the interconnected neurons within the brain that are thought to be associated with SAD. This 2013 review hypothesizes that the application of rTMS may create a balance in brain activity, serving as a form of therapeutic treatment for those with SAD. However, further development of this method must be done in order for it to become a valid method of treatment for SAD.2

bottom line: Experiencing anxiety is a part of being human. It can come in bouts and it can be uncontrollable. However, if this anxiety visits all too often and causes harmful impairments, then a visit to a mental health specialist or a medical doctor is recommended. As research on SAD continues, better methods for identifying SAD and ways to treat it will follow.tw

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References 1.

“Social Anxiety Disorder and Alcohol Abuse.” adaa.org. (2014).

2.

“Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat Social Anxiety Disorder: Case Reports and a Review of the Literature.” Clin Pract Epidemiol Ment Health. (2013).

3.

“Social Phobia: Social Anxiety Disorder.” nimh.nih.gov.

4.

“Social Anxiety Disorder: A Review of Environmental Risk Factors.” Neuropsychiatr Dis Treat. (2008).

5.

“Cerebral Blood Flow in Subjects with Social Phobia During Stressful Speaking Tasks: A PET Study.” Am J Psychiatry. (2001).

6.

“Symptomatology and Diagnosis of Social Anxiety Disorder.” Social Anxiety Disorder. (2004).

7.

“Cognitive Behavorial Therapy.” nami.org. (2012).

8.

“How Long Should You Take Anti-depressants.” webmd.com. (2010).

9.

“Beta-Blockers.” texasheart.org. (2013).

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body in focus

“you said what now?”

communication and relationships by peter chu| design by nicole chang

Ever talk to someone and end up feeling frustrated because your message

total wellness ▪ spring 2014

left: valuevitaly/istockphoto; right:p2007/istockphoto

just doesn’t seem to be getting through? Speaking with someone can seem both challenging and scary, but greater awareness and a proper set of tools and techniques can make all the difference. From words to tone of voice to body language, it may be difficult to keep track of all the components of communication. And just how can you tell if you or someone else is being too passive or aggressive or a mix of both? Maintaining quality relationships requires effective communication and active listening in order to exchange and analyze both positive and negative feelings as well as the intricacies of grievances, wants, and needs. Read on to discover some ways in which you can try to express yourself more effectively and nourish your relationships.

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say what you need to say If you want to communicate more effectively, you should know that there is more to it than just the words that come out of your mouth. In a 1967 study published in the Journal of Consulting Psychology, subjects listened to words on a recording spoken in 3 different tones that conveyed liking, neutrality, or disliking. The subjects were then asked to interpret what emotion was behind the words being said. It was found that the subjects guessed more accurately and were more influenced by the tone of the voice than by the words themselves. Thus, this study indicates that the tones of liking, neutrality, and disliking had more influence on how the subjects reportedly felt than the actual word being said. The conclusions of this research suggest that tone has more power in getting an emotion or feeling across to another person than typing or writing text for the other person to read.1

face-to-face time In addition to words and the tones with which they are expressed, nonverbal cues of facial expression and body language have been shown to play an important part in conveying meaning as well. In the same 1967 study mentioned in the Say What You Need to Say section above, the subjects were additionally shown photos of faces that conveyed the emotions correlating with the tones used. When comparing how the subjects interpreted the emotion based only on tone to how the subjects felt the emotion with the recording and the photos, the researchers concluded that the recorded voice in combination with the photos led to higher accuracy in interpreting meaning than just the voice itself; in fact, for every 2 correct responses based only on tone of voice, subjects had 3 correct responses based on both tone of voice and facial expression.1

styles of communication3 passive: Passive communicators tend to withdraw into themselves in order to avoid confrontation. As a result, they may easily become anxious or even shut down in conversations and let other people choose how they should think or act. aggressive: The aggressive communication style is identified by the tendency to verbally attack the other person by being controlling or provoking and may even lead to physical intimidation or violence.

Thus, this mode of communication may be destructive towards other people, property, and even the aggressive communicators themselves. passive-aggressive: Passive-aggressive communicators deal with issues that bother them in an indirect manner. They may cause confusion by acting the opposite of how they really feel about something. All in all, they usually choose to not openly acknowledge what they really think or feel in a conversation. assertive: Assertive communication, meanwhile, encompasses a healthy self-awareness. Those who communicate assertively express their needs and wants directly with others while still acknowledging those of others. This style involves a sound sense of identity, self-respect, and responsibility for your own feelings and actions.

One of the implications of this 1967 study seems to be that much of communication comes through nonverbal cues. Thus, it may be better to close that text message or chat box and meet in person since it can become easier to misunderstand or misinterpret a message when a nonverbal aspect of communication, namely facial expression, is missing.1

the way the body’s talking definitely makes sense

total wellness â–Ş spring 2014

There’s more to nonverbal cues than just facial expression though. A 2012 study in Science had subjects view only images of bodies in their interpretation of positivity or negativity, from loss to victory to pain, and found that the body plays an important role in the expression and perception of emotions.

In 4 separate experiments, participants more accurately guessed the emotion based on body language, either alone or combined with facial expression, than based on facial context alone.2 This suggests that, rather than facial expressions alone, body posture and appearance work together with the face to more effectively communicate emotion and meaning.

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non verbal communication6 open posture: An open posture tends to show less threat and fear, which subsequently can heighten approachability. Having the arms hang down or held outwards with the hands palms-up rather than as fists communicates to other people that there are fewer barriers to overcome. Open palms, in general, can suggest that nothing is being concealed.

speaking assertively4 Being assertive means that you express yourself effectively and stand up for what you believe in while also respecting the needs and beliefs of others. From a boost in self-esteem to healthy stress management, using assertive communication shows that you can simultaneously support your own interests, be aware that other people may have opposing views, and are willing to try resolving conflicts. In other words, communicating assertively gives you a better chance of successfully getting your message across by minimizing defensive reactions from others.

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assess your style. Do you always say what’s on your mind or keep quiet? Do you accept additional responsibilities to the point that you feel overloaded? Are you quick to pass judgment or place blame on others or yourself? Asking yourself these questions can act as a self-assessment of your communication style.

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rehearse what you want to say before you say it. It may even help to write out what you want to say beforehand and practice as if it were a script. Role play with a friend and ask for an honest opinion on your communication.

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start small. As you begin practicing more assertive communication techniques, use low-risk situations to start.

For example, try to address an issue with your friend before approaching a problem at work, or vice versa, depending on which you are more comfortable with. Maintain a healthy self-awareness, evaluate yourself, and make any changes if necessary.

leaning forward: By leaning forward, people can show that they are listening to the other person. Assertive communicators check in with themselves and the other person both to confirm what is being said and how to respond to concerns raised in the conversation. maintaining eye contact: Regular and appropriate eye contact (try not to stare the other person down) communicates attentiveness. Rather than hiding the face or body, barriers to communication such as a disinterest via wandering eyes or eye rolls can be removed to encourage more effective communication.

communication for healthy relationships7 “I” statements: By using sentences that begin with “I”, you allow yourself the opportunity to state your own opinions, make your own observations, or express your own emotions while preventing yourself from placing blame on or accusing the other person. A potential template to follow may be: “I feel/think/want [feeling/ thought/desire] when [behavior/action/cause] because [reason].” reflecting: As a listener, it may be advisable to not question, challenge, argue, approve of, or disapprove of what the other person is saying. Instead, attempt to reflect the other person by stating, in your own words, what the other person is saying to you. This requires only that you listen carefully, but it does not necessarily mean that you need to qualify the emotions or reasoning that you hear.

Playing the part of a good listener can be just as important as speaking assertively when practicing effective communication techniques. In addition, being able to listen closely and reply appropriately requires being attentive to what the other person is saying both verbally and nonverbally. Effective nonverbal techniques include maintaining eye contact, keeping an open posture, slightly leaning forward, being relaxed, concentrating on what the other person is saying, and restating what the other person just said beforehand to show that you are listening attentively. Overall, expressing warmth, friendliness, openness, respect, and creating a space for other people to vent may help them feel that they are heard and that their emotions are validated.

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basic tips: Try to stay positive and remind yourself that you care about the other person. Avoid attacking one another by discussing behaviors rather than overall personalities, and try to be open to sharing and discussing your emotions and feelings. These types of conversations can often be very anxietyprovoking for most people – especially those who are conflict-avoidant. One potential way to make these conversations easier is to connect it with a value. If, for instance, someone has a value of honesty or openness or respect, and they recognize that communicating openly with the other person is consistent with this value, he or she is likely to be more motivated to have the conversation.

left: 4x6/istockphoto; right: daisy-daisy/istockphoto; fcafotodigital/istockphoto

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what is active listening?5

romantic breakups: ways to approach, execute, or deal 1. Ask to meet face-to-face. Upon making the decision to initiate a romantic breakup, it is advisable to not perform the action over email, text, or social networking sites. As stated in the previous sections on effective communication, both tone and body language give the other person the opportunity to interpret the sentiments and emotions beneath the words. Thus, a phone call may be a step up from an email or text because the other person can hear your tone. However, meeting in person would also incorporate the other key component, namely body language, for effective communication.8 2. Focus on the positive and minimize the negative. Whether you’re on the initiating or receiving end of a romantic breakup, it may be beneficial for those who experience a romantic breakup to focus on the positive aspects of the overall experience and to be grateful despite the negative aspects.

By taking advantage of positive psychology, examining the positive elements of a past relationship has been shown to foster personal growth and prosperity.9

negative communication behaviors4 stonewalling: Sometimes characteristic of men, stonewalling means to shut down conversations entirely by ignoring, giving the silent treatment, or physically leaving the environment. Stonewalling tends to leave conflicts unacknowledged and unresolved.

contempt: Expressing contempt through sarcasm, eye-rolling, sneering, mocking, or hostile humor may demean the other person as well as his or her concerns.

3. Expressive writing, which combines the cognitive and emotional aspects of an experience as opposed to simpler diary-keeping, has also been suggested as a coping strategy for romantic breakups because it allows the mind to process thoughts and decrease negativity.10 Furthermore, it may even be more helpful to focus on the positive aspects of the breakup and focus on ideas such as confidence, optimism, relief, satisfaction, thankfulness, and wisdom. Specifically, a suggested writing prompt has been to write down 5 things you appreciated about the past relationship that you would want in a potential next one as well as 5 things you would not want to re-create. In other words, it may be healthier to try learning from the relationship instead of focusing on any negative aspects.8

defensiveness: Speakers tend to fuel the flames of conflict by using excuses, placing blame, counterattacking, or finding other ways to avoid taking responsibility for an issue or problem. The previously stated “I” statements in the section titled Communication for Healthy Relationships on page 26 may help speakers shy away from this negative communication behavior.

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criticism: Hearkening back to aggressive communication, criticism includes verbal accusations or putting down the other person by yelling or namecalling. basic tips: Attempts to repair these negative communication behaviors include smiling, using appropriate humor, commenting on the communication itself, or finding other ways for 2 people to be supportive towards one another.

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relationship health and social media The use of social media in trying to resolve conflicts has been shown to be deleterious to relationship health. For example, a 2013 study in Cyberpsychology, Behavior, and Social Networking surveyed 205 Facebook users and concluded that greater Facebook usage is associated with negative relationship outcomes, such as breakup, divorce, and cheating.11 According to the research, it seems that partners tend to monitor each other’s Facebook activity, which may incite jealousy and arguments concerning previous partners. However, this study only holds for relatively newer relationships of 3 years or less.

The leader of the study suggests that cutting back on Facebook usage could help reduce conflict, especially for newer couples who are still in the process of learning about one another.12 Using social networking sites may expose individuals to previous partners and inadvertently harm relationship health.

Another study published in Cyberpsychology, Behavior, and Social Networking analyzed data from 464 participants which revealed that maintaining online contact with an ex-partner creates additional stress about a breakup; this was shown to lower personal growth and hinder the post-breakup adjustment. Overall, it was found that being exposed to an ex-partner via social media may obstruct the healing process associated with moving on from a past relationship. In the end, the study suggests that avoiding exposure to an ex, both on the web and in person, may be better for a broken heart.13

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Effective communication is a skill that can be learned similarly to any other skill. And just like with any other skill, it comes with practice. By maintaining awareness that effective communication requires the intimate links among the 3 characteristics of tone, body language, and words, you can try to incorporate each component into how you choose to express yourself to others.

Overall, research seems to suggest that from words to facial expression to body language, each component of effective communication builds and adds onto the previous one until the most holistic picture of emotion is presented. Also remember that active listening forms part of the foundation of effective communication because by dutifully and earnestly listening to others, you might comfort and encourage others to lend their attention to you. Finally, knowing how to smooth out any ruffled feathers after a romantic breakup could help foster your self-esteem. Having these difficult conversations may reap rewards if you are willing to practice these skills. By keeping in mind how to communicate effectively, you may bring your friendships and relationships to greater heights, one “I” statement at a time. t w References 1.

“Mehrabian’s communication study.” changingminds.org. (2013).

2.

“Don’t read my lips! Body language trumps the face for conveying intense emotions.” princeton.edu.

(2013).

3.

“Four Styles of Interpersonal Communication.” sandiego.edu. (2013).

4.

“Being Assertive: Reduce stress, communicate better.” mayoclinic.org. (2011).

5.

“Techniques of Effective Communication.” Communication and Nursing Education. (2012).

6.

“Assertive Body Language.” changingminds.org. (2013).

7.

“Healthy Relationships/Effective Communication.” portal.utpa.edu. (2014).

8.

“How to Break Up Gracefully.” webmd.com. (2007).

9.

“Positive Psychology: An Introduction.” Am Psychol. (2000).

10.

“Emotional and physical health benefits of expressive writing.” Adv Psychiatr Treat. (2005).

11.

“Cheating, breakup, and divorce: is Facebook use to blame?” Cyberpsychol Behav Soc Netw. (2013).

12.

“Excessive Facebook Use Can Damage Relationships, Study Suggests.” sciencedaily.com. (2013).

13.

“Facebook Surveillance of Former Romantic Partners: Associations with PostBreakup Recovery and Personal Growth.” Cyberpsychol Behav Soc Netw. (2012).

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left: mattjeacock/istockphoto; kulicki/istockphoto

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the take away

total wellness ›› on the cover

total wellness ▪ spring 2014

“All that we are is a result of what we have thought. The mind is everything. What we think we become.”

–BUDDHA

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features

in pursuit of bodily perfection

total wellness ▪ spring 2014

What is the “ideal body”? Is it really possible to achieve? In a culture where being thin or muscular is seen as the “right” way to be, trimming down and bulking up have become the center of focus.

Portrayals of what is “normal” keep getting thinner for women and more muscular and toned for men, contributing to growth in body dissatisfaction, negative body image, disordered eating, and extreme exercise approaches. And in a college environment, such pressures and expectations can be exaggerated, leading students to obsess over appearance, gym time, and eating patterns. Trying to achieve such standards can take a toll on us, reducing our self-esteem, taking up our time and energy, and even burning holes in our wallets in pursuit of bodily perfection.1 Read on to learn more about what’s driving these unrealistic standards of beauty, how it’s influencing certain health behaviors, and how we can best achieve a healthy body image.

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left: dale robins/istockphoto; right (in order): skodonnell/istockphoto; brendan hunter/istockphoto

by allison newell | design by emily hsu

› barbie and the drive for thinness: the skinnier the merrier At a young age, girls are exposed to dolls (like Barbie) and influenced to think that a tiny waist, no body fat, and large breasts are characteristics of how a woman should look.

Barbie’s Dimensions if Life Size

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5’9’’, 110 pounds: this is 76% of what is considered a healthy weight for her height. Based on her height and weight, her BMI (body mass index) would be 16.2, which fits the criteria for anorexia. › 18 inch waist and 33 inch hips, paired with over-sized breasts (a 39 inch bust), form a body ideal nearly impossible to attain, let alone walk in.1

g.i. joe and the drive for muscularity: meat up to man up

GI Joe’s Dimensions if Life Size

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55 inch chest 27 inch biceps Bicep is almost as big as his waist and bigger than most competitive bodybuilders (15-16 is the average size), creating once again a body ideal impossible to attain naturally.5

barbie and g.i. joe are not the only ones to blame Other Factors Influencing the Thin and Muscular Ideal There are many other factors contributing to body dissatisfaction and the desire to be slim.

This emphasis on thinness can be seen in advertisements, fashion models, Miss America pageant winners, and photo manipulation technologies, to name a few. Such media depictions have moved away from highlighting the natural curves of a woman’s body and shifted towards more stick-like, emaciated physiques.

According to the The National Eating Disorders and Screening for Mental Health, the body type portrayed in advertising as the ideal is estimated to be possessed naturally by only 5% of American females.5 Not only that, but the average American woman is 5’4’’ and 140 pounds, whereas the average fashion model is 5’11’’ and 115 pounds. Fashion models are thinner than 98% of American women.1 There are numerous factors that can lead to body image disturbances and glorification of muscularity as well. Emphasis on chiseled abs, defined muscles, and toned physique can be seen in advertisements, male fashion models, and popular culture, in which the male body has become increasingly visible, muscular, and trim, according to a 2008 literature review published in Body Image.6 Besides the mass media, ideas about what is beautiful can be inherited through socialization. Our parents, peers, romantic relationships, and schooling can all influence and exacerbate the pressure to be thin or muscular.

Overall, these pressures in achieving thinness and muscularity can lead to the development and maintenance of unhealthy behaviors, which are further explored next.

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While a lot of research has been focused on women, cultural changes demand that attention be paid to men’s body image as well. Boys are exposed to action figures (such as G.I. Joe or cartoon superheroes) and are influenced to believe that bulging muscles and a toned physique make the ideal man. According to 2006 study published in Body Image, action figures have become more muscular and large over the last 25 years, and may influence the perceptions of idealized body type that focuses on lean, muscular physique.4

A national survey conducted by the Center of Appearance Research at the University of the West of England found that a large percentage of men were unhappy with their muscularity, with 62.8% thinking their arms and chests weren’t muscular enough.2 › According to the Screening for Mental Health, in a survey of 185 female students on a college campus, 58% felt pressure to be a certain weight. In addition, 44% of the 83% that dieted for weight loss were of normal weight.3 › 25% of men and 45% of women are on a diet at any given time.1

exploring body image related risks 1 dieting risks A quick internet search on “diets” will bring about an extensive, almost endless list of dieting methods: Paleo, Atkins, Jenny Craig, South Beach, and the list goes on. But most diets can be categorized under 4 main types:

1. low carbohydrate: foods such as bread, pasta, and sugar are limited or replaced with proteins, vegetables, and fruits.

2. low fat: cut out or restrict fat intake, including saturated fats and cholesterol, often making it easier to reduce calories.

3. low calorie: typically allows 800 to 1500 calories per day 4. very low calorie: allows 800 calories or less and is often used for significant short term weight loss.

Dieting, or the restriction of caloric intake or certain food groups to achieve weight loss, is quite prevalent, with 47% of US adults trying to lose weight at any given time.7 Not only that, but 1/3 of US adults are estimated to be obese, and dieting has become the most common approach to losing weight in obese and overweight individuals.8 However, it’s important to distinguish between healthy weight loss and unhealthy weight loss through dieting. According to the Centers for Disease Control and Prevention, healthy weight loss isn’t just about a short-term diet or program – it has to be an ongoing lifestyle.

In order to reduce the risk of chronic illnesses associated with obesity, reducing calories (within a realistic range and in accordance with a doctor’s recommendation) paired with exercise are essential for weight loss. Once the weight is lost, continuing a healthy diet with exercise needs to be maintained for the long run. But for individuals who already fall in the normal weight range and are striving for leanness and weight loss, it’s important to consider the negative consequences of dieting.

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left: malerapaso/istockphoto; renewer/istockphoto; right: renewer/istockphoto

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While short-term, restrictive dieting by itself can lead to temporary weight loss, the positive short-term effects have the potential to be undermined by possible negative long-term effects. The key to successful dieting is not to drastically cut calories to the point where you are not getting enough to eat and/or are fighting your natural hunger signals. This drive for instant results and immediate gratification is neither beneficial for your body nor your mental state. These effects are often not maintained in the long run, as most people return to their original weight once they get off the diet plan.9 For obese individuals on diets, the success rate for long-term weight reduction is poor and most eventually regain the weight they had worked so hard to lose.10

low calorie dieting has the potential to counteract the effects of initial weight loss, because it can increase chronic psychological stress and cortisol production A 2010 study published in Psychosomatic Medicine looked at the 2 main behaviors that comprise dieting: monitoring caloric intake and restricting caloric intake. Researchers found that restricting calories increased total output of cortisol. One of the functions of cortisol is to increase energy availability to the body, and so it would follow that cortisol would be released when the body is low on energy due to restricted caloric intake.

The researchers also found that monitoring calories increased perceived stress, since having to monitor can be a daily hassle and potentially become a chronic stressor. This illustrates that dieting may harm rather than benefit psychological wellbeing and biological functioning.7 These findings don’t mean that individuals engaged in weight management shouldn’t be selfaware of eating patterns or give up portion control. However, it suggests that while the number on the scale may be going down, it may be doing harm psychologically because of the negative emotions and aversive feelings of hunger that the act of restricting can elicit.

dieting with emphasis on caloric restriction may disrupt intuitive or mindful eating processes Intuitive eating is eating based on physiological hunger and satiety cues rather than emotional or situational cues. In other words, you are in tune with your body’s natural hunger signals. Calorie restrictive dieting, however, can lead individuals to avoid eating even when their body is telling them it’s hungry because they fear surpassing the strict calorie limit they have set for themselves. In a 2013 study published in Eating Behaviors, dieting was associated with negative feelings due to feeling restricted in what you could eat, as well as eating more to soothe emotions than to satisfy actual physical hunger.11 A 2008 study published in Obesity further iterates this point: dietary restriction has been shown to create feelings of deprivation, which can lead to cravings and overindulgence in restricted foods when the opportunity arises. When people diet, they have to exert cognitive control over internal signals about hunger and satiety and limit what, when, and how much they eat. Overtime, this rigid control can override physiology and undermine people’s understanding of their body’s signals and disrupt their ability to know what they want to consume.12

Weight cycling is a phenomenon where one loses weight via cognitive restraint of food intake.13 In this process, the dieter is originally successful in losing weight, but is unsuccessful at maintaining the desired weight for the long term and gains the undesired weight back. The dieter seeks to lose this regained weight, starting the cycle all over again. This often leads to a repeated cycle of weight loss and weight regain (this

According to the Centers for Disease Control and Prevention, the key to achieving and maintaining a healthy weight is ongoing lifestyle modifications that include regular exercise, healthy eating, and balancing the number of calories consumed with number of calories the body uses.15

health at every size (HAES) approach ›

HAES is a new non-weight centric public health strategy, focused on weight-neutral, balanced nutrition and physical activity.16 › According to the 2010 Dietary Guidelines for Americans, a balanced diet includes:15,17 • whole grains, fruits, vegetables, healthy fats (like avocado and olive oil) • lean proteins, poultry, fish, beans, eggs, nuts • an avoidance of foods high in saturated and trans fats, salt, and added sugars • a focus on eating healthily and in moderation and pairing with moderate exercise, rather than counting calories and restricting

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weight cycling or “yo-yo” dieting can negatively affect our mental health

resemblance to the up and down motion of a yo yo is what gives it the nickname “yo yo dieting”). This type of dieting is prevalent in males and females, and is common in both overweight and non-overweight individuals. These constant weight fluctuations can have a problematic effect on mental state and self-esteem, including increased risk for mental illness, life dissatisfaction, and binge eating.14

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2 eating disorders Until recently, the field of body image and eating disorders has been dominated by research focused on the female population. However, with rising pressures on males to achieve an ideal body, research has turned to looking at eating disorders in both sexes. According to the National Eating Disorders Association, approximately 10% of individuals with eating disorders are male.

Overall, about 24 million Americans suffer from an eating disorder.3

anorexia nervosa According to the DSM 5 (the DSM 5 stands for the 5th edition Diagnostic and Statistical Manual of Mental Disorders and acts as a common language and standard criteria for classifying mental disorders), anorexia nervosa is characterized as a refusal to maintain body weight at or above a minimally normal weight for age and height. Two types of anorexia exist: restricting type (no binge eating or purging behaviors – solely food restriction) and bingeeating/purging type (self-induced vomiting, laxatives, and diuretics).1 Warning signs:18

› Deliberate self-starvation for weight loss

› Fear of gaining weight

› Refusal to eat or highly restrictive eating

› Continuous dieting

› Compulsive exercise

› Cold sensitivity

› Absent/irregular periods (esp. amenorrhea, which is the absence of 3 or more periods)

orthorexia Orthorexia is a pathological obsession for pure foods and a fixation on clean, healthy eating, leading to dietary restrictions. The name “orthorexia” was coined by Steven Bratman, MD, with “orthos” meaning “straight” and “proper” and “orexia” meaning “appetite.”

Orthorexia is not officially recognized by the DSM, but it is becoming more common. There is still debate over whether it should be classified as an eating disorder or obsessive compulsive disorder.19 Orthorexics obsessively avoid foods which may contain artificial colors, flavors, preservant agents, pesticide residues or genetically modified ingredients, unhealthy fats, foods containing too much salt or too much sugar, and other components.20 Such an obsession often leads to excessive worry, dissatisfaction, and loss of social functioning. Daily activities become dominated by planning, buying, and preparing proper meals. These behaviors typically develop as an initial means to lose weight, improve health, or treat a disease.21 Orthorexia is seen in both males and females, but a 2004 study in Eating and Weight Disorders found a higher prevalence in men and in those with lower levels of education.22

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According to the DSM-5, symptoms include recurrent episodes of binge eating (eating a large amount of food in a discrete period of time with a sense of lack of control) and recurrent and inappropriate compensatory behavior to prevent weight gain (vomiting, laxative use, fasting, and excessive exercise to get rid of the food eaten). One must experience at least one binge/purge episode a week for more than 3 months in order to be diagnosed.1 There are two types of bulimia: purging (vomiting, laxatives, diuretics) and non-purging (fasting, exercise).

Warning signs:1

› Preoccupation with food

› Binge eating, often in secret

› Vomiting after bingeing

› Abuse of laxatives, diuretics, and diet pills

› Compulsive exercise

› Swollen salivary glands (caused by irritation from vomiting)

› Broken blood vessels in the eyes

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left: kzenon/istockphoto; right: pixhook/istockphoto

bulimia nervosa

3 muscle dysmorphia Muscle Dysmorphia (MD) is a body image disturbance seen in both sexes but suffered primarily by men. MD is categorized as a form of Body Dysmorphic Disorder, which is an excessive concern and preoccupation with imagined or slight defects in physical appearance.

In MD, the preoccupation is with levels of muscularity and leanness and a compulsion to achieve these desired levels of physique. Compulsions can include endless hours at the gym, buying supplements, abnormal eating behaviors, and substance abuse (esp. anabolic steroid use). According to a 2005 review in the Journal of Athletic Training, the focus is not on how thin one can get, but rather on how muscular one can get.23 This is often why MD is referred to as “reverse anorexia” or “bigorexia”. A 2001 study in Psychotherapy and Psychosomatics found that male bodybuilders exhibit a pattern of eating and exercising as obsessive as those with eating disorders, but with a “reverse” focus on gaining muscle as opposed to losing fat.24 In addition, men with muscle dysmorphia were more likely to exhibit significantly greater psychopathology in terms of quality of life, suicide attempts, and prevalence of substance use disorders and anabolic-androgenic steroid use, according to a 2005 study published in Body Image.25 It’s important to note that not all males focus on muscularity. For example, gay men are less likely to want to bulk up, more likely to strive for the thin ideal, and consequently more likely to develop eating disorders.26 Warning signs:1

› Viewing one’s body as puny despite efforts and success at body building

› Distorted body perception leading to extreme efforts to increase lean muscle mass and overall body size

› Measures to increase muscle mass, such as excessive exercise, dietary manipulation, high protein intake, and steroid use

4 excessive or compulsive exercise

Warning Signs:27

› Working out even if you are tired, sick, or injured

› Feeling obligated to workout

› Feeling anxious or guilty for skipping a workout

› Constantly preoccupied with weight

› Basing self-worth off of workouts

Healthy Amount of Exercise for Adults (ages 18 to 64), according to US Department of Agriculture:28

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Exercise and sports are good for us physically and psychologically.

However, compulsive exercise, to the point where an individual engages in several workouts a day for more than 2 hours, may be overdoing it. While there is a fine line between what is a healthy amount of exercise and what is too much, if an individual’s life depends on and is organized around exercise, it may be time to reevaluate. If one is not careful, risks may include undernourishment, fatigue, excessive weight loss, frequent injuries, weakened social relationships, or feelings of isolation.27

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At least 2.5 hours of moderate, aerobic exercise per week OR at least 1 hour and 15 minutes of vigorous, aerobic exercise per week › Around 30 minutes of moderate exercise each day is ideal › 2 days per week of strength building activities, like push ups, sit ups, and lifting weights

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taking a new perspective According to UCLA’s Student Nutrition Action Committee (SNAC), here are some steps we can take to improve and maintain a healthy body image.

focus less on numbers and more on a healthy, balanced lifestyle There is no such thing as one “ideal body weight” for height – we each have a healthy weight based on body type, bone structure, genetics, muscle mass, and what weight our body tends to maintain. Trying to achieve an unrealistic body weight is just setting yourself up for failure and future maladaptive behaviors. Diet and exercise can be manipulated to achieve desired effects, but there is a limit to what and how much you can do. Be realistic in determining how you want to look and avoid sacrificing health and happiness for an impossible goal.

It is often assumed that the more weight you lose, the healthier you are. However, this concentrated focus on numbers on the scale is missing the mark. Other indicators, such as blood pressure and cholesterol levels, are also important in assessing an individual’s health. Just because you are thin or have lost weight doesn’t necessarily equate to perfect ratings on other health indicators.

BMI is typically a reliable indicator of body fat and potential risk for chronic disease, and is calculated based on height and weight. Specifically, it is calculated by dividing one’s weight (in kilograms) by the square of one’s height (in meters) and is intended to measure how much a person’s weight departs from what is considered healthy for their height. However, it’s important to take note that BMI does not distinguish between fat and muscle. For athletes and individuals with a muscular build, BMI measurements may overestimate body fat and tip them into the overweight range, according to the National Heart, Lung, and Blood Institute.29

bmi chart 18.5 or less

underweight range

18.5 - 24.9

normal or healthy range

25 - 29.9

overweight range

30 and above

obese range

A 2008 study published in Eating Disorders concluded that the frequency of “fat talk” (conversations about eating and bodyrelated issues) is positively related to eating disorders and body dissatisfaction in college undergraduates with and without eating disorders.30 While much research has focused on body related talk among women, a 2013 study published in Body Image concluded that negative body talk among men also has an effect on body image. The researchers found that engaging in negative body talk was associated with drive for muscularity, disordered eating behavior, and appearance investment, and hearing muscle or fat talk resulted in an increase in body dissatisfaction.31 These findings reveal that surrounding ourselves with positve body talk can help prevent body dissatisfaction and help nurture a healthy body image and love for our bodies.

for more resources about body image and health related disorders: Bruin Resource Center 310-825-6385 http://www.brc.ucla.edu/

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Counseling and Psychological Services 310-825-0768 www.caps.ucla.edu

left: ariwasabi/istockphoto; right: rzdeb/istockphoto

total wellness ▪ spring 2014

surround yourself with people who have healthy relationships with food, weight, and their bodies. avoid “fat talk.”

the bottom-line Current physical ideals are biologically unattainable for many and go against how the body should actually be, yet we are bombarded on a daily basis that these ideals are normal, desirable, and achievable. Comparisons to such ideals can compromise our psychological health in regards to body dissatisfaction, low self-esteem, and body image disturbances. These in turn can lead to risky health behaviors and outcomes such as temporary restrictive dieting, eating disorders, and extreme exercise routines.

By becoming aware of these risks and turning to more sustainable, realistic, and bodyaccepting approaches, we can achieve “total wellness” of both mind and body. tw

“Dietary Guidelines for Americans, 2010.” health.gov. (2014).

“Anorexia Nervosa: Symptoms.” mayoclinic.org. (2014).

“Orthorexia- a new diagnosis?” Psychiatr Pol. (2012).

20.

“Orthorexia or when a healthy diet becomes an obsession.” Arch Latinoam Nutr. (2007).

21.

“Orthorexia nervosa: a new eating behavior disorder?” Actas Esp Psiquiatr. (2005).

22.

“Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon.” Eat Weight Disord. (2004).

23.

“Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders.” J Athl Train. (2005).

24.

“Body image and psychopathology in male body builders.” Psychother Psychosom. (2001).

25.

“Clinical features of muscle dysmorphia among males with body dysmorphic disorder.” Body Image. (2005).

26.

“A review of body image influences on men’s fitness goals and supplement use.” Am J Mens Health. (2007).

27.

“Exercise Addiction: How Much is Too Much.” healthline.com. (2013).

28.

“Physical Activity.” choosemyplate.gov. (2014).

29.

“Aim for a Healthy Weight.” nhlbi.nih.gov. (2014).

30.

“Fat talk among college students: how undergraduates communicate regarding food and body weight, shape and appearance.” Eat Disord. (2008).

17.

18.

19.

37

total wellness ▪ spring 2014

References 1.

“The Body Project.” bradley.edu. (2014).

2.

“Beer belly is biggest body issue for men.” info.uwe.ac.uk. (2012).

3.

“Eating Disorders.” mentalhealthscreening.org. (2010).

4.

“Change in sociocultural ideal male physique: an examination of past and present action figures.” Body Image.

(2006).

5.

“Body Image.” snac.ucla.edu. (2011).

6.

“Impacts of exposure to images of ideal bodies on male body dissatisfaction: a review.” Body Image. (2008).

7.

“Low Calorie Dieting Increases Cortisol.” Psychosom Med. (2010).

8.

“Obesity and Overweight.” cdc.gov. (2013).

9.

“Effects of diets and their role in weight control.” Psychol Health Med. (2007).

10.

“Biology’s response to dieting: the impetus for weight regain.” Am J Physiol Regul Integr Comp Physiol. (2011).

11.

“Dieting, exercise, and intuitive eating among early adolescents.” Eat Behav. (2013).

12.

“The Trust Model: A Different Feeding Paradigm for Managing Childhood Obesity.” Obesity. (2008).

13.

“A model for the dynamics of human weight cycling.” J Biosci. (2006).

14.

“Medical, metabolic, and psychological effects of weight cycling.” Arch Intern Med. (1994).

15.

“Healthy Weight- it’s not a diet, it’s a lifestyle.” cdc.gov. (2013).

16.

“Obesity, health at every size, and public health policy.” Am J Public Health. (2014).

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total wellness ▪ spring 2014

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38

features

the biological basis of road rage by julia feygelman | design by barbara wong

total wellness ▪ spring 2014

Many of us have witnessed it. Whether it’s during rush hour, a race for the best parking spot, or a sticky situation, there’s often that one driver who feels the need to honk excessively, yell aggressively at other drivers, or point fingers through the window. Perhaps certain people do it for show, but sometimes, road rage can actually be a “symptom” of mental disorders such as intermittent explosive disorder (IED), for example. If you think you may have IED or you are a confrontational driver, it is important to understand this behavior and how to manage it. Why? A 2005 study in Behaviour Research and Therapy found that aggressive driving is a risk factor for motor vehicle accidents (MVAs) and that it is crucial to understand the related psychiatric perturbations in order to develop effective intervention programs.1 A 2007 study published in the American Journal of Health Behavior confirms that perpetrators and victims of any type of road rage have a noticeably higher risk of accident involvement than those who do not exhibit road rage (82% higher for perpetrators and 89% higher for victims).2 Read on to discover how different psychiatric phenomena including IED may be the bases of aggressive driving. More importantly, find out about methods for controlling these conditions and the unsafe behaviors that they may cause.

39

››

potential causes of road rage

what is it?

A 2002 article from CNS Drugs describes IED as distinct episodes of aggressive impulses that result in serious assaultive acts towards people or destruction of property.3 IED has been found to be more common than originally believed. A 2012 study in The American Journal of Psychiatry reveals that 5 to 7% of the US population is affected.

Individuals with the disorder can be identified as having higher levels of aggression, impulsive behavior, family risk of aggression, and neurobiological markers of aggression.4

how it could lead to road rage

total wellness ▪ spring 2014

Because IED is characterized by aggressive behavior, people who have IED tend to exhibit impulsive bursts of aggression, such as road rage. Research is still on-going to understand the biological basis of IED. Recently, a 2014 study in the Journal of the American Medical Association – Psychiatry found a direct relationship between abnormally high levels inflammatory markers in the blood and subjects with IED. These inflammatory markers were present in conjunction with measured aggression and recorded history of aggression. In other words, the more aggressive someone is, the more inflammatory markers were detected in the blood.

Interestingly, the markers were also present significantly at higher levels in IED subjects versus in people with other psychiatric disorders or none at all.5

why it’s a concern

Many aggressive drivers may have IED, and the driving behaviors associated with this disorder are a huge risk factor for MVAs. An estimate from 1997 attributes ⅓ of all MVAs that cause personal injury and ⅔ of MVA fatalities to aggressive driving, according to a 2002 study in Behavior Research and Therapy.6 While IED may not seem like a serious condition, leaving it unaddressed could be dangerous. As a 2011 article from the Journal of Counseling and Development iterates, road rage can result in physical violence and even death.7

40

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) AND OPPOSITIONAL DEFIANT DISORDER (ODD) what is it?

ADHD constitutes a deficit in behavioral inhibition in 4 of the brain’s (neuropsychological) functions. A 1997 article in the Psychological Bulletin lists these as working memory, selfregulation of emotion, internalization of speech, and behavioral analysis and synthesis.8 Or, simply put, it is a problem of not being able to focus, being overactive, not being able to control behavior, or a combination of these, according to the National Library of Medicine.9 ODD, on the other hand, is “a pattern of disobedient, hostile, and defiant behavior toward authority figures,” according to the National Library of Medicine.10 In this section, we’ll look at the consequences of having these disorders (ADHD and ODD) simultaneously and the specific effects that can ensue.

how the combination of ADHD and ODD could lead to road rage

The culprit potentially instigating road rage in these disorders is emotional impulsiveness (EI). EI is impulsive behavior driven by affect (emotion or desire). A 2010 study in the Journal of the American Academy of Child & Adolescent Psychiatry reports that EI accompanying both ODD and ADHD does indeed cause behavioral impairments like road rage. This conclusion makes sense because the characteristics of ADHD and ODD without the consideration of EI cannot fully account for road rage, so EI is then attributed as the cause. However, stronger data is still lacking and further research is required to turn this assumption into a well-supported hypothesis.11

when ODD is absent …

ADHD on its own can also be an agent of road rage. A 2002 article in Neuropsychopharmacology found converging evidence that ADHD is tied to abnormalities of dopamine neurotransmission (attributed to regulation of emotional responses). Neurotransmitters are chemicals that transmit

in order: rzdeb/istockphoto; rapideye/istockphoto; juanmonino/istockphoto

INTERMITTENT EXPLOSIVE DISORDER (IED)

signals throughout the brain.12 Read more about dopamine on page 7 in this issue’s Q&A article.

A 2008 study published in Aggression and Violent Behavior suggested that dysfunctional interactions between the serotonin (attributed to happiness) and dopamine systems in the brain may be an important mechanism underlying the link between impulsive aggression and disorders it coexists with, such as ADHD. Specifically, low serotonin activity coupled with high dopamine activity appears to increase impulsive behavior. The study showed that dopamine is directly related to impulsive behavior by administering dopaminergic stimulants to non-ADHD subjects, who then displayed increased impulsivity. Since the 2002 study mentioned above found a correlation between dopamine neurotransmission and ADHD, and this study found another between dopamine and impulsive aggression, these studies taken together suggest that faulty dopamine neurotransmission and ADHD can both play an important role in road rage.13 The road rage connection is made here by treating aggression as a reliable predictor of road rage. Nevertheless, the study does not itself make an explicit statement about road rage.

why it’s a concern

BORDERLINE PERSONALITY DISORDER (BPD) what is it?

People with BPD may have symptoms conducive to road rage.

In 2009, the Journal of the American Psychoanalytic Association noted that a low threshold for impulsive aggression (hence road rage) can be observed in BPD and may be related to excessive amygdala (a region of the brain that plays an important role in the processing of emotion) reactivity.16 In fact, a 2012 study from Social Cognitive and Affective Neuroscience made the novel finding that the amygdalas of men who are easily angered responded more actively to angry facial expressions than did the amygdalas of less angry men and women, showing a relation between personal anger traits and reaction to anger.17 In addition, excessive functioning in the regions of the brain concerned with the regulation of dopamine (dopaminergic hyperfunction) are associated with impulsivity and emotional dysregulation in patients with borderline personality disorders. In fact, it has been shown that subjects given drugs that either increase or decrease dopamine levels exhibit either more or less aggressive behavior, respectively.

Neurochemically, there are then 2 possible anomalies that can explain impulsive or aggressive behavior in people with BPD, making them more prone to road rage: excessive amygdala reactivity and dopaminergic hyperfunction.13

why it’s a concern

There is a correlation between the prevalence of BPD and road rage. A 2010 study in the International Journal of Psychiatry in Medicine claims that BPD is likely one of the significant contributory factors of reckless driving. In a survey of 419 individuals, ⅓ reported having road rage. Furthermore, individuals with road rage were 15% more likely to have BPD versus those in the non-road rage group.18

According to the National Institute of Mental Health, people with BPD can have rash behavior, problems regulating emotions and thoughts, and shaky relationships with other people.15

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total wellness ▪ spring 2014

Clinical studies indicate that young drivers with unaddressed ADHD have 2 to 4 times as many motor vehicle collisions and moving violations than a similar non-ADHD population, states a 2013 book titled A Clinician’s Guide to ADHD by Dr. Joseph Sadek, associate professor of psychiatry at Dalhousie University. The drivers’ problem profiles commonly include road rage.14

how it could lead to road rage

modifying driver beliefs

There are 5 main beliefs that can motivate aggressive road rage:

1. “make good time” The driver thinks it is necessary to drive to one’s destination as fast as possible.

2. “be number one” The driver has a sense of rivalry and belief that confidence and status can be attained by “beating” another driver in a self-imagined contest such as racing.

3. “try and make me” With this passive-aggressive thinking, the driver loses a sense of self-esteem by allowing other drivers “have their way”.

4. “they shouldn’t allow it” The driver believes that anyone who fails to measure up to the driver’s own personal self-created standards shouldn’t be allowed on the road.

5. “teach them a lesson” The driver thinks it is necessary to punish other drivers perceived to be threatening, annoying, or inconvenient.

total wellness ▪ spring 2014

The goal in reference to these beliefs is to educate drivers to alter their philosophy by introducing them to “supportive driving.”

They are taught to respect and cooperate with other drivers instead of viewing them as the bad guys. In “supportive driving,”drivers are also encouraged not to look at driving as a competition.7

The UCLA Counseling and Psychological Services (CAPS), located at John Wooden Center West, provides individual counseling for students in a wide variety of mental health issues and also has a specific program for ADHD, one of the possible conditions fueling road rage. Additionally, UCLA CAPS can offer individualized treatment plans. More information can be found at www.counseling.ucla.edu.

psychotherapy 8-session treatments utilizing relaxation coping skills (RCS) and a combination of cognitive and relaxation coping skills (CRCS) both significantly reduced driving anger post-treatment and at a 1-month followup. The treatment protocols included applications of progressive relaxation, relaxation imagery, and breathing-cued relaxation. The CRCS intervention also included, in addition to relaxation methods, cognitive restructuring (learning to recognize irrational thoughts and repudiate them).7

personal relaxation techniques There are also many simple relaxation techniques that can help a driver stay calm in stressful situations. These include breathing/stretching exercises, prerecorded relaxation tapes catered to anxious drivers, soothing music/audiobooks, herbal tea, and aromatherapy.7 The DMV (Department of Motor Vehicles) postulates that reacting as calmly as possible to frustrating driving situations is a good way to avoid road rage. Some tips for doing so include taking a deep breath and venting about stressful driving stories to friends, family, or on online forums.19

Now that you are well-informed about the various ways of handling road rage, pass it on! If someone you know experiences road rage, tell him or her about treatment options and coping techniques like those suggested by the DMV. If one doesn’t help, trying another is a good idea. They can also be continued and/or repeated if road rage appears to return or worsen. Remember that road rage affects not only the person who has it but it can also be very dangerous for others due to the direct correlation between accident statistics and aggressive driving.

42

& fotografie/istockphoto

road rage

According to a 2011 article in the Journal of Counseling and Development, counseling is likely to help individuals manage their driving anger and road rage tendencies because counseling has been shown to reduce maladaptive anger in general.7

left: prill mediendesign

››

dealing with

counseling

CONCLUSION Road rage isn’t just the occasional exaggerated reaction to frustrating driving situations. Numerous studies suggest that mental disorders tied to neurochemical abnormalities and sometimes other biological markers, like inflammation, are the true bases for road rage (at least for a portion of the population). IED, ADHD/ODD, and BPD are 3 such mental disorders that can lead to deadly accidents on the road when ignored. Luckily, there are treatments and coping methods that have been shown to be successful, including counseling, relaxation techniques, and altering one’s “driving philosophy” through learned belief systems. If you experience road rage or know someone who does, don’t write it off as no big deal. By being informed and taking steps towards altering the behavior, you might spare your own or someone else’s life! tw References 1.

“Psychiatric and behavioral problems in aggressive drivers.” Behav Res Ther. (2005).

2.

“Road rage and collision involvement.” Am J Health Behav. (2007).

3.

“Intermittent Explosive Disorder: Epidemiology, Diagnosis and Management.” CNS Drugs.

(2002).

4.

“Intermittent Explosive Disorder as a Disorder of Impulsive Aggression for DSM-5.” Am J Psychiatry. (2012).

5.

“Elevated Plasma Inflammatory Markers in Individuals With Intermittent Explosive Disorder and Correlation With Aggression in Humans.” JAMA Psychiatry. (2014).

6.

“Intermittent explosive disorder and other psychiatric co-morbidity among court-referred and self-referred aggressive drivers.” Behav Res Ther. (2002).

7.

“Road Rage: Risk Factors, Assessment, and Intervention Strategies.” J Couns Dev. (2011).

8.

“Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD.” Psychol Bull. (1997).

9.

“Attention deficit hyperactivity disorder.” ncbi.nlm.nih.gov. (2013).

10.

“Oppositional defiant disorder.” ncbi.nlm.nih.gov. (2010).

11.

“The Unique Contribution of Emotional Impulsiveness to Impairment in Major Life Activities in Hyperactive Children as Adults.” J Am Acad Child Psy. (2010).

12.

“Dopaminergic System Genes in ADHD: Toward a Biological Hypothesis.”

Neuropsychopharmacol. (2002).

13.

“Role of serotonin and dopamine system interactions in the neurobiology of impulsive aggression and its comorbidity with other clinical disorders.” Aggress Viol Behav. (2008).

14.

Sadek, Joseph. “A Clinician’s Guide to ADHD.” (2013).

15.

“What is borderline personality disorder?” nihm.nih.gov. (2014).

16.

“The Neurobiology of Personality Disorders: Implications for Psychoanalysis.” J Am Psychoanal Assoc. (2009).

17.

“Interaction between trait anxiety and trait anger predict amygdala reactivity to angry facial expressions in men but not women.” Soc Cogn Affect Neurosci. (2012).

18.

“Road Rage: Relationships with Borderline Personality and Driving Citations.” Int J Psychiatry Med. (2010).

19.

“Road Rage: How To Deal With It.” dmv.org. (2014).

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43

features

beating the blues by rebecca tang | design by alexandria villanueva

left: nico_blue/istockphoto; right: abramovtv/ istockphoto

total wellness â–Ş spring 2014

Feeling somewhat down recently? You may not be alone. In fact, depression affects more than 26% of US adults and is the most common form of mental illness.1 However, feeling sad does not necessarily mean that you require drug treatment or cognitive therapy. Read on to learn more about the different types of depression, as well as ways to combat the blues.

44

››

what is depression?

There are mild to severe forms of depression, including:2-3

adjustment disorder, also known as

situational depression, is a short-term condition that arises from stress and major life changes. It rarely lasts for more than 6 months.

seasonal depression (SAD), although not

an official disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), may occur along with major depressive disorder (MDD). SAD is a time-related form of depression that commonly occurs in the fall and winter, when there tends to be a lack of daylight.

dysthymia is a mild, chronic depression that lasts for 2 years or more.

major depressive disorder (MDD), also

known as clinical depression, is the severest form of depression; it can cause significant disruptions in one’s life, affecting performance at work or school as well as relationships with family or friends.

how can you tell if you have depression? what are some common symptoms?2,4-5 common symptoms include: › Thoughts of suicide or suicide attempts › Dangerous or destructive behavior › Mixed features, including both depression and mania. Examples of mixed features include: elevated self-esteem, talking too much, or racing thoughts. If you are also experiencing suicidal thoughts or behaviors, you should seek immediate professional care.

total wellness ▪ spring 2014

› Changes in appetite, either eating less or overeating › Feelings of hopelessness or pessimism, i.e. fixating on past mistakes and blaming oneself for events that were not one’s responsibility › Insomnia or excessive sleeping › Physical aches and pains, including headaches and stomachaches › Loss of interest in activities once considered enjoyable › Slowed speaking, body movements, or thinking, which may lead to difficulties in concentrating or making decisions › Anxiety, restlessness, or agitation, including excessive worrying or the inability to sit still

45

what are some possible causes of depression? in the central nervous system, is known to elevate or depress mood, depending on the amount that is present in the body; low serotonin levels can contribute to depression.6

› melatonin: A 2013 study in the American Journal of

Neurodegenerative Disease proposes that shifts in circadian rhythm, the biological “clock” for daily activities such as sleep, may be linked to depression, since such changes lead to disturbances in melatonin production. The study suggests that there is a relationship between depression and sleep disruption, although further research is encouraged to assess this claim.7

inflammation

Additionally, bodily inflammation can lead to depression. A 2008 study from Nature Reviews Neuroscience proposed that infection in nerve cells can signal the brain to exacerbate the immune system, causing bodily inflammation and possibly leading to the development of symptoms of depression.8

total wellness ▪ spring 2014

genetics/family history

Genetics or a family history of depression may also play a role in an individual’s risk for depression. It is estimated that the heritability of major depression is 31 to 42%. However, environmental factors may also influence one’s likelihood of developing the blues.9

environmental factors

When faced with stress (i.e. strained or absent relationships with family or friends), individuals with an inclination towards depression are more likely to respond emotionally than to use problem-solving to cope.10

46

climate changes

In addition to stress, changes in climate and latitude can affect mood in patients with SAD.4

childhood trauma

Trauma at a young age may lead to changes both in the nervous and endocrine systems, consequently increasing risk for depression later on as an adult.11

obesity

A 2010 study in the Archives of General Psychiatry found that there is a correlation between obesity and depression, with obese individuals (specifically, women) having a 55% chance of developing depression and those with depression having a 58% chance of being obese. From this information, the study suggested that the medical field should be aware of and monitor mood in order to prevent, detect, and treat both obesity and depression.12

socioeconomic status

Weight issues may also be due to economic factors in one’s social setting (the “socioeconomic status”), which was addressed in a study from the Journal of Affective Disorders in 2010. It suggested that socioeconomic status (SES) disparities can contribute to major depression in women; factors such as limited availability of nutritional foods and limited abilities to ascertain them can lead to issues in obesity and subsequently, changes in mood.13

Depression is understood as an interaction between genetics and environmental factors; therefore, depression cannot be classified as being purely due to heredity or the external setting.14

left: svedoliver/istockphoto; right (in order): peregrina/istockphoto; andrewsoundarajan/istockphoto; irochka_t/istockphoto; ostill/ istockphoto

brain chemistry › serotonin: Serotonin, a naturally-occurring chemical found

how can I recover from depression?

diet

supplemental vitamins

A 2005 study in the Journal of Psychopharmacology suggests that since depression is said to be linked to low levels of red cell folate and vitamin B12, taking low doses of folic acid and vitamin B12 may help improve treatment outcomes in depression.15

According to a 2006 study in Public Health Nutrition, the Mediterranean diet has been shown to help reduce depression prevalence. Foods rich in folic acid, vitamin B12, and omega-3 fatty acids, such as fruits, nuts, legumes, and fish can potentially help with depression in individuals.17 Similarly, a 2010 study in The American Journal of Psychiatry found that a diet rich in vegetables, beef, lamb, fish, and wholegrains were associated with lower chances of depressive disorders. On the contrary, an “unhealthy� diet consisting of processed or fried foods, refined grains, sugary products, and beer lead to a higher possibility of psychological symptoms.18

medications

exercise

A 2001 study in the British Medical Journal found that exercise, particularly aerobic activities like running, cycling, or swimming, may reduce symptoms of depression, at least in the short term for some patients.19 Furthermore, a 2007 review in the American Journal of Lifestyle Medicine encouraged depressed patients to get a minimum of 30 minutes of brisk walking regularly in order to achieve health benefits.20

47

total wellness â–Ş spring 2014

A study published by the British Medical Journal in 2002 tested the effectiveness of tricyclic antidepressants, chemical compounds which are also known to treat depression, along with selective serotonin reuptake inhibitors (SSRIs). The study concluded that tricyclic antidepressants are valid drugs to treat depression, but further research is needed to determine the benefits and harms of different dosages. Because of the limitations of the study, SSRIs continue to be far more commonly-used drugs.16

A 2005 study in the Journal of Affective Disorders suggests that yoga may be an effective strategy to combat depression.21 Likewise, a 2009 study in Complementary Therapies in Clinical Practice revealed that participation in yoga activities over a couple of months lead to a notable decrease in anxiety.22 However, further studies are necessary to determine which types of yoga are most effective and what levels of severity of depression are likely to respond to these interventions.

For more information, check out Namaste: Promoting Mental Wellness Through Yoga in Issue 2, Volume 14 of Total Wellness.

total wellness ▪ spring 2014

mindfulness

A 2009 study published by the Journal of Psychosomatic Research implied that mindfulness-based stress reduction therapy, a therapeutic version of meditation, may enhance treatment outcome for depression when integrated with behavioral therapy.24

cognitive therapy and pharmacotherapy

A 1981 study in The British Journal of Psychiatry found that a combination of cognitive therapy (a method used to reverse negative thoughts) and pharmacotherapy (medical treatment by drugs) induced more effective treatment for depression than when they were used separately.25

48

light therapy

Light therapy may prove to help fight the blues. In fact, a 1984 study in the Archives of General Psychiatry demonstrated that exposing patients who live in low sunlit regions to bright, artificial light may have an antidepressant effect.23

bottom line: Not all forms of depression require medication. In fact, you can also take measures to boost your mind by going outside and working out or eating a wellbalanced diet. Additionally, there are resources on campus, including UCLA Counseling and Psychological Services (CAPS), that can help you. You do not need to face depression on your own – remember, you are not alone. tw

References 1.

“Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.” Arch Gen Psychiatry. (2005).

2.

“Depression Health Center.” webmd.com. (2012).

3.

“Diseases and Conditions.” mayoclinic.org. (2014).

4.

“What is Depression?” nimh.nih.gov. (2011).

5.

“Depression (major depressive disorder).” mayoclinic.com. (2013).

6.

“Serotonin and its place in the pathogenesis of depression.” J Clin Psychiatry. (1988).

7.

“Aging, circadian rhythms and depressive disorders: a review.” Am J Neurodegener Dis. (2013).

8.

“From inflammation to sickness and depression: when the immune system subjugates the brain.” Nature Reviews Neuroscience. (2008).

9.

“Genetic Epidemiology of Major Depression: Review and Meta-Analysis.” Am J Psychiatry. (2000).

10.

“Social environmental factors in unipolar depression: Comparisons of depressed patients and nondepressed controls.” J Abnormal Psychology. (1983).

11.

“The link between childhood trauma and depression: Insights from HPA axis studies in humans.”

Psychoneuroendocrinology. (2008).

12.

“Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies.” Arch Gen Psych (2010).

13.

“Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults.” J Affective Disorders. (2010).

14.

“Research and treatment approaches to depression.” Nat Rev Neurosci. (2001).

15.

“Treatment of depression: time to consider folic acid and vitamin B12.” J Psychopharmacol. (2005).

16.

“Meta-Analysis of Effects and Side Effects of Low Dosage Tricyclic Antidepressants in Depression: Systematic Review.” BMJ. (2002).

17.

“Mediterranean diet and depression.” Pub Health Nutr. (2006).

18.

“Association of Western and Traditional Diets With Depression and Anxiety in Women.” Am J Psychiatry. (2010).

19.

“The Effectiveness of Exercise as an Intervention in the Management of Depression: Systematic Review and Meta-Regression Analysis of Randomised Controlled Trials.” BMJ. (2001).

20.

“Themed Review:Anxiety/Depression: Lifestyle Medicine Approaches.” Am J Lifestyle Med. (2007).

21.

“Yoga for Depression.” J Affective Disorders. (2005).

22.

“Effects of yoga on depression and anxiety of women.” Compl Ther Clin Prac. (2009).

23.

“The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis.” J Psychosom Res. (2009).

24.

“The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination.” BJ Psych. (1981).

25.

“Seasonal Affective Disorder: A Description of the Syndrome and Preliminary Findings with Light Therapy.” Arch Gen Psychiatry. (1984).

left: sehenswerk/istockphoto; cybernesco/istockphoto; blackjack3d/ istockphoto; right: gmvozd

yoga

features

prescription drug abuse: legal drugs & their deadly outcomes by julie escobar | design by jessica sun

total wellness â–Ş spring 2014

When someone is feeling ill or a bit under the weather, it is not uncommon to take some form of medication to treat or alleviate the symptoms. However, while many prescription pills prescribed by doctors are used for medical purposes, studies show that an increasingly large number of individuals have misused or abused them.1-2 Using a medication without a prescription or in a way other than as prescribed is known as prescription drug abuse. According to the Centers for Disease Control and Prevention (CDC), drug overdose rates in the US have more than tripled since 1990, and more than 12 million people reported using painkillers for non-medical purposes in 2010.3 These may include taking a higher-than-recommended dose of certain drugs in order to lose weight or stay thin, or for the experiences or feelings elicited after taking the drug. Why are these rates increasing? One reason may be that doctors are now prescribing more drugs for a greater number of health problems than in past years, particularly for pain management. Another reason may be that the availability of drugs to individuals without a prescription has increased via the internet.2, 4 No matter the reason, prescription drug abuse has become a major concern for society. Read on to learn about some of the most commonly abused prescription drugs, how to use drugs safely, and what you can do to avoid prescription drug abuse.

49

while there are many different medications that can be abused, the following are some of the most commonly abused prescription drugs:10 what types of medications do they include?

what are they?

Prescription drug abuse is not only receiving national attention by policy makers and public health officials, but it has been recognized as a growing epidemic. The US Department of Health and Human Services, Drug Abuse Warning Network, estimated that approximately 1.6 million emergency department (ED) visits resulted from medical emergencies involving drug misuse or abuse in 2004; an approximate 39% of those cases included the use of pharmaceuticals.5 This number has dramatically increased to an estimated 2.5 million in 2011. From this total, approximately 1.2 million ED visits involved the nonmedical use of prescription medicines, overthe-counter drugs, or other types of pharmaceuticals.6 The intent to use drugs like prescription painkillers to get “high” or for other nonmedical reasons has become a popular form of misuse.7 According to the Monitoring the Future study – the nation’s largest survey of drug use among youth – and a 2010 article from the Journal of Clinical Pharmacology and Therapeutics , prescription drugs are the second-most abused category of drugs after marijuana.8-9

opioids

Medications usually prescribed to relieve pain.

›

central nervous system (CNS) depressants

Medications used to treat anxiety and sleep disorders.

›

stimulants

Medications most often prescribed to increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration.

Amphetamine-like drugs such as: › Dextroamphetamine (i.e Dexedrine, Adderall) › Methylphenidate (i.e. Ritalin, Concerta)

Hydrocodone (i.e. Vicodin) › Oxycodone (i.e. OxyContin) › Morphine (i.e. Kadian, Avinza) › Codeine › Other related drugs

Benzodiazepines (i.e. Valium, Xanax) › Non-benzodiazepine sleep medications (i.e. Ambien, Lunesta, Sonata) › Barbiturates (i.e. Mebaral, Luminal Sodium, Nembutal)

›

Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injuryrelated pain. › Morphine is most often used before and after surgical procedures to relieve severe pain. › Codeine is prescribed for mild pain.

›

Benzodiazepines are not usually prescribed for long term use due to their association with tolerance, dependence, and addiction. › Non-Benzodiazepines are known to have fewer side effects and less risk of dependence. › Barbiturates are used less frequently to reduce anxiety or to help with sleep problems because of their higher risk of overdose.

Medical use of stimulants has begun to wane due to their potential for abuse and addiction. They are only used now to treat a few selected health conditions including: ADHD, narcolepsy, and depression.

left: serts/istockphoto

total wellness ▪ spring 2014

what do we know?

when are these types of medications commonly used?

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the road to addiction While many who misuse prescription drugs enjoy them for recreational use, abuse of certain prescription drugs can lead to addiction.

Addiction, as defined by the National Institute on Drug Abuse, is a “chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite serious adverse consequences, and by long-lasting changes in the brain.”10 In many cases, addiction results from the abuse of medication prescribed for medical purposes, including chronic noncancer pain. According to a 2013 article from The Korean Journal of Pain, many physicians who lack effective alternative interventions for chronic noncancer pain management have opted to use opioid pharmacotherapy. While the increase in opioid use brings gains in the form of therapeutic benefits, it also leads to a higher incidence of adverse drug events, including increased medication misuse and increased opioid-related mortality.11

how much is too much?

The use of painkillers by Americans quadrupled between 1999 and 2010. In 2010, enough painkillers were prescribed to medicate every American adult around-the-clock for a month.

Even more startling is a report from the CDC confirming that the number of overdose deaths is now greater than those who have died from heroin and cocaine drug use combined.7 While striving to reduce the number of people who misuse, abuse, or overdose from powerful prescription drugs, it is important to understand how some of the most common prescription drugs work on the brain and body as well as what the consequences of abuse are.

opioids

When abused, a single large dose can cause severe respiratory depression and death. Regular or longer term use/ abuse can lead to physical dependence and/or addiction.10

Despite the benefits that medications can provide, they can sometimes cause unintended, harmful results. These reactions are called adverse drug reactions.12 Below are some of the different forms of adverse drug reactions: drug interactions can result when 2 or more drugs taken together react chemically with each other, causing an effect that would not occur if the drugs were taken separately.13

› › drug›toxicity indicates that an individual has accumulated too much of a medication in the › bloodstream.

As the effects of medications are more › pronounced at toxic levels, side effects may be more › severe. › 14

idiosyncratic drug reactions (IDRs) are unpredictable adverse drug reactions that do not occur in most patients.

However, these reactions can be life-threatening in the rare cases when they do occur. Such a reaction does not occur in most people within the range of doses used clinically and is usually specific to an individual.15 drug allergies give rise to a group of symptoms commonly seen in response to allergic reactions to drugs or medications. Such allergic reactions include hives, itching, skin rash, swelling (of the lips, tongue, or face), or wheezing.16

› › › Almost any drug can cause an adverse remember: reaction,›which makes it imperative for individuals to pay special attention to the proper dosage and time-related instructions when taking medication.16

central nervous system (CNS) depressants Depressants affect the brain by increasing the amount of a certain inhibitory neurotransmitter in the brain called GABA (gammaaminobutyric acid). By increasing the effects of GABA, these drugs produce a drowsy or calming effect on the body, benefitting those with anxiety or sleep disorders.

Continued use of CNS depressants may lead individuals to require larger doses in order to achieve the same therapeutic effects. Physical dependence and withdrawal may also occur when the use of such drugs is reduced or abruptly stopped.10

stimulants Stimulants enhance the effects of natural chemicals in the brain, including the neurotransmitter dopamine. When taken nonmedically, an increase in dopamine induces a feeling of euphoria. Other effects caused by stimulants include an increase in blood pressure/heart rate, an increase in blood glucose, and the constriction of blood vessels.

It is possible to become dependent upon or addicted to stimulants.

Repeated abuse can lead to feelings of hostility or paranoia.10

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Besides bringing pain relief, opioids may also produce a wide range of side effects including drowsiness, mental confusion, and nausea. Because some people report a euphoric response to opioid use, those who wish to intensify their experience may use opioids for reasons other than prescribed.

forms of adverse drug reactions

mixed drugs and other interactions: Individuals who use prescription drugs should be mindful of the chemical reactions that may occur when taking other medications or substances. According to the CDC, about 1/2 of prescription painkiller deaths involve at least one other drug, including benzodiazepines, cocaine, and heroin.3

opioids

central nervous system (CNS) stimulants depressants

Opioids should not be used with other substances that depress the central nervous system (CNS), such as alcohol, antihistamines, benzodiazepines, or general anesthetics. Such combinations increase the risk of life-threatening respiratory depression.10

Usually, CNS drugs should not be combined with any other medication that causes CNS depression, including prescription pain medications, overthe-counter (OTC) cold and allergy medications, and alcohol. Using CNS depressants with other substances may result in irregular heart rhythm.10

Stimulants should not be mixed with antidepressants or with OTC cold medicines that contain decongestants.

Stimulants, which can be seen as any agent that enhances function, include drugs that increase alertness and reduce fatigue. Antidepressants may in fact enhance the effects of a stimulant. Decongestants, which are chemically related to adrenaline, used in combination with stimulants, have been found to cause blood pressure to become dangerously high or lead to irregular heart rhythms.10

Please note: It is not safe to use any of the above prescription drugs without the supervision of a licensed physician. Drugs should not be mixed or used with other substances unless authorized.

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6

Don’t increase or decrease medication doses without talking with your doctor first.

Learn about possible interactions of the prescription medicine with alcohol and other prescription and OTC drugs.

7

Talk to your doctor about any history of substance abuse.

3

Never stop taking a medication on your own.

8

4

Don’t crush or break pills.

Never use another person’s prescription medication, and don’t give them yours.

5

Understand the drug’s effects on driving and other daily tasks.

9

Do not take medication after the expiration date. Expired medical products may be less effective and/ or risky due to a change in chemical composition or a decrease in potency.

If you have expired medicine, it should be disposed of properly. Read the label for disposal instructions.

1

Always follow the prescription medication directions carefully.

2

left: jorgegonzalez/istockphoto; ds011/istockphoto; right: ajt/istockphoto

total wellness ▪ spring 2014

guidelines for using drugs safely17-18

what can you do?

Because prescription drugs are legal, they are easily accessible and harder for the medical community and law enforcement to control. The Office of National Drug Control Policy states that “while there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over who used drugs [recreationally] for the first time in 2009 began by using a prescription drug nonmedically.”8 Here are some things you can do to reduce the abuse of prescription drugs:

follow disposal guidelines.

Learn how to dispose of unused medicines by visiting the following site (http://www.fda.gov/Drugs/ ResourcesForYou/Consumers/default. htm) and typing “disposal of unused medicines” in the search box.

seek treatment and support individuals in recovery.

If you or a loved one needs help with substance abuse, find a treatment center near you today, or talk to your doctor about referral drug treatment programs.

take advantage of community take-back programs, which collect and dispose of unwanted and unused prescription drugs from consumers.

Call your city or county government’s household trash and recycling service and/ or your local police or sheriff’s department to see if a take-back program is available in your community.

CalRecyle maintains a website of pharmaceutical and medical sharps take-back sites throughout California. Visit the following link for more information: http://www. calrecycle.ca.gov/FacIT/Facility/Search.aspx

bottom line The rise and frequent use of prescription drugs for medical and non-medical purposes make it important to understand the biological consequences and/or adverse drug effects that can occur from regular and/or irregular use. Always follow the label instructions and speak with your doctor before stopping or changing your medication dose, and be wary of the possible chemical interactions that may occur when taking other drugs or alcohol simultaneously. Due to the legal nature and relatively easy accessibility of prescription drugs within and outside the home, individuals should follow the proper disposal guidelines to decrease the misuse of prescription drugs. tw

total wellness ▪ spring 2014

References 1.

“Abuse of prescription drugs and the risk of addiction.” Drug Alcohol Depend. (2006).

2.

“Major increases in opioid analgesic abuse in the United States: Concerns and strategies.” Drug Alcohol Depend.

(2006).

3.

“Policy Impact: Prescription Painkiller Overdoses.” cdc.gov. (2013).

4.

“About Prescription Drug Abuse.” attcnetwork.org. (2013).

5.

“Drug Abuse Warning Network, 2004: Selected Tables of National Estimates of Drug-Related Emergency Department Visits.” samhsa.gov. (2009).

6.

“Drug Abuse Warning Network, 2011: Selected Tables of National Estimates of Drug-Related Emergency Department Visits.” samhsa.gov. (2013).

7.

“Prescription Painkiller Overdoses in the US.” cdc.gov. (2011).

8.

“Prescription Drug Abuse.” whitehouse.gov. (2013).

9.

“Prescription drug abuse: Insight into the epidemic.” Clin Pharmacol Ther. (2010).

10.

“Prescription Drugs: Abuse and Addiction.” drugabuse.gov. (2011).

11.

“Opioid pharmacotherapy for chronic noncancer pain: The american experience.” Korean J Pain. (2013).

12.

“Adverse drug reactions: Definitions, diagnosis, and management.” Lancet. (2000).

13.

“Drug Interaction Studies - Study Design, Data Analysis, Implications for Dosing, and Labeling Recommendations.” fda.gov. (2012).

14.

“Drug Toxicity.” freemd.com. (2010).

15.

“Idiosyncratic drug reactions: Current understanding.” Annu Rev Pharmacol Toxicol. (2007).

16.

“Drug Allergies.” nlm.nih.gov. (2013).

17.

“Prescription Drug Abuse.” webmd.com. (2012).

18.

“Don’t Be Tempted to Use Expired Medicines.” fda.gov. (2012).

53

decoding the nutrition label

carrageenan

by pauline yang and chalisa prarasri | design by natalie chong

Carrageenan is extracted from red seaweeds and algae. It is an edible substance used to thicken and stabilize food and medicinal products. It has the same thickening effects as gelatin, but it is more favorably used because it is a plant-based product, as opposed to the animal-based gelatin.2

Carrageenan is approved for use in food – both by the FDA and the European Union’s (EU’s) Scientific Committee on Food.5-6 However, a quick internet search with the terms “carrageenan safety” comes up with hits citing a number of alarming studies that detail the dangers of carrageenan. Some of these studies are explained below:

Given the studies above, why is carrageenan still allowed in our food? The answer is that these studies may not be as conclusive as they seem. Let’s take a look at why some of these studies may not draw the alarming conclusions they appear to: excessive amounts of carrageenan: Many of the studies that implicate carrageenan in cancer formation and gastrointestinal damage use excessive amounts carrageenan.

The carrageenan made up a large part of the animals’ diets in these studies (between 2 to 18%), whereas it is estimated that people only consume 30 to 50 mg of carrageenan per day through additives. To put this into perspective, a 5% carrageenan diet is equivalent to 3,230 mg for each kg of body weight per day. That’s approximately 193,800 mg per day for a 133 lb person!5 poligeenan contamination: There is currently no substantial evidence to suggest that poligeenan is present in food-grade carrageenan, much less at the proportions necessary to elicit damaging effects based on the studies on poligeenan.5 conflicting studies: Studies that found no evidence of a negative effect of carrageenan are not as well-publicized.

However, these do exist. For example, a study on colon cancer similar to the ones mentioned earlier found that carrageenan given as 0, 1.25, 2.5, and 5% of rats’ diets did not lead to increased tumor formation.5,10

carrageenan as a carcinogen: According to a 1978

the bottom line

what products may contain carrageenan?

Carrageenan has some medicinal medicine:

effects, such as the ability to sooth irritated mucous membranes. In some cases, it is also used as a form of laxative when taken orally.3

food and beverages:

Carrageenan is added to foods and beverages to create a thicker consistency. It is a common ingredient in almond milk and soymilk, yogurt, chocolate, and nutritional shakes. It is also added to cereal, deli meats, and baked goods.4

toothpaste:

Carrageenan may be added to toothpaste to make the product thicker.5

how safe is it to consume?

review published in Cancer Letters, scientists have discovered that some rats fed poligeenan (a non-food grade type of carrageenan) for 24 months developed colorectal tumors, indicating that poligeenan could lead to colon cancer.7 Though poligeenan is not used in food, the concern is that food-grade carrageenan may be contaminated with poligeenan, since poligeenan is a degraded form of carrageenan.5

total wellness ▪ spring 2014

a dose of healthy skepticism

carrageenan and gastrointestinal damage: A

2002 correspondence published in Environmental Health Perspectives noted that monkeys who had 2% poligeenan in their diets experienced negative gastrointestinal effects, including cyst formations and changes in stool consistency.8

carrageenan and diabetes:In a 2012 study published in Diabetologia, scientists tested the effects of carrageenan on glucose tolerance and insulin sensitivity, factors related to diabetes. Mice were given a relatively small dose of

54

The evidence for carrageenan as a dangerous product in the everyday doses we get from food is inconclusive, and at best, small. Carrageenan is an edible, FDA-approved substance that can be found in common everyday items. There is a concern that it could be harmful in large quantities. However, the amount of carrageenan that a person is exposed to on a daily basis is nowhere near the amounts used in many of these alarming studies, so barring some preliminary evidence that carrageenan can affect glucose tolerance (which still needs to be verified with further research), it seems that carrageenan is safe when consumed in small amounts. t w References 1. “Carrageenan.” webmd.com. (2009).

2. “Carrageenan.” encyclo.co.uk. (2013).

3. “Carrageenan.” naturaldatabase.therapeuticresearch.com. (2014).

4. “What has carrageenan in it?” livestrong.com. (2011).

5. “Opinion of the Scientific Committee on Food on Carageenan.” ec.europa.eu/food/.

(2003).

6. “Database of Select Committee on GRAS Substances Reviews: Carrageenan.” fda.gov. (2006).

7. “Induction by degraded carrageenan of colorectal tumors in rats.” Cancer Lett. (1978).

8. “Carrageenan in Foods: Response.” Environ Health Perspect. (2002).

9. “Exposure to the common food additive carrageenan leads to glucose intolerance, insulin resistance and inhibition of insulin signaling HepG2 cells and C57BL/6J mice.” Diabetologia. (2012).

10. “Lack of tumor promoting effects of carrageenan on 1,2- dimethylhydrazine-induced colorectal carcinogenesis in male F344 rats.” J Toxicol Pathol. (2001).

4kodiak /istockphoto

what is carrageenan?

carrageenan (10 mg of carrageenan per liter of water) and subsequently had their glucose and insulin levels measured.

Scientists found that their glucose tolerance was impaired.

During the study, the control group’s glucose levels decreased by more than 80% while the levels in carrageenan-treated mice did not change.9

left:

Although carrageenan is not a familiar or common household name, it is a versatile ingredient used in many things from medications to food to toothpaste.1

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:

q&a

R

Talin Babikian, PhD, Assistant Research Professor, Clinical Neuropsychologist in Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine

breathe easy: your guide to air purifiers

seeds in our diets

Carol Chen, MS, RD, Dietitian, UCLA Arthur Ashe Student Health and Wellness Center

Helen Lavretsky, MD, Associate Professor, Department of Psychiatry, UCLA David Geffen School of Medicine

Psychologist, Affective Disorders Program Coordinator, UCLA Counseling and Psychological Services (CAPS)

mind games

prescription drug abuse

taking nerves to the next level

decoding the nutrition label

Karen Miller, PhD, Neuropsychologist, UCLA Stewart and Lynda Resnick Neuropsychiatric Hospital

Michael Treanor, PhD, NIMH PostDoctoral Fellow in the UCLA Anxiety Disorder Research Center (ADRC)

“you said what now?” communication and relationships

Aleksandra O. Kalinich, PsyD, UCLA Counseling and Psychological Services (CAPS)

in pursuit of bodily perfection

Melissa Magaro, PhD, Clinical Psychologist, Affective Disorders Program Coordinator, UCLA Counseling and Psychological Services (CAPS)

Raffi Tachdjian, MD, MPH, Assistant Clinical Professor of Medicine and Pediatrics, Division of Allergy and Clinical Medicine, UCLA David Geffen School of Medicine

Zhaoping Li, MD, Assistant Professor, UCLA Center for Human Nutrition, UCLA David Geffen School of Medicine

copy-edits and review

Leslie Chang, Julie Escobar, Tiffany Lin, Chalisa Prarasri, and Shannon Wongvibulsin

layout revisions

Barbara Wong, Shannon Wongvibulsin, and Karin Yuen

cover & table of contents

Designed by Barbara Wong and Karin Yuen

the biological basis of road rage

Felix E. Schewizer, PhD, Department of Neurobiology, UCLA David Geffen School of Medicine

55

total wellness ▪ spring 2014

Raffi Tachdjian, MD, MPH, Assistant Clinical Professor of Medicine and Pediatrics, Division of Allergy and Clinical Medicine, UCLA David Geffen School of Medicine

the science behind happiness beating the blues Melissa Magaro, PhD, Clinical and exercise

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