What's Trending? by Total Wellness Magazine

total wellness

a ucla student wellness commission publication

what’s trending? keeping up with today’s health crazes

inked

your guide to tattoos

hot yoga

runner’s high how it works for you

total wellness ▪ summer 2015

and why it’s hot right now

1 summer 15 | vol 15 | issue 3

a message from the director If there is one thing a research publication does well, it’s ask questions. We ask questions and challenge common claims so that we can provide our readers with the most informed content. For this issue, we decided to ask questions about some of the most popular trends in health and fitness. What scientific backing do these well-talked-about subjects actually have? Join us as we explore trendy topics such as detoxing (pages 9-10), hot yoga (pages 28-30), coconut oil (pages 41-45), and probiotics (pages 14-17). This issue marks the end of my time as Director for Total Wellness, and I’d like to take a little time to thank those on Leadership before me, and those taking the reins after me. I give Shannon Wongvibulsin, Chalisa Prarasri, Karin Yuen, and their leadership team credit for developing the amazing magazine that stands strong today. They had a great vision and put forth so much time and energy to making every issue darnnear perfect. It’s their passion and legacy that has kept this magazine thriving. Our incoming director, Chris Phan, and his leadership team have already shown a tremendous amount of dedication in making sure that the magazine transitions smoothly into the upcoming school year. I can’t commend them enough for how proactive they have been! I can’t wait to see the things to come in Volume 16. As my time with Total Wellness comes to a close, you can find me working in business development and marketing for another company dedicated to helping people live better, Liv360.com. I couldn’t have asked for a better learning experience, better colleagues, or better readers than those I found with Total Wellness. I wish you all the best of health this school year, physically and psychologically. Cheers!

total wellness ▪ summer 2015

Anne-Marie Theriault Outgoing Director

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

editors’ notes Dear readers, This message comes as both a greeting and a farewell… This past year, our talented team of writers continually surprised me with original titles, the newest research, and unique perspectives on day-to-day health topics. I also learned so much from my experience of taking on the challenging position of editor-in-chief. I’ve come to truly admire all the past editors, because let me tell you, as a writer, I hadn’t realized how much actually went into the whole process, from brainstorming topics to opening that first shiny copy. My time as editor had its ups and downs, and now it must come to a bittersweet end as I wrap things up during my senior year. I may have stretched myself thin with many commitments, and I think the learning outcome was that, no matter what, always put your health first! How ironic that the very message we were preaching in the magazine, I let slide for myself. Health encompasses stress and sleep (and I want to especially stress the importance of sleep!), so I remind everyone to give 50% of your energy to a select few endeavors that you are passionate about, and give the other 50% to your health. I want to thank everyone who supported and encouraged me throughout my time with the magazine, including Shannon and Chalisa, the past editors-in-chief, Pavan, my co-editor, Annie, our director, the ‘14-’15 leadership team, and my parents. Last but not least, I’d like to make an honorable mention to a few of our writers who continually produced excellent work and demonstrated exceptional organization: Payam, Omid, and Chris. That being said, I have complete confidence in our new leadership team to advance Total Wellness and make it bloom more than it ever has. Enjoy this issue and see you around campus!

Julia Feygelman Outgoing Co-Editor-In-Chief

Though I have graduated from UCLA and will soon no longer be a part of Total Wellness Magazine, it will always be a part of me. Working with fellow staff members to have a meaningful impact on our readers’ lives has made each endless hour of writing and editing worthwhile. Together, we accomplished something much larger than any of us could do alone, and I am thankful for the opportunity to work with such brilliant, inspiring people. I have no doubt that the passion and determination of the incoming leadership will carry them to success in the coming year, and I am excited for the future of the magazine. Wishing you good health and happiness now and forevermore,

Pavan Mann Outgoing Co-Editor-In-Chief

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As both a writer and an editor for Total Wellness Magazine, I have always emphasized one particular goal: to help readers make informed decisions toward a healthier, happier life. Even though prebiotics, probiotics, kefir, detox, and coconut oil are referred to as healthy, it is still important to understand, evaluate, and deeply consider each choice you make, as if it were a tattoo or a new drug. Thus, our writing team has selected some trendy and a few taboo topics to get you thinking critically about what you choose to do with your mind and body.

leadership meet our staff: director Hello readers! As I transition from my role as a staff writer to serve as Total Wellness’s director for the coming year, I want to introduce you to the magazine’s entirely new leadership team, all of whom will be starting their positions for the first time officially this fall. I am excited to work alongside such talented and dedicated team members to find better ways of helping keep you up to date on what’s new in health and wellness. In this issue, we examine trendy health topics ranging from hot yoga (page 28) and coconut oil (page 41) to detoxing (page 9) and psychoactive drugs (page 22). Read on to take a closer look at the benefits of practicing yoga in a steamy environment to seeing how drugs can affect your brain and body behavior.

Striving to stay fit and in style can be difficult. That’s why we took a look at the latest research to see how healthy the newest health fads are. Regardless of what health trends are in vogue, it is important to critically evaluate the science behind the claims and stay true to yourself.

We hope that this issue, like our cover story on tattoos, will leave a positive mark on the health of our readers.

REBECCA TANG Co-Copy Editor

TIFFANY LIN Co-Copy Editor

PETER CHU Managing Editor

total wellness ▪ summer 2015

NATALIE CHONG Art Director

cover:karandaev/istockphoto

Chris Phan Incoming Director

total wellness co-editor-in-chief

co-copy editor

Julia Feygelman

Tiffany Lin

director Annie Theriault

co-editor-in-chief Pavan Mann

co-copy editor Rebecca Tang

art director Natalie Chong

managing editor

webmaster

Peter Chu

Sepideh Parhami

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

design

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

Emily White Pauline Yang Danielle Zola

Alison Jeng Jackie Nguyen Kimberly Rich Molly Sanders Nancy Vu Sophia Fang

advisory & review Peter Lio, MD

Christopher Evans, PhD

Director, UCLA Brain Research Institute

Assistant Professor, Northwestern University School of Medicine

Christine Grella, PhD

Emeran A. Mayer, MD

Professor, UCLA School of Medicine

Lawrence Taw, MD, FACP

Dolores Hernandez, MA, RD

Nutrition Education Coordinator, UCLA Dining Services

Assistant Clinical Professor, UCLA School of Medicine

Eve Lahijani, MS, RD

FITWELL Services Program Director, UCLA Recreation

Gary Lask, MD

Assistant Clinical Professor, UCLA School of Medicine

Elisa Terry, CSCS

Nutrition Health Educator, UCLA Office of Residential Life

Kirsten Tillisch, MD

Director, UCLA Dermatologic Surgery Service

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Total Wellness is a free, student-run publication and is supported by advertisers, the Student Wellness Commission (SWC), the Undergraduate Students Association (USAC), the Arthur Ashe Student Health and Wellness Center, UCLA Healthy Campus Initiative (HCI), UCLA Recreation, and UCLA Health System: Center for East-West Medicine. Contact 308 Westwood Blvd., Kerckhoff Hall 308 Los Angeles, CA 90024 Phone 310.825.7586, Fax 310.267.4732 totalwellnessatucla@gmail.com www.totalwellnessmagazine.org Subscription, back issues, and advertising rates available upon request Volume 15, Issue 3 ÂŠ 2015 by Total Wellness Magazine. All rights reserved. Parts of this magazine may be reproduced only with written permission from the editor. Although every precaution has been taken to ensure the accuracy of the published material, Total Wellness cannot be held responsible for the opinions expressed or facts supplied by authors. We do not necessarily endorse products and services advertised. The information in Total Wellness is not intended as medical advice and should not replace the advice of your physician. Always consult a health care provider for clarification.

{contents} 02

message from the director

editors’ notes

in the news

Q&A

credits

ARTICLE COLUMNS pain therapy probiotics bathing psychoactive drugs hot yoga kefir

11 self-care 14 eat well 18 breathe well 22 mind well 28 body in focus 46 food pick

FEATURES

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cover story 32

tattoos

runner’s high

coconut oil

meet the

committees of

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

[Bruin Consent Coalition]

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

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

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

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

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

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

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

BRUIN RUN/WALK

know your resources!

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

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

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

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

in the news

by pavan mann| design by alison jeng

AT UCLA NONINVASIVE SPINAL CORD STIMULATION OFFERS HOPE FOR PARALYZED PATIENTS

Researchers at UCLA have developed and tested a new procedure that has helped five human subjects regain some voluntary motion after complete paralysis without invasive surgery. While other studies involve a surgically implanted spinal cord stimulator to administer electrical stimulation, this study tested the effects of a unique pattern of electrical currents that causes no discomfort to patients and is administered noninvasively and externally on the skin near the lower back and tailbone. After just 18 weekly training sessions, each only 45 minutes in duration, the five patients recovered some voluntary control of their legs, even though they were all previously completely paralyzed for over 2 years due to athletic injuries or auto accidents. These findings are quite far from becoming a treatment option for people with spinal cord injuries and paralysis, and it is uncertain whether or not this treatment will help patients regain the ability to walk. However, this study offers the hope of recovering many lost bodily functions and an improved quality of life overall for the millions of patients living with severe or complete paralysis, especially since it does not rely on costly, complicated surgery.6,7

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3D PRINTED HEART HELPS UCLA CARDIOLOGISTS CONDUCT A COMPLICATED SURGERY

After enduring two hospitalizations and developing congestive heart failure, Richard Whitaker was in dire need of replacing his malfunctioning pulmonary valve, which controls the amount of blood flowing from the heart to the lungs. However, due Whitaker’s abnormally large pulmonary arteries and previous surgeries, open-heart surgery was too dangerous. Instead, UCLA cardiologists planned to guide the new valve through a vein in the leg to the heart, carefully placing the valve and its scaffolding, supporting stent into the appropriate location. Using CT scans, a silicon-like material, and advanced technology, they designed, created, and printed a 3-D model that was used as practice before conducting the less invasive procedure. The innovative doctors found that their solution was a perfect fit in their test run on the model, and the actual operation proceeded exactly as planned, working instantly and smoothly. After only four days, Whitaker was able to return home without missing a beat. This unique case is one of the first to utilize revolutionary 3-D printing in a medical setting, thereby progressing minimally invasive, individualized treatment for each patient, helping doctors practice procedures, and facilitating the development of new scientific advancements and devices.8

NEW DISCOVERIES

NEW STEROID-BASED EYE DROPS MAY HOLD THE SOLUTION TO CATARACTS

Normally, crystallin proteins in the lens of the eye are necessary for the structure and transparency of the lens. However, a cataract is formed when they inappropriately clump together, clouding the lens and causing progressively worsening blurry vision. Surgery is currently the only potential treatment available for cataracts, which are the most common cause of vision loss after the age of 40 and of blindness worldwide. However, researchers at the University of California, San Diego have developed a game-changing eye drop solution containing lanosterol, an important steroid needed to prevent the harmful aggregation of different cataract-causing crystallin proteins. They found that treatment containing lanosterol decreased protein aggregates in isolated human lens cells and reduced the severity of cataracts in both rabbits and dogs. While studies must still be done to test the efficacy and safety of lanosterol treatment in humans, the researchers are hopeful that their eye drops provide a new solution for the problem of cataracts.1,2

EBOLA VACCINE IS SUCCESSFUL IN CLINICAL TRIALS CONDUCTED IN AFRICA

A randomized clinical trial conducted by the World Health Organization in Guinea, Africa has revealed that a newly developed vaccine is effectively and safety preventing Ebola virus disease with an efficacy that translates to 100%. Of the 2014 eligible people who received vaccination immediately upon detection of Ebola within their community, there were zero new cases of Ebola, and of those 2380 who received vaccination three weeks after detection, there were only 16 new Ebola cases. Researchers believe that the success of the trial relies upon its novel ring vaccination design, which had never been done in a clinical trial setting before. In this method, contacts of Ebola patients and the contacts of these contacts receive the vaccination, thus immunizing and protecting people at risk while preventing the disease from spreading. Though the study has not yet reached completion, the team has decided to offer the vaccine immediately upon detection in all communities for the remainder of the trial due to its convincing outcomes so far. If proven effective by the end of the trial, the vaccine will be useful in managing current and future Ebola outbreaks.3,4,5

References 1. “Lanosterol reverses protein aggregation in cataracts.” Nature. (2015). 2. “Eye drops could dissolve cataracts.” Science. (2015). 3. “Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial.” The Lancelet. (2015). 4. “Unusual Ebola vaccine study pays off in Guinea.” sciencemag.org. (2015). 5. “Ebola vaccine works, offering 100% protection in African trial.” sciencemag.org. (2015). 6. “In UCLA study, non-surgical approach helps people with paralysis voluntarily move their legs – a first.” newsroom.ucla.edu. (2015). 7. “Noninvasive Reactivation of Motor Descending Control after Paralysis.” J Neurotrauma. (2015). 8. “UCLA doctors use 3-D printed model to guide tricky heart valve replacement.” newsroom.ucla.edu. (2015).

Q: A:

q&a by sepideh parhami | design by alison jeng

what is detoxing? Detoxing (short for detoxification) is a rising trend purported to improve health by removing accumulated substances (believed to be harmful) from the body.1 Although rooted in ancient Eastern practices2, detoxing has seen a recent revival. A cleanse, or a detox diet, aims to assist the digestive and urinary tracts in neutralizing or eliminating these “toxins.” Detox plans may be prescribed by a naturopathic doctor or simply followed by an individual as they often incorporate commercially available ingredients and products1 Some common regimens include fruit and vegetable juice fasts, soup cleanses, supplements in powder or pill form, laxatives1, sauna therapy, baths with clay, salts, or other chemicals.2

Q: what are the toxins in question? A: The toxic substrates that detox regimens, or cleanses, attempt to target are extremely vague and ill-defined. The reasoning tied to these cleanses usually involves some generic mention of “toxins” without giving specifics. Researchers assume the culprits to be along the lines of: ❯ ❯ ❯ ❯ ❯

Chemical additives used in processed foods.1 Metabolic byproducts of foods containing certain compounds like mold or iodine1 Mercury and lead, which can enter the body through both environmental and dietary pathways1 POPs (persistent organic pollutants), or industrial chemicals whose slow rate of decomposition causes them to linger in human fat tissue1 BPA (bisphenol A), a chemical common in plastic food and drink packaging. It is known to disturb hormone levels and may be linked to cancer.3 Q: how does detoxing theoretically work?

A: Each plan, depending on its approach, operates on a different theoretical mechanism of action. Many cleanses reduce food intake to nutrient-rich fruits and vegetables with the aim of simply alleviating some of the stress placed on the liver due to its role as a buffer against harmful chemicals like alcohol, medications, and byproducts of digestion.2,4,5 Others emphasize direct toxin extraction through sweat (sauna), using salt to encourage water-soluble compounds to diffuse out of the skin (osmosis baths), or feces (laxatives).2

Q: is there evidence in favor of detoxing being healthy? A: Well, there isn’t much evidence for it yet, and some experts say detox diets can actually be detrimental to health (see next question). A 2014 review study in Journal of Human Nutrition and Dietetics confirms that pollutants, industrial chemicals, and metals certainly do stick around in the body by depositing themselves into various tissues, which can potentially cause developmental defects or diseases like cancer in the long term.1 However, the few studies that have been done to evaluate the efficacy of detoxing in eliminating accumulated

toxins in humans do not compare results with control groups, making it difficult to say whether specific detox products or programs actually improve health.1 Furthermore, formal research on detoxification suffers from conflicts of interest, as companies and organizations are conducting and publishing research on their own products.1 The same review study argues that current evidence is scant at best and the scientific community must closely scrutinize the claims of detox diets as they gain popularity.1

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Animal research suggests that certain nutritional components may bind to and carry away toxins via urine or feces. Although their efficacy has yet to be tested in humans, there are supplements that operate on this gleaned knowledge. For example, citric, malic, and succinic acids naturally present in certain fruits may be able to dissolve aluminum deposited in bones, while iron, calcium, and magnesium supplementation may prevent storage of aluminum in the first place. However, the study that showed that acids have a significant detoxification effect in mice used 25 times the dosage recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization, making it difficult to extrapolate results to humans.1 Selenium and Chlorella algae are thought to aid in urinary excretion of mercury (as well as lead in the case of Chlorella).1 Olestra is a fat additive found in many diet foods that cannot be absorbed by the body. When consumed, olestra enters the digestive tract, dissolves POPs embedded in organ tissues, and forms a compound with the released POPs that is eventually eliminated.

Q: what are the possible risks of a detox diet? A: Noted risks of following a detox plan include: ❯ Low energy levels and fatigue due to restricted food/calorie intake.6 ❯ Sudden spikes or drops in blood sugar due to high fructose (the sugar in fruit) content of juices, which can lead to physical weakness and impaired mental function.2 ❯ Developing an eating disorder or a generally unhealthy attitude toward food.7 ❯ Not getting adequate nutrients, especially in those who are ill and need nutritional support for recovery.7 ❯ Electrolyte imbalance, where ions necessary for nervous system function aren’t present in the proper proportions. This can cause fainting or cardiac problems.7 ❯ The taste of acetone in the mouth. This byproduct of fat breakdown is produced when the body can no longer rely on carbohydrate intake.8

❯ Losing money. Some detox products on the market are nothing more than commercial ventures that capitalize on unsubstantiated claims.9 Exercise good judgment by questioning extravagant promises, identifying marketing tactics that play into fear by using words like “poison” to refer to toxins, and seeking scientific evidence before using a detox product. ❯ Introducing unknown, potentially harmful substances into the body. The FDA has reported numerous cases in which diet and detox supplements contained hidden ingredients like untested pharmaceuticals, prescription drugs, or even controlled substances under strict government regulation due to safety concerns.10 For example, sibutramine, a drug banned for exacerbating heart conditions by elevating blood pressure and heart rate, has been detected in several detox pill brands.10

bottom line We’d say the jury’s still out, but they have yet to be presented with adequate evidence in this case. Health crazes such as detoxing pop up more quickly than their claims can be evaluated from a scientific standpoint. Detoxing’s alleged benefits are certainly appealing, so should you decide to try it for yourself, exercise caution by: ❯ running the detox plan by your physician before starting ❯ investigating to the best of your ability the reputation of any products you plan to buy or diets you plan to follow ❯ keeping a light schedule on days where the regimen calls for restricting food intake stopping if you’re not feeling well. t w

left: chris bernard photography/istockphoto right:illustration by alison jeng

total wellness ▪ summer 2015

References 1. “Detox diets for toxin elimination and weight management: a critical review of the evidence.” J Hum Nutr Diet. (2014). 2. “Detoxification Protocols.” drlwilson.com. (2014). 3. “The Facts About Bisphenol A.” webmd.com. (2013). 4. “Detox 101: Know The Basics Before You Begin.” mindbodygreen.com. (2013). 5. “Anatomy and Function of the Liver.” medicinenet.net. (2014). 6. “Juice Cleanses: Health Hocus Pocus.” health.usnews.com. (2014). 7. Conversation with Eve Lahijani, M.S., R.D., UCLA Residential Life Nutrition Health Educator. (2015). 8. “Ketoacidosis and Ketosis.” ketogenic-diet-resource.com. (2011). 9. “Inevitably, someone will say, ‘But my juice cleanse WORKED.’ No, it really didn’t.” upworthy.com. (2015). 10. “Tainted Weight Loss Products.” fda.gov. (2015).

self care

aches, and strains, and pangs, oh my!

natural methods to alleviate pain by catherine hu| design by jackie nguyen & alison jeng

Although it is quick and easy to pop a pain reliever pill nowadays, there are many alternatives to using pharmacological drugs, which, in comparison to non-pharmacological techniques, often must be prescribed. These alternatives include non-

total wellness â&#x2013;Ş summer 2015

pharmacological techniques such as physical therapy and rehabilitation, as well as â&#x20AC;&#x153;nutraceuticals,â&#x20AC;? or food-derived supplements.1 Many of these techniques can even lead to longterm relief that pharmacological drugs fail to provide.There is an extensive list of non-pharmacological treatments, but this article will go into some of the most common therapies.

physical therapy Physical therapy incorporates various forms of exercise such as stretching, strengthening, and aerobic conditioning into the pain recovery program.2 A 2013 study published in Spine found that when patients received physical therapy shortly after the occurrence of lower back pain, they had a lowered chance of needing further medical services.3 There are different techniques for varying injuries, depending on whether the objective is to increase muscle elasticity, increase joint movement, or relieve muscle fatigue.

techniques: method & pain type soft tissue mobilization

Soft tissue pain results from muscle tension around a joint.4 Since there are many muscles that attach and stabilize a joint (the connection between two bones), it is important to make sure they remain flexible to sustain muscle function and prevent spasms.

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myofascial release During this therapy, light pressure is applied to loosen muscles with restricted movement and to increase elasticity.5 This technique may be helpful for those with fibromyalgia, a chronic syndrome characterized by pain, fatigue, sleep problems, and psychopathology such as anxiety and depression.6 A 2011 study published in Evidence-Based Complementary and Alternative Medicine found that anxiety, pain, sleep, and overall quality of life improved for patients with fibromyalgia, based on a series of questionnaires immediately after myofascial release treatment and one month after treatment.6 Myofascial release works to relieve pain from the soft tissues, which include tough membranes that surround, wrap, and support all muscles.5 This pain originates from “trigger points,” or stiff areas within the tissues that could be caused by stress.5 Depending on the technique used, physical therapy can be useful not only for pain relief, but also for the alleviation of psychological conditions associated with certain pain states.

nutraceuticals Nutraceuticals can include supplements such as calcium, which helps keep bones strong to prevent fracture-associated pain, as well as fruit extracts that are rich in antioxidants, compounds that maintain healthy cell conditions throughout the body and help protect against inflammation that can cause swelling and pain. Certain supplements may help ward off osteoarthritis, a chronic disease that can cause ssevere pain resulting from the destruction of the cartilage covering bone surfaces and impaired joint motion.7 Pomegranate extract, for example, is a nutraceutical often used with osteoarthritis, as it may reduce inflammation and the associated pain.8 Other nutraceuticals include omega-3 fatty acids, vitamin C, willow bark, and more. Nutraceuticals, which are not regulated by the Food and Drug Administration (FDA) are foods (or parts of those foods) that may provide medical or health benefits, including the prevention and/or treatment of a disease.”7 A 2012 study published in Therapeutic Advances in Musculoskeletal Disease found that pomegranate fruit powdered extract fed to mice with arthritis helped in suppressing joint inflammation, and even reduced the risk of arthritis development.7

joint mobilization Physical therapists work to increase the range of motion of a restricted joint, or a joint that has a limited range of movement.4 This is a good alternative to icing and massaging a muscle spasm, as the restricted joint is often the underlying problem.4 Pain results from a pulled muscle in this case, and the restricted joint can cause muscle spasms.

top left: stocklib/istockphoto right:johnny scriv/istockphoto

To maintain joint movement after a muscle injury, soft tissue mobilization is used to mobilize tissue fluids, relieve muscle tension, and introduce elasticity into fibrous muscle tissue.4 In order to restore tissue texture, the physical therapist usually applies traction force to the tight area. This can involve deep pressure and rhythmic stretching.4

additional therapeutic modalities: method & pain type superficial heat This method uses heat up to 1-2 cm below the skin to relieve muscle pain.9 A 2002 study published in Spine found that continuous low level heat wrap therapy, in which the affected area is heated to 104°F, provided more relief of lower back pain than treatments of either acetaminophen or ibuprofen.10 This method can be performed by an individual or also professionally by a therapist.

bottom line There are many ways to relieve pain nonpharmacologically, with techniques ranging from noninvasive treatments, like heat and massage, to intake of supplements. Common conditions such as back and muscle pain can be targeted with these methods, as well as more serious conditions such as osteoarthritis. These alternatives may be good choices for those who seek to avoid pain relief medications that can result in side effects and only short-term alleviation. To sum things up, a pain-free life is not too far away, and may more likely be realized with the incorporation of non-pharmacological therapies. t w

This method can help relieve pain-inducing inflammation and local muscle spasms.9

therapeutic cold (cryotherapy) Unlike superficial heat, the purpose of cryotherapy, or cold therapy, is to cool the tissue in order to constrict the vessels, reduce swelling, and act as an analgesic to pain associated with muscle spasms.11 For example, athletes can take ice baths to reduce tissue swelling.

References 1. “Non Pharmacological Therapies in the Management of Osteoarthritis.” Yves Henrotin. (2012). 2. “Physical Therapy Health Center.” spine-health.com. (2015). 3. “Management Patterns in Acute Low Back Pain: the Role of Physical Therapy.” Spine. (2012). 4. “Specific Manual Physical Therapy Techniques.” spine-health.com. (2015). 5. “Back Pain.” mayoclinic.org. (2012). 6. “Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia.” Evid Based Complement Alternat Med. (2010). 7. “Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence.” Arthritis Res Ther. (2006). 8. “Current nutraceuticals in the management of osteoarthritis: a review.” Ther Adv Musculoskelet Dis. (2012). 9. “Nonpharmacologic Management of Pain.” J. Am. Osteopath. Assoc. (2004). 10. “Continuous Low-Level Heat Wrap Therapy Provides More Efficacy Than Ibuprofen and Acetaminophen for Acute Low Back Pain.” Spine. (2002). 11. “Superficial Heat.” medscape.com. (2013). 12. “Physical Therapy and Health Outcomes in Patients With Spinal Impairments.” Phys Ther. (1996). 13. “How much physical activity do adults need?” cdc.gov. (2014).

This type of pain results from muscle spasms, or pain that comes and goes.

exercise A 1996 study from Physical Therapy showed that workers with lower back pain were able to return to work faster and had less long-term sick leave when prescribed endurance exercise training as treatment versus a control group.12 This effect may be due to endurance exercise increasing blood flow to painful muscles as well as increasing endorphin levels.12 Centers for Disease Control and Prevention recommends at least 2 hours and 30 minutes of moderate-intensity aerobic exercise weekly (such as brisk walking).13

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Consider adding daily exercise into your regimen, as endurance exercise may reduce pain sensitivity.12

eat well

what are microorganisms doing in my food? by payam mirfendereski| design by kimberly rich & alison jeng

total wellness â&#x2013;Ş summer 2015

The study of microorganisms is gradually becoming more integral to healthcare. Deeper study of microorganisms is well-warranted, given that many of the functions in our bodies are mediated by microorganisms, which in fact outnumber our own body cells 10 to 1.1 The symbiosis, or mutualistic relationship, between humans and microorganisms is an ancient one. The different microorganisms, including bacteria and archaea, that comprise our microbiota play a central role in health (check out issue 2 for more details on the critical role of the microbiota). Nonetheless, it is only with the advent of novel scientific technology that we have been able to methodically use the properties of the microbiota for treating disease. Fermented foods, probiotics, and prebiotics are food items that either introduce new microorganisms into our body or take advantage of microorganisms already there, thereby tweaking our microbiota for maximum health benefits. Today the consumption of fermented foods, probiotics, and prebiotics entails both preventive and therapeutic properties. It is this selective engineering of our microbiota that can help us harness the power of small, living organisms for our own everyday health.

fermented foods what is it?

Fermentation is the process by which a number of our primary food staples are produced, and it relies on microorganisms such as yeast and bacteria that convert sugars to acids and alcohols.2 Alcoholic fermentation is responsible for producing beer and wine while lactic acid fermentation is responsible for producing dairy alternatives. Fermented foods include cheeses, yogurts, leavened and sourdough breads, sausages, vinegar, pickled vegetables, and alcoholic beverages.3 Fermented foods have been around for thousands of years, and the process of fermentation has increasingly become a purposeful means of providing palatability, nutritional value, longer shelf life, and medicinal properties to food.4

increase nutritional value Some types of fermentation can selectively raise the protein content of certain foods, thereby increasing the relative concentration of essential amino acids. Rice fermentation, for example, can hydrolyze and release some of the sugars present in the rice, thereby indirectly boosting the percentage of protein per serving. Rice fermentation can also increase the availability of vitamins such as thiamine, the lack of which may cause beri-beri, a disease that may lead to paralysis and heart failure. The enrichment of ordinary food products through fermentation is particularly useful in developing countries, where vitamin supplements are expensive and less accessible. increase palatability Fermentation is also responsible for converting inedible compounds to digestible, nutritious, and palatable food. Indeed, examples have been documented of microorganisms transforming straw and paper into edible mushrooms! Fermentation can also create distinct flavors and textures, such as meaty flavors in vegetarian dishes, largely due to the increased protein content mentioned above. These protein-rich meaty flavors are present in Chinese soy and Japanese miso sauces and in the meatsubstitute tempeh, all three of which are produced via soybean fermentation.3

left: antigerasim/istockphoto right:msphotographic/istockphoto

preserve food Even with the advent of chemical preservatives and refrigeration, the food industry has continued to rely on fermentation for the preservation of many foods due to energy efficiency and cheapness.3,4 Food can be preserved through acetic acid fermentation (used to produce vinegar), lactic acid fermentation (used to preserve various vegetables, fish, shrimp, sauerkraut, and kimchi), alcoholic fermentation (used to convert perishable fruit juices to wine and cereal grain to beer), and alkaline fermentation (used to convert soybeans into foodstuffs such as the Japanese natto).3 counter lactose intolerance According to a 2008 review published in Alimentary Pharmacology and Therapeutics, fermented dairy products effectively increase tolerance to lactose, the primary sugar found in milk. Fermented dairy products contain bacteria that produce enzymes, such as lactase, that break down lactose into its component sugars, glucose and galactose. While many individuals are intolerant to lactose, glucose and galactose are readily absorbed by the body or fermented into lactic acid.5 Lactic acid fermentation, which occurs in the muscle cells, plays a major role in energy production and metabolism.

Fermentation of milk generally results in its acidification and coagulation as well as a longer shelf-life. Fermented alternatives to milk include yogurt, kefir, and buttermilk, which are produced through various bacterial and yeast cultures. These fermented products are pasteurized, or carefully heated so as to reduce the number of pathogens present in the products. Pasteurization does not eliminate all microorganisms, leaving beneficial microbes unscathed and viable.6

fermented food highlights

kombucha: a drink produced by the fermentation of tea and sugar through a symbiotic association of bacteria and yeasts.13 sauerkraut: a dish made from finely chopped cabbage fermented by several lactic acid producing bacteria. Sauerkraut contains a multitude of biogenic amines, which are precursors to many of the basic building blocks of life.14 kefir: a fermented dairy beverage produced by adding kefir grains (a mixture of probiotics and other molecules) to milk.15

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what does it do?

tempeh: a fermented product made from cooked soybeans. Tempeh has a high content of proteins, essential fatty acids, vitamins, and fiber.16

prebiotics what are they?

Prebiotics are nondigestible food ingredients that provide health benefits by selectively stimulating the growth and activity of bacterial species already present in the colon.7 Prebiotics are typically fibers that are either found naturally in plants or synthesized industrially. Prebiotics are not microorganisms like probiotics, but they can enhance the proliferation of beneficial microbes to maximize sustainable changes in the human microbiome. Rather than being digested or absorbed by human cells, they are fermented by the microbiota.8 In effect, prebiotics feed the beneficial bacteria already present in the body. The most common type of prebiotics comprises dietary fibers such as inulin, which can be found in fruits, vegetables, and increasingly in various processed foods.7

what does it do?

provide immune support The effects of prebiotics on the immune system are largely modulated by the probiotics they affect. Prebiotics act by improving the colonization and growth of probiotics and other microorganisms already present in the body, thus boosting the power of probiotics. The fermentation of particular prebiotics can cause a decrease in intestinal pH, which makes the environment unfavorable to pathogens.8 Prebiotics can also stimulate the production of signaling proteins that modulate immune responses against disease-causing agents.7

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prevent allergy Prebiotics are most effective in combating allergic reactions if consumed during childhood. According to a 2011 article published in the Journal of Leukocyte Biology, nutritional intervention with prebiotic fibers appears to be effective in priming infants’ immune systems and inducing protective mechanisms against allergy. Moreover, this preventative effect seems to be preserved long-term, even after prebiotic supplementation has been stopped. The key to this long-term allergy prevention lies in prebiotics’ enhancement of the intestinal barrier and the gut’s immune system.7 A 2014 study published in the Proceedings of the National Academy of Sciences of the United States of America discovered that certain bacteria naturally found in the body are protective against allergic reactions, and that antibiotic use indirectly affecting these bacterial populations can render individuals more sensitive to food allergens.9 Prebiotics may be effective in combatting these allergic reactions by enhancing the growth of the body’s beneficial bacteria and countering the effects of antibiotics that unintentionally kill the body’s beneficial bacteria.

probiotics

At the same time, probiotics maintain mucus integrity and mucus production in the gut, thereby creating a natural barrier against pathogens. Pathogens are unable to cross the mucus barrier that covers the intestines, so this mechanism helps in preventing infection.

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In another mechanism of action, probiotics produce proteins called defensins, which bind to pathogenic bacterial cells. Defensins form pores that allow nutrients and ions to flow out of the harmful bacterial cells, thereby killing them.10 Probiotics can also provide immune support by activating antiinflammatory factors and mitigating pro-inflammatory factors.10

alleviate certain gastrointestinal diseases Clinical studies have not been conclusive regarding the effects of probiotics on all gastrointestinal diseases. Nonetheless, a 2005 review published in the Journal of Internal Medicine suggests probiotics to be justified in treating acute diarrhea in children and in preventing antibiotic-associated diarrhea.11 The effectiveness of probiotics against certain infections in the gastrointestinal tract may be due to their facilitation of reduced barrier permeability.9 Probiotics may also be capable of limiting the colonization of pathogenic bacteria by producing acids that lower the pH of the gastrointestinal tract, resulting in an environment that is not conducive to the growth of diseasecausing bacteria.12

bottom line Probiotics, prebiotics, and fermented food all take advantage of microorganisms such as bacteria and yeast to improve our well-being. By selectively manipulating our microbial populations, these food elements help preserve the integrity of our digestive and immune systems. Consuming prebiotics helps us nourish our existing microbiota and encourage higher abundance of beneficial types of microbes. Foods containing live microorganisms have been around for thousands of years, and thanks to more research elucidating their health benefits, they will probably remain a staple of our diets in the future. For now, simply take a moment to appreciate the millions of microorganisms present in your food that keep you healthy! t w

References 1. “NIH Human Microbiome Project defines normal bacterial makeup of the body.” nih.gov. (2012). 2. “Yeast Fermentation and the Making of Beer and Wine.” Nature Education. (2010). 3. “Nutritional significance of fermented foods.” Food Res Int. (1994). 4. “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry.” J Phys Anthropol. (2014). 5. “Probiotics, prebiotics, and synbiotics: impact on the gut immune system and allergic reactions.” J Leukocyte Biol. (2011). 6. “Probiotics and their fermented food products are beneficial for health.” J Appl Microbiol. (2006). 7. “Targeting the Human Microbiome With Antibiotics, Probiotics, and Prebiotics: Gastroenterology Enters the Metagenomics Era.” Gastroenterology. (2009). 8. “Review article: lactose intolerance in clinical practice - myths and realities.” Aliment Pharm and Therap. (2008). 9. “Commensal bacteria protect against food allergen sensitization.” P Natl Acad Sci USA. (2014). 10. “Probiotics, gut microbiota and health.” Médecine et Maladies Infectieuses. (2010). 11. “Probiotics and gastrointestinal diseases.” J Intern Med. (2005). 12. “Fermented milks: a historical food with modern applications—a review.” Eur J Clin Nutr. (2002). 13. “Tea, Kombucha, and Health: A Review.” Food Res Int. (2000). 14. “The effects of lactic acid bacteria inoculants on biogenic amines formation in sauerkraut.” Food Chem. (2000). 15. “Kefir - a complex probiotic.” Food Sci Tech Bull Funct Foods. (2005). 16. “A Low Cost Nutritious Food ‘Tempeh’- A Review.” World Journal of Dairy and Food Sciences. (2009).

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what are they? Probiotics are living microorganisms such as bacteria and yeast that improve health when consumed in food or supplements.7 Probiotics are different from the body’s own commensal bacteria, and must be ingested through various fermented foods or in the form of powders, tablets, capsules, pastes, or sprays.10 A 2009 article published in Gastroenterology notes that the consumption of probiotics can introduce microbial components that humans lack and that have known beneficial functions, including the prevention of diseases relating to the gastrointestinal tract.10 Nonetheless, more well-controlled studies are required to determine the effects of probiotics on diseases. The most common types of probiotics are Bifidobacterium and Lactobacillus bacteria, which are found commonly in fermented yogurts and cheeses.7 what do they do? provide immune support Certain probiotics are capable of blocking pathogenic (diseasecausing) microbes in the intestines by producing antibacterial substances that kill pathogenic bacteria. Others produce the same result by attaching to epithelial (surface) cells in the intestine.7 This mechanism is a form of competitive inhibition, in which probiotics compete with pathogens for binding sites and ideally prevent pathogens from infecting the epithelial surface.

breathe well

BATH TIME! by omid mirfendereski| design by alison jeng

total wellness â&#x2013;Ş summer 2015

Sometimes, nothing feels better than taking a long and relaxing bath. Throughout history, baths have been used not only for personal hygiene, but also for social, religious, and therapeutic purposes. In this article, we will discuss balneotherapy and hydrotherapy, two fascinating ways that water is used for healing, and examine the scientific research both in favor and against them.

history Water treatments have been recognized and used since ancient times. According to a 2005 article in Rheumatology International, both the Greeks and the Romans were wellversed in the medicinal qualities of water. The Greeks found that immersion in water could help relax muscles, and the Romans found that water with certain minerals could have medicinal properties such as pain relief.1 According to a 2004 article in The Cochrane Library, at the time of the Greek physician Hippocrates, bathing was considered useful for curing most illnesses. Bathing as a form of treatment regained its ancient popularity in the 16th century, and it has been used for various purposes ever since. Nowadays, thermal and seawater baths are most common in Western European countries, Israel, and Turkey.2 Popular sites for water therapy include the Dead Sea in Israel, Kangal Hot Springs in Turkey, Blue Lagoon in Iceland, and Baile Govora in Romania. However, other sites for water therapy include local health spas, swimming pools, and even bathtubs at home.3

definitions

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The field of water therapy is often a murky one, with categories and subcategories that are not rigidly defined. Nevertheless, over the years, researchers have come to an agreement over certain definitions. According to a 2010 article in the International Journal of Biometeorology, balneotherapy is the use of natural mineral waters, gases, and peloids (mud or clay) for therapeutic purposes, while hydrotherapy is the use of plain water (tap water) for therapeutic purposes.4 Balneotherapy derives from the Latin word balneum, meaning bath, and hydrotherapy derives from the Greek word hudor, meaning water.

balneotherapy what is it? Balneotherapy aims to improve joint motion, strengthen muscles, relieve muscle spasms, improve mobility, and soothe pain.2 Balneotherapy generally uses thermal mineral waters, meaning high-temperature waters consisting of various ions and molecules. Waters below 35°C are called hypothermal, those between 35°C and 36°C are called isothermal (almost equal to human body temperature), and those above 36°C are called hyperthermal.4 The total concentration of certain ions, such as sodium, calcium, and chloride, in these waters must be above 1 g/L to qualify as balneotherapy. The amounts of ammonia, nitric oxide, and nitrogen dioxide, all of which which may affect breathing or cause irritation to the skin and eyes, must be negligible. In addition, there should be no bacteria in order to minimize the possibility of infection.1 Often, there may be gases such as carbon dioxide, hydrogen sulfide, and radon dissolved in the waters.4 Instead of just mineral water, balneotherapy may use peloids such as peat, mud, or clay, which are natural products composed of mineral water, organic compounds, and inorganic compounds that can be applied directly to the body.4,5 how does it work? Balneotherapy decreases the levels of certain inflammatory mediators such as cytokines and possibly increases the pain threshold, thereby bringing about pain relief.6 Immersion eases joint mobility by increasing the stretching ability of tendons, and hot water leads to vasodilation, or widening of blood vessels, which may reduce vascular spasms and flush out molecules that stimulate inflammation and pain. Although the underlying mechanisms are not known, it is believed that interactions between minerals and the skin also provide certain benefits, such as decreased inflammation and decreased risk of bacterial infection.6,7

promising research joint diseases A 1999 study published in the Israel Medical Association Journal found that balneotherapy at the Dead Sea had a beneficial effect on patients with knee osteoarthritis, with improvements lasting at least 3 months.8 A 2002 article published in Rheumatology International found that balneotherapy was effective in decreasing the number of tender points, or pain trigger points, in patients with fibromyalgia syndrome, a common rheumatological (musculoskeletal) diagnosis marked by fatigue, sleepiness, anxiety, and widespread musculoskeletal pain.6

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back pain A 2005 study published in Research in Complementary Medicine found that balneotherapy may be effective for treating lower back pain. Subjects who took mineral water baths as opposed to tap water baths saw reduced muscle spasms and increased rotation of the spine.9

Despite its potential benefits for the body, balneotherapy is often criticized for its lack of concrete evidence, standardization, and internationally accepted definition. The fact that balneotherapy is used in certain countries but not in others is another drawback to the universality of balneotherapy.4

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drawbacks

what is it? Hydrotherapy is used to treat conditions such as osteoarthritis and rheumatoid arthritis, which are diseases marked by degeneration or inflammation of the joints, and fibromyalgia, which is a disease marked by musculoskeletal pain and fatigue as discussed before.4 The technique manipulates the various physical properties of water, such as temperature, hydrostatic pressure, buoyancy, viscosity, and electric conductivity to achieve its aim.4 how does it work? According to a 2010 article published in the Handbook of Disease Burdens and Quality of Life Measures, buoyancy in water leads to a relative decrease in body weight and thus to a decrease in the muscle tension necessary for maintaining an upright posture. This makes it easier, for example, to stand upright in a pool than to stand upright on the ground. The increased hydrostatic pressure in blood vessels, which pushes water out of the vessels, leads to an increase in blood volume and a decrease in heart rate, which may result in relaxation and reduced stress. Psychologically, the sensation of warm water on the skin and the decrease in body weight lead to feelings of relaxation and pleasure.10 promising research A 2002 article published in Physiotherapy found that hydrotherapy may be beneficial in pain reduction, emotional stability, joint mobility, and strength.11 pain Hydrotherapy may relieve pain by numbing nerve endings with pressure and temperature and by relaxing the muscles. It may also bring about pain relief by reducing joint swelling through diuresis, or urine production, which prevents the buildup of fluid in the body.1,12 joint diseases A 1996 article published in Arthritis and Rheumatology found that hydrotherapy that involved simultaneous immersion and exercise produced greater improvements in rheumatoid arthritis than either immersion or exercise on its own, as a result of enhancing blood flow and reducing pain.13 depression In a 2008 study published in Medical Hypotheses, subjects who took cold showers 1 to 2 times per day appeared to improve in their depressive symptoms. The researchers suggested that when people are exposed to the cold, their sympathetic nervous system (the part of the nervous system responsible for the fight-or-flight response) is activated, thus increasing the blood level of endorphins and releasing more norepinephrine. Beta-endorphin may produce a sense of wellbeing, and norepinephrine is one of the key excitatory chemicals in the brain that may be deficient in depressive individuals.14

sports performance A 2002 article published in the Journal of Athletic Training found that ice-water and cold-water immersion were equally effective in treating hyperthermia, or elevated body temperature.15 In a 2013 study published in the Journal of Science and Medicine in Sport, runners completed 2 treadmill exercise bouts (until exhaustion) with a 15-minute interval in between, during which the runners either sat down or submerged themselves (hip-level) in an ice bath. Performance after 15 minutes was found to improve after the ice bath as compared to after seated rest, potentially as a result of vasoconstriction (narrowing of blood vessels) and thus increased blood volume in the heart and lungs. The increased blood volume may have led to reduced cardiac strain and therefore to delayed onset of fatigue.16 drawbacks There are, however, certain risks attached to hydrotherapy. According to a 2003 article published in Epilepsia, hot-water bathing may result in seizure or epilepsy in certain at-risk individuals who have the genes running in their family.17 A 2000 article published in Physiotherapy found that hydrotherapy involving immersion up to the shoulders may restrict thoracic (chest) expansion as a result of hydrostatic pressure on the muscles. This may reduce the amount of oxygen reaching the body and may thus be detrimental to the respiratory system.18

beyond water therapy Balneotherapy and hydrotherapy may be used in conjunction with many other alternative therapies, such as aromatherapy, massage therapy, and acupressure. To learn more about these types of therapy, take a look at our “Integrative Medicine” issue (Volume 11, Issue 2).

bottom line Research supports the notion that bathing may be used for therapeutic purposes. Balneotherapy and hydrotherapy have been shown to improve a variety of conditions, including osteoarthritis, fibromyalgia, lower back pain, depression, and hyperthermia. The two techniques do have their downsides, namely their lack of standardization and their potential side effects, but these are minor in comparison to the potential positive outcomes for the general population. So the next time you are feeling pain in your back or your joints, consider taking a thermal or ice-water bath to relax and ease the strain. t w References 1. “A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology.” Int J Biometeorol. (2010). 2. “Hydrotherapy, balneotherapy, and spa treatment in pain management.” Rheumatol Int. (2005). 3. “Balneotherapy for rheumatoid arthritis.” The Cochrane Library. (2004). 4. “Balneotherapy.” webmd.com. (n.d.). 5. “Peloids and pelotherapy: Historical evolution, classification, and glossary.” Appl Clay Sci. (2013). 6. “The effects of balneotherapy on fibromyalgia patients.” Rheumatol Int. (2002). 7. “Balneotherapy in Medicine: A Review.” Environ Health Prev Med. (2005). 8. “Balneotherapy at the Dead Sea area for knee osteoarthritis.” Israel Med Assoc J. (1999). 9. “Effectiveness of Balneotherapy in Chronic Low Back Pain – a Randomized Single-Blind Controlled Follow-up Study.” Res Complement Med. (2005). 10. “Spa Therapy and Quality of Life.” Handbook of Disease Burdens and Quality of Life Measures. (2010). 11. “Evidence for Effective Hydrotherapy.” Physiotherapy. (2002). 12. “Spa Treatment (Balneotherapy) for Fibromyalgia - A Quantitative-Narrative Review and a Historical Perspective.” Evid Based Complement Alternat Med. (2013). 13. “A Randomized and Controlled Trial of Hydrotherapy in Rheumatoid Arthritis.” Arthritis Rheum. (1996). 14. “Adapted cold shower as a potential treatment for depression.” Med Hypotheses. (2008). 15. “Ice-Water Immersion and Cold-Water Immersion Provide Similar Cooling Rates in Runners with ExerciseInduced Hyperthemia.” J Athl Train. (2002). 16. “Effect of post-exercise hydrotherapy water temperature on subsequent exhaustive running performance in normothermic conditions.” J Sci Med Sport. (2013). 17. “Hot-Water Epilepsy.” Epilepsia. (2003). 18. “Hydrotherapy: Detrimental or beneficial to the respiratory system?” Physiotherapy. (2000).

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hydrotherapy

mind well

your mind & body on psychoactive drugs by sydnie bui | design by jackie nguyen

About 23.9 million Americans (9.2% of the population) ages 12 years and older used a psychoactive drug in 2012. That’s about 1 in every 10 people. And of that total, a little over 2.8 million were new users.1 Psychoactive drugs are capable of dramatically affecting your brain and body and are used recreationally, therapeutically, or both. They can induce a rainbow of effects, both positive and negative. So what else can psychoactive drugs do besides make you high? And why do people use drugs anyway?

what are psychoactive drugs? Psychoactive drugs are those that interact with your brain chemistry, which can result in changes in mood, behavior, and perception. They include stimulants, depressants, hallucinogens, and opiates.2 Some of these drugs can be used to treat illnesses, such as depression and attention deficit hyperactivity disorder (ADHD). Others have no current medicinal purpose and are used only for recreation because of their pleasurable effects.

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common neurotransmitters Neurotransmitters are chemicals released by neurons (brain cells), allowing them to communicate with others cells. Psychoactive drugs mimic neurotransmitters and interfere with cell activity by increasing or decreasing the rate at which they transmit signals, and this change in activity affects our mood, behavior, and cognitive state. Some neurotransmitters, like gamma-aminobutyric acid (GABA), can function as either inhibitors or exciters. Other neurotransmitters, like serotonin, have more complex effects, and depending on the receptor, can cause an increase or decrease in activity. Below is a list to familiarize you with the neurotransmitters mentioned in this article. Keep in mind that this list is not exhaustive, as the roles of neurotransmitters are still being explored.

serotonin: Involved in the sleep-wake cycle, appetitive behaviors (sex and eating), mood, pain, memory, and body temperature dopamine: Involved in initiation of movement, posture, mood, pleasure, and the reward system norepinephrine: Involved in the sleep-wake cycle, attentiveness, wakefulness, learning, blood vessel contraction, and heart rate changes (i.e., “fight-or-flight” response, etc.) GABA: Major inhibitory neurotransmitter involved in motor control, vision, anxiety regulation, and execution of behavior, among many other brain functions; triggers the flow of negatively charged chloride ions into the cell through ion channels, and causing the cell to become more inhibited glutamate: Major excitatory neurotransmitter involved in cognition and learning, in addition to many other functions3 opioids: Opioids produced in the body include endorphins and enkephalins; they regulate hunger, mood, immune response, and our reaction to pain4

stimulants

what are they? Stimulants, also known as “uppers,” excite the nervous system, which consists of the brain, spinal cord, and peripheral nerves. They can increase alertness, decrease appetite, boost mood and self-esteem, and improve mental or physical performance. Legal stimulants in the US, like Ritalin or Adderall, can be prescribed for things like ADHD, narcolepsy (a sleep disorder that causes extreme drowsiness), and weight loss. However, both legal and illegal stimulants have the potential of being abused. They work by amplifying the effect of excitatory neurotransmitters (chemicals that increase the chance of a neuron sending a signal). Taking stimulants also increases blood pressure, heart rate, and blood glucose.5 Excessive or prolonged use can cause anxiety, restlessness, irritability, aggressiveness, dizziness, heart palpitations, excessive sweating, paranoia, seizures, and suicidal tendencies.6 Examples of stimulants include cocaine, methamphetamine, amphetamine, and caffeine.

a closer look: Cocaine aka: Coke, Charlie, Snow, Blow, Crack Status in the US: Illegal

background and neurochemistry Cocaine is extracted from coca leaves and comes in two forms: crack cocaine and powdered cocaine.7 Both powdered cocaine and crack cocaine are white, and crack cocaine can appear lumpy.8 Users snort and inject the powdered form while crack cocaine is smoked. Once cocaine is inside the body, it travels to the brain, where it blocks the reabsorption of neurotransmitters like serotonin and dopamine. The neurotransmitters linger in the space between the neurons and continue to exert their effects on the receiving neuron. This brings about a consistent euphoric, or “high,” and overly alert feeling.7

Aside from milder side effects like irritability, cocaine can have major consequences. Because cocaine can cause blood vessels to constrict, the likelihood of experiencing a heart attack, stroke, or seizure, as well as stomach ulcers and impaired sexual function, is increased when taking this drug.7 Taking cocaine can also increase your chance of a heart attack. In a survey of 10,085 adults published in Circulation (2001), regular cocaine users, defined as those who have taken cocaine more than 10 times over a lifetime, had a higher occurrence of nonfatal heart attack as compared to infrequent users and nonusers. One possible explanation is that high concentrations of neurotransmitters like norepinephrine cause an increase in heart rate, making your body require more oxygen. The narrowing of blood vessels (also caused by the drug) makes supplying oxygen difficult, thus leading to higher chances of a heart attack. Other possibilities include more platelet clumping (which can block arteries) and higher blood concentrations of proteins that prevent blood clot degradation.9

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the bad: what it can do to you

depressants

narcotics

what are they?

Depressants work in the opposite manner of stimulants. Also known as sedatives, tranquilizers, or “downers,” depressants reduce the activity of the nervous system. Many increase the effect of GABA (a neurotransmitter that inhibits neuron activity).10 This produces a calming effect, as well as relaxed muscles, drowsiness, and lowered blood pressure and heart rate. Depressants can be prescribed to treat anxiety, panic, and sleep disorders. However, they can also slow reaction time, cause temporary amnesia and confusion, weakness, slurred speech, lack of motor coordination, and slow heart rate to the point of death.11

Also known as “opioids,” these drugs relieve pain and dull the senses. Narcotics can be found in plants or made in the laboratory.19 Narcotics work by binding and blocking opioid receptors, which are involved in the pain pathway.20 They can reduce anxiety and aggression, as well as suppress coughing and induce sleep. Unwanted effects include constipation, slowed motor activity, difficulty concentrating, extreme drowsiness, constricted pupils, and apathy.19 Examples include heroin, morphine, codeine, and opium.

Examples include benzodiazepines, barbiturates, alcohol, and marijuana.

a closer look: Benzodiazepines

aka: Benzos, BZDs, Tranks Status in the US: Legal (if prescribed)

background and neurochemistry Benzodiazepines, such as Xanax and Valium, are typically prescribed for anxiety, panic attacks, insomnia, muscle relaxation, seizure prevention, and anesthesia.12 Benzodiazepines enhance the sensitivity of receptors to GABA, making some neurons less likely to become excited.13

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the bad: what it can do to you Chronic use or abuse can cause blurred vision, drowsiness, confusion, motor impairment, coma, and increase the risk of anorexia. When taken with other sedatives or alcohol, fatal overdose may occur.12 According to a 1986 review in Biological Psychology, benzodiazepines can interfere with memory formation. The inability to form new memories is called anterograde amnesia.. Memories stored prior to the amnesic episode remain intact, however. Benzodiazepines, by enhancing the effects of inhibitory neurons in the brain’s memory system, may interfere with the transferring of shortterm memories to long-term memory storage. Recall and verbal proficiency were also more affected than performance in recognition and visual tests.14

a closer look: Heroin

aka: Thunder, Hell Dust, Black Tar, Smack, Junk, Dope Status in the US: Illegal

background and neurochemistry Heroin is made from morphine and appears as a black tar-like substance or white or brown powder.22 It can relieve pain or suppress coughing, but it is not legally prescribed. Heroin can be mixed with other substances such as sugar, methamphetamine, or cocaine. It can be injected, smoked, or snorted. Once in the brain, heroin is converted back into morphine, where it then binds to opioid receptors.21 Because of its unique structure, heroin can cross the blood brain barrier (a system that helps prevent harmful substances in the blood from entering the brain) more rapidly than morphine.23 Thus, its effects come on more quickly. Heroin users feel a euphoric “rush”, although physical side effects may include drowsiness, nausea, dry mouth, and slower breathing.22

the bad: what it can do to you Along with the side effects mentioned above, signs of an overdose include blue lips and fingernails, slower breathing, clammy skin, convulsions, coma, and death.22 Heroin may also contribute to poorer impulse control. A study in the Archives of Clinical Neuropsychology (2002) tested heroin addicts and non-users on attention, impulse control, mental flexibility, and abstract reasoning. The results indicated that increased heroin usage was correlated with poorer impulse control but did not appear to affect attention, mental flexibility, or abstract reasoning. It is unclear if impulsivity is a cause or result of heroin use. Furthermore, it is possible that the average years of heroin use (5) among the subjects was not long enough to impact attention and mental flexibility and abstract reasoning. The results from the study could help in the customization of treatment programs for heroin addiction. For example, smaller patient group sizes offer fewer distractions to potentially act impulsively on. This would allow the patients to remain focused on the treatment tasks at hand.24

hallucinogens

what are they? Hallucinogens can be found in plants and fungi or made synthetically. They can alter mood and the sense of reality by interacting with the receptors of neurotransmitters like serotonin or glutamate. This can affect areas of the brain responsible for hunger, sensory perception, mood, pain, learning, and memory. The effects of hallucinogens can vary from person to person.15 Some people experience time and space distortions, and the perception of colors and sounds is often enhanced. Hallucinogens can also lead to pupil dilation, increased heart rate and blood pressure, dry mouth, excessive sweating, and nausea. Deaths from hallucinogen overdose are rare. Instead, they are generally due to suicide or dangerous behavior rather than the substance’s direct physiological effects.15,16

a closer look: MDMA

aka: Ecstasy, Molly, E, XTC, M Status in the US: Illegal

background and neurochemistry

the bad: what it can do to you

Synthetically produced in the lab, MDMA is short for 3,4-methylenedioxymethamphetamine and can be considered both a stimulant and hallucinogen. This means that it excites the nervous system and can alter sensory perception and perception of time. MDMA typically comes in a tablet form, but it can also be found in capsule, powder, or liquid form. Although MDMA is also known as “ecstasy,” ecstasy tablets differ in that they may contain a concoction of other drugs like cocaine or caffeine. MDMA promotes the release of neurotransmitters like dopamine, serotonin, and norepinephrine, making users feel warm, empathetic towards others, and less anxious.17

As with using any other drug, taking MDMA comes with some unwanted side effects include dehydration, high body temperature, blurred vision, seizures, panic attacks, and fainting.17 MDMA usage may also negatively affect your memory. According to a 2003 review published in Pharmacological Reviews, several studies showed that long-term MDMA users showed cognitive deficits in verbal and visual memory. They also had delayed reaction times to visual and auditory stimuli. Other studies reported that MDMA users had fewer serotonin receptors, which may affect memory. There also appears to be a gender difference in the susceptibility of neurons to the effects of MDMA, such that females are more vulnerable.18

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Examples of hallucinogens include MDMA, LSD, psilocybin, phencyclidine, and ketamine.

why do people use drugs? therapeutics Drugs aren’t all bad. In acceptable, controlled doses, they can be used to treat a variety of conditions, such as narcolepsy and pain. According to the Centers for Disease Control and Prevention, 48.7% of people in the US were using at least 1 prescription drug in the last 30 days between 2009 to 2012, and the most commonly prescribed drug type was analgesics like morphine.25 As mentioned before, stimulants, like amphetamines (i.e., Adderall), can be prescribed for ADHD to improve focus. They can also help treat depression. However, stimulants alone are not as effective as using other types of treatment in conjunction, such as cognitive-behavioral therapy (CBT). CBT is a type of psychotherapy that involves changing thinking or behaviors in order to change how a person feels.26,27 Depressants can be used for anesthesia and as a treatment for anxiety.28 They can also lessen sleep disturbances, act as anticonvulsants, aid in muscle relaxation, and because they work similarly to alcohol, non-alcohol depressants can help reduce alcohol withdrawal symptoms.29

The use of hallucinogens for therapy is less established but is an up-and-coming area of exploration. According to a 2011 study published in the Journal of Psychopharmacology, MDMA can help treat patients with post-traumatic stress disorder (PTSD) when used with psychotherapy. The researchers suggested that MDMA can reduce fear, which is useful for patients revisiting traumatic experiences.30 The results of a 2014 pilot study in the Journal of Psychopharmacology indicated that psilocybin, also known as “mushrooms,” can improve the results of smoking cessation attempts when patients were also treated with CBT.31 However, research on the therapeutic value of hallucinogens is still ongoing and their use in this manner is still not accepted as the standard of care. Lastly, narcotics are used to alleviate moderate to severe pain, such as acute (sharp, relatively short-lived) pain, post-surgical pain, and debilitating chronic pain stemming from severe accidents or injuries.32

recreation pleasurable. Some drugs, like alcohol and nicotine, are socially and culturally acceptable, although they create negative short- and long-term health problems. Interestingly enough, the prevalence of drinking and smoking are declining, each down by about 4% between 2002 and 2012, and the social stigma associatd with smoking has increased with greater awareness of its harmful health effects.33

There are many reasons why people start using drugs, such as trying to fit in, rebelling against authority, curiosity, or simply because they believe it will make experiences more

Many people continue using psychoactives without experiencing harmful consequences. But why do some individuals develop substance use disorders while others do not?

total wellness ▪ summer 2015

Psychoactive drugs can be used recreationally, whether they have a therapeutic purpose or not. The most commonly used legal psychoactives are caffeine and alcohol. Among illicit drugs, marijuana is the most commonly used. According to the 2012 National Survey on Drug Use and Health, there were approximately 18.9 million current marijuana users age 12 and older.33 To learn more about marijuana, check out “The Lowdown on the High of Marijuana” in Volume 15, Issue 3.

substance use disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a guide that provides criteria for diagnosing mental disorders. The DSM-5 defines substance use disorders as mild, moderate, or severe, depending on the number of criteria a patient meets. It is also further categorized based on the substance. For example, a patient can be diagnosed with stimulant use disorder or opioid use disorder. A person can be diagnosed with a substance use disorder if his or her recurring substance use habits cause significant physical, mental, and social impairments. Some of the criteria for a substance use disorder diagnosis include: craving for the substance, failure to control oneself when using the substance, the need to use larger amounts to feel the same effects (tolerance), withdrawal, and continued use despite it interfering with social obligations.34

addiction versus dependence: aren’t they the same? The short answer is “no,” substance addiction and dependence are not the same thing. You can think of dependence as physical dependence—your body becomes more tolerant of the drug’s effects, and when you stop using the drug, you experience symptoms (like irritability) that go away when you take the substance (or a similar one) again. Addiction can be considered more mental. It is the craving along with the compulsive and uncontrolled use despite negative consequences. The two conditions are not mutually exclusive, but do not always co-occur either. It is possible to be dependent without being addicted, such as among individuals who used prescription opioids for relief of chronic pain or used sleep aids for insomnia. It is also possible to be addicted without being dependent, although dependence often characterizes

risk factors Risk factors can increase the chances of developing a disorder, but they are not 100% predictive. Below is a list of some risk factors that may contribute to developing a substance use disorder: ❯ family history of addiction: This may indicate a genetic predisposition, whether it is how quickly the individual’s body can metabolize the drug or having a more risk-taking, novelty-seeking personality. ❯ comorbidity, or having co-occurring disorders: For example, a person diagnosed with depression may use alcohol as a way to cope and subsequently become dependent. ❯ gender: Males are twice as more likely to have drug problems than females. ❯ peer pressure: Some people, especially young adults, may feel the need to use drugs as a way to conform or be accepted by others. ❯ age of first use: Those who begin using substances at a younger age are more likely to become addicted. ❯ nature of the substance: Some drugs, like cocaine, are more addicting than others.36 References 1. “DrugFacts: Nationwide Trends.” drugabuse.gov. (2014). “Psychoactive Drugs.” medical-dictionary.thefreedictionary.com. (2015). 3. “The Brain from Top to Bottom: Neurotransmitters.” thebrain.mcgill.ca. (n.d.). 4. “The Brain from Top to Bottom: Opiates.” thebrain.mcgill.ca. (n.d.). 5. “Drug Fact Sheet: Stimulants.” dea.gov. (n.d.). 6. “Stimulants.” drugabuse.gov. (2014). 7. “Cocaine Use and Its Effects.” webmd.com. (2013). 8. “Drug Fact Sheet: Cocaine.” dea.gov. (n.d.). 9. “Cocaine Use and the Likelihood of Nonfatal Myocardial Infarction and Stroke.” Circulation. (2001). 10. “Prescription Drug Abuse: CNS Depressants.” drugabuse.gov. (2014). 11. “Drug Fact Sheet: Depressants.” dea.gov. (n.d.). 12. “Benzodiazepine Abuse.” webmd.com. (2014). 13. “Benzodiazepines: Overview and Use.” drugs.com. (2014). 14. “Tranquillising memories: A review of the effects of benzodiazepines on human memory.” Biol Psychol. (1986). 15. “DrugFacts: Hallucinogens - LSD, Peyote, Psilocybin, PCP.” drugabuse.gov. (2014). 16. “Drug Fact Sheet: Hallucinogens.” dea.gov. (n.d.). 17. “MDMA (Ecstasy) Abuse.” drugabuse.gov. (2006). 18. “The Pharmacology and Clinical Pharmacology of 3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”).” Pharmacol Rev. (2003). 19. “Drug Fact Sheet: Narcotics.” dea.gov. (n.d.). 20. “Narcotic Analgesics.” drugs.com. (2015). 21. “Morphine (and Heroin).” nhtsa.gov. (n.d.). 22. “Drug Fact Sheet: Heroin.” dea.gov. (n.d.). 23. “Heroin.” faculty.washington.edu. (2014). 24. “The Impact of Heroin on Frontal Executive Functions.” Arch Clin Neuropsychol. (2002). 25. “Therapeutic Drug Use.” cdc.gov. (2015). 26. “DrugFacts: Stimulant ADHD Medications: Methylphenidate and Amphetamines.” drugabuse.gov. (2014). 27. “Depression Treatment Options.” webmd.com. (2013). 28. “The Medical Uses of Depressants.” livestrong.com. (2011). 29. “Benzodiazepines - Oral.” medicinenet.com. (2005). 30. “The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study.“ J Psychopharmacol. (2011). 31. “Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction.” J Psychopharmacol. (2014). 32. “Therapeutic Use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective.” Pain Physician. (2010). 33. “DrugFacts: Nationwide Trends.” drugabuse.gov. (2014). 34. “Substance Use Disorders.” samhsa.gov. (2014). 35. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” drugabuse.gov. (2012). 36. “What Are the Risk Factors for Addiction?” medicalnewstoday.com. (2009).

bottom line Stimulants, depressants, hallucinogens, and narcotics can all affect your mind and body. By interfering with various neurotransmitter systems, their momentary positive effects can become addicting. Each drug comes with a slew of side effects and deleterious consequences, and in some cases even death. Although many people experiment with drugs without any noticeable harmful consequences, it is possible to develop substance use disorders in the long run. With that being said, the probability of becoming dependent or addicted depends on a variety of risk factors, including history exposure to stressors, comorbidity of other mental disorders, the social environment, and genetics. t w

total wellness ▪ summer 2015

body in focus

crank up the heat for hot yoga written & designed by nancy vu

A grand total of 20.4 million people practice yoga in the United States.1 If you’re one of these many people who have awakened their inner yogi, you may agree that the wide range of physical, mental, and spiritual benefits makes yoga worth the hype. However, if you’re a yoga newbie, you have lots of options. There are many different yoga styles, including Hatha, Vinyasa, Iyengar, and Ashtanga. Each different kind of yoga has its own perks and quirks, but one special type that has stood out is hot yoga—in the yoga world, heat is in! But what exactly is the craze about hot yoga? Discover why some like it hot.

what is it?

what about bikram yoga?

Hot yoga can refer to any type of yoga that’s done in a heated room. The room is kept warm and toasty at 95°F to 105°F. The heating system of each yoga studio varies and may involve solar panels, radiant heat panels, hydronic heating, or infrared heaters. Some studios also have humidifiers installed and may turn up the humidity level of the room during hot yoga sessions.2

The terms hot yoga and Bikram yoga are often used interchangeably, but technically, not all hot yoga is Bikram yoga. Bikram yoga is a popular type of hot yoga founded by a man named Bikram Choudhury. Bikram studios typically have their temperatures cranked up to at least 105°F with at least 35% (usually 40%) humidity. This was designed to replicate the climate of India (where not only Choudhury was born but also where yoga was originally founded). Introduced to the US in the 1970s, this type of yoga is a series of 26 postures done over a period of 90 minutes.3

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total wellness ▪ summer 2015

a warm welcome to hot yoga

benefits of roastin’ in a hot yoga studio detoxification Good things may come to those who sweat! Although many may argue that you don’t really “sweat off” toxins (unwanted or harmful substances) during hot yoga, results from some studies show that this may not just be a myth. A 2011 study in Archives of Environmental Contamination and Toxicology analyzed the amount of various toxins in blood, urine, and sweat collected from 20 individuals. These toxins included dangerous metals and metalloids, such as lead, mercury, aluminum, and arsenic. Researchers found that many toxic elements seemed to be mostly excreted through sweat.4 This suggests that sweating, induced by activities like hot yoga, is a potential way to eliminate toxins from the body. Still, more research needs to be done to confirm these results.

increased heart rate

The heated and humidified yoga studio may result in increased muscle flexibility and joint lubrication. In a 2013 study in the Journal of Strength and Conditioning Research, a group of healthy young adults received short-term Bikram yoga training (24 sessions in 8 weeks). After the exercise, participants each performed a fitness test and showed increased muscle flexibility, including that of the lower back, hamstring, and shoulders.5 Greater flexibility from a higher body temperature allows the body to be more supple and move more freely, allowing you to move more comfortably. In a cooler environment, you have lower body temperature and less muscle blood flow, which decreases the amount of oxygen that reaches your muscle. Since oxygen plays an important role in fueling your muscles, the muscles would tend to be stiffer and ultimately more prone to pulls and tears.6 Conversely, in a warm environment, not only can you stretch deeper in your yoga poses, but also, you may do so more safely with less chance of related injury.

improved mindfulness Working in a hot room may improve mindfulness (active attention to the present moment), which is negatively correlated to perceived stress. Practicing yoga in a heated and humid environment is thought to promote mind-body unity and pushes the limits of what your body can do under extreme conditions.8 In a 2011 study in the Journal of Exercise Science & Fitness, people participated in an 8-week Bikram yoga program, where they attended at least 20 sessions. Mindfulness was measured from a questionnaire, and perceived stress was also measured. Mindfulness improved and perceived stress decreased after the program, suggesting that Bikram yoga sessions improve mental health.9

total wellness ▪ summer 2015

increased flexibility

With hot yoga comes an increased heart rate and the perks that come along with it. In one study, experienced Bikram practitioners completed a Bikram yoga study session, and researchers explored the body’s response to the workout. Although they found that Bikram yoga burns the same amount of calories as just walking briskly for the same amount of time, results showed elevated heart rates averaging 160 beats per minute (compared to about 120 when walking briskly).5 Revving up your heart rate can result in burning fat, weight loss, improved stamina, decreased cholesterol, and many other health benefits.7

❯❯

a heads up before heating up

❯❯

help! i’m a beginner... what do i wear? To beat the heat, stick to light, breathable clothing that wicks moisture. Also, try to wear form-fitting clothing so that there’s minimal restriction when you do your postures and so that you don’t feel too sticky.

Hot yoga can be your friend, but it can also be your enemy. The high heat and humidity of a hot yoga studio may cause dehydration, cardiovascular stress, extreme weakness, exhaustion, and dizziness. During exercise, the body gets rid of extra heat by increasing the blood supply to the skin through the dilation of blood vessels. Sweating, specifically the evaporation of sweat from the skin, also helps the body cool down. However, when you exercise in hot, humid conditions (like during hot yoga), heat loss through sweating may not be enough, and the regulation of body temperature may fail and can cause heat stroke. The excess heat may lead to harmful side effects, eventually leading to collapse, unconsciousness, and, in some cases, even death.10

what should i bring? You’ll need a yoga mat and towels if your studio doesn’t provide them for you. Towels are typically used to clean off sweat and to put over your mat so that you don’t slip and slide, so consider using a non-slip yoga towel if possible. Also, water will be your best friend, so don’t forget to bring lots of it! Alternatively, you can bring sports drinks, which have been shown to aid hydration by supplying electrolytes (minerals that help regulate a variety of bodily processes), which are lost in sweat.13

Just in case, check in with your healthcare provider to make sure that hot yoga is safe for you and your individual health status. Remember to stay hydrated at all times (both before and during class). Drinking water several hours before exercising allows enough time for adequate fluid absorption and for excess fluid to be lost as urine.11 Also, try to steer clear of thick, baggy clothing made of cotton since this tends to absorb sweat and become heavy. During the session, if you experience dizziness, nausea, fatigue, cramps, or weakness, stop and find a cool place to rest.12

what should i expect? Different postures, breathing exercises, and lots of sweat (everywhere)! any other tips? For some people, the intense heat can cause significant harm, so it’s important to listen to your body and take a break if you need to.

bottom line

total wellness ▪ summer 2015

References 1. “New Study Finds More Than 20 Million Yogis in U.S.” yogajournal.com. (2012). 2. “How Hot is Hot Yoga?” about.com. (2014). 3. “A Bikram Yoga Studio Temperature.” livestrong.com. (2013). 4. “Blood, urine, and sweat (BUS) study: monitoring and elimination of bioaccumulated toxic elements.” Arch Environ Contam Toxicol. (2011). 5. “Bikram yoga training and physical fitness in healthy young adults.” J Strength Cond Res. (2013). 6. “Warming-up and stretching for improved physical performance and prevention of sports-related injuries.” Sports Med. (1985). 7. “The Advantages of Increased Heart Rate During Exercise.” livestrong.com. (2010). 8. “Hot Yoga Benefits.” livestrong.com. (2013). 9. “An Examination of the Effectiveness of an 8-week Bikram Yoga Program on Mindfulness, Perceived Stress, and Physical Fitness.” J Exerc Sci Fit. (2011). 10. “Nutrition and Athletic Performance.” Amer Col Sports Med. (2000). 11. “Physiological effects of exercise.” Contin Educ Anaesth Crit Care Pain. (2004). 12. “Exercise and Fluid Replacement.” Amer Col Sports Med. (2007). 13. “Bikram Yoga Risks.” livestrong.com. (2011).

left:chris bernard photography inc./istockphoto right:bob prosser/flickr

With so many different styles of yoga out there, it can be difficult to find which one works best for you. One option to consider is hot yoga, where you literally work up a sweat. The environment of this “hot” new fitness trend may require a bit of adjustment, and braving through the class might be challenging. However, as long as you take precautions, like drinking enough water, hot yoga can provide benefits that other types of yoga cannot. t w

totalwellness ›› on the cover

total wellness ▪ summer 2015

“To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.” – RALPH WALDO EMERSON

image:bob prosser/flickr

total wellness â&#x2013;Ş summer 2015

cover story

inked what to know about tattoos by elsbeth sites| design by sophia fang

total wellness ▪ summer 2015

You probably know someone with a tattoo. Perhaps you have one yourself, or maybe you’re in the early design stages of dreaming up the perfect quote-symbol combination for your right shoulder. The dragons, anchors, and flocks of birds that you see adorning bodies of all types are created by using needles to inject ink below the skin’s surface. Though painful and permanent, there are countless reasons why people choose to get tattoos. They can be beautiful pieces of artwork, memories, or can even serve medical or aesthetic purposes. If you are curious about how a shooting star on your ankle might impact your health or how difficult it might be to remove it in the future, this is just the guide for you.

how do tattoos work? Tattooing involves rapidly and repeatedly piercing the skin 1 to 2 mm deep with needles bearing pigment in order to deposit the ink below the epidermis, the outermost layer of skin cells, and into the dermis, where hair follicles and blood vessels lie. The needle is not hollow like a hypodermic needle that administers shots at the doctor’s office; rather, it is coated in ink before each successive puncture. For areas of the design that are to be colored in or shaded, the artist uses a needle bar that holds several needles together in a line or clump to achieve the desired coloring. The ink does dye the epidermis, but this layer sloughs off with time, almost like a peeling sunburn. The ink that remains in the dermis will remain visible for a lifetime, but its appearance does eventually begin to fade. The process of getting a tattoo wounds the skin, so the body’s immune system reacts by sending white blood cells to the punctured, damaged tissue and seals the wound with collagen fibers. These large immune cells engulf the ink and some are carried to the lymph nodes, which are organs distributed throughout the body that play an important role in filtering foreign particles. Some of these ink-carrying cells are localized to the site of the damage and remain there indefinitely. However, over a span of many years, some of these cells migrate short distances within the dermis, which causes older tattoos to look less sharp and defined than they once did.1

what is in tattoo ink? Tattoo ink is composed of pigments suspended in a carrier solution. Carrier solutions are typically some sort of alcohol, usually ethanol or glycerol, that disinfects the pigment mixture and keeps it evenly mixed. The pigment provides the tattoo’s color. In the past, pigments were made mostly from minerals and lampblack (pure carbon made by burning carbon-based substances like petroleum). These materials are still used as pigments, but modern artists now have a wider range of colors at their disposal with pigments made from metal salts (chemical compounds with both metallic and non-metallic atoms), and plastics. The FDA has not approved any tattoo pigments for injection into the skin. Many pigments used in tattoo inks are industrial-grade colors suitable for printers’ ink or automobiles. 2

pain

risks

of getting a

total wellness ▪ summer 2015

tattoo?

With the right health and safety practices, getting a tattoo is a fairly safe procedure. However, there are risks involved, and anyone interested in getting a tattoo should take them into account before making a decision.

infection Unsterilized needles can pass along hepatitis B and HIV. Hepatitis B is a viral infection that causes a potentially life-threatening liver infection3, and HIV infection causes the deterioration of the immune system and leads to AIDS.4 The viruses responsible for both can be transmitted through contaminated needles. Medical professionals strongly recommend against it receiving a tattoo from an unlicensed or otherwise irresponsible tattoo artist, but if you do, make sure you are vaccinated for hepatitis B.

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❯❯

what are the

Keep in mind that a tattoo is a series of tiny puncture wounds, so there will be some pain. The amount of pain experienced varies depending on the person’s pain tolerance and the placement of the tattoo. Areas with a high concentration of nerve endings, such as the hands and face, tend to be very sensitive to tattooing pain. Fortunately, tattooing does not cause much bleeding. Each puncture will release a small droplet of blood which accumulates and forms a thin film, but the tattoo artist should continually wipe this away. A small amount of plasma and tissue fluid may continue to ooze out of the tattoo for a few hours.

how can tattoos be removed? Even though tattoo removal can be possible, you should assume that every tattoo is permanent.

surgery The most efficient method of tattoo removal is surgical excision of the entire tattoo. A surgeon removes the inked skin with a scalpel, then either closes the wound with stitches or applies a skin graft if the tattooed area was exceptionally large. As with any other surgical procedure, this will leave a scar, and the procedure is costly.9

tattoo removal cream

The market for this product is completely unregulated. Even though a product may claim to be clinically tested or approved by dermatologists, there is no enforcement of these claims by the FDA. They are advertised as topical creams that are absorbed by the epidermis, and upon reaching the dermis either destroy the pigments or stimulate their expulsion. Many products provide a chemical or mechanical exfoliant that sloughs away the epidermis to allow the product better contact with the dermis. Though they may claim otherwise, tattoo removal creams are not without side effects, including chemical burns and scarring.10

laser removal This method requires many sessions of laser exposure, which stands for Light Amplification by Stimulated Emission of Radiation. Multiple laser treatments are long and painful, and cannot guarantee a perfect and scarless removal of the tattoo. The larger the tattoo, the more sessions will be required to remove it. However, it is one of the few treatment options regulated by the FDA, and the only removal procedure that has the potential to not leave any scarring. Pulses of high-intensity laser energy pass through the epidermis and are absorbed by the ink pigments. The energy causes the pigment to break into small particles, which are then metabolized or excreted by the body, or transported to and stored in lymph nodes or other tissues. Though the cost of the treatment will depend on the size, type, and location of the tattoo, it is in general a very expensive procedure, and may not be covered by oneâ&#x20AC;&#x2122;s insurance unless the removal is being performed for medical reasons.2

allergies There is a small risk of allergic reactions to ink in some people.

excessive scarring

granulomas After detecting the foreign ink substance, the body may sequester it into many giant pigment-filled cells, surrounded by a ring of white blood cells called lymphocytes. The result is firm lumps of inflamed tissue beneath the skinâ&#x20AC;&#x2122;s surface, usually about the size of large cystic pimples.6

MRI complications

Tattoos may swell or burn when undergoing an MRI. An MRI is essentially a giant magnet, and as tattoo pigments are often metal salts, they are pulled by magnetic attraction. In rare instances, these compounds can create an electric current that increases the local skin temperature enough to cause a cutaneous burn.7 However, this should not deter you from seeking medical treatment should you need it and you have a tattoo.

The pigment that seems to cause the most adverse reactions, typically granulomas, is red. Red pigments are made from mercury-containing compounds, which can react badly when in contact with other mercury compounds found in vaccines and preservatives.8

total wellness â&#x2013;Ş summer 2015

Sometimes scar tissue invades the surrounding healthy skin and becomes larger than the original wound in a process called keloid scarring. These scars are shiny, red, and rubbery growths of collagen tissue that protrude from the skin and can significantly detract from the aesthetics of the tattoo. They seem to occur more often in people with dark skin tones.5

trichloroacetic acid

This acid causes a chemical burn that leads to necrosis (selfdigestion of cells) of the epidermis and dermis that leads to elimination of the pigments from the dermis. Today, this procedure is generally not performed because of the risks of scars, though the product is still sold online.10

heat burns

Heat burning is one of the oldest tattoo removal methods. It involves destroying the tattooed epidermis by applying a heated metal or embers to burn the skin off. The process is as painful as it sounds, which makes it difficult to endure multiple treatments. Burns also cause scars and increase the long-term risk of developing skin cancer.10

tattoo tips Think long and hard on this decision. Removing a tattoo is much more difficult than getting one. If you’re thinking about getting a tattoo, assume that it will be with you for life.

choose your artist wisely

total wellness ▪ summer 2015

Check with your state and city regulations concerning tattoo artist certifications. There is no federally mandated protocol that must be followed in order to become a professional tattoo artist, and state licensing and certification requirements vary. In some cases, there are no statewide regulations, and requirements are left to county or city governments. In general, tattoo artists must complete a training program and pass an exam that measures their ability to understand and follow health and safety protocols, not their creative ability in designing or applying body art.11

registration and vaccination In California, a tattoo artist must register him/herself with the local enforcement agency. Artists must show evidence of their current hepatitis B vaccinations, and evidence of completion of OSHA bloodborne pathogen training in order to prove that they have learned how to safely work with and dispose of blood. This certification must be displayed in their place of work.12

portfolio

Examine the artist’s portfolio, and read customer reviews. If other customers are not happy with a particular artist, there is a good chance you won’t be either. Ensure that every piece of equipment they use has been sterilized and that the facility appears clean.

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certification

are there any

temporary

tattoo alternatives? decal tattoos These are the small, temporary tattoos that were once only popular with children, but have recently gained newfound popularity in the form of gilded jewelry tattoos—the kind you may have seen on Beyoncé or Ariana Grande lately. They typically last a few days, but begin to flake off the skin about a day after application. Though most people have no negative reactions to them, the FDA has received a few reports of rashes.13

henna tattoos

Henna, a coloring made from the Lawsonia inermis plant, is FDA approved only for use as a hair dye; however, it has been used to stain designs into skin for thousands of years. The plant is ground into a paste and is applied to the skin, which causes a stain that darkens with application time.14 Henna designs are naturally an orange-brown color, so blue or black hennas have had other ingredients, most likely p-phenylenediamine, added to them. There have been reported cases of serious rashes and other reactions to these blue or black dyed hennas, so if you’re considering a henna tattoo, you may want to stick with the brown paste, or test the henna in a small patch before use.13

bottom line Surgery and laser removal should only be performed by a licensed and experienced physician, dermatologist, or plastic surgeon. The American Society for Laser Medicine and Surgery website can help you find a doctor experienced in tattoo removal.2 If you want your skin to be a canvas for beautiful artwork but don’t love the idea committing to it for life, temporary and henna tattoos are great alternatives.

total wellness ▪ summer 2015

Tattoos are a meaningful part of human culture, and they appeal to people of all walks of life. As long as they are well thought-out and performed with expertise, they are fairly safe and can provide a lifetime of art. Should a tattoo ever lose its special place in the owner’s heart, removal can be possible. Surgery and laser removal are the safest, most efficient, and also most expensive tattoo removal methods.

References 1. “Tattoos and Tattooing: Part II: Gross Pathology, Histopathology, Medical Complications, and Applications.” Am J Foren Med Path. (1992). 2. “Think Before You Ink: Are Tattoos Safe?” fda.gov. (2015). 3. “Hepatitis B.” who.int. (2015). 4. “HIV/AIDS.” who.int. (2015). 5. “Keloid Scars and Hypertrophic Scars.” nhs.uk. (2014). 6. “Tattoo Reactions.” emedicine.medscape.com. (2014). 7. “Tattoo-Induced Skin ‘Burn’ During Magnetic Resonance Imaging in a Professional Football Player.” Sports Health. (2011). 8. “The Science of Tattoos.” dermadoctor.com (2015). 9. “Surgical Excision for Unwanted Tattoos.” asds.net. (2015) 10. “The Risks of Do-it-Yourself and Over-the-Counter Devices for Tattoo Removal.” Int J Derm. (2014). 11. “Licensed Tattoo Artist: Job Description and Education Requirements.” education-portal.com. (2013). 12. “CAL. HSC. CODE 119306 : California Code - Section 119306.” findlaw.com. (2015). 13. “Temporary Tattoos, Henna/Mendhi and ‘Black Henna.’” fda.gov. (2014). 14. “About Henna.” silknstone.com. (2014).

feature

runner’s high

by monica morucci | design by katie allio

total wellness ▪ summer 2015

How do you feel when you go running? For some, running only brings feelings of fatigue, discomfort, or sweatiness. For others, running can produce not only sensations of physical exertion, but feelings of euphoria as well. These euphoric sensations are termed “runner’s high.” This article will describe what it feels like to experience runner’s high as well as explain the science behind these sensations.

characteristics of runner’s high what is it? There is no standard definition of runner’s high, but this phenomenon is often described as the experience of euphoria, well-being, and a reduced state of discomfort or pain while running. Many accounts describe runner’s high as occurring during an extended period of exercise like at the end of a long run. Despite the name, these feelings are not limited to running but are also associated with other long-duration, rhythmic-type exercises, like swimming.1

feelings of euphoria

what it is Euphoria is a state of intense happiness, elation, well-being, and excitement. Certain drugs, including stimulants, alcohol, or marijuana, as well as activities like sex and exercise can induce euphoria. There are several theories that seek to explain the mechanism for feelings of euphoria associated with exercise.

how it works endocannabinoids Another source of these euphoric feelings may be the endocannabinoid system (ECS). The ECS consists of lipids called endocannabinoids (eCBs), their receptors, and enzymes. eCBs bind to cannabinoid receptors which are the same receptors bound by THC, the active ingredient in marijuana (to read more about marijuana, check out the Volume 15, Issue 2 article “The Lowdown on the High of Marijuana”). This binding produces feelings of bliss, euphoria, and peacefulness felt both during marijuana use and exercise.3 Thus, it is hypothesized that eCBs may be responsible for the positive feelings produced by exercise.

total wellness ▪ summer 2015

endorphins One theory, called the “endorphin-driven runner’s high,” is often based on measuring the amount of endorphins released by the brain into the blood. However, it is important to note that simply the amount of endorphins produced may not be an accurate way to quantify the endorphins’ effects on the brain.2 A more precise method is to directly measure endorphin binding, since endorphins produce their effects by binding to receptors in the brain. A 2008 study in Cerebral Cortex was the first to use this method to measure exerciserelated endorphin binding. The researchers used positron emission tomography (PET), which produces a 3D image of the brain tissues, to measure the binding of an endorphin competitor in the brain rather than the blood.2 The endorphin competitor is a different compound with a similar structure that allows it to bind to the same receptor as an endorphin. The researchers found that post-exercise, the binding of the endorphin competitor decreased. This means that the brain produced a high amount of endorphins that occupied receptors, leaving less available receptors for the competitor to bind. This occurred along with the athlete’s’ self-reported increases in euphoria, providing evidence that the postexercise change in mood was due to the release of endorphins in the brain.2 This study is the first to provide evidence in living tissue of the release of endorphins in the brain correlated with exercise-induced feelings of euphoria.

pain insensitivity what it is Substantial human and animal research demonstrate that exercise may result in an increase in pain thresholds and tolerances and a decrease in pain rating. This is referred to as exercised-induced analgesia (EIA), or the inability to feel pain.4 A 2000 review in Sports Medicine presents evidence of this effect in human cycling and running, as well as rodent swimming studies. The mechanisms of EIA are not well understood, but the effect occurs more consistently when exercise is high intensity or above 70% of maximal aerobic capacity.4 Most studies concentrate on aerobic exercise, like cycling and running, but there is some evidence of EIA with resistance exercise, like weightlifting.4 This inability to feel pain may explain how marathon runners can push through the last few miles of the 26.2 mile race and even experience feelings of elation despite fatigue, sore muscles, and irritating blisters.

how it works opioid theory

endocannabinoid theory

A leading hypothesis for the mechanism of EIA is the opioid theory. Opioids are compounds that bind opiate receptors in the brain, spinal cord, gastrointestinal tract, and other organs. This binding produces feelings of euphoria and reduces sensations of pain by reducing the intensity of pain signals reaching the brain. Opioids produced by the body are called endorphins, and produce similar effects. It is hypothesized that these opioids produced by the body are responsible for pain reduction following exercise, although the evidence is mixed.4 Examples of opioids not made by the body are morphine and codeine, which are often prescribed as pain relievers.

Another EIA mechanism theory is activation of the endocannabinoid system (ECS). A 2003 study in Neuroreport Cognitive Neuroscience and Neuropsychology was the first to show that exercise of moderate intensity activates the ECS. Additionally, eCBs and their targets are present in pain-related regions where they have been shown to exhibit pain-reducing effects.3,5 Another study published in the Journal of Pain in 2014 recorded increases in eCBs after exercise, accompanied by increases in pain thresholds and decreases in pain rating6. THC, a type of cannabinoid responsible for the euphoric effects of marijuana, also produces pain-relieving effects.7 These analgesic effects drive the use of marijuana for the treatment of chronic pain.

bottom line

References 1. “Runner’s High: Is it For Real?” webmd.com. (2006). 2. “The runner’s high: opioidergic mechanisms in the human brain.” Cereb Cortex. (2008). 3. “Physical activity and the endocannabinoid system: an overview.” Cell Mol Life Sci. (2014). 4. “Analgesia following exercise.” Sports Med. (2000). 5. “Exercise activates the endocannabinoid system.” Neuroreport. (2003). 6. “Mechanisms of exercise-induced hypoalgesia.” J Pain. (2014).

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The race is still being run for the science behind “runner’s high.” Several theories, like the opioid and endocannabinoid theories, have been advanced to explain the feelings of euphoria and analgesia reported by some athletes, but a consensus has not yet been reached. Don’t let this dissuade you from exercising; however, exercise still has its many benefits, even without the “runner’s high”! t w

all about coconut oil

feature

by danielle zola | design by alison jeng

Teeth whitener, skin moisturizer, hair care productâ&#x20AC;Ś and yummy ingredient in homemade desserts?

total wellness â&#x2013;Ş summer 2015

If you have ever been skeptical about the seemingly endless list of uses for coconut oil, you arenâ&#x20AC;&#x2122;t the only one. Read on to discover the truth about this fad food!

what is coconut oil? Coconut oil is a semi-solid, edible, pale-yellow oil derived from the dried coconut meat that is used in food as well as beauty products. The oil is extracted by pressing the dried coconut fruit, and can be used in cosmetics such as soaps, detergents, makeup, hair, and nail and skin care products. Coconut oil can also be used in food preparation in foods like chocolate, candies, and oil substitutes for cooking.1 It can be purchased at a grocery store for $12 to 18 per pint.2

what is in coconut oil? Coconut oil is a saturated fat, which means that the carbon chain of its molecules have no double bonds and are therefore “saturated” with hydrogen molecules. When eaten in excess, this is a property that can increase the amount of cholesterol in the blood, thereby increasing the risk of cardiovascular disease.3 Saturated fats are also in red meat, dairy, and palm oil, which are okay to have in one’s diet in moderation.2,4,5 Of all foods containing saturated fat, coconut oil has the highest amount! Fat extracted from coconuts is 92% saturated fat.2 By contrast, unsaturated fats or “healthy fats” are found in fish oils, nuts, avocados, and olive oil.2

Another aspect of coconut oil adds to its unique molecular composition--medium chain fatty acids (MCFAs). MCFAs are fatty acids that are processed faster and more completely than other longer fatty acid chains, and the quick metabolization in the liver causes them to be more readily absorbed.8 MCFAs are made up of a 6 to 12 carbon chain, which differentiates them from their long-chain counterparts. Because MCFAs have a smaller metabolic weight compared to long chain fatty acids and don’t need to be digested by bile salts as longer chains do, they have the ability to enter the bloodstream faster from the intestines. Their smaller size and lower energy needed to metabolize in turn allows them to be used as a more readily available source of energy.9

One tablespoon of coconut oil contains: > 117 calories (17%) > 14 grams of fat (22%) > 12 grams of saturated fat (60%) > No vitamins or minerals

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total wellness ▪ summer 2015

On an even deeper molecular level, coconut oil is unique in its composition. It is made up of 44% lauric acids and 16.8% myristic acids—an unusual combination of the two compared to other oils.2 Lauric acid is a saturated fat that is found primarily in vegetable fats and used as vegetable shortening. Some research suggests that lauric acid found in coconut oil may make it a safer alternative than other types of fats in cooking that don’t contain lauric acid.6 Myristic acid is another saturated fat found in both plant oil and dairy fat that causes increased cholesterol levels in the body over time.7 While coconut oil has some properties that are considered unhealthy, its unique composition can be considered better than other options.

coconut oil + food

A study in the American Journal of Clinical Nutrition evaluated human response to high saturated fat diets in a study of 19 healthy volunteer males between the ages of 22 and 29. The study monitored effects of fats from beef, coconut oil, and safflower oil, all of which are categorized as saturated fats. Results showed that coconut oil acts consistently with other saturated fats in its ability to elevate cholesterol levels in the blood.12 In addition, an article in Postgraduate Medicine highlights that a diet containing high amounts of saturated fat increases the amount of low-density lipoproteins (LDLs) in the body and has the potential to accelerate build up in artery walls and cause atherosclerosis. The same study also reviews a large trial on women analyzing the effects of saturated fat on health risks. Results showed that a 5% increase in the intake of saturated fatty acids could result in up to a 17% increase in the risk of cardiovascular disease.10 In this way, coconut oil and other products with a high saturated fat content have the potential to accelerate adverse health effects and lead to cardiovascular diseases and are recommended to be consumed in moderation.10

MCFAs the good: As mentioned above, MCFAs in coconut oil can be used in the body as a readily available energy source because of their lower metabolization energy and smaller size.9 The saturated fat content of coconut oil is made up of almost 50% MCFAs, particularly lauric acid. A 2003 study published in the Asia Pacific Journal of Clinical Nutrition conducted a doubleblind, randomized experiment involving 82 participants with ages ranging from 21 to 59 years. All participants consumed the same standard-packaged meals, except that the experimental subjects consumed test bread made with 1.7 g MCFA while the control subjects consumed a bread made with long-chain fatty acids as a breakfast substitute for a period of 12 weeks. Results showed that participants consuming the bread made with MCFAs instead of long-chain fatty acids exhibited decreases in body weight, the total amount of body fat, and cholesterol levels.13 heart health While oils and fats can contribute to cardiovascular disease as described above, a review in Postgraduate Medicine also found that MCFAs can act as an antioxidant, which reduces the risk of some cardiovascular problems normally associated with fat in one’s diet. The review describes mechanisms through which oils and fats contribute to the risk of cardiovascular disease, yet also highlights the existing views on coconut oil’s cardioprotective effects. It further underlines the properties of MCFA’s as a quick source of energy and coconut oil’s status as an antioxidant with anti-inflammatory properties. Antioxidant properties may even work toward the prevention of cardiovascular disease and make it a possible dietary intervention in isolation or in combination with exercise.10 As good as this sounds, coconut oil’s high saturated fat content and antioxidant properties underscore the controversy surrounding its potential disadvantages and advantages to health, as exemplified in International Journal of Health and Rehabilitation Science’s review. The review suggests that the current research surrounding coconut oil is inconclusive in terms of affecting cardiovascular disease but may have some other health benefits that have yet to be accepted as fact. Even though the definitive effects of coconut oil are not known, it is likely to be associated with both positive and negative effects on health.14

total wellness ▪ summer 2015

cardiovascular health the bad: saturated fat Dietary recommendations from the US Government Dietary Guidelines advise limiting saturated fat in diet to less than 10% of total fat intake.2 Studies have shown that total fat, saturated fatty acids, and unsaturated fat consumption in diet are highly correlated to cardiovascular diseases.2 Excessive coconut oil, which is high in saturated fat, can increase one’s risk of cardiovascular disease because increased saturated fatty acid intake heightens the amount of cholesterol in the blood. This excess cholesterol can enter artery walls, causing them to thicken over time. This progression of atherosclerosis often shows no symptoms for many years, but can increase one’s risk of cardiovascular disease in middle to older age. Buildup of plaques from atherosclerosis restricts blood flow to the heart and can be very dangerous.11

coconut oil + teeth dental care how is it used? Oil pulling is an old practice involving the use of natural substances to clean teeth, detoxify gums, and whiten smiles through the use of coconut oil or other vegetable-based oils. For coconut oil pulling, the technique involves dissolving one tablespoon of coconut oil softened in warm water, then swishing the solution in your mouth for 10 to 15 minutes before spitting it out.15 does it work? A 2008 study published in the Indian Journal of Dental Research created a randomized, controlled, triple-blind experiment involving 20 males, ages 16 to 18 years, to study the effects of oil pulling. Ten subjects were assigned to the oil-pulling group using coconut oil and ten were assigned the control group, using a chlorhexidine mouthwash substitute that is common in popular mouthwashes. All participants started their daily routines with swishing the assigned solution in their mouth before brushing their teeth for a period of 10 days. The oil pulling therapy group showed a reduction in the total amount of bacteria that require oxygen, suggesting that oil pulling may be effective in reducing amounts of some types of bacteria and plaque in the mouth.16

other oil pulling mediums: better or worse? It seems that coconut oil may in fact be the most effective medium used for oil pulling against some bacteria found in the mouth. A 2010 study published in the Asia Journal of Public Health aimed at investigating the effect of oil pulling against oral microorganisms by comparing the effects of oil pulling using coconut oil, rice bran oil, corn oil, palm oil, sunflower oil, and soybean oil. The study found that coconut oil proved to have antimicrobial abilities against two specific tooth-decaying bacteria, Streptococcus mutans and Candida albicans. Additionally, lauric acid in coconut oil is more readily present than in other observed oils, and has antimicrobial activity against various groups of at least 10 additional bacterium. The same study concluded that oil-pulling overall could likely be used as a preventative home therapy to maintain oral hygiene in addition to regular tooth brushing, and that coconut oil contains a unique fatty acid composition that makes it distinct from other oil pulling methods.18

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total wellness â&#x2013;Ş summer 2015

Further, a 2010 study in the same journal examined the effectiveness of oil pulling practices involving swishing for 30 minutes, where a sample of the swished fluid was removed every 5 minutes for analysis. The material was observed under a light microscope to assess the status of the oil, general presence of microorganisms, and oil particle composition. Results indicate that this emulsification practice may remove unwanted bacteria through oil pulling therapy, as shown in oil samples analyzed in the study compared to the control group. Oil pullingâ&#x20AC;&#x2122;s anti-microbial effects have yet to be fully elucidated, yet these studies indicate that oil pulling can be effective in reducing bacteria and plaque.17

skin care irritation risk In 2008, the Cosmetic Ingredient Review Expert Panel compiled a final report, which analyzed the effect of coconut oil on the skin. Bar soaps containing 13% coconut oil were evaluated through a normal use test on 72 panelists for a period of two weeks. Not a single individual in the study reported responses of irritation. Additionally, in a double-blind randomized controlled study published in the Cosmetic Ingredient Review, coconut oil was found to not be an allergen even at 100% concentration. Subjects in the study had known allergic reactions to a specific compound known to be found in coconut oil, yet allergic reactions were not seen with pure coconut oil itself.1

wound healing Research released in a 2010 study analyzed the effects of the topical application of coconut oil on dermal wounds, which are harmful irritations of the skin. The study found that over a period of 10 days, minor, surface-level wounds healed faster when coconut oil was applied than when nothing was applied. The wound-healing component of virgin coconut oil is likely due to its antimicrobial fatty acids, particularly lauric acid. These antimicrobial properties are important because they inhibit growth of microorganisms, which may cause longer healing times for wounds.19

dry skin Xerosis is a common dry skin condition that is characterized by rough, itchy, dry skin that can be treated with different moisturizers used for all types of dry skin. A 2004 study of 34 patients with xerosis applied either mineral oil or coconut oil twice per day for two weeks. Results indicated that while coconut oil and mineral oil both showed significant improvement in increasing skin hydration levels, patients overall showed a trend toward more substantial improvement in dry skin condition with coconut oil than mineral oil.20 In this way, coconut oil can be beneficial to skin health and may be able to treat minor skin wounds as well as heal dry skin without causing skin irritation.

coconut oil + hair hair care mineral oil, sunflower oil, and coconut oil Oils such as sunflower oil and mineral oil have been known to improve hair health when used as an additional step to one’s hair care routine. Mineral and sunflower oils are commonly used hair products because they do not induce an oily feeling in hair, are odorless, and are cheaper options than coconut oil. A 2002 study published in the Journal of Cosmetic Science compared mineral oil, sunflower oil, and coconut oil to observe respective effects on hair health. The study concluded that coconut oil was the only one of the three common hair oils found to reduce protein loss for both undamaged and damaged hair. The researchers concluded that these proteins are key for preserving hair strength and health, likely due to the lauric acid content and low molecular weight.21

bottom line Coconut oil contains unusually high amounts of saturated fats compared to other oils. Though saturated fats are generally considered unhealthy in foods, the amount of MCFAs in coconut oil has some benefits as well. While coconut oil may be a necessity for certain recipes, diets high in saturated fats have the potential to increase one’s risks of cardiovascular diseases, so enjoy in moderation! Coconut oil may have health benefits as well due to its composition of unusual MCFAs and lauric acid, and it can improve hair, skin, and oral health. t w

References 1 “Final Report of the Cosmetic Ingredient Review.” Cosmetic Ingredient Review. (2008). 2 “The Truth About Coconut Oil.” webmd.com. (2015). 3 “Saturated Fats.” heart.org. (2015). 4 “The Role of Reducing Intakes of Saturated Fat in the Prevention of Cardiovascular Disease: Where Does the Evidence Stand in 2010?” American Society for Nutrition. (2011). 5 “Fatty Acids: Structures and Properties.” Encyclopedia of Life Sciences. (2005). 6 “Find a Vitamin or Supplement: Lauric Acid.” webmd.com. (2015). 7 “Impact of Myristic Acid Versus Palmitic Acid on Serum Lipid and Lipoprotein Levels in Healthy Women and Men.” Arteriosclerosis and Thrombosis. (1994). 8 “Medium-Chain Triglycerides: An Update” The American Journal of Clinical Nutrition. (1982). 9 “Medium Chain Fatty Acid Metabolism and Energy Expenditure: Obesity Treatment Implications.” Life. (1998). 11 “What is Atherosclerosis?” webmd.com. (2015). 12 “Plasma Lipid and Lipoprotein Response of Humans to Beef Fat, Coconut Oil, and Safflower Oil.” The American Journal of Clinical Nutrition. (1985). 13 “Effect of Dietary Medium- and Long-Chain Triacylglycerols (MLCT) on Accumulation of Body Fat in Healthy Humans.” Asia Pacific J Clin Nutr. (2003). 14 “Coconut Oil and Health Controversy: A Review.” Int J Health Rehabil Sci. (2013) 15 “Oil Pulling Therapy.” Indian J Dent Res. (2008).

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coconut oil + skin

food pick

kefir by elsbeth sites and zoe merrill | design by alison jeng

total wellness â&#x2013;Ş summer 2015

You might have read about the health benefits of kefir or seen some unfamiliar bottles on the dairy shelves at the grocery store. Have you tried it? Though kefir has been around for thousands of years, this yogurt-like drink known for its probiotic benefits has been gaining popularity in the US lately. Hereâ&#x20AC;&#x2122;s what you should know if youâ&#x20AC;&#x2122;re interested in this creamy, tangy drink!

what is kefir? Kefir is a fermented dairy drink that can be made from any type of animal milk. Thought to have originated in the Caucasus Mountains of Europe, kefir has been attributed to Eastern Europe, Russia, and Southwest Asia. To make kefir, a symbiotic culture of bacteria and yeast is added to dairy in the form of “kefir grains.” These “grains” are not actually grains, but gelatinous masses that harbor a generous variety of bacteria and yeast. The gelatin itself is kefiran - a starchy gel exuded by Lactobacillus kefiranofaciens— a particular bacteria species within the grains. Several bacterial species including L. kefiranofaciens and Lactobacillus kefiri digest lactose, the naturally occurring sugar within milk, and excrete lactic acids which make the milk tart. Meanwhile, several yeast species, including Saccharomyces cerevisiae, consume lactose and produce alcohol and carbon dioxide by-products. This yeast action makes kefir carbonated, or fizzy, like a soda. The bacteria that you consume when you consume kefir survive in your intestines and stimulate the growth of more beneficial microorganisms, earning kefir the title of “probiotic food.” Kefir is usually found in liquid form and sold in bottles. Almond milk, coconut milk, coconut water, and soymilk “kefirs” can be made using bacteria that digest sugars other than lactose. But as they are not made from dairy, they are not truly kefirs.

how is kefir made?

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Though the two foods share many of the same bacteria species, yogurt cultures do not contain yeast as kefir grains do. Since the yeast are the producers of carbon dioxide in kefir, yogurt is not carbonated. Despite starting from different cultures, kefir has many of the same probiotic properties as yogurt.2 Though the two foods are similar, kefir contains a more varied range of microorganisms than yogurt, and thus is considered a more complete probiotic.2

A newer, less traditional method of production involves using bulk cultures derived from kefir grains to produce larger batches and decrease the risk of contamination. The primary difference between the traditional and industrial methods is the type of fermentation-starter used. Industrially made kefirs are made with pure, specifically selected bacterial cultures in order to create a kefir that is consistent from bottle to bottle. Traditional kefirs are made using the aforementioned kefir grains, which are more variable and can give different batches of kefir unique flavors.4 In a 2013 Turkish study published in the Journal of Dairy Science, the choice of grain versus a natural starter culture did not dramatically alter the content of the resulting microorganisms, so there doesn’t seem to be a significant difference between traditional and commercial kefirs.

total wellness ▪ summer 2015

how is it different than yogurt?

Kefir is traditionally made by pasteurizing milk, cooling it to 20°-25°C, then adding the kefir grains. During an incubation period of 18 to 24 hours, the bacteria and yeast within the grains begin the fermentation process by digesting lactose and excreting acid and carbon dioxide.2 During fermentation, kefir grains increase both in size and number and can then be reused to make new batches of kefir.3 After this fermentation process, the grains are filtered out and what remains is a thickened, milky substance that is suitable for consumption.

why drink kefir? Though it’s renowned for its internal probiotic power, kefir may also provide a slew of other health benefits. The effect of probiotics on the immune system has been a promising area of research recently. According to a study in Critical Reviews in Food Science and Nutrition, microorganisms in fermented foods can activate our immune cells and, in particular, can improve the gut-mucosal immune system by increasing the number of immune cells in our intestines.5 Research into the effects of kefiran is still in its early stages, but in rats kefiran has been shown to reduce blood cholesterol and blood sugar levels.6 Kefir may also help people who suffer from lactose maldigestion, a less severe version of lactose intolerance. This effect, also observed when consuming yogurt, is due to the presence of beta-galactosidase, an enzyme found in yogurt and kefir starter cultures. People who have lactose maldigestion produce insufficient amounts of this enzyme, thus they have difficulty breaking down the lactose in dairy products.7

bottom line

total wellness ▪ summer 2015

Kefir is a tangy dairy beverage that can help cultivate a healthy flora of gut bacteria, which keeps the digestive system running smoothly. If you enjoy yogurt, you’ll likely enjoy kefir as well. So consider giving it a try next time you pass those opaque bottles. Your colon will thank you! t w

References 1. “Kefir: A Symbiotic Yeasts-bacteria with alleged healthy capabilities.” Rev Iberoam Micol. (2006). 2. “Kefir improves lactose digestion and tolerance in adults with lactose maldigestion.” Journal of the American Dietetic Association. (2003). 3. “Microbiological, technological and therapeutic properties of kefir: a natural probiotic beverage.” Brazilian Journal of Microbiology. (2013). 4. “Effects on different fermentation parameters on quality characteristics of kefir.” Journal of Dairy Science. (2013). 5. “Immune system stimulation by probiotic microorganisms.” Critical Reviews in Food Science and Nutrition. (2014). 6. “Effects of an exopolysaccharide (kefiran) on lipids, blood pressure, blood glucose, and constipation.” BioFactors. (2004). 7. “Kefir improves lactose digestion and tolerance in adults with lactose maldigestion” Journal of the American Dietetic Association. (2003).

total wellness â&#x2013;Ş summer 2015

Enjoyed reading this issue? Read all of our issues online!

www.totalwellnessmagazine.org/issues

read all of our past issues online at

www.totalwellnessmagazine.org

total wellness â&#x2013;Ş summer 2015

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

aches, and strains, and pangs, oh my!

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:

Lawrence Taw, MD, FACP, Assistant Clinical Professor, UCLA Center for East-West Medicine, UCLA David Geffen School of Medicine

what are microorganisms doing in my food?

Emeran A Mayer, MD, Professor, Division of Digestive Diseases, UCLA David Geffen School of Medicine Kirsten Tillisch, MD, Associate Professor of Medicine, Division of Digestive Diseases, UCLA David Geffen School of Medicine

bath time!

inked: what to know about tattoos

Gary Lask, MD, Director, Dermatologic Surgery Service, Dermatology Laser Center, Mohs Micrographic Skin Cancer Surgery Unit, Clinical Professor of Dermatology, UCLA David Geffen School of Medicine

runnerâ&#x20AC;&#x2122;s high

Christopher Evans, PhD, Director, Brain Research Institute, Hatos Center for Neuropharmacology, Professor, Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine

all about coconut oil

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

kefir

Peter Lio, MD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University Feinberg School of Medicine

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

your mind & body on psychoactive drugs

Payam Mirfendereski, Omid Mirfendereski, Christopher Phan, Nancy Vu, Ruchi Desai

Christine Grella, PhD, Professor, Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine

crank up the heat for hot yoga Elisa Terry, CSCS, FITWELL Services Program Director, UCLA Recreation

copy-edits and review

layout revisions

Alison Jeng & Jackie Nguyen

cover & table of contents

total wellness â&#x2013;Ş summer 2015

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