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total wellness

a ucla student wellness commission publication

the building blocks

of health

+

your guide to protein shakes mind over stomach

psychology of eating quick & easy

three-ingredient snacks

fall 13 | vol 14 | issue 1

a message from the director

total wellness ▪ fall 2013

It gives me great pleasure to welcome you to Volume 14 of Total Wellness! We launch Volume 14 with the theme The Building Blocks of Health to emphasize our dedication to providing you with the fundamentals necessary to achieve wellness. Inspired by our cover story on protein (which is sometimes referred to as the “building blocks of life”), this issue’s theme seeks to remind our readers that at Total Wellness, we strive to start from the basics and provide education for better health rather than recommendations alone. With each article, we hope to supply you with another “building block” that you can utilize in your day-to-day life. Whether it’s choosing a protein shake (pages 28-32) that is right for you or trying to discern which common health beliefs are actually true (pages 40-46), Total Wellness is here to help you navigate through all the information that’s out there. With our team of dedicated writers, designers, editors, leadership, and professional reviewers, we strive to empower our readers with the latest scientific knowledge concerning health in order to promote your wellness. If you’re a regular reader of the magazine, as you browse this issue, you’ll notice some familiar features as well as some significant changes from our previous volumes. With our partnership with UCLA’s Healthy Campus Initiative, we have aligned our columns with the initiative’s goals; to help you Live Well, we have included the Eat Well, Move Well, and Mind Well Departments. Additionally, we have partnered with UCLA Health System: Center for East-West Medicine and added a Self-Care Column, through which we will cover practical health topics and

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describe practices you can utilize in your daily life. In addition to these new columns, Volume 14 features the continuation of In the News, Q&A, Body in Focus, and Decoding the Ingredient Label from our previous volumes. We’ve not only revamped the magazine for Volume 14, but we’ve also expanded connections with our readers through our social media sites. Now, you can follow us on Instagram (@totalwellnessmagazine) and Twitter (@totalwellnessLA) in addition to liking us on Facebook (@TotalWellnessMagazine@UCLA). We encourage you to interact with us, tell us what you’d like to read about in the magazine, and submit a question for our Q&A column. If you’re a new reader and would like to learn more about us, visit us online at http:// www.totalwellnessmagazine.org. Also, if you’d like to browse our previous issues, read our publications online at http://issuu.com/ totalwellnessmagazine. We hope you enjoy Total Wellness and gain the “building blocks” you need to achieve better health. Cheers to your health,

Shannon Wongvibulsin Director and Editor-in-Chief

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

editor’s note

JULIE ESCOBAR Co-Copy Editor

TIFFANY LIN Co-Copy Editor

BARBARA WONG Co-Art Director

KARIN YUEN Co-Art Director

LESLIE CHANG Managing Editor

ANNIE THERIAULT Outreach Director

HARINI KOMPELLA Finance Director

KEVIN SUNG Webmaster

total wellness ▪ fall 2013

Hello Readers! Welcome to the newest volume of Total Wellness. I’m very excited to assume the role of Editor-in-Chief of this beautiful publication alongside Shannon this coming year. As a writer, I knew how much I loved the magazine, but it wasn’t until I worked closely with our amazing staff on this issue that I really understood the extent of the painstaking dedication that goes into the creation of each published piece. At Total Wellness, we really put everything we have into our work, so I just want to extend a shout-out to our awesome crew for all of the heart in this issue and the ones to come. This issue’s theme hits on what I see as a crucial part of healthy living - which is the idea that our state of health is the culmination of the little choices we make each minute of each day. Today, will you take that extra sip of water? (Learn about adequate hydration on page 7.) Will you take the long way around that gas station on your morning walk to avoid harmful fumes? (Read about what might be in the air you breathe on pages 47-52.) Will you reach for the hot sauce at lunch (learn about spicy foods on pages 37-39), or choose one of our healthier threeingredient snacks (pages 13-16) over that bag of chips? Here at Total Wellness, we hope to provide the information you need to make informed, healthy decisions every single moment you can. That’s why we work so hard to objectively present the evidence exactly as we find it. That way, you can decide for yourself what the facts mean to you, or you can follow our interpretation. Don’t believe us? You don’t have to. Check out the research yourself by looking at our new References sections at the end of each article. Remember, every good decision you make today could be one that your beautiful, healthy self will thank you for tomorrow, or maybe 50 years from now. Choose to do your future-self a favor. I’m looking forward to a wonderful year with you all.

leadership

Hoping to help you make each day the best it can be,

Chalisa Prarasri Editor-in-Chief

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words from the commissioner Hello Bruins! We’ve got exciting things going on with SWC this quarter! As we wind down fall quarter, some of our biggest events of the year are taking place. Our World AIDS Day fair featuring AIDS & HIV resources, research opportunities, and professionals will take place in Bruin Plaza on Monday, November 25th from 11 am-2 pm. During the fair, HIV testing vans will be parked nearby and SWC members will usher students to get free testing; if you haven’t been tested, come out to the event or check our website (http://swc.ucla.edu/) for ways to get tested. In addition, 7,000 in Solidarity: A Campaign Against Sexual Assault is in full force. UCLA and the University of California, Office of the President will be forming a new Sexual Harassment and Sexual Assault Policy that will affect all UCs come March 2014. In response, the campaign has rallied students to provide their input to the first draft of this policy and will be introducing its first of many consent and bystander intervention workshops called “End the Silence: What You Need to Know About Sexual Assault” on Tuesday, November 26th from 7-9 pm. To close out the quarter, 7000 in Solidarity will have an art exhibit in Kerckhoff Art Gallery throughout Week 10 entitled, “7000 Rising: A Consent Revolution.” The opening will be December 3rd from 5-7pm featuring sexual assault survivor photos and statements similar to Project Unbreakable, art submission from survivors, and a video screening of “...no lies,” a short film from 1970 commenting on rape culture and sexual assault on college campuses, which remains relevant today. The opening night will be poignant, passionate, and powerful, so we hope to see you there!

total wellness ▪ fall 2013

Though we have large events nearly every week, don’t forget to check out our weekly CPR & First Aid classes by visiting our website, and be sure to look out for our many amazing winter quarter events, like I <3 My Body Week and 7000 in Solidarity: Consent Revolution Week, in January! Best,

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

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

Staff Writers Peter Chu, Julia Diana Feygelman, Sally Kim, Grace Lee, Sofia Levy, Tiffany Lin, Pavan Mann, Halee Michel, Jennifer Miskabi, Allison Newell, Lillie Luu Nguyen, Sepideh Parhami (intern), Vesta Partovi (intern), Elsbeth Sites, Rebecca Tang, Emily White, Pauline Yang Design Natalie Chong , Karen Chu, Emily Hsu, Allison Newell, Catrina Pang, Kristen Sadakane, Mary Sau, Jessica Sun, Annie Theriault, Alexandria Villanueva, Barbara Wong, Shannon Wongvibulsin, Karin Yuen Web Team Erik Jue, Mary Sau Advisory & Review William Aronson, MD

Professor, UCLA School of Medicine

Susan Bowerman, MS, RD, CSSD

Assistant Director, UCLA Center for Human Nutrition

Leah FitzGerald, RN, FNP, PhD

Assistant Professor, UCLA School of Nursing

Dena Herman, PhD, MPH, RD

Adjunct Assistant Professor, UCLA School of Public Health

Eve Lahijani, MS, RD

Nutrition Health Educator, UCLA Bruin Resource Center

Melissa Magaro, PhD

Clinical Psychologist, UCLA Counseling and Psychological Services

Lilia Meltzer, RN, NP, MSN

Lecturer, California State University, Long Beach

William McCarthy, PhD

Adjunct Professor, UCLA School of Public Health

Rena Orenstein, MPH

Assistant Director, Student Health Education

Allan Pantuck, MD, MS, FACS

Associate Professor, UCLA School of Medicine

Julie Skrupa, AADP, CHHP

JWellness101, Owner and Health Coach

Raffi Tachdjian, MD, MPH

Assistant Clinical Professor, UCLA School of Medicine

Elisa Terry, NSCA-CSCS

FITWELL Services Program Director, UCLA Recreation

Alona Zerlin, MS, RD

Research Dietitian, UCLA Center for Human Nutrition

Total Wellness is a free, student-run, publication and is supported by advertisers, the Student Wellness Commission (SWC), the Undergraduate Students Association (USAC), the Arthur Ashe Student Health and Wellness Center, UCLA Healthy Campus Initiative (HCI), UCLA Recreation, and UCLA Health System: Center for East-West Medicine. Contact 308 Westwood Blvd., Kerckhoff Hall 308 Los Angeles, CA 90024 Phone 310.825.7586, Fax 310.267.4732 totalwellnessatucla@gmail.com www.totalwellnessmagazine.org www.swc.ucla.edu Subscription, back issues, and advertising rates available on request

Savannah Badalich SWC Commissioner

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Volume 14, Issue 1 © 2013 by Total Wellness Magazine. All rights reserved. Parts of this magazine may be reproduced only with written permission from the editor. Although every precaution has been taken to ensure the accuracy of the published material, Total Wellness cannot be held responsible for the opinions expressed or facts supplied by authors. We do not necessarily endorse products and services advertised. The information in Total Wellness is not intended as medical advice and should not replace the advice of your physician. Always consult a health care provider for clarification.

contents IN EVERY ISSUE 02 03 04 06 07 55

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

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DEPARTMENTS 08 self care An Inside Scoop on the Science Behind Chicken Soup and the Common Cold

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13 eat well Three-Ingredient Snacks 17 move well Exercise: Can it Improve Cognition? 19 body in focus Skincare Jargon: What Does That Mean? 21 mind well Mind Over Stomach: The Psychology of Eating 54 decoding the nutrition label Aspartame

28 cover story Shake it Up with Protein 33 Iron Deficency Anemia 37 Capsaicin, Spice, & Everything Nice 40 Common Health Myths Debunked 47 What’s in the Wind?

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total wellness ▪ fall 2013

cover: alexey iwanov/istockphoto; right: stuartbur/istockphoto; paul kline/ istockphoto; martindvonka/ istockphoto; floortje/istcokphoto; right: sorendls/istockphoto

FEATURES

ON THE COVER 28 Protein Shakes 21 Psychology of Eating 13 Three-Ingredient Snacks

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in the news

what’s happening in health? | design by karin yuen

RESEARCH AND NEW FINDINGS NOW OR LATER? RESISTING BRAIN TEMPTATIONS

As part of a growing body of research exploring areas of the brain most associated with self-control, neurologists in France sought to examine the role the hippocampus plays when the brain must choose between receiving an award now or in the future, particularly when waiting may result in a prize individuals like better. Published in the journal PLOS Biology, researchers found that when immediate rewards were presented as pictures and future awards were presented as text, the amount of brain activity in the hippocampus increased more when selecting a future reward. This increase suggests that the hippocampus helps assess the value of a reward that individuals have to imagine, compared to a reward they can see. Hence those with hippocampal damage may find it difficult to pursue long-term goals and may be more prone to impulse control problems.1

EXPERIMENTAL DRUG TO HELP TREAT LUNG CANCER

Research has shown promise in a new experimental drug as an effective treatment for individuals with non-small cell lung cancer (NSCLC), the leading cause of cancer death among men and women worldwide. Edward Garon, MD, director of thoracic oncology at UCLA’s Jonsson Comprehensive Cancer Center, has released the preliminary results from a study of the new drug, MK-3475. Patients (who had been treated previously for their disease without positive results) received MK-3475 every 3 weeks. Among them, 24% responded to the drug with their tumors shrinking. Based on this data, experimenters are currently enrolling patients to enter Phase 2 (of 3) of the study to compare different doses of MK-3475 to standard chemotherapy for lung cancer.3

AT UCLA

FEW WINNERS AMONG HEALTH APPS

total wellness ▪ fall 2013

According to a report from the IMS Institute for Health Informatics, a majority of the 16,257 credible health apps available today are hardly used. Among the most popular are lifestyle apps such as calorie counters and exercise trackers like MyFitnessPal. But what could be discouraging users from using those remaining? The IMS report states that only 2,000 apps allow users to enter data to track their health, and even fewer apps use sensors to measure a person’s health status, such as heart rate, or address a specific health issue, like diabetes. While there is potential value in mobile health apps, many may remain unused until issues regarding overall quality function and better access by consumer populations have been addressed.2

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BIOLOGICAL CLOCK TO MEASURE AGE OF HUMAN TISSUE

A recent study, published in the journal Genome Biology, discovered a biological clock rooted in our genomes that may help scientists improve their understanding of the human aging process. The research study focused on DNA methylation, a chemical modification of the building blocks that make up our DNA, and resulted in the first ever age-predictive tool. Steve Horvath, PhD, a professor from the David Geffen School of Medicine and the UCLA Fielding School of Public Health, used data from both healthy and cancerous human tissue to determine how age affects DNA methylation levels from pre-birth through 101 years of age. The tool, which allows researchers to accurately gauge the age of diverse human organs, tissues, and cell types, also demonstrated that some parts of the body, like a woman’s breast tissue, age much faster than the rest of the body.4 t w References 1. “Resisting temptation: It’s all in your brain.” cnn.com. (2013). 2. “The Long List of Health Apps Features Few Clear Winners.” npr.org. (2013). 3. “Experimental drug shows encouraging results in treating most common form of lung cancer.” newsroom.ucla.edu. (2013). 4. “UCLA scientist uncovers biological clock able to measure age of most human tissues.” newsroom.ucla.edu. (2013).

NUMBERS

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hundred thousand deaths in the US each year result from cardiovascular disease and stroke

14.2 percent of women 18 years and over are in fair or poor health

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billion dollars total medical costs incurred by the American healthcare system each year for sexually transmitted infections cdc

left (in order): henrik jonsson/istockphoto; donnichols/istockphoto; right: krasyuk/ istockphoto; dmax-foto/istockphoto

by julie escobar

q&a

Q: A:

what causes dehydration? how can I stay hydrated? by lillie luu nguyen | design by emily hsu

Dehydration is a condition that occurs when the loss of body fluids, mostly water, exceeds the amount that is taken in. An estimated 75% of Americans are chronically dehydrated.1 A shortage in water consumption could be a result of low amounts of body fluids or a loss of water through bodily processes such as excessive perspiration, high urine output, diarrhea, and water vapor released in every breath.

water vs. coconut water vs. sports drinks

The easiest way to avoid dehydration is to simply drink more liquids! To reduce additional water loss, avoid diuretics, substances that promote the production of urine. Substances such as the caffeine in coffee, silica in oats, and herbs are natural diuretics that could lead to dehydration if consumed in excessive amounts.3 Strenuous exercise on high heat index days may also induce dehydration, so keeping cool indoors or wearing light clothing on hot days is advised.4

There are many ways to rehydrate, but which liquid is the best thirst quencher? Turns out the results vary based on the intensity of the workout! In a 2012 study in the Journal of the International Society of Sports Nutrition, results revealed little difference between how effective each beverage was in the hydration status for participants who ran on the treadmill for an hour.8 However, during strenuous exercise, coconut water’s lower sodium content is where it fails as a good refresher. This is due to the fact that people lose more sodium than potassium, and coconut water alone cannot replace that lost sodium.9 When sports drinks are ingested during intense workouts, they not only replace the lost sodium with electrolytes, but they also help replenish the sugar supply that was broken down by the muscles during exercise. In the end, sports drinks become advantageous for overall rehydration during intense and/or endurance exercise, making it the ultimate thirst quencher!

are 8 glasses of water a day necessary?

rehydrate often!

No! Refer to Common Health Myths Debunked on page 41 to learn more! To put things into perspective, a recommended glass of water is approximately 8 oz = about 240 ml = 1 cup.5 According to a 2004 study by the Institute of Medicine (IOM), it is recommended that the total fluid intake for men and women should be 125 oz (15 cups) and 91 oz (11 cups) per day,6 respectively. This may sound extreme, but remember that these guidelines are for total fluid intake, which includes fluid from all foods and beverages. Some foods with high water content are: lettuce (95%), celery (95%), bok choy (95%), watermelon (92%), mushrooms (92%), spinach (92%), broccoli (91%), grapefruit (91%), milk (89%), and orange juice (88%).7

Being well hydrated not only replenishes the body of lost fluids, but is also advantageous in keeping body temperature regulated, maintaining the balance of fluids, and increasing energy.10 So have a cup of any fluid you wish (in moderation!) and eat foods with high water content to keep the body happy and hydrated. t w

what are the symptoms? Increased thirst, dry mouth, faintness, increased palpitations, cramping, nausea, and dark yellow to amber urine are indicators of dehydration.2

how can dehydration be prevented?

References 1. “Water: an essential but overlooked nutrient.” J Am Diet Assoc. (1999). “Dehydration in Adults.” webmd.com. (2011). 3. “Dehydration affects brain structure and function in healthy adolescents.” Hum Brain Mapp. (2011). 4. “Dehydration Influences Mood and Cognition: A Plausible Hypothesis?” Nutrients. (2011). 5. “Foods That Cause Dehydration.” livestrong.com. (2011). 6. “”Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8 x 8”?” Am J Physiol Regul Integr Comp Physiol. (2002). 7. “The Wonders of Water.” webmd.com. (2010). 8. “Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men.” J Int Soc Sports Nutr. (2012). 9. “Coconut Water Is an Excellent Sports Drink -- For Light Exercise.” sciencedaily.com. (2012). 10. “Water, Hydration and Health.” Nutr Rev. (2010). 2.

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total wellness ▪ fall 2013

got a question? We love curious readers. Send your question over to totalwellnessatucla@gmail.com and the answer may appear in a future issue.

self-care

an inside scoop on the science behind

chicken soup and the common cold

total wellness â&#x2013;Ş fall 2013

For centuries, chicken soup has been considered a remedy for colds. In fact, the Egyptian Jewish physician and philosopher Maimonides advised people to consume chicken soup for the relief of respiratory tract symptoms in his 12th century treatise. Furthermore, a range of other cultures have utilized chicken soup in their traditional healing practices to combat the common cold. It is even common practice in todayâ&#x20AC;&#x2122;s modern society to turn to chicken soup as a cold remedy, but what is the science behind chicken soup? Read on to uncover some insight into the common cold and the scientific evidence behind the cold-fighting properties of chicken soup.

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left: dny59/istockphoto; right: ansonsaw/istockphoto

by shannon wongvibulsin | design by annie theriault

why are colds more common when it’s cold? Although being cold by itself does not cause people to come down with the common cold, the combination of the following can contribute to why colds occur more frequently during the fall and winter seasons:

Rhinoviruses (viruses that cause the common cold) thrive in low temperatures. According to a 2013 article in Nature News, researchers have recognized this fact for decades.1 Additionally, a 2009 article published in Respiratory Medicine reported that in a cold environment, the upper respiratory tract temperature may be more favorable to the replication of rhinoviruses, leading to an increase in occurrences of the common cold during times of lower temperature.2

conditions, the mice produced fewer antiviral immune signals than in warmer conditions. This reduction in antiviral signals allowed infections to persist more easily at colder temperatures. Furthermore, the scientists performed research on human airway cells grown in either a cold or warm lab setting and infected the cells with rhinoviruses that cause colds in humans. From this study, they demonstrated that the infected cells grown in a warmer environment underwent programmed cell death (a form of cell suicide resulting from an immune response to limit the spread of the infection) at a higher rate than the cells infected in the colder environment.1

At low temperatures, our bodies may produce fewer antiviral immune signals and leave us more vulnerable to infections. At the 2013 American Society for Microbiology conference, scientists from Yale University presented their research that demonstrated how low temperatures may compromise natural defenses against rhinoviruses. In their study involving mice and a mouse-specific rhinovirus, they found that in colder

staying warm to prevent the common cold?

A 1968 study published in the New England Journal of Medicine examined 44 volunteers for experimentally induced rhinovirus infections and found that exposure to low temperatures (approximately 39 to 50°F) did not influence the frequency or severity of colds resulting from the strain of rhinovirus used in the study.4

A 2005 study published in Family Practice demonstrated that subjects who had their feet chilled in a cold water bath were more likely to self-report cold symptoms 4 to 5 days after the chilling procedure compared with the control participants who did not have their feet chilled.5

Cold temperatures and low humidity, characteristics of the “cold” season, are associated with increased occurrences of acute respiratory tract infections (which include conditions like the common cold) according to the 2009 Respiratory Medicine article mentioned previously.2 Additionally, the US Department of Health and Human Services: National Institute of Allergy and Infectious Diseases (NIAID) explains that cold-causing viruses “survive” better in low humidity, which occurs during colder months. Furthermore, the NIAID also reports that cold weather can cause the lining of the nose to become drier and more susceptible to viruses that cause the common cold.3

Despite the inconclusive nature of research concerning the relationship between cold temperature exposure and the common cold, the cautious thing to do may simply be to stay warm during the cold season. Additionally, Dr. KaKit Hui, MD, the founder and director of the UCLA Center for East-West Medicine and the Wallis Annenberg Professor in Integrative East-West Medicine, places great emphasis on keeping the head, neck, shoulders, and feet warm to avoid unnecessary loss in body heat.

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total wellness ▪ fall 2013

Can being physically cold actually increase your chances for coming down with the cold? There’s still controversy over this topic, and researchers have reported findings that suggest different answers to this question.

the science behind chicken soup increased movement of nasal fluids:

total wellness ▪ fall 2013

into some therapeutic

ingredients 10

garlic A 2001 study published in Advances in Therapy demonstrated through a double-blind, placebo-controlled experiment that the group receiving garlic supplements had significantly fewer colds than the placebo group. Additionally, when afflicted with the common cold, those who received the garlic supplements recovered more quickly than those who were part of the placebo group.11 Although details behind garlic’s ability to exhibit antiviral properties is not well understood, a 2009 review published by The Cochrance Library states that garlic’s sulfur-containing derivatives may play a role in its antiviral effects.12

top left: floortje/istockphoto; bottom far left: evna11/istockphoto; right: juxtagirl/istockphoto; hudiemm/istockphoto

››

a closer look

Although hot fluids typically aid in the movement of nasal mucus, chicken soup can be superior to hot water in increasing the movement of nasal mucus, clearing the airways, and easing congestion. This insight into chicken soup is based upon a study that examined the nasal mucus velocity of 15 healthy subjects who drank cold water, hot water, or chicken soup. The results of this research (published in a 1978 article in CHEST – the official journal of the American College of Chest Physicians) demonstrated that compared with hot water and cold water, hot chicken soup led to improved nasal mucus velocity.6 Furthermore, according to a 1998 report from Coping with Allergies and Asthma, chicken soup may improve the ability of the tiny hairline projections in the nose (called cilia) to prevent infectious particles from afflicting the body.7

anti-inflammatory effect: A 2000 study published in CHEST suggested that the mild antiinflammatory effect conferred by chicken soup could be one of the reasons behind the soupâ&#x20AC;&#x2122;s ability to mitigate symptomatic upper respiratory tract infections like the common cold. Typically, when an individual comes down with a cold, the body responds with inflammation in the upper respiratory tract. The inflammatory response in turn signals white blood cells (WBCs) to migrate to the region. This migration of WBCs into upper respiratory tract may contribute to the commonly encountered cold symptoms, such as stuffy noses. When the researchers measured the ability of the WBCs to migrate through a filter from one side of a chamber to the other side, they found that fewer cells migrated to the other side of the chamber in the

presence of chicken soup. As a result, the scientists of the study propose that some ingredient in the soup may be responsible for slowing or blocking the migration of these WBCs to the upper respiratory tract and thus, aid in relieving cold symptoms. Nevertheless, from this study of chicken soup (made from ingredients including chicken, onions, sweet potatoes, parsnips, turnips, carrots, celery, parsley, salt, and pepper), the researchers were unable to identify the biologically active compound.8,9 A 2012 study published in the American Journal of Therapeutics suggested that a compound called carnosine, which is found in sources like chicken soup and chicken breast, could help inhibit the proinflammatory conditions typically associated with the initial stages of viral infections and prevent the development of the common cold.10

Although the common cold has been a long-standing and frequently encountered ailment, many unresolved questions remain concerning the common cold. However, scientific research has provided us with greater insights into the science behind chicken soup and possible reasons why colds are more common during seasons with lower temperatures. Although debate remains as to whether being cold can increase your risk of catching the common cold, it may be best to err on the safe side and stay warm this cold season.

ginger

According to a 2013 review published in Food Science and Nutrition, the major onion flavonoid (a compound with antioxidant effects) is a molecule known as quercetin.13 Furthermore, a 2005 study published in the Federation of European Biochemical Societies Journal reported that quercetin may exhibit antiviral properties.14

A 2013 study published in the Journal of Ethnopharmacology demonstrated that fresh ginger is effective against human respiratory syncytial virus (HRSV) infections, which are responsible for a wide range of respiratory illnesses including the common cold. The authors report that fresh ginger prevents infection from this virus by blocking viral attachment and internalization.15

total wellness â&#x2013;Ş fall 2013

onions

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These findings about garlic, onions, and ginger may provide insight into the scientific basis of long-standing practices to combat the common cold such as the following traditional remedies:

› › ›

1 to 2 cloves of fresh garlic, cup of boiling water, and honey to taste 1 to 2 oz of lower white portion of green onion bulbs (scallions), cup of boiling water few slices of fresh ginger, cup of boiling water, honey to taste

To learn more about ways to treat and prevent the common cold, check out Combating the Common Cold in our Issue 2, Volume 12. t w

Annual Student Conference for Integrative Medicine (ASCIM 2014) "Science and Art of Whole-Person Healing for the 21st Century"

10AM - 4PM, Saturday, March 1st, 2014 UCLA Ronald Reagan Medical Center, Tamkin Auditorium B-130

total wellness ▪ fall 2013

• References 1. “Cold viruses thrive in frosty conditions.” nature.com/news. (2013). 2. “Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections.” Resp Med. (2009). 3. “Common Cold.” niaid.nih.gov. (2011). 4. “Exposure to Cold Environment and Rhinovirus Common Cold – Failure to Demonstrate Effect.” N Engl J Med. (1968). 5. “Acute cooling of the feet and the onset of common cold symptoms.” Fam Pract. (2005). 6. “Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance.” CHEST. (1978). 7. “Chicken Soup for Allergies and Asthma.” Coping with Asthma and Allergies. (1998). 8. “Chicken Soup Inhibits Neutrophil Chemotaxis In Vitro.” CHEST. (2000). 9. “Chicken Soup Really Is Good for a Cold.” abcnew.go.com. (2000). 10. “Management of the virulent influenza virus infection by oral formulation of nonhydrolized carnosine and isopeptide of carnosine attenuating proinflammatory cytokine-induced nitric oxide production.” Am J Ther. (2012). 11. “Preventing the Common Cold With a Garlic Supplement: A Double-Blind, Placebo-Controlled Survey.” Adv Ther. (2001). 12. “Garlic for the common cold.” The Cochrane Library. (2009). 13. “Onion: Natural Protection Against Physiological Threats.” Crit Rev Food Sci Nutr. (2013). 14. “Modulatory effects of plant phenols on human multidrug-resistance proteins 1, 4 and 5 (ABCC1, 4 and 5).” FEBS J. (2005). 15. “Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines.” J Ethnopharmacol. (2013).

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Featuring: Victoria Maizes, MD, University of Arizona Center for Integrative Medicine

Michael Goldstein, PhD, UCLA Fielding School of Public Health & Healthy Campus Initiative

Interactive workshops (Tai Chi, Yoga, Creative Arts, Herbal Medicine, and more!)

Professional Student Panel (Including Nursing, Osteopathic, Naturopathic, and Oriental Medicine) Register now at: < http://exploreIM.ucla.edu/events/ASCIM-2014 >

left: floortje/istcokphoto; right: sorendls/istockphoto

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

eat well

three-ingredient snacks by grace lee | design by natalie chong

When hit with food cravings in between meals or between classes, it is easier to buy

something off a vending machine for the sake of convenience, despite knowing that consuming processed foods can be detrimental to health. To balance the need to chow down on munchies and to eat in a health-conscious manner, here are some simple, delicious recipes to try out for people who are short on time and resources, featuring snacks that can be made with three ingredients (or less!):

total wellness â&#x2013;Ş fall 2013

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almond butter

Circulation published a study in 2002 that concluded the consumption of almonds can reduce heart disease risk factors.1 In addition to providing cardioprotective benefits, almonds may help with weight loss.2 Almonds are full of unsaturated fat, which helps lower bad cholesterol, and fiber, which helps you feel full longer. Additionally, almonds can help improve the health of the lining of the arteries and may stabilize blood sugar.3 Moreover, a 2003 study by the Journal of the American College of Nutrition concludes that almond butter can help significantly decrease LDL cholesterol.4

bananas

Bananas are high in potassium (which can help build muscle),5 B vitamins (which helps form red blood cells and can also help calm stress), vitamin B6 (which can help your immune system)6, and fiber (which can help protect your heart).7 In addition, bananas contain prebiotics, which help stimulate the growth of beneficial bacteria that help digestion.8 In baking, bananas can also be used as a sugar replacer due to their natural sweetness.

dark chocolate/ cocoa powder

High in antioxidants, dark chocolate can help lower blood pressure levels.9 According to an Antioxidants & Redox Signaling paper in 2011, cocoa - a major component of dark chocolate - may exhibit antiinflammatory properties, reduce risk for diabetes, and protect skin from damage by UV radiation. Though consumption may increase oneâ&#x20AC;&#x2122;s satiety, cocoa is also calorie-dense, and it should be consumed in moderation to prevent weight gain.10

eggs

total wellness â&#x2013;Ş fall 2013

flax seeds

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Eggs have had a bad rep for being rich in cholesterol, yet a recent study in 2013 by the British Medical Journal suggests that high egg consumption (1 per day) may not be linked to heart diseases.11 As a good source of protein and being relatively low on calories, this food staple also provides iron (which the body needs to build protein), B vitamins (which helps form red blood cells), and folate (which helps metabolize amino acids).12 Currently, the American Heart Association has deemed that daily egg consumption is acceptable provided that other cholesterol sources such as meat, poultry, and dairy are limited.13 Read more about eggs on page 43. Another good source of fiber, flax seeds are high in antioxidants, which may help protect eaters against cancer and inflammation.14 A 2010 article published by The Canadian Journal of Cardiology, which examined the cardiovascular effects of flax seeds, found that they are rich in fatty acids not only present in fish, but also known for their potential to combat cardiovascular diseases. Evidence suggests that flax seed supplements can additionally decrease cholesterol, as well as help protect against health problems caused by obesity and diabetes.15

left: elenathewise/istockphoto; photomaru/istockphoto ; stepan popov/istockphoto; natikka/istockphoto; burwellphotography/istockphoto right: kasiam/istockphoto; elenathewise/istockphoto; kevindyer/istockphoto; valentinarr/istockphoto

in the pantry

Honey has antibacterial and anti-inflammatory properties, and darker colored honey tends to have more antibacterial and antioxidant power.16 Antioxidant consumption may contribute to weight loss; in a study detailed by the International Journal of Biological Sciences in 2012, it was noted that rats and diabetic human subjects consuming honey in moderation may experience reduced weight gain. The journal also notes that honey can produce lower glycemic response in rabbits, suggesting that it may help lower elevated blood glucose if not consumed in excess.17

rolled oats

Oats are a good source of soluble fiber, which can help people lose weight by maintaining a sense of satiety and aiding the digestive system. It can be used to lower high cholesterol, preventing cardiovascular diseases, and stabilize blood sugar levels, which can help control diabetes.7 Moreover, the Archives in Internal Medicine released a study in 2005 suggesting that fiber consumption may also prevent hypertension.18 In addition, Critical Reviews in Food Science and Nutrition in 2012 noted that oats have higher protein content than most cereals, which also may be beneficial to weight loss,19 as diets high in protein are believed to reduce appetite and increase satiety.20

tofu

Derived from soy, which provides a plant-based complete protein source, tofu and other soy products may prevent stroke, prevent cancer (notably breast and prostate cancer), and lower cholesterol, according to the 2003 article published by The Journal of Perinatal Education.21 In populations where soy is highly consumed, notably in east Asian countries, there are also fewer instances of cardiovascular diseases and osteoporosis.22 However, it is important to choose good quality soy products; a 2004 study by Carcinogenesis, which noted that American soy tends to be highly processed compared to that of Asian countries, indicated that consumption of processed soy may stimulate estrogen-dependent breast cancer tumors.23

virgin coconut oil

There have been many testimonials regarding the health benefits of this food staple, ranging from improving poor immune function to helping combat weight gain. In 2013, Evidence-based Complementary and Alternative Medicine released a study observing the effects that virgin coconut oil consumption has on rats with high blood pressure; researchers noticed that consumption prevented blood pressure elevation.24 However, its effect on humans is still uncertain and requires more research. Since this particular oil is high in calories and has a high amount of saturated fat, which may negatively affect cardiovascular health, it may be best to consume this in moderation.25

total wellness â&#x2013;Ş fall 2013

honey

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recipes {chocolate bark}

{granola bars} ingredients

ingredients

2 tbsp cocoa powder 2 tbsp coconut oil (unmelted) ½ tsp honey

3 cups rolled oats ¾ cup honey ½ cup coconut oil (optional: 1 cup rice crispy) (optional: 1 cup dark chocolate chips)

directions

directions

› › ›

› › › ›

Mix the ingredients in a bowl. Spread the mixture on a dish lined with parchment paper. Put in a freezer for 20 minutes.

{flax seed crackers}

{pancakes}

ingredients

ingredients

½ cup flax seeds 1 medium banana (optional: cinnamon, to taste)

2 bananas ½ cup almond butter 2 eggs

directions

directions

› ›

› › ›

Mix the ingredients in a bowl. For each cracker, drop 1 tbsp of the mixture and press flat on a greased pan (fill the pan). Bake for 20 minutes at 300°F.

Mix the ingredients in a bowl. Cook on a greased pan on low-medium heat. Optional: serve with syrup.

{oatmeal cookies}

{chocolate pudding} ingredients

ingredients

1 packet silken tofu (firm) 2/3 cup dark chocolate chips

1 cup rolled oats 2 bananas ½ cup dark chocolate chips

directions

directions

› › ›

› ›

Microwave chocolate chips for two and a half minutes. Drain the tofu and puree in blender until smooth. Add the melted chocolate and blend again.

Mix the ingredients in a bowl. Place the cookies on a greased cookie sheet. Bake for 15 minutes at 350 degrees.

Next time you have food cravings, try for a healthier alternative, such as these simple, easy-to-make recipes. t w References 1. “Dose response of almonds on coronary heart disease risk factors.” Circulation. (2002). 2. “Almonds May Help in Weight Loss.” webmd.com. (2013). 3. “Nuts and your heart: Eating nuts for heart health.” webmd.com. (2013). 4. “Effects of plant-based diets high in raw or roasted almonds, or roasted almond butter on serum lipoproteins in humans.” J. Am. Coll.Nutr. (2003). 5. “Potassium in Diet.” Medline Plus. (2013). 6. “Food for Men: 10 Foods to Boost Male Health.” webmd.com. (2013). 7. “Dietary Fiber: Insoluble vs. Soluble.” webmd.com. (2013). 8. “Fruit Bites for Teens: Bananas.” webmd.com. (2012). 9. “Dark Chocolate Is Healthy Chocolate.” webmd.com. (2013).

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10. “Cocoa and Chocolate in Human Health and Disease.” Antioxid. Redox Signaling. (2011). 11. “Egg consumption and risk of coronary heart disease and stroke: doseresponse meta-analysis of prospective cohort studies.” Br. Med. J. (2013). 12. “Dietary Friend or Foe?” webmd.com. (2013). 13. “Common Misconceptions about Cholesterol.” American Heart Association. (2013). 14. “The Benefits of Flaxseed.” webmd.com. (2013). 15. “The cardiovascular effects of flaxseed and its omega-3 fatty acid, alphalinolenic acid.” Can J Cardiol. (2010). 16. “Medicinal Uses of Honey.” webmd.com. (2013). 17. “Honey - A Novel Antidiabetic Agent.” Int. J. Biol. Sci. (2012). 18. “Dietary Fiber and Blood Pressure.” Arch. Intern. Med. (2005).

“Proteins in oats; their synthesis and changes during germination: a review.” Crit. Rev. Food Sci. Nutr. (2012). 20. “High protein diet for weight loss.” webmd.com. (2013). 21.. “Soy Protein.” J Perinat Educ. (2003). 22. “The Science of Soy: What Do We Really Know?”Environ Health Perspect. (2006). 23. “Soy processing influences growth of estrogen-dependent breast cancer tumors.” Carcinog. (2004). 24. “Virgin coconut oil prevents blood pressure elevation and improves endothelial functions in rats fed with repeatedly heated palm oil.” Evid. Based Complement Alternat. Med. (2013). 25. “The Truth About Coconut Oil.” webmd.com. (2013). 19.

left: vikif/istockphoto; robynmac/istockphoto; aalex81/istockphoto; joe biafore/istockphoto; spyross007/istockphoto; subjug/istockphoto right: dougberry/istockphoto

total wellness ▪ fall 2013

Heat the coconut oil and honey in a pot on low heat. Mix in the rolled oats (and other dry ingredients). Spread the mixture on a dish lined with parchment paper. Refrigerate for 20 minutes.

move well

exercise: can it improve cognition? by chalisa prarasri

aerobic exercise) can, in fact, improve specific types of cognition. In 2008, Nature Neuroscience published a review (cleverly titled “Be smart, exercise your heart”) that gives an overview of what scientists have managed to learn about exercise and the brain in these decades.1 Read on to learn what this review has to say about the subject.

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It’s well-established and widely accepted that exercise can help prevent disease and reduce stress in addition to increasing strength and endurance – but what if it could do more than that? Although the effect of exercise on brain function is less commonly understood, decades of research dating as far back as the 1930s have found evidence to suggest that physical activity (especially

| design by barbara wong and karin yuen

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what does working out do to the brain?

It may help you have more brain waves. A brain wave isn’t actually formally defined in neuroscience, but this term is usually used to describe electrical patterns measured using EEG (electroencephalography, a technique where electrodes are attached to the scalp). It was found that aerobically fit individuals typically have increased baseline measures of brain activity as measured by EEG (in terms of frequency) compared to less fit individuals, meaning that the brains of aerobically fit people appear to be more active at rest, potentially leading to increased cognitive ability.1

It may make the brain itself bigger. Studies suggest that more physically fit people tend to have larger volumes of grey matter (neuron cell bodies) in their prefrontal and temporal lobes and larger volumes of white matter (axon tracts, a.k.a. the connections in the brain, as well as glial cells, a.k.a. support cells) at the back of the brain. Brain volume has been associated with increased cognitive performance in older adults (adults beyond their middle years),1 and there is some evidence for this association in young adults as well.2 It may lead to better long-term memory. Exercise was found to increase the production of BDNF in the human brain, a compound necessary for long-term memory formation as well as for the growth and survival of new brain cells. Higher BDNF levels in the hippocampus have been associated with better learning and memory in rodent models.1 It can do a lot of other stuff (depending on age group). The results above are listed because they pertain to young adults as well as people in other stages of life. However, the effect of exercise on the brain has been much more extensively studied in older adults than in any other age group (likely because there is interest in combating age-related cognitive decline). The following are a few effects of exercise by age group:

total wellness ▪ fall 2013

Children: Exercise may help academic performance as well as encourage brain development in children.1 › Young adults: A more recent study published in Neuropsychological Rehabilitation in 2009 found that an aerobic exercise program consisting of 30 minute running sessions 3 times per week for 6 weeks led to improved scores in visualspatial memory, but not verbal memory in young adults.3 › Older adults: it may slow down mental deterioration as well as improve performance in many different types of cognitive tasks in older adults.1

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how does exercise cause these effects?

Studying the molecular mechanisms of exercise on the brain is, naturally, difficult to do with human models. That’s why scientists have turned to animal models (usually rodents) to answer this question. In animal models, it was found that exercise (usually running on a wheel) may:

Increase brain cell proliferation (new cells being born from neural stem cells) and survival in the hippocampus, a brain region typically associated with learning and memory.

Lead to the release of compounds (IGF1 and VEGF) implicated in the formation of new blood vessels in certain parts of the brain (for supplying oxygen and nutrients).1

the bottom line While the relationship between exercise and cognition is not yet fully understood, decades of research have provided evidence for an association between aerobic exercise and better cognition. So next time you consider skipping the gym to finish some work, remember that you may be depriving your brain of some valuable enrichment! tw

Reference 1. “Be smart, exercise your heart: exercise effects on brain and cognition.” Nature Rev Neurosci. (2008). 2. “Sex Differences in Brain Gray and White Matter in Healthy Young Adults: Correlations with Cognitive Performance.” J. Neurosci. (1999). 3. “Aerobic endurance exercise benefits memory and affect in young adults.” Neuropsychol. Rehabil. (2009).

left: adventtr/ istockphoto; right: jgroup/istockphoto;

It may improve the brain’s processing power. EEG experiments have consistently and robustly suggested that aerobically fit people display larger and faster brain waves associated with 1) distributing our attention and 2) encoding things to our memory banks. Additionally, data from MRI (magnetic resonance imaging) and behavioral studies suggest that physical activity has a disproportionately greater effect on cognitive functions requiring more executive control (control of brain functions involved with coordinating multiple processes such as scheduling, planning, working memory, multi-tasking, and dealing with ambiguity). This means that the brain may receive the most cognitive benefit from exercise when it comes to performing executive functions.1

body in focus

skincare jargon: what does that mean? by emily white | design by alex villanueva

Finding the right combination of skincare products is difficult enough, but deciphering the labels is even harder. What do those complex names even mean? Here is the breakdown of a variety of skincare products and ingredients.

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ingredient: salicylic acid

ingredient: alpha tocopherol

alternative names: neta hydroxy acid in dermatology found in: most over-the-counter facial cleansers1 uses: Salicylic acid, a derivative of aspirin, is antimicrobial as well as anti-inflammatory. It kills bacteria and inhibits oil production in the skin in order to prevent acne. concerns: It is one of the most gentle acne products,2 but individuals with preexisting dry skin may experience more dryness or irritation after use.

alternative names: vitamin E found in: most common moisturizers and cosmetics uses: Aside from preventing water loss (and thus maintaining moisture) through the skin, vitamin E is also an important antioxidant that protects skin from free radicals, highly reactive molecules that are damaging to cells6. It works well to lock in moisture and is widely used for its moisturizing and antioxidant properties. concerns: It is a commonly used ingredient with minimal concerns.7

alternative names: n/a found in: strong or prescription acne treatments including cleansers and creams uses: Benzoyl peroxide is a stronger antibacterial than salicylic acid and is used for mild to moderate acne cases,2 often in combination with other treatments as a supplementary defense.3 concerns: Since it limits oil production, it can excessively dry and irritate skin.

ingredient: retinoids alternative names: retinol, isotretinoin found in: prescription pills, taken orally to manage acne, as well as topical treatments for both acne and aging uses: Retinoids, derivatives of vitamin A, are used in anti-acne and anti-aging products to promote cell turnover and reduce the production of sebum, an oily substance produced by glands in the skin.4 According to a 2011 study in Clinical, Cosmetic, and Investigational Dermatology, retinoids, specifically isotretinoin, are proven to be one of the most effective ways to relieve severe acne.2 concerns: Since retinoids inhibit sebum production, skin can become very dry and sensitive. In addition, the utilization of retinoids varies depending upon individual dosing needs, potential health risks, and recommendations made by a supervising physician.4

total wellness ▪ fall 2013

ingredient: alpha hydroxy acid (AHA) alternative names: glycolic acid is the most commonly used AHAs found in: chemical exfoliants and some anti-aging products uses: AHAs break down bonds between skin layers, allowing top layers to slough off.5 This is important for cell regeneration and skin permeability to nutrients and moisture. AHA improves acne by unblocking pores and allowing oils and bacteria to escape. It also reduces both hyperpigmentation and wrinkles and gives skin a more uniform texture.5 concerns: AHA is a gentle exfoliant so there is minimal risk associated with it. The only known risk is increased sensitivity to sunlight and higher risk for sunburns, which can be mediated by sunscreen. Chemical exfoliants (like AHA) are more effective in reducing acne and resurfacing because they strip more layers of skin, but this also leads to higher risk of complication, including scarring.5

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ingredient: hyaluronic acid (HA) alternative names: n/a found in: deep-moisturizing products uses: HA is a naturally occurring component of skin and is important in retaining water as well as the skin’s structure and density by regulating water balance, pressure, and ion movement. It is not as commonly used as vitamin E, but is still an effective moisturizer and skin protectant. concerns: Since HA is naturally found in skin,8 there is minimal risk associated with it.

the take away Understanding the purposes and risks of various skincare ingredients is the first step in deciding upon the best regimen. Over-the-counter products are safe, as long as they are used according to the directions. Before making any major changes, it is a good idea to consult a doctor as well. With this in mind, there are products out there to treat any number of skincare woes, and learning the language of dermatology can be beneficial to your skincare goals. tw References: 1. “Salicylic Acid (On the Skin).” nlm.nih.gov/medlineplus. (2013). 2. “Management strategies for acne vulgaris.” Clin Cosmet Investig Dermatol. (2011). 3. “Retinoid plus antimicrobial combination treatments for acne.” Clin Cosmet Investig Dermatol. (2011). 4. “Face to face with oral isotretinoin.” J Clin Aesthet Dermatol. (2012). 5. “Evidence and considerations in the application of chemical peels in skin disorders and aesthetic resurfacing.” J Clin Aesthet Dermatol. (2010). 6. “Vitamin A.” webmd.com. (2013). 7. “Cosmeceuticals for hyperpigmentation.” J Cutan Aesthet Surg. (2013). 8. “Hyaluronic acid: A key molecule in skin aging.” Dermatoendocrinol. (2012).

left: left: eans/istockphoto; right: elenathewise/ istockphoto

ingredient: benzoyl peroxide

mind well

mind over stomach

the psychology of eating written & designed by allison newell

Family, friends, music, variety, plate size, labels, and menus. You may be thinking: what do these things mean and how are they possibly connected? The answer is that all of these factors can influence our eating behaviors, oftentimes without our awareness. We typically think that consumption is influenced by physiological factors like a grumbling stomach or thirst. But thereâ&#x20AC;&#x2122;s much more to the equation than just these basic signals. Environmental, social, and perceptual processes can shape our eating behaviors as well. By becoming more aware of these influences, we can make better choices for our health and wellbeing. Read on to learn about some fascinating food studies that may just change the way you think about your next meal!

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the size-contrast illusion description: Large plates and bowls can influence us to misjudge serving size and consume more. Even using larger utensils (like large spoons) makes us more likely to serve a larger amount without being aware of it. why it happens: This phenomenon can likely be attributed to the “size-contrast illusion.” We experience this illusion almost on a daily basis – set a small object next to a larger object, and it appears smaller than it did before. For example, a cup of rice served on a large plate is going to “appear” smaller compared to a cup of rice on a small plate. When this happens, people are prone to serve more onto the large plate because it doesn’t “seem” like enough. In the images to the right, both black circles are the same size. However, when the black circle is placed on the larger white circle, it appears smaller compared to the black circle on the smaller white circle. Now imagine that the black circles are food and the white circles are the plates. This is the size contrast illusion at work! When people over-serve because of this illusion, it can lead to over-consumption because people generally eat most of what they serve themselves. ice cream social study: In a 2006 study published in the American Journal of Preventive Medicine, 85 nutrition experts attended an ice cream social and were randomly given a 17 oz or 34 oz bowl and either a smaller or larger ice cream scoop. The researchers found that those given the larger bowl spooned out 31% more ice cream than those using a small bowl, without being aware of it! Given a larger spoon, they spooned out 14.5% more than those using a smaller spoon.1

the variety effect description: When there is more variety, or even when we just “think” there’s more variety, consumption is likely to increase.

total wellness ▪ fall 2013

jelly bean and m&m studies: In a 2004 study published in the Journal of Consumer Research, half of the participants were offered jelly beans in a tray that was divided into 6 parts, each part filled with jelly beans of the same flavor. The other half were offered the same 6 flavors, but the jelly beans were mixed together. Individuals who served themselves from the tray with mixed flavors of jelly beans ate 23 jelly beans on average, and individuals who served themselves from the organized tray ate an average of 12. Despite the fact that the number and flavor of jelly beans were the same, mixing them up (or what researchers call a “disorganized” assortment) almost doubled the amount a person, on average, grabbed and consumed! This illustrates that “thinking” or perceiving that you get more variety can influence a person to serve themselves more. In the same study, researchers discovered that even variety of color increases consumption! When participants were given either a bowl of 7 colors of M&Ms or 10 colors of M&Ms, people with 10 colors ate 43% more M&Ms than those with 7 colors, despite the fact that color doesn’t affect the taste of the M&Ms.3

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bottom left: paul kline/istockphoto right: odonnell photograf/istockphoto; jaroslaw wojcik/isotckphoto

why it happens: Barbara Rolls, PhD, Professor of Nutritional Sciences and Biobehavioral Health at Penn State University, found that if people are offered 3 different flavors of yogurts, they consumed an average of 23% more than if offered only 1 flavor (even if the 1 flavor was their favorite)!2 This study helped to define what is known as “sensory specific satiety”. This is when our senses get numbed and “bored” if they are constantly experiencing the same stimulus. It explains why the first bite of a food is typically the best, and each consecutive bite becomes less tasty, to the point where we become tired of eating it and the enjoyment has decreased. When a variety of food is offered, we tend to experience more hunger and cravings for more flavors and textures.

the salience principle description: The more noticeable a food is, the more likely we are to eat it. We are more prone to eat food displayed on our kitchen counters or office desks than food that’s out of sight. why it happens: The more we see food, the more we think about the

food, and the “no, I don’t want to eat that” eventually turns into a “yes.” Foods that are salient are constant temptations, especially for someone who lacks self-control.

hershey kiss study: In a 2004 study conducted by Brian Wansink, PhD, Director of the Food and Brand Lab at Cornell University, 30 Hershey Kisses were placed on the desks of secretaries. The candies that were placed in transparent containers (thus, the candies were visible and noticeable) were consumed 46% faster than those placed in opaque/solid containers, even when the participants knew there were candies in each type of container!4

eating companions description: Eating with 1 person can lead us to eat 33% more food on average. Eating with 7 or more people

can lead us to eat a whopping 96% more on average! According to a 1992 study published in Physiology and Behavior, the relationship between the number of eating companions and food intake/meal duration is linear. So as the number of people you eat with increases, the amount consumed also increases.5

why it happens: When eating and socializing with others, particularly close family and friends, people tend to

talk longer and linger longer at the table, allowing more time and opportunities to eat. In addition, it can be difficult to monitor food intake during interesting conversations, to the point of forgetting how much we’ve eaten! However, there are some ways to moderate this phenomenon. How fast or slow your eating companions eat is one of them. People tend to mimic the speed at which others eat – so the slower they eat, the slower you may eat, and vice versa. Also, eating with unfamiliar people can actually decrease food intake because self-monitoring and selfawareness is high (for example, first dates or job interviews).6

eating companion & cookies study: In a 2003 study published in Psychological Bulletin, participants were offered cookies as a snack. They found that someone else had also showed up for the snack (this “someone” was actually an undercover pacesetter instructed to eat 1, 3, or 6 cookies). The researchers found that the more cookies the pacesetter ate, the more cookies the unsuspecting participant ate!7

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manipulating menus description: When meals on a menu are given descriptive names, customers typically find them more attractive. Attention-grabbing verbs like “slow-cooked” and “lightly pickled” or adjectives like “savory” or “tangy” can be enticing. Also, how prices are displayed can affect what item we choose on the menu. why it happens: Descriptive names and words lead to expectations, and expectations can influence how the food tastes to us. Descriptors that are geographic (Chicago-style deep dish pizza), nostalgic (Grandma’s apple pie), sensory (sweet, minty, smoked), or brand-named (Minute Maid, Coca-Cola) can connect the food to a specific experience or improve perceptions of a food. In regards to menu pricing, sometimes restaurants will leave out dollar signs and decimals so the prices seem less salient and intimidating, influencing one to choose an item they may have not chosen had there been a dollar sign or decimal. descriptive label study: In a 2005 study published in Food Quality and Preference, customers who ate foods with descriptive menu names (like “Succulent Italian Seafood Filet”) rated the food as more appealing and tasty and left more positive comments than those who ate the same exact dish named “Seafood Filet.”8

the health halo effect description: People tend to eat more of a food product when it is labeled as “lowfat,” “low calorie,” “high in fiber,” or any advertising that portrays a food as healthy.

why it happens: People see these products as “healthier” to eat, and therefore believe that it must be okay to eat more of it.

McSubway study: According to a 2007 study published in the Journal of Consumer Research, participants estimated that sandwiches and burgers from fast food restaurants claiming to be healthy (like Subway) contained 35% fewer calories than those from restaurants not making healthy claims (like McDonald’s), even though the calorie content was the same. Not only were they biased due to the health halo effect, but they were more likely to eat more unhealthy sides such as mayo, chips, cookies, and soda with their “healthy” sub-sandwich.9

pause points description: People tend to eat less from multiple/segmented sleeves and eat more

why it happens: Presenting food in multiple sleeves makes serving size more salient to the eater/snacker. Segmentation allows people to pause and think before they open the next sleeve or continue eating, providing a break in automated eating sequences and encouraging better monitoring. potato chips study: In a 2012 study published in Health Psychology, 2 groups of

college students were given tubes of potato chips (think of Pringles!) to eat.; 1 group received tubes that contained some chips that were dyed red and were interspersed at intervals that suggested adequate serving size. Clueless as to why some chips were red, the students who had the red chips ate 50% less than their peers without the red chips, suggesting that the red markers may have acted as “stop signs” to end food consumption.10

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left: electric crayon/istockphoto; mark gillow/istockphoto; bariscan celik/isotckphoto right: ju-lee/istockphoto; tova photography/istockphoto

total wellness ▪ fall 2013

from single, large sleeves of food. For example, sleeves of Ritz crackers are traditionally long in length, but consumers now have the option to buy the same amount of crackers that are divided into many “mini” sleeves.

eat to the beat description: Slow music can influence people to linger longer in a restaurant. Furthermore, the more time spent inside a restaurant, the more likely we are to spend more money on food! Fine dining restaurants often use slow music (like jazz, elevator music) to get you to linger and enjoy the experience, which can lead to greater food satisfaction. Fast music can make people get out quick, prompting them to eat too fast and overeat because they don’t realize they are full. Fast food chains play more upbeat, fast-paced music (like pop, satellite radio) to get as many customers in and out, in order to serve as many customers as they can to increase revenue. why it happens: We tend to mimic the pace of the music. Quick music, quick eat. Slow music, slow eat.

music study: According to a 1986 study published in the Journal of Consumer Research, a restaurant switched between fast, upbeat music and soft, relaxing music over a period of 8 weeks. The experimenter tracked how long the patrons ate and how much they spent. The results revealed that diners listening to the slower music lingered 11 minutes longer than did diners listening to the fast music. They did not spend more money on food, but they did spend more money on drinks!11 The fact that the restaurant specialized in wine may have contributed to this increase in drink consumption over food consumption, thus limiting the scope of the study. However, research on how ambient factors like lighting, decorations, and music all work together simultaneously to influence eating consumption is underway. For example, in a 2012 study published in Psychological Reports, a section of a Hardees restaurant was transformed into a fine dining experience by using softer lighting, fancier decorations, and jazz ballads. Those who ate in the fine dining section didn’t eat as much food as the diners in the unrenovated section, but they did linger longer and were more satisfied with their food!12

empty bowls & plates description: Do we stop eating when our bodies tell us they are full? Or

when there’s no food left on the plate? Surprisingly, people tend to judge whether they are full based on visual cues, such as an empty plate or bowl!

why it happens: We consider what we are served as the “proper”

amount, influencing us to eat all of it, or almost all of it. People rely on their eyes and seeing a clean, empty plate as a sign of completion, rather than paying attention to how their stomachs feel.

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total wellness ▪ fall 2013

bottomless soup bowl study: In a 2005 study published in Obesity, participants who were unaware that they were eating from a “bottomless” soup bowl that constantly refilled (so it never emptied) ate 73% more than those who ate from normal bowls!13

the guide

›› turning theory into practice

ways to eat more

ways to eat less

Use bigger dishes and utensils.

Use smaller dishes and utensils.

Eat with family and friends/big groups of people.

Eat with 1 person or by yourself, or eat with people you are less familiar with. Pace yourself with the slowest eater.

Listen to fast-paced music during meal time.

Listen to slow-paced music during meal time

Buy food products that aren’t segmented into multiple sleeves or packages (i.e. large tub of greek yogurt rather than individual sized yogurts).

Buy food products that come in segmented sleeves or packages (i.e. mini Pringles containers rather than a whole tube).

Hide junk food and candy in non-transparent Make food more visible by placing it in common containers to make less visible, and put them areas of the house or office, or by using seehigh up on shelves or cupboards. While you’re through containers, especially for vegetables at it, tell the waiter to take away the bread and fruits. basket or chips early before it all gets eaten!

Buy more variety (like trail mix rather than one type of nut). Eat at buffets.

Say no to variety (for example, buy only plain bagels rather than onion, blueberry, and plain bagels).

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the take away As you can see, there is more at play than just physiology when it comes to food consumption. Whether you are looking to eat more or eat less, becoming aware of these drivers of consumption, and using them to your advantage, is key to leading a healthy lifestyle and becoming a mindful eater. To learn more about the psychology of eating, check out Mindless Eating (by Brian Wansink, PhD), which served as the inspiration for this article. t w

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References 1. “Ice Cream Illusions: Bowls, Spoons, Self-Serve Portion Sizes.” Am. J. Prev. Med. (2006). 2. “Experimental analysis of the effects of variety in a meal on human feeding.” Am. J. Clin. Nutrit. (1985). 3. “The Influence of Assortment Structure on Perceived Variety and Consumption Varieties.” J. Cons. Res. (2004). 4. “Environmental Factors that Increase the Food Intake and Consumption Volume of Unknowing Consumers.” Annu. Rev. Nutr. (2004). 5. “The amount eaten in meals eaten by humans is a power function of the amount of people present.” Physiol. Behav. (1992). 6. “Environmental Factors that Increase the Food Intake and Consumption Volume of Unknowing Consumers.” Annu. Rev. Nutr. (2004). 7. “Effects of the Presence of Others on Food Intake: A Normative Interpretation.” Psychol. Bull. (2003). 8. “How descriptive food names bias sensory perceptions in restaurants.” Food Quality Pref. (2005). 9. “The Biasing Health Halos of Fast-Food Restaurant Health Claims.” J. Cons. Res. (2007). 10. “Red potato chips: segmentation cues can substantially decrease food intake.” Health Psychology. (2012). 11. “The Influence of Background Music on the Behavior of Restaurant Patrons.” J. Cons. Res. (1986). 12. “Lighting and music affect food consumption and satisfaction in surprising ways.” foodpsychology.cornell. edu. (2012). 13. “Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake.” Obesity. (2005).

total wellness ›› on the cover

“As I see it, every day you do one of two things: build health or produce disease in yourself.” – ADELLE DAVIS

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features

shake it up with protein by peter chu | illustration and design by kristen sadakane

what is protein? Protein (a biological macromolecule composed of building blocks known as amino acids) is responsible for building up and maintaining various parts of the body, including bones, skin, and muscle.1 The various amino acids that make up proteins may be deemed essential amino acids if the body must acquire them from outside sources (such as food or drink), or nonessential if the body can produce the amino acids itself. Different sources of complete protein, or protein sources that supply all of the essential amino acids, include meat, eggs, fish, and dairy products.2 Vegetarians need not worry! By combining various plant sources (such as legumes, beans, nuts, and whole grains), the full complement of essential amino acids can be obtained. Additionally, plant proteins come with the added benefits of fiber as well as additional vitamins and minerals.3

wait, what does that mean? your guide to essential terms

whey concentrate: whey is 1 of 2 proteins found in milk (the other is casein), and whey concentrate is the dried material left behind after liquid milk is filtered and strained; contains lactose

protein isolate: further processing of concentrate; peptides may be broken down into individual amino acids

nitrogen balance: a way of expressing the amount of nitrogen taken into the body via protein sources and the amount that is excreted positive nitrogen balance: occurs when the body retains more nitrogen than is excreted, and occurs during periods of growth, such as childhood, pregnancy, and when an individual is building muscle negative nitrogen balance: nitrogen loss is greater than nitrogen intake; nitrogen is drawn away from both muscle and vital organs and the body begins to break down; often occurs during illness

total wellness ▪ fall 2013

why do some people use protein shakes? The use of protein shakes does not necessarily have to be reserved for competitive bodybuilders or Olympic athletes. A 2004 study published in the International Journal of Sport Nutrition and Exercise Metabolism surveyed individuals ages 18 and over who exercised regularly at a gym in New York. Results of the survey revealed that 84.7% of typical gym-goers took supplements, 42.3% of whom drank protein shakes at least 5 times a week. It was found that those ages 45 and younger consumed protein shakes to build muscle while older participants opted for a multivitamin to ward off future illness.4 Overall, protein intake keeps the body in positive nitrogen balance so that the body is able to rebuild itself after physical stress. Getting adequate amounts of amino acids is crucial to supporting the body’s muscles and preventing excessive protein catabolism, or breakdown, which may hinder one’s health goals. All in all, there are plenty of other reasons that people use protein shakes, from meal replacements when they are trying to lose weight to supplements in order to gain weight.

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equilibrium: nitrogen intake and loss are equal; this is the usual state for many people5

branched chain amino acids (BCAAs): the essential amino acids leucine, isoleucine, and valine; help prevent fatigue and maintain muscle mass and strength; stimulate release of insulin to prevent muscle breakdown6

original illustrations by kristen sadakane

The phrase “protein shake” might be thrown around by avid gym-goers who are looking to incorporate more protein into their diets. On a deeper level, however, the use of protein shakes is multifaceted. From being labeled as whey or casein or soy to being used for weight loss or muscle gain, protein shakes, in all their varieties and purposes, can be difficult to decipher and understand. It is important, therefore, for consumers like you to learn how to use and choose different sorts of protein supplements in order to better meet your health and wellness goals.

naming proteins: more wheys than one

whey

One type of protein found in protein supplements is whey, which is derived from the liquid part of milk that is left after the majority of it has been processed to manufacture cheese. Whey is known as the “king of protein” because of its high levels of both essential and branched chain amino acids, or BCAAs (“branched” referring to the chemical structure of amino acids such as leucine, isoleucine, and valine). Whey protein is not only rich in vitamins and minerals, but it is also rapidly digested and absorbed.7 Whey protein itself comes in two main forms: concentrate and isolate. To produce whey concentrate, substances including water, lactose, ash, and some minerals are removed in order to increase the concentration of biologically active peptides, which compose proteins and efficiently aid in muscle recovery. Whey’s isolate form, on the other hand, is one of the purest protein sources available with protein concentrations of 90% or higher due to the significant removal of fat and lactose. It is important to note, however, that many of the proteins within isolate may be denatured due to manufacturing.7 For example, a 2013 study in Food Chemistry showed that 2 methods of processing whey protein isolate (heating or drying) denatured the proteins up to 90% and 68.7%, respectively.8

casein

soy

In addition to whey, casein is the other major protein found in bovine milk, and it is what gives milk its white color. The biologically active peptides in casein protein aid in the uptake of nutrients and vitamins in the body. More importantly, it is a complete protein and is able to form a gel in the stomach that can provide a sustained slow release of amino acids. The gel takes longer to digest inside the stomach, which not only maximizes protein absorption and provides an efficient supply of nutrients, but also can be more filling. This attribute may not only maintain a prolonged positive nitrogen balance in the body, but also help improve satiety and starve off hunger.7

Soy protein, a widely used vegetable protein, is complete and provides a high concentration of BCAAs, like those found in whey protein, that can fuel working muscles during exercise. Like whey protein, it is available both as a concentrate and as an isolate. Soy concentrate contains about 70% protein, mostly from defatted soybeans; the soy isolate form, similar to that of whey, contains a superior concentration of protein around 90%. However, compared to whey, soy protein is an appealing option for those looking for non-animal protein sources as well as those who are lactose intolerant and have a tough time finding lactosefree whey options.7

what if I am a vegan or a vegetarian?

total wellness ▪ fall 2013

Because proteins from vegetable sources may lack 1 or 2 essential amino acids, it is suggested that vegetarians consume a variety of vegetables, fruits, grains, and legumes to cover all their bases.7 That is not to say, however, that all proteins contained in these foods are incomplete. An example of a plant-based source of complete protein is soy. A wide array of non-animal foods including quinoa, buckwheat, spirulina, hemp, and chia seeds can also offer a full complement of essential amino acids.9 The minimum amount of daily protein recommended by the Institute of Medicine, an organization that serves as an adviser to improve health in America, is 0.8 g/kg body weight (55 g for a 150 lb individual) for adults to prevent the slow breakdown of tissues.3 Vegetarians may need more protein than omnivores to account for the fact that plant proteins are somewhat less digestible. Nonetheless, as long as one’s diet is rounded and incorporates complete proteins from a range of sources, supplements such as protein shakes may only be necessary as a means of acquiring protein conveniently.

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what if I am trying to lose weight?

could using protein shakes help me lose weight?

total wellness ▪ fall 2013

When it comes to weight loss, it has been shown that casein and soy protein can both be effective. A 2007 study published in Metabolism analyzed weight-loss efficacy in 43 obese women after the incorporation of casein or soy meal replacement protein shakes into their diets. Researchers were able to conclude that body fat loss for the group using casein protein shakes were comparable to those of the group using soy protein shakes, namely that they observed a 22% to 24% body fat loss in both groups.10

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I’m always hungry on diets … One possible obstacle for working towards weight loss may include constant bouts of hunger due to low-fat and energy-restricted diets. However, it has been found that satisfaction in dieting is actually greater in those consuming a high-protein diet than in those consuming a lower-protein diet. Although not entirely specific to weight loss, one possible upside to increased protein intake via shakes may be improved satiety compared to counterparts consuming lower-protein diets.11

how much is enough?

can shakes act as meals?

One possible goal for those who want to be active may be to shed a few pounds, and naturally, they may get curious not only about how to exercise their bodies, but also what to put in them to help them achieve their goals. A 2000 study published in the Journal of the American College of Nutrition indicated that physically active individuals may require higher daily protein intake than sedentary individuals, namely 1.2 to 1.4 g/kg body weight (82 g to 95 g for a 150 lb individual) for regular endurance exercise and 1.6 to 1.8 g/kg body weight (109 g to 123 g for a 150 lb individual) for strength exercises.2 When looking for supplements to facilitate weight loss, it may be best to find shakes composed primarily of protein, preferably greater than 50%, with relatively fewer carbohydrates and fat content in order to limit overall calorie intake from fats and carbohydrates while still being satiated and energized from proteins.

Meal replacement shakes have become a primary method for lowering obesity rates around the world. It has been noted that a high intake of protein may be associated with greater chances of achieving weight loss. In a 2008 study in Nutrition Journal, 85 obese men and women were treated with meal replacement shakes enriched with soy and whey protein powder twice daily for 12 weeks that supplemented either a high-protein (2.2 g/ kg of body weight) or standard-protein (1.1 g/ kg of body weight) diet as well as 30 minutes of aerobic exercise daily. It was concluded that while both groups reported relatively similar weight loss, individuals given the meal replacement shake with a higher protein diet experienced significantly more fat loss.12 If protein shakes be used as meals, however, make sure you are still meeting your body’s daily need for calories and nutrients.

what if I am trying to increase muscle mass?

what if I just exercise for fun?

So maybe someone is looking to get big, strong, and macho or maybe just wants to carve out some muscle tone. Any sort of activity involving strength training, especially bodybuilding, can create an increased bodily demand for protein as a result of increased muscle fiber breakdown.13 In a 1998 study published in the Journal of Applied Physiology, it was found that consuming a liquid supplement composed of carbohydrates and protein before and after workouts induced measurable metabolic and hormonal responses within the body. These changes were responsible for both synthesizing glycogen to restore and maintain energy as well as providing protein to rebuild muscle mass broken down during a workout.14 A different study published in 1995 in the American Journal of Physiology Endocrinology and Metabolism found that during recovery after resistance exercise, muscle protein turnover increases due to accelerated synthesis and degradation.15 Thus, if you plan on taking on a high-intensity daily strength training regimen, it may be advantageous to use a protein shake both before and after a workout to maintain energy over the long run. On the other hand, if you are planning on more intermittent workouts, a protein shake simply after your workout may be more efficient because a greater amount of amino acids in the body after exercise may both synthesize and integrate more protein in the body.

Even without a strictly vegan or vegetarian diet or definite health goals, protein shakes can still be incorporated into a fitness regimen. For example, it has been shown that using a protein supplement after exercise improves muscle soreness. In a 2003 study, published in the Journal of Applied Physiology, 387 healthy male US Marines were assigned to 3 groups that were provided with nutrient supplements post-exercise. Those supplemented with protein, in comparison to those who were not, had an average of 33% fewer medical visits, 28% fewer visits due to bacterial or viral infections, 37% fewer visits due to muscle or joint problems, and 83% fewer visits due to heat exhaustion. However, it is worthwhile to keep in mind that basic training for these marines included up to 10-mile hikes, running 1 to 3 miles, sit-ups, push-ups, pull-ups, and even martial arts training. It is suggested that post-exercise protein supplementation, such as through protein shakes, may both enhance muscle protein deposition and positively impact health, muscle soreness, and tissue hydration during long periods of intense exercise.17 Granted, if you are not exercising at the same hardcore level as these marines, it may not be necessary to use protein shakes to ward off muscle soreness. In other words, if you are not really working out that hard or not burning a significant amount of calories during your workouts, consuming a recovery drink may actually lead to weight gain. After gauging your own personal level of activity, you may find that simply sticking with a wellrounded diet is a fine solution by itself.

carbs, protein, or both in a shake?

can protein shakes hurt?

On the other hand, it may not be necessary to couple carbohydrates with protein in order to supplement muscle mass growth. In 2007, in the American Journal of Physiology Endocrinology and Metabolism, a study suggested that as long as sufficient amounts of protein are ingested after resistance training exercises, co-ingesting carbohydrates may not be necessary to maximize muscle synthesis. However, the study does concede that because muscle glycogen stores can be depleted after resistance training, consuming simple carbohydrates may still be preferred in the attempt to quickly restore muscle glycogen.16 Therefore, in order to avoid feeling completely exhausted after a hard workout or if you have other physically-demanding activities scheduled for later in the day, taking in some simple carbs, such as the glucose and fructose sugars that are in fruit, with that protein shake may do a body good.

Beyond the previously mentioned potential health benefits is the added finding that protein-enriched meal replacement shakes do not adversely affect the liver, kidneys, or bone density in people with normal liver and kidney function. A 2010 study published in Nutrition Journal analyzed the effects of meal replacement protein powders on subjects undergoing a weight management program and reached the conclusion that the utilization of protein supplements does not necessarily tax certain organs within the body.18 When in doubt, listen to the age-old mantra of moderation and donâ&#x20AC;&#x2122;t go overboard on using protein shakes if you can naturally meet your bodyâ&#x20AC;&#x2122;s protein demand through your diet.

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total wellness â&#x2013;Ş fall 2013

shake before or after a workout?

the bottom line

References 1. “Protein shakes.” webmd.com. (2012). 2. “Beyond the zone: protein needs of active individuals.” J Am Coll Nutr. (2000). 3. “Protein: Moving Closer to Center Stage.” hsph.harvard.edu. (2013). 4. “Prevalent use of dietary supplements among people who exercise at a commercial gym.” Int J Sport Nutr Exerc Metab. (2004). 5. “What Is Nitrogen Balance?” wisegeek.org. (2013). 6. “Supplements 101: Branched-Chain Amino Acids (BCAAs).” ultimatenutrition.com. (2013). 7. “Protein - Which is Best?” J. Sports Sci. and Med. (2004). 8. “Comparative study of denaturation of whey protein isolate (WPI) in convective air drying and isothermal heat treatment processes.” Food Chem. (2013). 9. “Whey Concentrate vs. Isolate: What’s The Difference?” builtlean.com. (2013). 10. “Soy compared to casein meal replacement shakes with energy-restricted diets for obese women: randomized controlled trial.” Metabolism. (2007). 11. “High-Protein, Low-Fat Diets Are Effective for Weight Loss and Favorably Alter Biomarkers in Healthy Adults.” J Nutr. (2004). 12. “A controlled trial of protein enrichment of meal replacements for weight reduction with retention of lean body mass.” Nutr J. (2008). 13. “Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders.” J Appl Physiol. (1992). 14. “Hormonal responses to consecutive days of heavy-resistance exercise with or without nutritional supplement.” J Appl Physiol. (1998). 15. “Increased rates of muscle protein turnover and exercise in humans.” Am J Physiol Endocrinol Metab. (1995). 16. “Coingestion of carbohydrate with protein does not further augment postexercise muscle protein synthesis.” Am J Physiol Endocrinol Metab. (2007). 17. “Postexercise protein supplementation improves health and muscle soreness during basic military training in marine recruits.” J Appl Physiol. (2004). 18. “Protein-enriched meal replacements do not adversely affect liver, kidney or bone density: an outpatient randomized controlled trial.” Nutr J. (2010).

A diet of whole foods, all in all, will likely provide a sufficient amount of protein to meet daily requirements. However, protein supplements, such as those found as protein shakes, may be used as a convenient source of protein to round out a vegan or vegetarian diet, to foster weight loss, or to aid in building muscle. Shakes can also be useful when hectic or unpredictable days cause meals to be missed or daily activity to increase. In the end, the decision to incorporate protein shakes into one’s lifestyle is a personal one. That is, if protein shakes are used, individuals should take into account how different sorts of protein supplements might affect their bodies. The important thing to keep in mind is that nutrients from whole foods should come before those found in supplements. After all, they are only meant to be supplemental. t w

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total wellness ▪ fall 2013

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features

iron deficiency anemia by halee michel | design by natalie chong

According to a 2007 study in the American Family Physician, iron deficiency anemia (IDA), is the most common nutritional deficiency in the world. IDA affects 9 to 12% of non-Hispanic white women, about 20% of black and Mexican-American women, and 2% of adult men.1 Iron deficiency anemia occurs when the body’s hemoglobin level is below normal. Hemoglobin is the protein in red blood cells that transports oxygen throughout the body. Iron is an essential part of hemoglobin, and with lower levels, the body can’t get the necessary amount of oxygen.2 This discrepancy leads to fatigue, amongst other potentially impairing symptoms discussed in this article. Here’s a guide to understanding iron deficiency anemia, its common causes, why it may be a problem, symptoms associated with it, and possible ways to overcome it.

total wellness ▪ fall 2013 33

role of iron in the body: Iron is found in every cell and is essential to blood production. The body needs iron to make the oxygentransporting proteins hemoglobin and myoglobin.3 Hemoglobin is found in red blood cells and plays a role in transferring oxygen from the lungs to tissues. Myoglobin is found in muscles and accepts, stores, and transports and releases oxygen. Besides its function in blood production, some iron is stored as a component of protein for use in respiration, metabolism, and the synthesis of collagen and neurotransmitters.4

common causes of iron-deficiency: anemia

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menstrual bleeding occurs when the uterus sheds its lining because an egg isn’t fertilized. The lining contains blood which of course, contains iron.

internal blood loss contributes to iron deficiency anemia. Ulcers, hemorrhoids, and cancer are examples of conditions that may cause internal bleeding.

inability to absorb iron well from conditions like celiac disease, an inherited autoimmune condition, disables the small intestine from absorbing nutrients like iron properly. With this condition, the consumption of gluten creates an immune-mediated toxic reaction that harms the small intestine and affects absorption. Another contributor to IDA occurs when part of the stomach or small intestine is removed, resulting in less iron being absorbed.5 If you’re looking to add iron-rich foods into your diet, try red meat, egg yolks, dark leafy greens, dried fruit, or beans.6

insufficient intake of iron is a less conventional cause. It affects particular groups in need of extra iron, such as teens and pregnant women. Teenagers need iron for the substantial amount of growth that they experience, while pregnant women need extra iron for their developing fetus, the higher volume of blood, and the blood lost during delivery.7

increased requirements: According to Michele Hoh (MD, Associate Clinical Professor of Medicine, UCLA Family Medicine Practice, Iris Cantor/UCLA Women’s Health Center), rapid growth and frequent blood donations can cause an increase in the need of iron.

pregnancy contributes to iron loss through tissue growth and excessive blood loss during the delivery and postpartum period.3 A pregnancy takes around 700 mg of iron.1 According to a 2011 review published in Springer Verlag, postpartum anemia is a substantial health problem in post-pregnancy ›women. This condition is linked to emotional instability, depression, a poorer quality of life, and lowered cognitive ability. This same review shows that 14% of European women who took iron supplements and 24% of those who didn’t had postpartum anemia one week after their delivery.8

left: luckyraccoon/istockphoto; right: alasdair thomson/istockphoto

total wellness ▪ fall 2013

According to a 2007 study in the American Family Physician, iron is lost from bleeding, cell sloughing (shedding dead tissue), menstruating, and transferring iron to the fetus during pregnancy. Men and non-menstruating women lose about 1 mg of iron per day. Menstruating women lose between 0.6 and 2.5% more than this amount per day.1 Several causes depending on age, gender, and internal factors can lead to abnormally low levels of iron, establishing IDA.

why it’s a problem (risks involved): general concerns - complications from Anemia can cause fatigue that hinders or impairs physical activity in adults. It can affect memory and mental function in teens. For patients with anemia and kidney disease, heart failure, and/or cancer, severe risks may occur, including shorter survival time and higher mortality rates.9

symptons of IDA

additional considerations for pregnant In pregnant women, IDA can increase the risk for premature birth and low-birthweight babies.7

development of anemia: There are three stages in the development of anemia.

1 2 3

Anemia starts with an insufficient supply of iron. During this period, iron stores within the bone marrow are depleted. Symptoms are not usually present. Iron deficiencies develop and affect hemoglobin levels. Hemoglobin production declines to a level where anemia develops.9

how to overcome iron deficiency anemia: general recommendations: To ensure adequate iron intake, health professionals suggest consuming the dailyrecommended value of iron.10 gender and age

mg per day

males 19 to 50

8 mg

females 19 to 50

18 mg

pregnant women

27 mg

IDA-related symptoms occur because the heart has to work harder to pump more oxygenrich blood through the body.7 The main symptoms related to this lack of oxygen-rich blood include: + Weakness and fatigue + Shortness of breath + Lightheadedness Other symptoms may include: + + + + + + +

Headaches Ringing in the ears Irritability and moodiness Pale skin Mental confusion Loss of sexual drive Pica: the craving for unusual substances such as ice, crunchy foods (carrots, celery, potatoes), clay, or raw starch. Interestingly, pica can also be a cause of anemia.9

If you have anemia, it doesn’t necessarily mean that you will experience all of these symptoms. At the same time, having a few of these symptoms doesn’t necessarily mean that you have anemia. A doctor’s appointment should be scheduled in order to diagnose IDA.

total wellness ▪ fall 2013

general diagnosis Your doctor will diagnose IDA based on the results from tests, an examination of your medical history, and a physical exam.11

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general treatments:

If you are low in iron, your doctor may recommend iron supplements. After a period of taking these supplements, a follow-up visit will be scheduled to test your hemoglobin level.12

If your doctor suspects that the IDA is due to an insufficient supply of iron, then your doctor might advise you to eat more iron-rich foods. Sources rich in iron include red meats, beans, spinach, fish, and iron-fortified cereals, among other sources. Consuming foods high in vitamin C can aid the absorption of non-heme iron, especially when the iron-rich food and the vitamin C-rich food are eaten together. Sources high in vitamin C include bell peppers, guavas, oranges, strawberries, Brussels sprouts, broccoli, sweet potatoes, cauliflower, kale, and pineapples.12

More severe cases of anemia call for blood transfusions and possibly surgery.7

recommended treatments for pregnant women: • Screening pregnant women for anemia is recommended.13 The total iron binding capacity test (TIBC) is used to measure how much iron is being stored in your body. Iron levels can also be tested. Oral iron supplements may be prescribed.12 According to a 2007 study in the American Family Physician, the US Preventative Services Task Force recommends screening for iron deficiency anemia in pregnant women but not in other groups. The preferred diagnostic test for IDA in pregnant women is the serum-ferritin measurement, which tests the patient’s level of ferritin. Serum ferritin concentration less than 25 ng per mL is associated with a higher chance of iron deficiency.1

hemochromatosis

what it is: Hemochromatosis is the condition where too much iron builds up in the body. It occurs when a single gene mutation causes the intestines to absorb extra iron from food; the body, however, isn’t able to excrete the extra iron. causes: It’s mainly caused by genetics but can also be caused by years of consuming too much iron or having too many blood transfusions.

take home message

References 1. “Iron Deficiency Anemia.” Am. Fam. Physician. (2007). 2. “Handouts: Iron Deficiency Anemia.” anemia.org. 3. “Iron in Diet.” www.nlm.nih.gov. (2013). 4. ““Hemoglobin and Functions of Iron.” http://www.ucsfhealth.org. (2002). 5. “What is Celiac Disease?” celiac.org. (1998). 6. “Top Ten Iron Rich Foods.” www.webmd.org. (2005). 7. “Anemia Fact Sheet.” www.womenshealth.gov. (2008). 8. “Postpartum Anemia I: Definition, Prevalence, Causes, and consequences.” Springerlink. (2011). 9. “Anemia.” umm.edu. (2011). 10. “Iron.” http://ods.od.nih.gov. (2007). 11. “How is Iron Deficiency Anemia Diagnosed?” http://www.nhlbi.nih.gov. (2011). 12. “Iron and Iron Deficiency.” http://www.cdc.gov. (2011). 13. “Hemochromatosis.” http://www.diabetes.org. (1995).

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who it affects: It affects 1 out of every 200 to 300 people.

how common it is: The hereditary type of hemochromatosis is the most common singlegene disease in western populations.13

main image: ivan bajic/istockphoto; top right: eli_asenova/istockphoto; bottom right: atid kiattisaksiri/istockphoto; conclusion: pakhnyushchyy/istockphoto

total wellness ▪ fall 2013

If you are experiencing pica, fatigue, or one of the other symptoms, it doesn’t necessarily mean that you have IDA. However, if you are experiencing multiple symptoms, it’s best to consult a medical advisor for a proper diagnosis. Although insufficient iron intake isn’t a common cause of anemia, it’s still important to consume the daily-recommended values of iron to stay and feel healthy. t w

features

&

capsaicin, spice,

everything nice by pauline yang| design by jessica sun

total wellness â&#x2013;Ş fall 2013

What causes the burning sensation after eating or even touching something spicy? A chemical compound called capsaicin is responsible for the burn. Although you canâ&#x20AC;&#x2122;t taste or smell capsaicin, it is the main compound that contributes to the burn of peppers and other spicy foods. Capsaicin is an antioxidant, which protects cells from the harmful effects of free radicals. Peppers and spices that contain capsaicin are a good way of incorporating cancer-fighting antioxidants into a diet.1 Peppers also contain compounds such as flavonoids, which have antioxidant effects, and vitamin A, which is necessary to maintain strong tissues in the eyes, skin, and teeth.2

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the price of spice

risks of capsaicin

pain and capsaicin Different doses of capsaicin in spicy foods can cause a low amount of pain lasting from a few seconds to even a few hours. In a 1989 study published in Pain, scientists tested the effects of capsaicin by injecting it into subjects’ arms. The injection caused irritation and mechanical hyperalgesia, a higher sensitivity to pain. However, it did not seem to have any long-term physical consequences.3

In addition to pain sensitivity, it is speculated that capsaicin can have other adverse effects. Although there have been studies showing the anti-cancerous effects of capsaicin, it has been speculated that capsaicin may be a carcinogen, a cancer-causing agent. In a study published in 2011 by Cancer Research, scientists concluded that capsaicin blocks the receptor TRPV1, which provides the burning sensation after eating spicy food. When the TRPV1 receptor is blocked, the risk of skin cancer increases. The possible carcinogenic effects of capsaicin are even riskier in the presence of tumor promoters, such as sunlight.4 However, the amount of capsaicin in peppers such as jalapenos is a minimal 3,000 to 6,000 Scoville heat units, while pure capsaicin has a rating of 16,000,000 Scoville heat units. Because of the relatively minimal amount of capsaicin in the average pepper, there is little risk to eating spicy foods.

beat the heat: love spicy food but can’t handle the heat?

try dairy

cut the heat

Casein, a compound found in dairy products such as milk, cheese, and some protein supplements, can help combat the burn caused by capsaicin.5 So, if the heat from spicy peppers gets too hot to handle, drink a glass of milk. You can also eat a piece of cheese or have some yogurt, or even mix up a protein shake with whey protein, milk, and yogurt!

Additionally, to conserve the flavor of peppers but take away the spiciness, remove the seeds and membrane inside the peppers, where most of the heat is contained.

how you can add peppers to your daily diet jalapeños › Add to dips like salsa

total wellness ▪ fall 2013

and guacamole for an extra spicy kick.

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bell peppers › Cut and serve them with dip like hummus for a healthier version of chips and dip.

peppers › Blend into sauces that you can pour onto proteins like chicken, fish, or tofu.

peppers to › Add dishes like pasta and stir-fries.

spice is nice

no pain, no gain

burn baby burn

capsaicin vs. cancer

Although foods like chili peppers containing capsaicin can inflict pain on taste bud receptors, causing the “burn” experienced from spicy foods, they have also been found to relieve pain in patients with chronic pain from nerve and musculoskeletal disorders. Capsaicin has even been used in clinical trials, and there is strong evidence that it can help reduce the amount of pain experienced. According to a 2013 study published by Pain Medicine, there is evidence that a patch placed on the skin containing 8% capsaicin can stimulate the nerves in the peripheral nervous system and block the pain from reaching the spinal cord, and effectively lessen the amount of discomfort in patients suffering from neuropathic pain.6

It is speculated that ingesting a certain amount of spicy food can affect weight loss. A study published by the International Journal of Obesity, conducted in 2005, evaluated the effects of capsaicin with energy, or calories, and fat absorbance. The study found that in men and women, the daily average amount of calories consumed was 10-16% lower after having peppers with a very small amount of capsaicin before every meal. The results suggest that peppers with at least 0.25% of capsaicin could reduce the amount of calories ingested. Therefore, capsaicin consumption can decrease the consumed caloric amount by a small amount, but it should not be used as a primary weight loss supplement.7

It is likely that capsaicin can affect cancer cells and slow their proliferation, or growth. A 2013 study published in BMC Complementary and Alternative Medicine found that the growth of a type of cancer cell found in the mouth region was moderated when the cells were exposed to capsaicin. The cytotoxicity and viability, or strength, of the cells were also evaluated. The results showed that the capsaicin weakened the viability of the cells, indicating that it has anti-cancer effects.8

the bottom line Capsaicin seems to have a positive effect when moderately consumed. Furthermore, capsaicin can aid in decreasing appetite, reducing cancer cell growth, and lessening feelings of pain. To get the maximum benefits of capsaicin, try to incorporate different types of peppers into your meals! tw

total wellness ▪ fall 2013

References 1. “Antioxidant Activity of Capsinoids.” nbci.nlm.nih.gov. (2002). 2. “Vitamin A Benefit.” nbci.nlm.nih.gov. (2013). 3. “Dose-dependent Pain and Mechanical Hyperalgesia in Humans after Intradermal Injection of Capsaicin.” Pain. (1989). 4. “Sensory and Gastrointestinal Satiety Effects of Capsaicin on Food Intake.” IJO. (2005). 5. “A Hot Way Leading to Healthy Stay.” irjponline.com. (2012). 6. “The Capsaicin 8% Patch for Neuropathic Pain in Clinical Practice: A Retrospective Analysis.” Pain Med. (2013). 7. “The Two Faces of Capsaicin.” Cancer Res. (2011). 8. “Capsaicin induces cell cycle arrest and apoptosis in human KB cancer cells.” BMC Complement Altern. Med. (2013).

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features

common health myths

DEBUNKED by julia feygelman | design by catrina pang

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dibrova/istockphoto

total wellness ▪ fall 2013

Parental guidance, word-of mouth, and social habits contribute to our collective “common knowledge.” When it comes to health issues, nearly every person has some conclusions about healthy and unhealthy habits. While these sources of information are not the most reliable, they do lead to generally accurate conclusions. Meaning, people are usually aware that eating too much can cause weight gain, not brushing one’s pearly whites can result in cavities, smoking can increase the risk of lung cancer, etc... But is every piece of health information thrown around by the majority necessarily true? You might be surprised to find that some of the most commonly adhered to and long-lived pieces of advice are actually completely false. It is time to debunk them once and for all and honor those that stay true to the facts.

1

Drinking eight 8-oz glasses of water per day is necessary to stay adequately hydrated.

why the belief is held

the verdict? false

the real deal

Many organizations have made this recommendation, including the Institute of Medicine (IOM).1 The myth can be sourced back to a 1945 recommendation by the National Research Council, which once advised: “An ordinary standard for diverse persons is 1 milliliter [of water] for each calorie of food. Most of this quantity is contained in prepared foods,” but people ignored the latter sentence, leading them to believe that they needed to obtain the amount solely from drinks.2

According to a detailed 2002 review by the American Journal of Physiology, rigorous evidence for this belief seems to be lacking. The review, which sought to find scientific studies supporting the “8-by-8” (eight 8-oz glasses) claim, found, on the contrary, that studies following thousands of adults assertively suggest that such a large intake of water is not needed for healthy individuals.

The IOM set a new standard (in 2010) of 2.2 liters (about nine 8-oz glasses) daily for women and 3 liters (about 12.5 8-oz glasses) for men, coming from food and beverage combined, with about 19% coming from food. That comes out to about 7 net glasses for women and 9.5 for men. While these numbers are still close to the eight 8-oz glasses recommendation, they have decreased from the IOM’s 2004 guidelines. It is important to remember that the guidelines refer to all fluids, not just water.

Another possible reason for this belief might be because of Frederick Stare (MD, PhD, a highly regarded nutritionist and founder of the Department of Nutrition at the Harvard School of Public Health) who said in 1974 that people should consume “around 6 to 8 glasses per 24 hours,” with no evidence to support his claim.2

The “8-by-8” recommendation is also exaggerated because it disregards caffeinated drinks, juices or sodas, and mild alcoholic beverages like beer consumed in moderation as sources of hydration, which newer studies count towards the daily total.3 Meaning, these other beverages count towards a person’s total fluid intake, but people mistake the fluid recommendation for solely “water” intake. While not the healthiest, these drinks do contain water and some people rely on them, so if they drank 8 glasses of water in addition to the above beverages, that would make for an excessive and unrealistic amount of daily liquid intake.

The key for healthy people is to pay attention to thirst signals as a guide to fluid requirements. According to a 1965 study by the Journal of the American Medical Association, these thirst signals include but are not limited to: decreased skin turgor (rigidity of a tissue) and a “full” (swollen) tongue.5 Skin turgor can be self-determined by pinching the skin on the back of the hand between 2 fingers for a few seconds and then releasing it. Skin with decreased turgor (a sign of dehydration) remains elevated and returns to its original position more slowly. This, however, is a late sign in dehydration.6 An easy and effective way to track hydration level is by looking at urine color. According to a 2007 study by the Journal of the American College of Nutrition, pale yellow urine indicates euhydration (normal level of hydration),7 while darker yellow indicates dehydration.8

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total wellness ▪ fall 2013

Following the American Journal of Physiology’s investigation, numerous experiments stress the ability of the osmoregulatory system to keep water balance in check. This system maintains an organism’s internal balance between water and solutes (components of a solution or a substance dissolved in another substance).3 This basically means that it is not vital to drink exactly 8 glasses per day because the body can regulate its water concentrations as needed. It should be noted, nonetheless, that large intakes of fluid and water can be beneficial under special circumstances, such as during strenuous exercise or in hot climates,3 as long as you are mindful of balancing both electrolyte and water losses.

Keep in mind, however, that due to the body’s regulation responses, slight overhydration and underhydration can be atoned for over the short term. Thus, there is not one single water intake level that can globally be labeled as the “healthiest amount” for sufficient hydration.4 The new model represents an average, with the precise amount varying from person to person. So how does each individual figure out how much to consume?

2

Consuming foods that contain cholesterol raises blood LDL (low-density lipoprotein, or “bad” cholesterol) and increases the risk of coronary heart disease (CHD).

why the belief is held

the verdict? false

Some people avoid eating foods such as eggs, shrimp, and cheese because they believe that these foods contain high amounts of cholesterol that will raise their blood LDL.

While ingesting dietary cholesterol can raise blood cholesterol, there is a misconception about how and to what extent this cholesterol contributes to the dangerous problem of arteriosclerosis (thickening and hardening of the arteries) that leads to CHD. When the artery is inflamed and damaged, LDL tries to “patch it up,” and while this immune response is initially helpful, it becomes dangerous when the inflammation and LDL cause plaque buildup. Therefore, reducing dietary cholesterol does not completely eliminate the original cause of the problem of inflammation. The primary villains driving CHD are smoking, high blood pressure, elevated blood sugar levels, alcohol, and nutritional deficiencies, explains the New Zealand Journal of Natural Medicine in a 2012 article.9

This belief emerged in the general population because there is a myriad of controversial and contradicting information about this issue in the media. Also, many overgeneralize the findings by not differentiating between HDL (high-density lipoprotein, or “good” cholesterol) and LDL, which skews the upshot.

total wellness ▪ fall 2013

The conclusion? Healthy populations (i.e. with no history of heart disease, diabetes or stroke) experience no risk in developing CHD by increasing cholesterol ingestion.11 Also, it is often overlooked that saturated fat raises blood cholesterol more notably than cholesterol itself, as stated by a multi-authored article published by the University of Illinois.12 Trans fats, according to 1990 study by The New England Journal of Medicine, are even more detrimental because they not only raise LDL, but also lower HDL.13 A 1995 study in The American Journal of Clinical Nutrition adds that saturated fats are a more important elevator of LDL cholesterol than unsaturated fats.14 It appears as though the majority of studies on serum cholesterol point to fat as the culprit, not dietary cholesterol. The bottom line is, dietary fat gets immediately incorporated into VLDL (very low-density lipoprotein) and triglycerides which then also increase the LDL. This effect is seen much more with saturated fat than anything else, explains Rashmi Mullur (MD, attending physician in the Department of Endocrinology at the VA Greater Los Angeles Healthcare System and assistant professor at UCLA David Geffen School of Medicine).

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left: 2happy/istockphoto; right: stockcam/istockphoto; mphillips007/istockphoto; tpopova/istockphoto

According to a 2006 study performed by the Department of Nutritional Sciences, University of Connecticut and published in Current Opinion in Clinical Nutrition and Metabolic Care, dietary cholesterol increases both “good” and “bad” cholesterols, keeping the ratio at an innocuous level. The former article agrees that the balance between the two is more important than their individual values. Additionally, 70% of the population experiences mild to no alterations in plasma (i.e. contained in the blood) cholesterol when consuming high amounts of dietary cholesterol10 (see our Q&A on eggs and cholesterol from Issue 2, Volume 13 for the full scoop).

the real deal Foods containing relatively high levels of dietary cholesterol can have important health benefits.*

eggs ›

According to a 2011 article by the University of Maryland Medical Center, sulfur (which is contained in eggs) keeps joints healthy and may help in pain reduction. A 2002 study in Alternative Medicine Review agrees and expands on this finding, reporting that sulfur may be efficacious in helping to reduce the symptoms of arthritis and to treat allergies, pain syndromes, athletic injuries, and bladder disorders.18 Additionally, the Journal of Agricultural and Food Chemistry claimed in 2005 that eggs contain various elements (such as lysozymes and oligosaccharides) that help protect against bacterial and microbial infection.19

According to a 2010 study published in the Marine Pollution Bulletin and executed by the Department of Marine Science at Coastal Carolina University, shrimp contains omega-3 fatty acids, resulting in protective health effects such as reduced risk of cardiovascular disease, stroke, and diabetes.20

Stated in a 1996 article in the American Journal of Clinical Nutrition, shrimp consumption is also deemed healthy for the circulatory system because its lack of saturated fat turns the tables on its high cholesterol content and actually ameliorates the ratio of LDL (“bad” cholesterol) to HDL and lowers blood lipid levels (blood fat).21 * While cholesterol-rich foods may possess benefits due to their other properties, they should still be consumed in moderation as part of a balanced nutritional plan. The government’s “Dietary Guidelines for Americans” advises to choose a diet low in saturated fat and cholesterol, reports a 2011 article in Nutrition Reviews.24 According to a 1995 article in Circulation, there are indeed clinical health benefits (such as lowering the incidence of CHD) related to lowering dietary cholesterol intake.25 A 2000 study in the Cleveland Clinic Journal of Medicine confirmed that lowering cholesterol intake levels can, due to lowered blood LDL, reduce the risk of developing CHD.26

cheese ›

According to a 2009 article in Trends in Food Science and Technology, ingestion of probiotic cheese (aged cheese) has shown clinical benefits in its ability to deliver viable probiotic bacteria into the human body. Probiotics, as defined in 2008 by the International Scientific Association for Probiotics and Prebiotics and Dairy and Food Culture Technologies, are “products that contain an adequate dose of live microbes that have been documented in target-host studies to confer a health benefit”.22

The former journal also found that probiotic cheese could decrease the risk of hyposalivation (dry mouth, which can sometimes cause bad breath) and be advantageous for oral health in general.23

Note: The main problem cheese poses is over-indulgence of a high-fat dairy product that can also contain growth hormones if not organic. Eat cheese as a modestly-used topping or ingredient, not a food group, and buy organic whenever possible.

total wellness ▪ fall 2013

Eating eggs may decrease the risk of developing macular degeneration (loss of vision) up to 40% due to their carotenoid content, reports the Journal of the American College of Nutrition in 2000.15 Two large eggs contain 0.3 mg of carotenoid.16 To keep things simple, do not exceed 4 egg yolks/week (each containing 186 mg of cholesterol). Healthy individuals can safely consume up to 300 mg of cholesterol per day while people with heart disease or diabetes should stay below 200 mg/day.17

shrimp

43

why the belief is held

the real deal

The concern that reading in dim light could diminish eyesight might have originated in the feeling of eye strain when trying to read in the dark. Inadequate lighting can create the sense of having trouble focusing. It also decreases the rate of blinking and leads to uncomfortable dry eyes, especially when paired with squinting, say 2005 and 2006 articles in Optometry & Vision Science27 and Insight,28 respectively.

To adjust to lower illumination, the eye undergoes several reversible changes. Rhodopsin, a pigment in the retina (lining on the inside of the eye receiving light) is the first to perceive light and adapts immediately, while rods (photoreceptors in the retina) are more sensitive to light and require longer to adapt, reaching maximum sensitivity at around 30 minutes. Cones, photoreceptors responsible for color vision, take about 9 to 10 minutes to adjust. Luckily, the general consensus in ophthalmology is that reading in dim light does not damage or hurt your eyes. The changes that occur during dark adaptation can be accompanied by strain and temporary discomfort, but are not damaging. The British Medical Journal claimed in a 2007 article that hundreds of experts agree that reading in low light does not harm your eyes.29

the verdict? false These sensations (straining, dry eyes) are not problematic because the effects are only temporary. According to a 2003 patient handout, Taking care of your eyes: a collection of patient education handouts used by Americaâ&#x20AC;&#x2122;s leading eye doctors, reading in dim light does not lead to permanent damage to eyes. There are temporary negative effects, but the inherent functioning and structure of the eyes remain unchanged.29

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left: dgm007 /istockphoto; right: bibigon/istockphoto

total wellness â&#x2013;Ş fall 2013

3

Reading in dim lighting can damage eyes.

4

You must wait 1 hour after eating before swimming (or exercising).

why the belief is held The idea behind this belief is that muscle cramping arises (potentially leading to drowning if swimming) due to a lack of oxygen-carrying blood to muscles that flows, instead, towards the stomach to aid in digestion.

the verdict? true While it is best to wait several hours before exercising, it is not for the reasons most people believe. Neither swimming nor exercising after eating is life-threatening or harmful in the long run. However, it can still cause temporary yet significant discomforts. In a 1992 study by the International Journal of Sport Nutrition, all subjects who ate within 30 minutes of a triathlon vomited while swimming. Those with vomiting symptoms had eaten high-fat or high-protein meals. All individuals who experienced intestinal cramps had consumed fiber-rich foods before the race.30 A 1968 study published in American Association for Health, Physical Education and Recreation reported no complaints of stomach cramping with swimming after eating, but nausea did occur when participants ate within 30 minutes of swimming.31

the real deal According to a 2010 article published by Duke Medicine, the biggest dangers entailed by eating and swimming (or exercising) are most likely minor, non-life threatening cramps and nausea. Elisabetta Politi, RD, nutrition director at the Duke Diet & Fitness Center, mentions that the best thing to do is to eat 2 to 3 hours before exercising (to minimize possible discomfort).33 Eating just before recreational swimming should not cause any issues, reports the University of Arkansas for Medical Sciences.32

total wellness â&#x2013;Ş fall 2013

In the case of swimming, eating prior to the activity should not cause serious adverse effects. According to Charles Smith, MD, a board certified family physician at the Family and Preventative Medicine Department at UAMS (University of Arkansas for Medical Sciences), there is no medical evidence supporting the drowning myth. The reality is that there is enough oxygen to go around for both digestive purposes as well as muscle function.32

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The takeaway? When it comes to staying hydrated, don’t drink until you feel like a water balloon to fulfill the passé 8-by-8 requirement. Instead, focus on the body’s signals or follow the simple instructions for detecting dehydration. Craving a grilled cheese? Go ahead and indulge, in moderation. As long as the cheese is probiotic (such as cheddar, provolone, or gruyere) and not overflowing the sandwich, it shouldn’t be a problem. After the tasty meal, is swimming on the agenda? If too little time passes between these two activities, minor cramps may result, so wait a few hours (around 2) to be on the safe side. However, there is no need to fear drowning if waiting isn’t an option. If it’s evening, and some reading sounds appealing, don’t fret about “proper” illumination. Temporary ocular discomfort may occur in darker lighting, but any permanent damage is very unlikely. t w

Music for Your Health Join Total Wellness on

January 18th, 2014

from 10 AM - 3 PM in the Ackerman Grand Ballroom at UCLA for a

FREE music health conference This event will feature: Guest Speakers

total wellness ▪ fall 2013

References 1. “Water: How Much Should You Drink Every Day?” mayoclinic.com. (2011). 2. “Medical Myths.” BMJ. (2007). 3. “‘Drink at least eight glasses of water a day.’ Really? Is there scientific evidence for ‘8 × 8’?” Am. J. Physiol. (2002). 4. “Water.” Nal.usda.gov 5. “Clinical Signs of Dehydration and Extracellular Fluid Loss.” JAMA. (1965). 6. “Skin Turgor.” nlm.nih.gov. (2012). 7. “Assessing Hydration Status: The Elusive Gold Standard.” J. Am. Coll. Nutr. (2007). 8. “Understanding Clinical Dehydration and Its Treatment.” JAMDA. (2008). 9. “The Heart of the Matter – Beyond the Cholesterol Myth.” The NZ Journal of Natural Medicine. (2012). 10. “Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations.” Curr. Opin. Clin. Nutr. Metab. Care. (2006). 11. “Summary Measures of Population Health.” Cdc.gov. (2010). 12. “Dietary factors that increase blood cholesterol.” urbanext.illinois.edu. 13. “Effect of Dietary trans Fatty Acids on High-Density and Low-Density Lipoprotein Cholesterol Levels in Healthy Subjects.” N. Engl. J. Med. (1990). 14. “Dietary oils, serum lipoproteins, and coronary heart disease.” Am. J. Clin. Nutr. (1995). 15. “The Potential Role of Dietary Xanthophylls in Cataract and Age-Related Macular Degeneration.” J. Am. Coll. Nutr. (2000). 16. “Lutein and Zeaxanthin: Eye and Vision Benefits.” Allaboutvision.com. (2012). 17. “How Many Eggs Can I Eat a Day Without Adverse Effects?” healthyeating.sfgate.com. 18. “Sulfur in human nutrition and applications in medicine.” J. Altern. Complement. Med. (2002). 19. “Advances in the Value of Eggs and Egg Components for Human Health.” J. Agric. Food Chem. (2005). 20. “Mercury concentrations and omega-3 fatty acids in fish and shrimp: Preferential consumption for maximum health benefits.” Mar. Pollut. Bull. (2010). 21. “Effects of shrimp consumption on plasma lipoproteins.” Am. J. Clin. Nutr. (1996). 22. “Probiotics: definition, sources, selection, and uses.” Clin. Infect. Dis. (2008). 23. “Probiotic cheese: Health benefits, technological and stability aspects.” Trends in Food Science and Technology. (2009). 24. “The art of translating nutritional science into dietary guidance: history and evolution of the Dietary Guidelines for Americans.” Nutr. Rev. (2011). 25. “Cholesterol Reduction Yields Clinical Benefit.” Circulation. (1995). 26. “Blink rate decreases with eyelid squint.” Optom Vis Sci. (2005). 27. “Why do humans blink? A short review.” Insight. (2006). 28. “In cholesterol lowering, moderation kills.” Cleve. Clin. J. Med. (2000). 29. “Medical Myths.” BMJ. (2007). 30. “Gastrointestinal complaints in relation to dietary intake in triathletes.” Int. J. Sport Nutr. (1992). 31. “Effect of Food Consumption on 200-Yard Freestyle Swim Performance.” American Association for Health, Physical Education and Recreation. (1968). 32. “Do you have to wait 30 minutes after eating before swimming?” uamshealth.com. 33. “Myth or Fact: Wait 30 Minutes after Eating to Go Swimming.” dukehealth.org. (2010).

Ping Ho

MA, MPH (Founder and Director of UCLArts and Healing)

Robert Bilder

PhD, ABPP (Chief of Medical Psychology – UCLA Neuropsychology; Director of UCLA Health Campus Initiative's Mind Well)

Raffi Tachdjian

MD, MPH (Physician in UCLA Health System; President & Founder of Children's Music Fund)

Performances & Experiential Sessions RainPlay Laughter Yoga The Moving Voice & The Release of Issue 2, Volume 14 of Total Wellness Magazine

46

Sign up for the event today at http://www.totalwellnessmagazine.org/ 1st 100 people to register will get free lunch at the conference

features

what’s that in the wind?

by pavan mann | design by mary sau

left: martindvonka/istockphoto

total wellness ▪ fall 2013

It’s a bird! It’s a plane! Actually, it’s neither of those, but here’s a hint: it’s invisible, but everywhere— it’s air! Air is a mixture of nitrogen, oxygen, and other gases in our atmosphere. Differences in air pressure within our atmosphere cause moving air, also known as wind. Though the air we breathe keeps us alive, there are traces of chemicals and other matter that can actually cause harm to our health. Even if there aren’t dangers in the immediate environment, the wind can carry hazardous particles to our lungs from miles away. Being aware of what’s inhaled and taking action against it can prevent serious medical issues from developing. Read on to be blown away by what is carried in the wind and air!

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things that are in the wind

dust what is it? Dust is any fine, dry powder that is composed of small particles of earth, waste, or residue. Construction sites, pollution, and decomposition of organic matter, including human skin, can all be sources. Dust is often visible once it accumulates on a surface.

where does it come from? Dust seems to appear from

nowhere, but in reality, it can come from anywhere and can land everywhere. Even if the nearest desert is halfway across the globe, its soil can be blown by big dust storms to destinations that are miles away and even across oceans. In fact, a 2001 article published in Global Change and Human Health states that these desert soils and dusts traveling in the atmosphere are what create the orange color in sunrises and sunsets.1

pollen

what’s the risk? Though this dust dispersion seems like

what is it? Pollen is a collection of microscopic grains that

other pollen sources › weeds: ragweed, redroot pigweed, curly dock, lamb’s quarters, English plantain, sheep sorrel, sagebrush,6 and Russian thistle (tumbleweed)4

total wellness ▪ fall 2013

› grasses: bermuda grass, johnson grass, kentucky bluegrass, orchard grass, sweet vernal grass, timothy grass,6 and red top grass4

› trees: elm, catalpa, hickory, olive, pecans, sycamore, walnut,6 oak, ash, box elder, mountain cedar4

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are released from male plants into the air to fertilize female plants. According to a 2002 review in the Journal of Allergy and Clinical Immunology, pollen from plants is chemically complex and hosts several diverse allergens. This means that pollen is not only a carrier for lots of potential allergens, it can also come from several different plants hosting their own variety of different allergens, greatly increasing the likelihood and prevalence of pollen allergy.3 Allergens, as small particles, can even be carried on aerosol particles traveling in the air. This small-particle carriage was documented with grass, oak, birch, mountain cedar, and other potential allergens.3

where does it come from? Although most grains

traveling in the wind fall within 100 m of their source, they can also travel hundreds of miles to affect people who are not nearby.3 In addition to the small-particle carriage sources of pollen, the National Institute of Health names ragweed as the major producer of pollen in weeds. For a list of other weeds, grasses, and trees that produce pollen, see the sidebar to the left.4

what’s the risk? Pollen is a common culprit for allergy

and respiratory issues. The Lancet medical journal published a 2012 article that discussed how hay fever, otherwise known as allergic rhinitis, is a common but ignored and misdiagnosed disorder that affects the nasal mucosa. By irritating this area of the nasal passage, inflammation occurs, causing itching, sneezing, nasal congestion, and a runny nose during and after a hypersensitive reaction to an allergen, either indoors or outdoors.5 Despite the prevalence of allergic rhinitis, there are a variety of triggers that have not yet been identified or diagnosed. It is proposed that mold and dust are also potential causes. Though it is primarily a hazard for those with allergies,

left: dem10/istockphoto, steve cole/istockphoto; right: trancedrumer/ istockphoto

an issue for only those with dust allergies, there is hidden danger for everyone. The primary danger isn’t in just the dust itself, but in microorganisms like fungi, bacteria, and viruses that can be carried by dust. According to a review on dust storms published in a 2004 issue of EcoHealth, 20 to 30% of the bacteria and fungi in the Earth’s atmosphere are capable of causing a wide variety of diseases in people with weakened immune systems, young children, and the elderly.2 Trees, plants, crops, and animals may be infected as well, which can in turn affect human health. Additionally, places where desert dust is extremely common, like the Caribbean, are more likely to be exposed to dust that carries diseases and particles that suppress the immune system, weakening the immune response—a recipe for disaster because this combination enables infection and progression of dust-carried diseases.2

particulate matter what is it? The Centers for Disease Control (CDC) defines

particulate matter in a way that covers a broad spectrum of pollutants in the air, including dust, dirt, soil, acids, soot and smoke, and little drops of liquids. Larger particles like soot and smoke can be seen, but others are invisible.7 A 2013 review in the Canadian Journal of Cardiology revealed that chemically, particulate matter can contain metal oxides, acid condensates, transition metals, sulphate, nitrate, elemental carbon, and organic carbon.8 There are two categories of particulate matter: fine particles (PM2.5) and coarse dust particles (PM10). Fine particles are less than 2.5 µm in diameter and can be detected only with an electron microscope. Coarse dust particles have diameters between 2.5 µm and 10 µm.7

where does it come from? Wood stoves, forest fires,

volcanoes, coal fires, power plants, motor vehicles, factories, and construction sites all contribute to particulate pollution, as stated by the CDC.7 Fine particles, PM2.5, come from all types of combustion, including motor vehicles, power plants, wood burning, agricultural burning, and some industrial processes. Coarse dust particles, PM10, are created during crushing or grinding operations of construction and can be stirred up by vehicles traveling on roads.9

what’s the risk? Particulate matter accounts for 800,000

premature deaths per year, as estimated by the World Health Organization. The CDC warns that particles bigger than 10 µm can irritate your eyes, nose, and throat but do not usually reach your lungs. For reference, 10 µm is about 7 times thinner than 1 human hair.7 PM2.5, as revealed by a 2013 Environmental Toxicology study, can worsen inflammation, damage the layer between the alveoli and the capillaries in the lungs, and increase the permeability of lung cells in rats.10 Thus, these fine particles are small enough to invade deep into the lungs and even the bloodstream, therefore posing a greater hazard to health and adequate respiratory function.7 This abnormal condition of stress aggravates respiratory diseases, and for asthmatics, this could mean worsening symptoms, more frequent medication use, decreased lung function, and increased chance of mortality.11 A review from a 2012 issue of the Journal of Medical Toxicology found that particulate matter exposure has also been shown to have a small but significant adverse effect on the heart and its blood vessels (cardiovascular disease), as well as the blood vessels of the brain (cerebrovascular disease). Long-term exposure can significantly increase the chances of cardiovascular incidents and mortality rates. Short-term, acute exposures increase the likelihood of cardiovascular events within days of a pollution spike.11

particulars in particulate matter Since particulate matter is a vague term that incorporates a wide variety of pollutants in the air, it is hard to imagine what it may actually be comprised of. Here are a couple of examples: residual oil fly ash (ROFA)

› In 2002, a Toxicological Sciences article

defined ROFA as a pollutant that is made up of transitional metals, sulfates, and acids and is created in oil-fired power plants. It revealed that ROFA significantly increases the likelihood of a pulmonary event and impairs lung defense mechanisms.12 diesel exhaust particles (DEPs)

total wellness ▪ fall 2013

› DEPs come from vehicle emissions and

mostly contain carbon particles with a diameter of less than 1 μm, as stated in a 2013 Canadian Journal of Cardiology article.8 According to a 2007 study in Immunology and Cell Biology, DEP exposure is correlated to asthma, possibly due to cell suicide in the cells lining the lungs and breathing pathway.13

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where does it come from? National Geographic states

that “bad” ground-level ozone is created by a photochemical reaction when UV rays from sunlight react with nitrogen oxides (from car exhaust, coal power plants, and factories) in combination with a volatile organic compound (from gas, paint, and cleaning mixtures).18

what’s the risk? According to a 2013 study published in

mold what is it? Mold is a type of fungus, and its growth is often

associated with spoiling food, dampness, and other rotting organic matter.14 According to the Environmental Protection Agency, molds create tiny spores and waft through air indoors and outdoors continually to reproduce.15

Toxicology and Applied Pharmacology, ozone exposure in rats can induce hyperglycemia (excess glucose), lower tolerance of glucose, and increase levels of leptin, which regulates energy intake and appetite.19 These effects worsened in older or diabetic rats. In 2011, the Journal of Neurochemistry released an article that discussed how ozone can cause lung inflammation, which activates stress-responsive regions in the brain, indicating that the body and brain are under abnormal, harmful conditions.20 Though these studies were done on rats, they serve as animal models that can be applied to humans as well.

where does it come from? Contrary to popular belief,

mold does not only occur in wet environments. The strong, dry Santa Ana winds disperse mold spores from trees and bushes to the majority of Southern California. Additionally, mild winters that are wet but not that cold, like those in Los Angeles, can create a perfect environment for mold to grow.

H

C

what’s the risk? When mold spore counts increase, those

O +

total wellness ▪ fall 2013

O

ozone

O

O

what is it? The CDC defines ozone as a colorless, odorless

gas that is another component of air. Ozone naturally protects us from most of the sun’s harmful UV rays by creating a shield of gas 10 to 30 miles above the Earth’s surface. However, another kind of ozone occurs at ground-level because of pollutants, and it contributes to smog in urban areas.7

50

formaldehyde

H

O

what is it? Despite the fact that plants and animals

naturally produce small amounts of formaldehyde, it is still a dangerous carcinogen. Breathing air containing formaldehyde is the most common route of contact humans have with the pollutant because it is so widely used.

where does it come from? The CDC states that

formaldehyde is released into the air by industries using or manufacturing formaldehyde: some resins, wood products like plywood and furniture, automobile exhaust, cigarette smoke, paints and varnishes, some carpets, and permanent press fabrics. It is sometimes used as a food preservative, and it is found in some antiseptics, medicines, and make-up.7 The results of a 2011 study in the Journal of Occupational and Environmental Hygiene show that professional hair smoothing treatments, despite being labeled “formaldehyde-free,” are still capable of creating concentrations that breach exposure limits in the immediate vicinity surrounding the hair and head.21

what’s the risk? A 2013 publication in the Journal of

Toxicology and Environmental Health warns that though formaldehyde is a common industrial chemical, exposure is correlated with nasopharyngeal and sinonasal cancer. The data obtained in this study also indicate an increased risk of changes to human genetic information as well as a weaker immune system, possibly due to a decrease in counts of B-cells, which make antibodies against foreign invaders in the body.22

left: beholdingeye/istockphoto

who are affected by mold allergies become at risk of reaction. According to a 2013 study in the International Society for Microbial Ecology, fungi can disperse from outdoors, drifting usually within hundreds of meters, and settle indoors to grow.16 Thus, even if a moldy object is far away, it can still be dangerous for those who are susceptible to mold allergy. Allergic individuals are likely to react with rhinitis, described in the “Pollen” section above, or asthma. Sometimes, inflammation of the sinuses occurs due to blockage. In 2003, the Journal of Occupational and Environmental Medicine warned that mold can induce more serious respiratory illnesses such as allergic bronchopulmonary aspergillosis and allergic fungal sinusitis. Also, mold can physically destroy the building materials on which it grows, compromising the safety of the construction. Though mold is everywhere and unavoidable, major growths should be eradicated as soon as possible. 17

C

where does it come from? According to a 2007

O

carbon monoxide

what is it? Carbon monoxide is a odorless, tasteless, and

poisonous gas produced by, incomplete combustion of several types of fuel. The hemoglobin that carries oxygen in our blood has a much higher affinity for carbon monoxide. Once carbon monoxide binds, it takes the place of oxygen, which can no longer reach the brain and body as it should.

where does it come from? The California Department

of Forestry and Fire Protection warns that carbon monoxide can be created when gas, oil, kerosene, wood, or charcoal is burned. The most common source of carbon monoxide in outdoor air is exhaust from motor vehicles, but it can also come from industrial processes.23

publishing of The American Journal of the Medical Sciences, over 65% of ambient air sulfur dioxide in the United States comes from electric utilities like coal-fired power plants. Other sources are petroleum refineries, cement manufacturing, cars, ships, and machines that use diesel gas.24

what’s the risk? The article also states that sulfur dioxide

affects the respiratory systems of healthy patients as well as those with underlying pulmonary disease. Controlled human exposure studies reviewed in this article revealed that exposure increased airway resistance, making it harder to breathe, especially for asthmatics. Additionally, exposure to sulfur dioxide has been associated with cough and worsening of prior cardiovascular and respiratory illness.24

especially indoors where there is poor ventilation, it can cause harm and even death. A 2007 report published in The American Journal of the Medical Sciences revealed that both acute and chronic exposures to carbon monoxide are associated with an increased risk of both cardiac and pulmonary attacks.24 Indoor carbon monoxide alarms are highly recommended to prevent poisoning and improve the chances of early detection.

C H

H

C

C C

benzene

C

C H

H

what is it? Though benzene is described as sweet-smelling,

N

nitrogen dioxide

H

H

what’s the risk? When carbon monoxide accumulates,

it is very flammable and carcinogenic. It is a colorless gas that is used in many industries, as detailed below.

O

O

where does it come from? The CDC names gasoline,

of fuel burned at high temperatures, like motor vehicle exhaust, electric utilities, and industrial boilers.

fires, tobacco smoke, glues, rubbers, and factories as possible sources of benzene.7 Benzene is also used when plastics, detergents, pesticides, dyes, and other chemicals are manufactured. The National Library of Medicine states that humans inhale benzene fumes in ambient air, especially near high automobile traffic areas and near gas stations. Benzene can be accidentally consumed by drinking water from wells that are contaminated by leaking gasoline storage tanks or landfill runoff.26 However, most public drinking water supplies are benzene-free, or they contain less than 0.3 parts per billion.

what’s the risk? Nitrogen dioxide can irritate the

what’s the risk? A 2011 Environmental Toxicology study

what is it? Nitrogen dioxide is a brown gas, and as

mentioned before, contributes to the production of groundlevel ozone, or smog. The Environmental Protection Agency’s air quality standard for nitrogen dioxide is 0.053 ppm, which is measured as a mean concentration per year.25

where does it come from? Nitrogen dioxide is a product

S

sulfur dioxide

O

O

what is it? Sulfur dioxide is produced when fuel with sulfur, such as coal and oil, is burned.

found that compared to people who were not exposed to any benzene, those who underwent benzene exposure exhibited an increase in the level of DNA adducts, or cancer-causing chemicals that are bonded to DNA pieces.27 According to the CDC, this puts people at greater risk for chronic disease because of an increased susceptibility to disease and cancer.7 The CDC also warns that short term signs of inhalation may include drowsiness, dizziness, rapid heartbeat, and vomiting (if ingested). Long-term exposure can affect bone marrow growth, menses, and blood production, as well as result in low newborn birth weight and leukemia.7 High concentrations of inhaled or ingested benzene can even cause death. **Benzene and Formaldehyde Removal: As written in Issue 4, Volume 13 of Total Wellness Magazine, some plants can remove benzene and formaldehyde from the air, leaving cleaner air to breathe. For more information, go to our website and continue reading on page 26.

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total wellness ▪ fall 2013

lungs and make the body more susceptible to respiratory infections like the flu. Those exposed to much higher doses than that of normal ambient air may be more likely to have respiratory illness like influenza, especially children.25 In 2007, an article in The American Journal of the Medical Sciences hypothesized that respiratory infections are more likely because nitrogen dioxide weakens the immune system. Also, it revealed that those who constantly work near nitrogen dioxide, such as crop farmers near silos, have an occupational hazard and are more likely to be affected by the pollutant.24

what to do?

the bottom line

Air is ubiquitous and necessary for life, so entirely avoiding it is impossible. However, reducing contact with the harmful allergens and chemicals in air can be beneficial for health. Since people live in different environments and have varying allergies and sensitivities, it is crucial to monitor sources of airborne irritants and poisons. For example, those living near gas stations and construction sites may be more likely to be affected by benzene and particulate matter, respectively.

The effects and origins of some pollutants and allergens are no longer “up in the air”, so to speak. They come from sources all around the world, and the wind and air allow these particles and chemicals to travel great distances into the body. Though this may not affect some people, others who are prone to infection, allergies, or respiratory problems could potentially be facing major health hazards. The air can carry several triggers that cause symptoms and attacks to occur in those with allergies or asthma. Even a healthy individual can be poisoned or killed by excessive exposure to the gases and chemicals listed above. These molecules are also known to agitate the skin and eyes. Some effects are still being studied, such as the correlation between airborne particles and an increased likelihood of abnormal heartbeat rhythm. This arrhythmic risk was the subject of a 2013 review in the Canadian Journal of Cardiology, which found that results often vary greatly, depending on the subjects studied and intensity of contact.8

The Environmental Protection Agency’s Air Quality Index (AQI) is an excellent way to monitor daily local PM10, PM2.5, ozone, nitrogen dioxide, and carbon monoxide levels in the air. A pollen count can be useful in guiding those who are sensitive to pollen to avoid outdoor exposure. Pollen count is the number of grains of pollen per cubic meter of air collected over 24 hours. Weather stations and other allergy websites often report the concentration of all types of airborne pollen (or specific types, like ragweed) in the air at specific areas and times. Pollen counts are usually highest early in the morning on warm, dry, breezy days and the lowest during cold, wet times. On days when the air quality is very poor or pollen is very high, it may be safest to limit outdoor activity, especially for those with allergies.4

total wellness ▪ fall 2013

A 2012 article in the Journal of Medical Toxicology advises that indoor exposure to dangerous molecules be limited through the use of air conditioning and particulate air filters as well as by avoiding indoor burning and smoking.11 A review in Environmental Health Perspectives from 2000 suggested that immunotherapy can be an effective relief for pollen allergy and sometimes even mold spore sensitivity.28 If it is suspected that allergens, pollutants, and other poisonous gases are affecting health, a physician should be seen. Dr. Raffi Tachdjian, MD, MPH, Assistant Clinical Professor of Medicine and Pediatrics in the Division of Allergy & Immunology at the UCLA School of Medicine, recommends living a healthy, active lifestyle and eating a diet containing antioxidants to improve overall health and to boost the immune system.

52

Since these effects depend on an individual’s own body, lifestyle, and location, it is important that people pay particular attention to their immediate environment and identify pollutants that may be affecting their health. Being aware of what’s in the air and wind and taking action against the irritants can make breathing better and improve overall health. t w

t

tota

goin References 1. “Dust in the Wind: Long Range Transport of Dust in the Atmosphere and Its Implications for Global Public and Ecosystem Health.” Global Change and Human Health. (2001). 2. “Dust Storms and Their Impact on Ocean and Human Health: Dust in Earth’s Atmosphere.” EcoHealth. (2004). 3. “Airborne pollen: A brief life.” J. Allergy Clin. Immunol. (2002). 4. “Allergic diseases.” niaid.nih.gov. (2012). 5. “Allergic rhinitis.” The Lancet. (2012). 6. “Allergic diseases.” niehs.nih.gov. (2012). 7. “Air Contaminants.” cdc.gov. (2012). 8. “Air Pollution and Arrhythmic Risk: The Smog Is Yet to Clear.“ Can. J. Cardiol. (2013). 9. “Residual Oil Fly Ash Increases the Susceptibility to Infection and Severely Damages the Lungs after Pulmonary Challenge with a Bacterial Pathogen.” Toxicol. Sci. (2002). 10. “Rat lung response to ozone and fine particulate matter (PM2.5) exposures.” Environ. Toxicol. (2013). 11. “Clearing the air: a review of the effects of particulate matter air pollution on human health.” J. Med. Toxicol. (2012). 12. “Particulate matter.” airnow.gov. 13. Diesel exhaust particulate matter induces multinucleate cells and zinc transporter-dependent apoptosis in human airway cells.” Immunol. Cell Biol. (2007). 14. “Your allergies & the weather.” weather.com. 15. “Mold.” epa.gov. (2012). 16. Dispersal in microbes: fungi in indoor air are dominated by outdoor air and show dispersal limitation at short distances.” ISME J. (2013). 17. “Adverse human health effects associated with molds in the indoor environment.” ISME J. (2013). 18. “Ozone.” nationalgeographic.com. 19. “Ozone induces glucose intolerance and systemic metabolic effects in young and aged brown Norway rats.“ Toxicol. Appl. Pharmacol. (2013). 20. “Ozone inhalation activates stress-responsive regions of the CNS.” J. Neurochem. (2011). 21. “Characterization of formaldehyde exposure resulting from the use of four professional hair straightening products.” J. Occup. Environ. Hyg. (2011). 22. “Cytogenetic and Immunological Effects Associated with Occupational Formaldehyde Exposure.” J. Toxicol. Environ. Health. (2013). 23. “Nitrogen dioxide.” epa.gov. (2012). 24. “Outdoor air pollution: nitrogen dioxide, sulfur dioxide, and carbon monoxide health effects.” Am. J. Med. Sci. (2007). 25. “Carbon monoxide fact sheet.” fire.ca.gov. (2011). 26. “Hazardous substance data bank.” National Library of Medicine. (1999). 27. “DNA-adducts in subjects exposed to urban air pollution by benzene and polycyclic aromatic hydrocarbons (PAHs) in Cotonou, Benin.” Environ. Toxicol. (2011). 28. “Outdoor allergens.” Environ. Health Perspect. (2000).

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decoding the nutrition label

aspartame

by jennifer miskabi | design by karin yuen

Since aspartame’s introduction to the US market in the 1980s for use in food products, it has been a topic of national controversy. What exactly is aspartame and what does research say about it? Read on to find out what aspartame is, why it’s used, what foods contain it, and what the health concerns are.

Aspartame (also known as NutraSweet, Equal, and Spoonful) is an artificial sweetener used in many foods and beverages. The US Food and Drug Administration (FDA) officially approved the use of aspartame in dry foods in 1981. When first introduced to the US, the product was praised for its significant sweetness (about 180 times sweeter than table sugar), allowing one to use much less of this artificial sweetener to achieve the same level of sweetness or more in foods and drinks.1

what foods contain aspartame? Aspartame does not naturally exist in foods and drinks. Instead, it is added to enhance the sweetness of the product. According to a 2007 evaluation in Critical Reviews in Toxicology, diet carbonated soft drinks are the primary source of aspartame consumption in the US. Additionally, this sweetener may also be present in other products including fruit juices, chewing gum, breath mints, and candies (especially those labeled fat-free or sugar-free).2

total wellness ▪ fall 2013

what are some health concerns associated with aspartame? Aside from the possible effects it might have on those with phenylketonuria (PKU), there are no health problems that have been directly linked to aspartame consumption. Since individuals with PKU cannot break down phenylalanine (an amino acid found in many foods as well as aspartame), phenylalanine can accumulate in the blood of PKU patients and prevent essential chemicals from reaching the brain. However, for those without PKU, aspartame consumption has been demonstrated to be safe at the Acceptable Daily Intake (ADI) of aspartame, which is 50 mg/kg of body weight.3 Nevertheless, studies are still being conducted on this artificial sweetener to research health concerns associated with aspartame.

cancer: Although the link between aspartame and cancer is widely debated, most studies have found no definitive association. A 2005 study published in Environmental Health Perspectives raised concern about aspartame use in relation to cancer. The study found signs of lymphomas and leukemias in rats that consumed aspartame.4 However, both the FDA and the European Food Safety Authority (EFSA) called into question the results of this study, citing inconsistencies in their findings.5

54

Other studies conducted on this topic have been unable to consistently link aspartame use to cancer. For example, a 2009 study in Cancer Epidemiology, Biomarkers & Prevention found that aspartame consumption is not related to the risk for gastric, pancreatic, and endometrial cancers. 6

weight gain: Some argue that aspartame increases one’s appetite by stimulating hunger and thus, contributes to weight gain. In a 2013 study in Appetite, researchers found that aspartame and saccharin, compared to sugar, induced greater weight gain in rats with similar caloric intakes.7 Nevertheless, scientific evidence has not consistently supported this theory. For instance, a 1990 study in Physiology & Behavior that examined the relationship between sweetened beverage consumption and hunger and thirst in men demonstrated that aspartame-sweetened drinks do not increase hunger or food intake.8

headaches: According to the Centers for Disease Control and Prevention (CDC), one of the most common symptoms that aspartame consumers report are headaches.9 A 1987 doubleblind crossover study in the New England Journal of Medicine, conducted at the Duke University Medical Center, examined those who believed aspartame was the cause of their headaches. After administering either a placebo or aspartame to the subjects, the researchers found that in their population, aspartame was no more likely to cause a headache than the placebo.10 However, it is still unclear whether or not aspartame is the cause of such complaints.

the bottom line While numerous studies have been conducted on aspartame and its health effects, the results are inconclusive and are often conflicting. As such, the health effects of aspartame require further investigation through additional studies. For those of you that are worried about your aspartame intake, check the food label before you eat to look out for aspartame, NutraSweet, Equal, or any variation of an artificial sweetener. t w References 1. “What is Aspartame?” aspartame.info. (2013). 2. “Aspartame: A Safety Evaluation Based on Current Use Levels, Regulations, and Toxicological and Epidemiological Studies.” Crit. Reviews Tox. (2007). 3. “Q&A: Facts About Aspartame.” newsdesk.umd.edu. (2007). 4. “First Experimental Demonstration of the Multipotential Carcinogenic Effects of Aspartame Administered in the Feed to Sprague-Dawley Rats.” Environ. Health Perspect. (2005). 5. “FDA Statement on European Aspartame Study.” fda.gov. (2006). 6. “Artificial Sweeteners and the Risk of Gastric, Pancreatic, and Endometrial Cancers in Italy.” Can. Epidemiol. Biomarkers Prev. (2009). 7. “Saccharin and aspartame, compared with sucrose, induce greater weight gain in adult Wistar rats, at similar total caloric intake levels.” Appetite. (2013). 8. “Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men.” Phys. Behav. (1990). 9. “Evaluation of Consumer Complaints Related to Aspartame Use” cdc.gov. (2001). 10. “Aspartame and Susceptibility to Headache.” New Engl. J Med. (1987).

left: dusty pixel/istockphoto

what is aspartame and why is it used?

credits

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

q&a

R

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

an inside scoop on the science behind chicken soup and the common cold

three-ingredient snacks

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

common health myths debunked

skincare jargon: what does that mean?

what’s in the wind?

Cameron Chesnut, MD, Chief Resident in Dermatology, David Geffen School of Medicine at UCLA

Raffi Tachdjian, MD, MPH, Assistant Clinical Professor of Medicine and Pediatrics, Division of Allergy and Clinical Medicine at UCLA

mind over stomach: the psychology of eating

aspartame

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

A. Janet Tomiyama, PhD, Assistant Professor of Psychology, Division of Health Psychology at UCLA

shake it up with protein

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

iron deficiency anemia

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

Rashmi Mullur, MD, Attending Physician, Department of Endocrinology: VA Greater Los Angeles Healthcare System, Assistant Professor, David Geffen School of Medicine at UCLA

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

copy-edits and review

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

layout revisions

Barbara Wong, Shannon Wongvibulsin, and Karin Yuen

cover & table of contents

Designed by Barbara Wong and Karin Yuen

capsaicin, spice, & everything nice

Eve Henry, MD, Clinical Instructor and Fellow UCLA Center for East-West Medicine

55

total wellness ▪ fall 2013

Ka-Kit Hui, MD, FACP, Wallis Annenberg Professor in Integrative Medicine, Director of the UCLA Center for East-West Medicine, Chair of UCLA Collaborative Centers for Integrative Medicine

excercise: can it improve cognition?

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