a ucla student wellness commission publication
health – it’s music to my ears
combat stress with music
got health insurance? it’s the law
your tongue – a map to your health ways to overcome your
nervous habits winter 14 | vol 14 | issue 2
a message from the director It’s something most of us want. It’s something we tend not to appreciate until we lose it. And, it’s something we can’t buy. What is it? This precious, priceless, often overlooked component of our life is health. Over the past few months, three key conversations have driven significant changes for Total Wellness Magazine. And, we’ve been busy implementing all of these changes to help you better understand, value, and preserve or regain your health. Although Total Wellness is primarily a magazine publication, we have been constantly brainstorming ideas to improve our direct connection with the community. As a result of our increased outreach efforts, you can now find us on Instagram (@totalwellnessmagazine), Twitter (@ totalwellnessLA), and Facebook (@TotalWellnessMagazine@ UCLA). And now, we are embracing our dedication to directly spreading health knowledge to another level.
total wellness ▪ winter 2014
The first of these series of transformative conversations began with a discussion with Raffi Tachdjian, MD, MPH, an assistant clinical professor of medicine and pediatrics in the Division of Allergy and Clinical Medicine at UCLA and a long time member of Total Wellness’ Advisor & Review Board. After reflecting on the progress Total Wellness has made with expanding our readership, increasing our presence online, and organizing events on campus to promote wellness, we decided that the next step in Total Wellness’ efforts for increasing health promotion would be hosting a health conference open to both UCLA and the wider community. Learn more about Total Wellness’ Conference on page 35 and join us on January 18th for a day filled with music for health. With the goal of organizing a health conference, the Total Wellness leadership team had the privilege of meeting with UCLA Associate Vice Provost Michael Goldstein, PhD, professor of Public Health at UCLA, senior research scientist at UCLA Center for Health Policy Research, and chair of UCLA Healthy Campus Initiative (HCI) steering community. Although this meeting was set up in order to plan for the event, the discussion that arose with Dr. Goldstein has impacted Total Wellness well beyond plans for the conference. In addition to supporting our conference to promote health, Dr. Goldstein is interested in working with Total Wellness on what he believes is a more fundamental issue – health disparities. According to Dr. Goldstein, as the health-conscious population continuously “consumes” more and more wellness resources, an even wider gap can arise between those who are in good health and those who suffer from poor health. Consequently, rather than mainly distributing our magazines at locations like the John Wooden Center, Arthur Ashe Center, and Ackerman Union, Total Wellness is now partnering with UCLA HCI to target our distribution towards underserved populations in an effort to bring resources about healthy living made simple to those who can benefit most from empowering knowledge about everyday wellness.
However, we understand that distributing the magazines is not enough; we also need our target audience to pick up the publication and gain motivation to read its content. As a result, this led to the third of the series of transformative discussions. Based upon the constitution of our staff, readership, and event attendees, we have noted that our audience is primarily female. Nevertheless, health is clearly something that is essential for both genders. In an effort to increase the appeal of Total Wellness to both males and females, we have been cognizant of the selection of our cover images, article topics, and overall design aesthetics. With protein shakes on the cover of our last issue and music on the cover of this one, we hope to communicate that the contents of our magazine contain something of value for all our readers, both male and female. In this issue, you’ll find articles on topics ranging from how to improve your posture (pg. 40-42) to how the Affordable Care Act (ACA) will impact your healthcare (pg. 43-46). Additionally, discover what the tongue can indicate about your health (pg. 8-11) as well as ways to improve your mood (pg. 21-24) or avoid unhealthy nervous habits (pg. 47-49). Since this issue is centered on the theme of our community conference on Music and Health, you can also read about the impact of music on the mind (pg. 28-34) and for stress-relief (pg. 36-38). At Total Wellness, health is certainly music to our ears. We hope that it’s also music to your ears, and that you will share the insights you gain through our articles with your family and friends. In order to achieve our goal of reaching out beyond our typical audience, we need your help. Be sure to connect with us on Instagram, Twitter, and Facebook as well as share this magazine (also available online at http://issuu.com/ totalwellnessmagazine). Have ideas and want to contact us? Email us at email@example.com. 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 Happy 2014, everyone! As the year begins, it’s time to look back at 2013 and see what we’ve accomplished since the last round of new year’s resolutions. Did you do everything you wanted to do? Are last year’s promises still in progress? No matter your answer, this year is a fresh slate. We have yet another year to work hard to become the best that we can be – and all we need is the drive and desire to get it done. This issue of Total Wellness aims to give you the information you need to start this year on the right track. We have articles covering a range of topics to help you tweak your mind and body to reflect whomever you’ve decided you want to be. Want to stand proud and tall this year? Learn the why and how of good posture on pg. 40-42. Want to keep your spirits up through those inevitable tough times? See what simple habits can help boost your mood on pg. 21-24. Looking to change up your exercise routine? Find out how accurate exercise machines and self-quantification devices actually are on pg. 25-26, and see what the fuss surrounding creatine supplements is about on pg. 50. Want to start eating better? Learn about some common college eating habits and how to kick them on pg. 12-15.
JULIE ESCOBAR Co-Copy Editor
TIFFANY LIN Co-Copy Editor
BARBARA WONG Co-Art Director
KARIN YUEN Co-Art Director
LESLIE CHANG Managing Editor
ANNIE THERIAULT Outreach Director
HARINI KOMPELLA Finance Director
KEVIN SUNG Webmaster
To help this new year be the start of a new, better you, we are kicking it off with a conference surrounding the the theme of this issue – join us and our guest speakers and performers on January 18th to learn about the role music can play in determining everyday wellbeing. And in the meantime, see our overview of how music can affect the mind and body on pg. 28-35, or check out some more specific topics such as music’s impact on stress and sleep (pg. 36-38) or the effect of music volume on the ears (pg. 7). With so much to look forward to already, this year is bound to be amazing! Wishing you luck with all of your goals for this year (healthrelated or otherwise),
total wellness ▪ winter 2014
Chalisa Prarasri Editor-in-Chief
words from the commissioner Hello Bruins! With 2014 already underway, there is a lot in store for you all this quarter from the Student Wellness Commission. This issue of Total Wellness Magazine is filled with articles regarding music and your health, as we gear up for Total Wellness’ Music For Your Health Conference on January 18th! From a stress reliever to workout aide, music has many wonderful powers over our health. Flip through these pages and learn more. That’s not all we’ve got. On January 22nd, Student Wellness Commission will host Super QPR: Question, Persuade, Refer. This program is meant to break the stigma regarding mental health and educate students on the necessary steps to take, when a friend, family member, or peer comes to you regarding anxiety, depression, or suicide. In addition, our Body Image Task Force will be putting on its 2nd annual I <3 My Body Week from February 17th - 21st. I <3 My Body Week highlights body image positivity and the dangers of eating disorders, through yoga, panels, guest speakers, photography, art, and student expression.
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Our largest event this quarter will be 7000 in Solidarity: Consent Week. From January 27th - 31st, 7000 in Solidarity: A Campaign Against Sexual Assault will be hosting fairs throughout the week in various locations on campus with campus resources and educational booths present to educate students on sexual assault, survivor resources, and their Title IX rights. At night, we will host events from survivor sensitivity workshops, panels, and a speaker event featuring one of the biggest college sexual assault prevention activists in the nation, Annie E. Clark from the IX Network. We hope you will join us to inform yourself on your rights and resources, as well as know what to do in case a sexual assault survivor comes to you for help. Those are just some of the events Student Wellness Commission is hosting this quarter. To check out the rest of them – and there are many, many more, please visit our website at swc.ucla.edu! Stay Happy & Healthy,
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, Vesta Partovi, Elsbeth Sites, Rebecca Tang, Emily White, Pauline Yang Design Natalie Chong , Emily Hsu, Allison Newell, Catrina Pang, 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 firstname.lastname@example.org www.totalwellnessmagazine.org www.swc.ucla.edu Subscription, back issues, and advertising rates available on request
Savannah Badalich SWC Commissioner
Volume 14, Issue 2 © 2014 by Total Wellness Magazine. All rights reserved. Parts of this magazine may be reproduced only with written permission from the editor. Although every precaution has been taken to ensure the accuracy of the published material, Total Wellness cannot be held responsible for the opinions expressed or facts supplied by authors. We do not necessarily endorse products and services advertised. The information in Total Wellness is not intended as medical advice and should not replace the advice of your physician. Always consult a health care provider for clarification.
IN EVERY ISSUE 02 03 04 06 07 51
A Message from the Director Editorâ€™s Note & Leadership Words from the Commissioner In the News Q&A Credits
DEPARTMENTS 08 self care What Your Tongue Can Say About Your Health 12 eat well Eating Your Way to New Healthy Habits
16 move well Namaste: Promoting Mental Wellness Through Yoga 21 mind well Mood Boosting Habits 25 body in focus Only Just a Number 50 decoding the nutrition label Creatine
28 cover story Health is Music to My Ears 36 Musical Beats for Sleep & Stress Relief 40 The Importance of Posture 43 Getting Informed: New Changes in Our Healthcare System 47 Nail Biting, Hair Pulling, Skin Picking, Oh My!
12 total wellness â–Ş winter 2014
cover: original illustrations by karen yuen; right(in order): original illustration by karen yuen; therachelkay/istockphoto; synergee/ istockphoto; demid/ istcokphoto; original illustration by jessica sun
ON THE COVER 08 28 36 47 43
Your Tongue & Health Health and Music Music, Sleep, & Stress Nervous Habits Healthcare System
in the news
what’s happening in health? by shannon wongvibulsin| design by barbara wong
RESEARCH AND NEW FINDINGS ANTIBACTERIAL SOAPS - MORE HARM THAN GOOD?
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AN APPLE A DAY MAY SAVE THOUSANDS OF LIVES
Although statins are the common drugs prescribed to individuals with high risk for cardiovascular disease, Oxford University researchers have recently found that consuming an apple each day without increasing overall caloric intake could save a comparable amount of lives. The scientists examined individuals over the age of 50 residing in Britain and used data modeling to determine the influence of placing this group on statins versus eating an apple a day. From this analysis, the researchers predicted about 9,500 fewer deaths per year if the entire population over the age of 50 used statins. However, with an apple a day, they found a similar benefit: “8,500 fewer deaths from heart disease and stroke every year.” Since more research is still necessary, individuals currently on statins should not attempt to replace their medications with apples. However, these patients may benefit from adding an apple a day to their diet while still continuing with their statin medications.3-4
HIGH TESTOSTERONE LEVELS MAY RESULT IN WEAKER IMMUNE SYSTEMS
Recent research published in the Proceedings of the National Academy of Sciences (PNAS) found that men with higher levels of testosterone are more likely to be unresponsive to a vaccine against the H3N2 flu strain. This finding suggests that higher levels of testosterone correspond to weaker immune systems. In the study, the vaccine was given to male and female participants. Afterwards, the scientists measured the subjects’ responses to the vaccine by examining the expression of genes and proteins related to the immune system. From this analysis, the researchers found that high-testosterone males had the weakest response to the vaccine, while low-testosterone males responded roughly in an equal manner to females.5
AT UCLA TRANSIT DIFFERENCES IN AIR POLLUTION BETWEEN LA NEIGHBORHOODS
After collecting real-time air pollutant concentration measurements in 4 Los Angeles neighborhoods (Boyle Heights, downtown Los Angeles, West Los Angeles, and Mar Vista), UCLA researchers found that there were very large differences in pollutant levels between these communities based upon measurements taken in the summer afternoons. Specifically, they discovered that the Mar Vista community (also known as the North Westdale neighborhood) has “possibly among the highest concentrations of any neighborhood in the Los Angeles area.” This high level of pollution could be due to the fact that the community is greatly impacted by the pollutants resulting from aircraft activities at the Santa Monica Airport. Rather than focusing on smog and ozone levels, this research (published in Atmospheric Environment) is novel in that it examined differences in freshly emitted pollutants at the neighborhood level.6 t w References 1 “Antibacterial soaps come under FDA scrutiny.” mnt.com. (2013). 2 “FDA: Antibacterial soaps could pose health risks.” usatoday.com. (2013). 3 “An apple a day could save thousands of lives, study indicates.” foxnews.com. (2013). 4 “An apple a day keeps the doctor away.” bmj.com. (2013). 5 “Testosterone may make men likely to get the flu, study finds.” nbcnews.com. (2013). 6 “UCLA study: L.A. neighborhoods show striking differences in transit-related air pollution.” newsroom.ucla.com. (2013).
1 5 in
deaths annually are caused by cigarette smoking
1/3 approximate fraction of cancers that are preventable
rank of US healthcare system among 27 highincome nations in terms of efficiency
left (in order): andydidyk/istockphoto; dcdr/ istockphoto; right: original illustrations by karen yuen
Because of the widespread use of “antibacterial” soaps and body washes, the Food and Drug Administration (FDA) has issued a proposed rule that requires manufacturers to submit data to demonstrate that their “antibacterial” products are safe as well as more effective than plain soap and water. There is uncertainty whether the key components (triclosan and triclocarban) are actually effective germ-killing ingredients. Additionally, there are potential health risks associated with the use of these products. For example, antibacterial ingredients may interfere with hormone levels. Furthermore, some are concerned about the development of antibiotic resistance in bacteria. As a result, if companies cannot submit data to the FDA by December 2014 that demonstrate the safety and effectiveness of their “antibacterial” products over plain soap and water, these products will need to be reformulated or relabeled to stay on the market.1-2
can your music be too loud? by lillie luu nguyen | illustration and design by
Yes, your music can be too loud. Almost everyone is exposed to music on a daily basis, whether it’s through earphones on the way to class, on the radio in the car, or at a live performance. Music can act as a tool to assist people in concentrating better during exercise or their studies. Additionally, some use music as an outlet to release strong emotions of love, pain, or joy. However, many people may not be aware that listening to music that is too loud can have harmful effects on the physical wellbeing of ears as well as their mental health.
how loud is TOO loud?
As the surrounding environment gets noisier, the tendency is to increase the volume. If one were to listen to high volume music in the 120 to 129 decibels (dB) range, it would be equivalent to being at a live concert!1 However, when earbuds are placed into the ear, the output level can be boosted by an additional 7 to 9 dB.2 When using normal earbuds or headphones, if you cannot hear yourself speak during a normal conversation (60 dB), chances are that your music device’s volume is set too high to be at a safe limit. According to the National Institute for Occupational Safety and Health (NIOSH), the recommended safe threshold is 85 dB or less in 8 hours to keep hearing loss at a minimum.3 This is equivalent to standing next to a blender in use.4 Other proposed noise exposure times by the Occupational Safety and Health Administration (OSHA) are: duration per day (hr) 8 6 4 3 2 1.5 1 0.5 < 0.25
sound level (dBA*) 90 92 95 97 100 102 105 110 115
It’s important to emphasize that everyone’s individual susceptibility to noise-induced hearing loss varies. We don’t know who has “tough” ears and who has “tender” ears until it’s too late – there’s no way to predict prior to the damage being done.
what happens if the limit is exceeded?
physical Sound makes stereocilia, the sensory components of hair cells in the inner ear, rock back and forth. If the sound is too loud, the stereocilia can be bent or broken. This will cause the hair cell to die, rendering it incapable of sending sound signals to the brain. Once a hair cell dies, it will never grow back; when multiple hair cells are damaged or die, hearing loss ensues. The high frequency hair cells are the most easily damaged, so people with hearing loss from loud sounds often have problems hearing high pitched things like crickets or birds chirping.6 Excessively loud sounds can also cause tinnitus, a ringing, roaring, buzzing, or clicking in the ears.7 According to Alison Grimes (AuD, assistant clinical professor in Head and Neck Surgery and head of the Audiology Clinic at UCLA Medical Center), “It’s valuable to remember that noise exposure is cumulative over the lifetime: a concert or two every year, working with power tools intermittently, going to a few noisy football games in college, working in a factory – it all adds up to cause permanent hearing loss.” mood According to a 2013 study in Public Library of Science ONE, noise-induced hearing loss can cause various problems such as a poorer quality of life related to reduced social interactions, isolation, a sense of exclusion, depression, and possibly impaired cognitive function.8
ways to prevent hearing loss
The simplest method to reduce the risk of hearing problems is to lower the volume to levels comfortable enough that the ears are not overstimulated or strained. Moving away from the sound source should also be attempted when possible – the greater the distance, the lower the intensity. Avoiding prolonged noise exposure is also advised. Ear protection, such as earplugs and earmuffs, is helpful in situations where loud noises cannot be avoided, such as in industrial settings.9 t w References 1. “Harmful noise levels.” webmd.com. (2011). 2. “Output levels of commercially available portable compact disc players and the potential risk to hearing.” Ear Hear. (2004). 3. “Safety and Health Topics | Occupational Noise Exposure.” osha.gov. (2011). 4. “Dangerous Decibels: Frequently Asked Questions.” dangerousdecibels.org. (2013). 5. “Occupational Safety and Health Administration.” osha.gov. (2013). 6. “How do we hear?” dangerousdecibels.org. (2013). 7. “Decibel Hell: The Effects of Living in a Noisy World.” Environ Health Perspect. (2005). 8. “Epidemiology of Noise-Induced Tinnitus and the Attitudes and Beliefs towards Noise and Hearing Protection in Adolescents.” PLoS ONE. (2013). 9. “H.E.A.R. | Are you at risk?” hearnet.com. (2013).
total wellness ▪ winter 2014
* These proposed noise exposure times are the sound levels recommended by OSHA for different durations in a day. To put things in perspective, a jet taking off 100 meters (328.1 feet) away is between 120 to 130 dBA, 110 dBA is equivalent to being at a disco, and the sound of a jackhammer 15 meters (49.21 feet) away is between 90 to 100 dBA.5 The discrepancy between dB and dBA is that dB sound pressure levels are weighted, while dBA levels are weighted according to how the human ears perceive sound.
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What Your Tongue Can Say About Your Health
Not just for taste, the tongue is a vital organ in the body that plays key roles in facilitating digestion, forming speech, and providing the ability to taste. It contorts to assist swallowing, repositions to form phonetic sounds, and receives and relays salty, sweet, bitter, sour, and umami sensations from the foods we eat. While most people are cognizant of the kinetic and sensory functions of the tongue, many are unaware of the role that the tongue’s appearance can play in the evaluation of one’s health.
Remember your last doctor’s visit? Chances are, your practitioner asked you to “stick out your tongue.” In Western medicine, this is a common practice that allows a quick evaluation of the tongue and throat. Physicians and dentists usually look at the tongue for signs of nutritional deficiencies or more serious signs of cancer. The tongue is an important determinant of health in medical practices from around the world too. For example, in traditional Chinese medicine, practitioners place emphasis on the tongue for diagnostic evaluations, believing that the tongue actually reflects all the diseases of the body.
original illustrations by karen yuen
total wellness ▪ winter 2014
by vesta partovi | illustration and design by
what traditional chinese medicine has to say
Because it contains water, electrolytes, mucus, and enzymes, the tongue’s appearance is said to change with many physical changes in the body.1
heart/small intestine network
tongue color › deepening: A deviation from normal pink to a darker red or purple is thought to indicate increasing heat in the body. In traditional Chinese medicine, heat may mean inflammation, infection, hyperactivity of the organ network, or blood stasis. The color of the tongue may appear darker in different parts of the tongue relating to various organs in the body. For example, deep colored spots in the liver zone are thought to point to stagnation in the liver network, most commonly a serious issue of liver cirrhosis or cancer.1 › lightening: A deviation from normal pink to a pale or paper white indicates what traditional Chinese medicine calls a “cold symptom,” which can mean anemia, a sign of infection, or low energy and can give information as to the function of the corresponding organ network.1 tongue coating › A coating that is too thick is believed to be a sign of imbalance in the digestive system and decreased immune system function. › A yellow coating is thought to be a sign of a pathogen or inflammation in the body. › A peeling coat is thought to be a sign of damage or weakening to certain systems of the body. › The appearance of numerous distinctly red prickles on the tip of the tongue coupled with a red tongue and thick yellow/ white coating has been found to indicate appendicitis.2
total wellness ▪ winter 2014
ork liver netw
1) the tip: fire element, which corresponds to the heart/small intestine network 2) behind the tip: metal element, which corresponds to the respiratory-immune network 3) the sides: wood element, which corresponds to the liver network 4) the center: earth element, which corresponds to the stomach-spleen-pancreas network 5) the back: water element, which corresponds to the kidneybladder-hormonal network
liver netw ork
In traditional Chinese medicine, the tongue is a very indicative organ. It is seen as a “map” of the internal body. Its surface is divided into five-element zones: fire, wood, metal, earth, and water that correspond to one’s internal organ networks.
what western medicine has to say Regardless of which practice a person ascribes to, both Western medicine and traditional Chinese medicine agree that a healthy tongue shares these 4 qualities:3
1) pink or light red in color 2) smooth in texture with raised papillae (the visible bumps on the tongue in which taste buds are embedded) 3) proportionate in size (not inflamed or swollen) 4) thin, clear-white coating Anything out of the normal range for these 4 characteristics could indicate something wrong with your overall health. Here are a few distinct case examples.
“fiery, beefy, red”
color: This combination of appearances indicates very red a nutritional deficiency, most likely of texture: the vitamin B12. B-vitamin deficiencies shiny and smooth, or “bald” often manifest themselves as a type of (missing normal papillae) oral condition known as “glossitis” whose symptoms vary, but include the tongue’s: loss size: of papillae, change of color, swelling, burning, swollen with painful or pain. In the case of B12 deficiency, these burning sensation are the specific symptoms of glossitis, often coating: described as “fiery, beefy, and red.”4 normal
“smooth, tender, pale”
color: These symptoms point to glossitis caused by pale iron deficiency anemia. In this case, the lack texture: of hemoglobin in the blood gives the tongue shiny and smooth, or “bald” its pallor. Other symptoms of anemia-induced glossitis may include oral ulcerations, burning, (missing normal papillae) size: and lesions.5
When the tongue looks white and pasty – in patches or in its entirety – it’s an indication that there’s probably some sort of infection present on the tongue, such as an overgrowth or an autoimmunerelated inflammatory disease. One possible cause is thrush, which is an overgrowth of the fungus Candida (or yeast). Thrush can occur as a result of long-term or high dose antibiotic use, during which the healthy bacteria that help keep Candida from growing too much under normal circumstances are eliminated.6
If thrush is not the cause of a patchy, white tongue, the answer may be leukoplakia, a reaction to chronic irritation of the mucus membranes of the mouth. Among the causes of this chronic irritation are rough teeth or dental devices that rub against the cheek and gum, chronic smoking, and general tobacco use. Leukoplakia is usually harmless; however, it can be an early signifier of oral cancer.7
normal with patchy lesions size:
thick, pasty, white
original illustrations by karen yuen
total wellness ▪ winter 2014
“pasty, patchy, white”
“pasty, smelly, yellow” color:
A tongue with a pasty, yellow coating could indicate signs of bacteria, which produce hydrogen sulfide and cause halitosis,8 or bad breath. It is the type of bacteria and not the amount of bacteria that link the yellow coating to halitosis. According to a 2003 article published in the Journal of Clinical Microbiology, Solobacterium moorei, Eubacterium sulci, and Atopobium parvulum are the most probable culprits of bad breath when present on the tongue, while tongue coatings with Streptococcus salivarius and Rothia mucilaginosa present did not cause halitosis.9 If you want to learn more about how to conquer bad breath, check out Hocus Pocus Halitosis in our Issue 3, Volume 13.
“black hairy tongue” color:
black, “hairy” size:
“Black Hairy Tongue” is a harmless, temporary, but unsightly overgrowth of tongue papillae that traps bacteria and other debris to create the appearance of black “hair.” The cause of this tongue condition could be anything from poor oral hygiene, mouth-breathing, excessive use of tobacco, mouthwashes, some antibiotics, or bismuthbased medications. Along with the appearance change, sufferers of black hairy tongue might notice a metallic taste in the mouth and generally bad breath.10
“strawberry tongue” color:
dark red texture:
bumpy with enlarged papillae size:
white or none
The external appearance of your tongue is a littleknown indicator of the state of one’s internal health. The conditions described demonstrate how a combination of features can reveal different conditions, ranging from harmless to serious. Whether it’s through the techniques of Western medicine or traditional Chinese medicine, examine your tongue regularly to check for signs of ailment and upkeep your self-care! t w
the self-care column is sponsored by UCLA Health System: UCLA Center for East-West Medicine References 1. “Tongue Inspection: How’s Your Health?” acupuncture.com. (2010). 2. “Tongue image analysis for appendicitis diagnosis.” Inf Sci. (2005). 3. “Integrating next-generation sequencing and traditional tongue diagnosis to determine tongue coating microbiome.” Sci Rep. (2012). 4. “The Clinical Features of Chronic Vitamin Deficiency.” Geront Clin. (1986). 5. “Glossitis.” nlm.nih.gov. (2013). 6. “Thrush.” nlm.nih.gov. (2012). 7. “Leukoplakia.” nlm.nih.gov. (2011). 8. “Hydrogen sulfide-producing bacteria in tongue biofilm and their relationship with oral malodour.” J Med Microbiol. (2005). 9. “Diversity of Bacterial Populations on the Tongue Dorsa of Patients with Halitosis and Healthy Patients.” J Clin Microbiol. (2003). 10. “Black, hairy tongue.” mayoclinic.com. (2011). 11. “Prolonged use of a diaphragm and toxic shock.” Fertil Steril. (1982). 12. “Scarlet Fever: A Group A Streptococcal Infection.” cdc.gov. (2013). 13. “Kawasaki Disease.” nlm.nih.gov. (2013).
total wellness ▪ winter 2014
take home message
These symptoms are indicative of “Strawberry Tongue,” which can either appear as “White Strawberry Tongue” or “Red Strawberry Tongue.” “Strawberry Tongue” is another type of glossitis which occurs as a result of toxic shock syndrome (a staph infection that can affect anyone, but is commonly associated with tampon use in menstruating women),11 scarlet fever (a strep infection commonly affecting children ages 5 to 12),12 or kawasaki disease (an auto-immune disorder most common in children under 5).13
eating your way to new healthy habits
With busy schedules and long days, developing a regular eating routine can be difficult. Work and school often take priority, and over time, some unhealthy choices can turn into stubborn habits. Here, we take a look at some of those eating habits, what their potential consequences could be, and how you can improve them in the new year. 12
left: christian baitg/istockphoto; right(in order): ericsphotography/istockphoto; mitgirl/istockphoto
total wellness â–Ş winter 2014
by emily white | design by alex villanueva
the facts: One review published in the Asia Pacific Journal of Clinical Nutrition in 2012 suggests that the overall rate of metabolism in the body may be affected by rapid eating, potentially leading to overeating and obesity. Eating rapidly also interrupts the body’s natural cycle of satiation, so it is less obvious when the body is actually satisfied.1
the problem: eating in a rush Busy days do not always allow for lengthy mealtimes, so food is often finished in a rush or eaten on the way to the next stop.
how to improve: Eating more slowly has many positive effects on digestive health. Finding the time to enjoy regular meals, rather than gobbling on the go, will allow you to not only feel more satisfied after eating, but also healthier in the long run. Mealtime is perfect for catching up with friends and regrouping before attacking the rest of the day, so take advantage of it and enjoy a slower-paced, stressfree break.
According to a 2013 study in World Journal of Gastroenterology, rapid eating can also contribute to chest pain and weakening of muscles in the esophagus, as well as inadequate chewing, which may result in further damage to the esophagus and digestive tract.2 Additionally, in a 2013 study done on female students in Japan suggested that rapid eating may correlate to higher body fat ratios, and therefore a higher body mass index (BMI) and risk for obesity.3
the problem: mindless snacking
how to improve: Again, having a snack when you are hungry is encouraged. Through more conscious eating, getting an adequate amount of sleep, and stocking up on healthy snacks like cut veggies, nuts, or dried fruit to eat after a long night, you can make more satisfying choices, rather than filling up on empty snacks.
Major caloric intake (almost 50 to 75% of daily calories) for late-night snackers comes from those late-night snacks, which are usually lacking in nutrients, according to a study published in the Indian Journal of Psychological Medicine in 2010.5 Late-night snacking on high-fat foods can also have negative effects on sleep quality, as reported by the Journal of Clinical Sleep Medicine in 2011. Subjects who ate 30 to 60 minutes before sleep, especially foods high in fat, seemed to have shorter rapid eye movement (REM) periods (the cycle that provides the brain and body with energy and processes knowledge), reducing the overall quality of a night’s rest.6
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Those with busy days are especially susceptible to mindless late-night snacking while studying, watching TV, or going out with friends. It is important to eat when you feel hungry. However, be aware of how you feel and what exactly you are consuming.
In a study on snacking from the Nutrition Journal, snack foods were found to make up almost 1/4 of US adults’ total daily energy intake. Additionally, the study found that eating lower calorie, yet more nutrient-rich food (low-fat popcorn in this case), prevented overeating at the next meal. High-fat snack foods, as well as eating when not hungry, contributed to weight gain in follow-up studies.4
the facts: Aside from causing one to feel sluggish or sick, binge eating may indicate other more unhealthy habits and consequences.
the problem: binge eating Jam-packed days allow for less time to eat solid, regular meals, so overeating during free time or times of high stress is hard to avoid.
how to improve: Maintaining a regular eating schedule, and not letting hunger levels get too high during the day, is a good way to prevent binge eating. Practicing mindful eating, as well as minimizing stress and getting enough sleep, can also help to reduce weight gain and increase overall health.
One study published in The International Journal of Behavioral Nutrition and Physical Activity in 2013 suggests that overeating can be an effect of unhealthy behaviors such as starvation, whether it is to lose weight or not. Going long stretches of time without eating may induce a binge to compensate, causing obesity in the long term.7 A 2011 study from Sleep reveals a potential connection between sleep deprivation and overeating and gaining weight. The exact reason for this is unknown, but the statistical evidence indicates that there is a strong association between lack of sleep and uninhibited eating behaviors.8 Furthermore, according to a 2013 study from Journal of Obesity, times of high stress or anxiety can contribute to binge eating, which in turn increases the risk for weight gain and obesity. When emotions are running high, the selfregulation process for eating may become inhibited, causing binge eating and weight gain.9
the facts: In a 2013 study from Frontiers in Human Neuroscience, researchers found that eating breakfast regularly promotes a stable metabolism, which can improve cognitive performance and mood.11
total wellness â–Ş winter 2014
As found in a 2011 study by the National Purchase Diary, about 1 in 10 Americans does not eat breakfast. Among younger demographics (ages 18 to 34) this percentage is even higher, suggesting that 28% of males and 18% of females skip breakfast.10 Allowing for time to eat in the morning is not always easy, yet it is an important aspect of a healthy lifestyle.
how to improve: Aim to find a little extra time in the morning to eat a nutrient-packed breakfast, including whole grains and fiber, for maximum performance throughout the day. On-the-go meals like whole-wheat toast and nut butter, hard-boiled eggs, greek yogurt, or cut-up fruit are quick and easy options. Just taking a few minutes to eat in the morning may make all the difference for the rest of the day.
According to a study in Nutrition Research and Practice from 2011, skipping breakfast can be specifically correlated to anemia, a condition when the body is low on healthy red blood cells.12 This can result in shortness of breath, dizziness, and low energy.13 Read more about anemia in the Iron Deficiency Anemia article in Total Wellness Issue 1, Volume 14. Skipping breakfast may be related to appetite and blood sugar control resulting in diabetes, obesity, and other chronic diseases as found in a study from The Journal of Nutrition in 2011.14 In other words, eating breakfast may curb cravings throughout the day, while potentially minimizing risk for diabetes and obesity. Specifically for women, skipping breakfast can also cause irregular menstruation and other menstrual disorders according to a study published in Appetite in 2010.15
left: traveler1116/istockphoto; demid/istockphoto
the problem: skipping breakfast
An Enchanting Evening
the bottom line: Maintaining regular, healthy eating habits is an important aspect of a healthy lifestyle. Though it is easy to fall into bad habits during busy days, focusing on eating may have many positive effects, both mental and physical. By preparing healthy snacks ahead of time, breakfast becomes a breeze and snack cravings can be curbed. Getting enough sleep and attempting to eat more leisurely can both minimize stress and help prevent a variety of digestive and weight-related problems. The New Year is a fresh slate, so try adopting some new healthy habits to start the year off right. tw
References 1. “Sasang types may differ in eating rate, meal size, and regular appetite: a systematic literature review.” Asia Pac J Clin Nutr. (2012). 2. “Habitual rapid food intake and ineffective esophageal motility.” World J Gastroenterol. (2013). 3. “Cross-sectional study of possible association between rapid eating and high body fat rates among female Japanese college students.” J Nutr Sci Vitaminol. (2013). 4. “Popcorn is more satiating than potato chips in normal-weight adults.” Nutr J. (2012). 5. “Assessment of Night Eating Syndrome Among Late Adolescents.” Indian J Psychol Med. (2010). 6. “Relationship between food intake and sleep pattern in healthy individuals.” J Clin Sleep Med. (2011). 7. “Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings.” Int J Behav Nutr Phys Act. (2013). 8. “The association between short sleep duration and weight gain is dependent on disinhibited eating behavior in adults.” Sleep. (2011). 9. “The Clinical Obesity Maintenance Model: An Integration of Psychological Constructs including Mood, Emotional Regulation, Disordered Overeating, Habitual Cluster Behaviours, Health Literacy and Cognitive Function.” J Obes. (2013). 10. “ 31 Million U.S. Consumers Skip Breakfast Each Day, Reports NPD.” npd.com. (2011). 11. “Breakfast and cognition: sixteen effects in nine populations, no single recipe.” Front Hum Neurosci. (2013). 12. “Energy and nutrient intake and food patterns among Turkish university students.” Nutr Res Pract. (2011). 13. “What Are the Signs and Symptoms of Anemia?” nih.gov. (2012). 14. “Breakfast frequency and quality may affect glycemia and appetite in adults and children.” J Nutr. (2011). 15. “Skipping breakfast is associated with reproductive dysfunction in post-adolescent female college students.” Appetite. (2010).
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total wellness ▪ winter 2014
namaste: promoting mental wellness through yoga by sepideh parhami | design by allison newell
total wellness ▪ winter 2014
come as a shock that 1 in 4 American adults suffers from a mental disorder during a given year, with a quarter of those cases being classified as “severe.”1 With an estimated 60 million Americans whose quality of life is compromised by mental illness at a given moment in time,1-2 US health professionals have devoted much of their research to improving treatment of mental disorders, which has included investigating alternative therapies to supplement medical intervention. Yoga, with its 5,000 year history as an Eastern practice that develops mental, physical, and spiritual discipline, has been embraced as one such course of treatment. A yoga practice typically involves conscious body alignment or posture (asanas), hand positions (mudras), breath work, and internalizing mantras.3 There exist about 22 distinct types of yoga. Hatha and its emphasis on asanas is the most iconic in the US.3
Researchers and doctors have found that the ancient mind-body practice of yoga has potential not only to alleviate the emotional component of distress, but also to physically rewire the brain and body to fight stressors more effectively. But how exactly does yoga reshape the mind, and how can one maximize these benefits? Your answers ensue. May your newfound knowledge and revamped yoga practice help you say “namaste” (nah-muhstay, a reverential Sanskrit greeting) to inner tranquility.
left: synergee/istockphoto right(in order): stereohype/istockphoto
Because mental illness is often an invisible source of human burden, it may
vidya ›› bidding stress, sleeplessness, and sadness farewell with yoga stress what’s wrong: You’re feeling overwhelmed, unusually
tired, achy, or anxious. Or, as is true of the vast majority of American adults, your mere existence invites stress. science’s question: Can the challenging, strengthbuilding postures in yoga condition our bodies to better cope with stress? yoga’s answer: Inflammation, a swelling of tissues in the heart, skin, and hormone glands, is considered a biological indicator of stress levels. A 2010 study published in Psychosomatic Medicine revealed that yoga experts have quicker, less aggressive inflammatory responses to stress than novices do, suggesting that the experts’ bodies were better equipped to fight stress.4 Thus, the physical conditioning that comes as a reward from regular yoga practice can ward off bodily harm and psychological symptoms caused by stress. The novice yogi can also steer away inflammation. UCLA Semel Institute researchers recently conducted a study on caregivers under extreme stress and concluded that short, daily yoga-style meditation sessions modified gene expression to reduce inflammatory responses. Additionally, yoga was found to rebuild the immune system, which had been weakened by stress.5 Current research also suggests that stress can accelerate aging of brain cells, which can compromise mood and cognitive function. But fear not: findings from a 2013 study led by Helen Lavretsky (MD, a physician within the Psychiatry Department at UCLA David Geffen School of Medicine) showed that yogic meditation can reduce depression and unclear thinking while boosting a type of immune system activity that can slow down body and brain aging.6
what’s wrong: You’re physically and mentally
exhausted and have a hard time getting rest despite a desire to sleep. science’s question: Can yoga increase vigor and decrease fatigue? yoga’s answer: A 2012 study by the UCLA Medical Center, published in Cancer, determined that breast cancer survivors who attended 90 minute yoga classes 2 times a week experienced a statistically significant
depression what’s wrong: You’ve noticed a sudden onset of
extreme fatigue and restlessness, overwhelming sadness, difficulty experiencing pleasure, and/or feelings of inferiority. science’s question: How can yoga alleviate depression? yoga’s answer: The Indian Journal of Psychiatry published a 2013 study that showed a correlation between high levels of cortisol, “the stress hormone,” and depression. Using analytical techniques and a standardized psychological survey, researchers found that 1 month of daily home yoga practice resulted in a drop in cortisol levels, self-reported decreases in depressive symptoms, and an improved disposition.8
chemical imbalance what’s wrong: With chemical imbalances, certain
neurotransmitters (molecules in the brain that carry nervous system signals) made of amino acids aren’t acting optimally, hindering the body’s recovery from trauma and excessive adrenaline. This imbalance means that your body stays in a panicked state, devoting its energy to “fight or flight” and not to the body’s metabolic needs. science’s question: Does yoga enhance neurotransmitter activity to promote emotional and physical recovery after stressful events? yoga’s answer: A 2012 study published in Medical Hypotheses found that yoga increases electrical impulses down the vagus nerve, a major nerve that spans the brain to the torso and conveys signals from the brain to the body’s other organs. This vagus nerve activity increases metabolic function, which in return promotes growth and repair throughout the entire body. Even a single yoga session can increase vagus nerve signaling, but regular practice is more likely to elicit long-lasting gains.9
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decrease in their symptoms of chronic fatigue.7 The participants overall also saw “changes in vigor, depressive symptoms… [and] perceived stress.”7 The researchers hypothesize that yoga’s effects on the immune and neuroendocrine systems resulted in this improvement, but further studies examining these systems are needed to see if the same gains would be made in non-cancer patients.7
meditating on some less common disorders hypertension: Classified as a pressure reading at or above 140/90 mmHg (a unit of pressure) of
blood flowing through vessels, hypertension can cause stress on both brain and body systems, since the body has to work harder to circulate blood. A 2012 study put forth in the Canadian Journal of Cardiology suggested that the “mindfulness based stress reduction” component of yoga may lower blood pressure among already medicated hypertensives.10
schizophrenia: Schizophrenia is a serious mental illness marked by hallucinations, paranoia, and
psychotic episodes. A 2012 study in Acta Psychiatrica Scandinavica studied the effect of yoga intervention on diagnosed schizophrenics and used the “World Health Organization Quality of Life” questionnaire to show a decline in psychotic symptoms after sustained yoga sessions.11
ptsd: PTSD stands for post-traumatic stress disorder, a severe condition that can develop in the
aftermath of tragedy, such as war, mass casualty, or sexual assault. Memories or reminders of the tragic event can trigger panic attacks and cause the person to relive the horror. According to a 2013 clinical study in the Journal of Investigative Medicine, “mind-body practices were found to be a viable intervention to improve the constellation of PTSD symptoms such as intrusive memories, avoidance, and increased emotional arousal.”12
namaste ›› hello to vitality and inner peace total (mind-body) wellness Beyond the discussed physiological benefits, mental care experts seem to agree that yoga strengthens the psyche, promoting compassion for oneself and humanity as a whole.
teamwork... from such a personal activity?
“A series of experiments conducted by organizational behavior researchers at Stanford University and published in [...] Psychological Science [in 2009] suggest that acting in synchrony with others [...] can increase cooperation and collectivism among group members,”13 creating a sense of camaraderie and companionship among yogis who practice together.
Stanford University health psychologist and yoga instructor Kelly McGonigal, PhD, brings up a valuable perspective on the spiritual, self-discovery aspect of yoga: “In a yoga class, everyone is moving and breathing in at the same time and I think that’s one of the undervalued mechanisms that yoga can really help with: giving people that sense of belonging, of being part of something bigger.”13
where yoga fits in your routine Yoga blogger and teacher Eve Johnson offers the advice that “you’ve practiced enough when you see continuing improvement in your poses.”14 For someone who wants to embrace a moderate practice, just 15 or 20 minutes of both static and moving postures per session should provide strength and clarity that would be otherwise unrealized. A regular practice is recommended in order to see lasting changes in your mental wellbeing: it doesn’t need to be daily, but practice as frequently as you’re comfortable with.
left(in order): leontuna/istockphoto; stereohype/istockphoto; right(in order): juanmonino/ istockphoto; alexandernovikov/istockphoto; alexandernovikov/istockphoto; yuri_arcurs/ istockphoto
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the human experience and life’s bigger picture
postures to incorporate into your practice passive inversions
Passive inversions are where the head hangs lower than the heart, improving blood flow to the brain and delivering oxygen and nutrients to the upper body.7
posture to try: rabbit pose
Kneel on the ground with your thighs perpendicular to the floor. Grasp your heels from the outside. Inhale and tuck your chin into your chest and bend forward until your forehead rests against your knees and the top of your head presses into the ground. Be careful not to twist your neck while you are holding the pose. Hold for about 20 seconds, and come out of the posture. Follow up with a backbend to release pressure in the spine.
Backbends elongate the spine, promoting blood flow while amplifying nervous system signals.7
posture to try: camel pose
Again, kneel on the ground with your thighs perpendicular to the floor. Cusp your hands around the outside of your heels. Put your body weight into your hands and tilt your head back, letting go of tension in your neck. Arch your upper back as much as possible, creating a C-shaped curve in your spine. Hold for about 10 seconds the first time you perform the pose, as you may feel lightheaded once you come back up. Hold the pose for up to 20 seconds in the future.
Balances require your full attention and centered focus in order for you to not fall over. This can be a strategy for silencing intrusive thoughts.
posture to try: tree pose
Stand with your feet parallel to each other, knees touching each other and big toes touching each other. Lift your right leg up with your hand and position your foot against your inner thigh, with your leg turned out to the right side as much as possible. Hold your hands with your palms together in a prayer position and look straight ahead to establish your balance, then swing your arms straight overhead palms together and hold the pose for as long as you can. Repeat with the left leg.
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Using supportive “props” (such as foam blocks or blankets) decreases the amount of strain on the body by limiting how much you have to contort yourself while protecting against poor form.
posture to try: supported forward bend
Stand again with your feet parallel to each other, knees touching each other and big toes touching each other. Place 2 foam blocks on the floor about 2 inches in front of your toes, and bend forward from the waist holding your spine straight. Once you can’t go any further, let the head hang, and reach your arms for the blocks on the ground. Allow the blocks to support the weight of your body. Hold for about 10 seconds and come back to standing position. In this pose, the blocks lessen strain on the hamstrings as you stretch them. This is also an example of an inversion.
just breathe Oxygen is extremely important to cognitive processes, since the brain needs about 3 times as much oxygen as body muscles do, and brain cells thrive only when blood is properly oxygenated.15 As you practice yoga, be sure to breathe in through the nose and out through the nose to stimulate the pineal gland,16 a key component of the endocrine system that regulates rest and repair. If you are focusing on breathing and not on holding a posture, deep breathing in through the nose and out through the mouth allows a greater volume of filtered air to flow through and revitalize the body.16 Engage the diaphragm (the large muscle below the lungs) to achieve maximum oxygen capacity. This is also known as belly breathing, since your stomach expands instead of your chest.
a soundtrack to your practice Try picking a playlist that reinforces the calming or energizing goals of your yoga practice. Various schools of yoga have competing views on incorporating music, but when it comes to your personal practice, it’s up to you if you’d like to practice in silence or play tunes in the background. Some author-selected suggestions:
› Clear your thoughts: “Hide and Seek” by Imogen Heap › Put on a smile: “Everything is Sound” by Jason Mraz › Motivation: “Sunshine” by Matisyahu › Unwind: “The Boxer” by Simon and Garfunkel › Get pumped: “You’ve Changed” by Sia
› Appreciate the simple things: “Say (All I Need)” by OneRepublic › Courage: “Brave” by Josh Groban
Recent science has shown that yoga makes lasting headway in alleviating common mental conditions such as stress, fatigue, depression, and chemical underactivity, as well as less common, more serious diseases like hypertension, schizophrenia, and PTSD. Embrace a regular practice that incorporates these facets of yoga to achieve mental balance and inner peace. Namaste. t w
If you believe you are currently struggling with an undiagnosed mental illness, please seek professional treatment from your medical provider or local mental health clinic.
UCLA Counseling and Psychological Services: (310) 825-0768 20
References 1. “NIMH: Statistics: Any Disorder Among Adults.” nimh.nih.gov. (2005). 2. “USA QuickFacts from the US Census Bureau.” quickfacts.census.gov. (2013). 3. Correspondence with Dr. Helen Lavretsky, MD, Associate Professor in the Department of Psychiatry David Geffen School of Medicine, UCLA. (2013). 4. “Stress, Inflammation, and Yoga Practice.” Psychosom Med. (2012). 5. “Yogic meditation reverses NF-B and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial.” Psychoneuroendocrinology. (2013). 6. “A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity.” Int J Geriatr Psychiatry. (2013). 7. “Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial.” Cancer. (2012). 8. “Cortisol and antidepressant effects of yoga.” Indian J Psychiatry. (2013). 9. “Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.” Med Hypotheses. (2012). 10. “904 Hypertension Analysis of Stress Reduction Using Mindfulness Meditation and Yoga: Results from a Randomized Controlled Trial.” Can J Cardiol. (2012). 11. “Yoga in Schizophrenia: a systematic review of randomised controlled trials.” Acta Psychiat Scand. (2012). 12. “Mind-body practices for posttraumatic stress disorder.” J Invest Med. (2012). 13. “Yoga as a practice tool.” apa.org. (2009). 14. “When it comes to yoga practice, how much is enough?” myfiveminuteyoga.com. (2011). 15. “My Brain Needs Oxygen -- What Can I Do?” nacd.org. (2012). 16. “How to Exhale in Pranayama.” yogajournal.com. (2009).
left: cat/chat/istockphoto; right: wragg/istockphoto
total wellness ▪ winter 2014
savasana ›› in conclusion
mood boosting habits by julia feygelman | design by catrina pang
Waking up on the wrong side of the bed, feeling cranky, being a Debbie Downer, acting like a party pooper, being down in the dumps, and getting asked â€œwhy the long face?â€? No matter how it is described, a bad mood can put a damper not only on the individual, but on the surrounding people. But what exactly does it mean to be in a bad mood? Is it a state of mind, a physical state, or a combination of both? What causes this condition, and how might it be avoided or improved?
what contributes to bad moods? Many factors may contribute to a bad mood, and some of the more common ones include sleep deprivation, inappropriate diet, medications, and other triggers.1 A good way of avoiding a bad mood is to watch for these parameters: getting enough sleep in a night (6 hours minimum), eating well, and taking care of your body.2 However, even under close regulation of these lifestyle elements, a bad mood can arise rapidly due to a particular event or almost anything that seems displeasing, feels stressful, or is irritating. Continue reading to learn a few tips that can help fix that bad mood simply and effectively!
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preferably even longer.9 While caffeine consumption does acutely raise blood pressure levels, which may sound alarming for people with hypertension (HTN), the long term effect is negligible as it is only temporary and a tolerance to it can be developed, which greatly diminishes the potential risks. The Nurses’ Health Study, which followed 1.4 million people, reported that an intake of up to 6 cups of coffee every day was not tied to an increased risk of HTN, according to the Journal of the American College of Cardiology in 2013.10
listen to music + excercise the why and the how: Hard-core house music has
the why and the how: Despite caffeine’s bad
reputation, a 2011 study conducted by the Department of Nutrition at the Harvard School of Public Health found a correlation between caffeine consumption and decreased depression rate. Women who consumed 4 cups of coffee per day showed a slightly lowered risk for depression than those who drank 2 to 3 cups or less. The caffeine in coffee is a central nervous system stimulant, meaning it speeds up physical and mental processes.3 This added energy could potentially ward off the sluggishness, fatigue, and trouble concentrating that accompanies bad or depressive moods, thus inhibiting them.4
how to benefit: While the above study analyzed the
total wellness ▪ winter 2014
effects of a 4 cups-a-day intake, most individuals should not consume so much. A possible downside of coffee or strongly caffeinated tea is a big “crash” in energy and mood following the boost. Limit your daily intake to avoid other side effects like dizziness or restlessness. A reasonable and effective intake level is 100 mg of caffeine (roughly the amount in 1 cup of instant coffee). According to a 1997 16-subject study in Psychopharmacology, the ingestion of 100 mg of caffeine resulted in improved mood and reduced anxiety 30 and 60 minutes post-consumption.5 Other caffeine sources include black or green teas and dark chocolate.6 In addition to the mood-boosting benefits that the caffeine from these sources provide, they also contain antioxidants. Antioxidants are substances which play an important role in preventing cell damage in the entire body.7 Check out the Center for Science in the Public Interest’s website for the caffeine content of many popular teas, coffees, foods, and drugs.8 However, there are some things to be aware of when consuming caffeine. A 2008 study in Sleep Medicine Reviews reported reduced sleep time and difficulty falling asleep when caffeine was consumed within 30 minutes of sleeping, so avoid caffeine consumption within 30 minutes of sleep,
how to benefit: If you have 30 minutes to spare,
engage in some light to moderate exercise to get a burst of serotonin. According to the US Department of Health and Human Services in 2008, 30 minutes of exercise on most days is the minimum duration recommended to reap health and mood benefits, but a person can always start with a shorter amount of time and work towards a goal of 30 minutes through gradual increase.16 At first, it may seem like a daunting task, but the positive feelings created afterwards will make it worth the effort. The American Academy of Pediatrics confirms that “music benefits mood and confidence” so plug in your favorite tunes while you exercise to get a double dose of mood-boosting goodness.17
left(in order): therachelkay/istockphoto; andreaortizg/istockphoto; right(in order): cristian baitg/istockphoto; alvarez/istockphoto
consume caffeine (yep, you read that correctly)
the biggest positive effect on mood among the effects of disco-pop, indie, rock/rap, heavy rock, indie/pop, and hardcore house music genres.11 In addition, listening to music while driving can lower respiration rate and have a positive effect on the body while uplifting and sustaining a good mood. The same study also found that listening to music did not negatively affect driving patterns during high demand situations.12 Furthermore, listening to aerobic dance music while exercising decreased fatigue versus exercising with no music.13 This is a win-win situation because exercise alone boosts mood. Following an exercise program can also act as an antidepressant, relieve anxiety, and enhance mood.14 This is because exercise causes a rise in the levels of serotonin, a chemical in our brains that accounts for feelings of pleasure and happiness.15
smile! the why and the how: The act of smiling, even a forced
smile, sends a signal to the brain that you are in a good mood, even if this was not previously the case.20 A theory presented in 2010 to the Society for Personal and Social Psychology and later published in Psychological Science discovered that subjects who had gone through Botox procedures (thus limiting their range and ability for facial expressions) took longer to read and understand angry or sad statements versus non-Botox subjects, which confirmed a relation between facial expressions and the brain’s ability to process emotion.21 According to David Havas (PhD, University of Wisconsin Laboratory for Language and Emotion lab director and assistant professor) who commented on this finding, “there is a long-standing idea in psychology called the facial feedback hypothesis … essentially, it says, when you’re smiling, the whole world smiles with you.” This means that our cognitive (mental) processes are “rooted in basic bodily processes of perception, action, and emotion.”21
how to benefit: If you’re in an inexplicable funk or
chow down on fruits and veggies
spending time with friends but just not feeling as excited and jubilant as you expected, help yourself get into a good mindset by smiling. It may just turn the tables on your mood and give you the extra push to feel positive. That smile might just turn into a real one! In fact, Gretchen Rubin, author of The Happiness Project published in 2009, found that fake laughter often morphs into true laughter, and chronicled many instances in which she felt happier by acting happier.
the why and the how: Consuming fruits and vegetables
(over unhealthy foods) has been shown to have a noticeable impact on young adults’ moods.18 By following young adults’ food/mood diaries, researchers found that consumption of fruits and veggies made them calmer, happier, and more energetic in their daily lives, reports the British Journal of Health Psychology in 2013.19 Further analyses ensured that fruits and veggies were causing the healthy mood and not the other way around. Indeed, subjects who consumed a sufficient number of servings one day had improved moods the next day, and the correlation was thus established.19
how to benefit: Just how much do you need to consume?
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The former study found that 7 to 8 servings were needed daily for a significant mood boost. A serving is approximately 1/2 a cup, or the amount that can fit into your palm. An easy way to ensure adequate consumption is to dedicate half of each plate of food to vegetables and to snack on whole fruit when you are hungry.
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The Ashe Center is conveniently located in Bruin Plaza, right in the center of campus!
HOURS total wellness ▪ winter 2014
References 1. “Mood.” goodtherapy.org. (2012). 2. “How much sleep do we need?” Sleep Med Rev. (2001). 3. “Caffeine-related disorders.” Encyclopedia.com. (2003). 4. “Coffee, caffeine, and risk of depression among women.” Arch Intern Med. (2011). 5. “Effects of hot tea, coffee and water ingestion on physiological responses and mood: the role of caffeine, water and beverage type.” Psychopharmacology. (1997). 6. “Healthier Ways to Get Your Caffeine.” webmd.com. (2005). 7. “Antioxidants.” nlm.nih.gov. (2012). 8. “Caffeine Content of Food & Drugs.” cspinet.org. (2012). 9. “Caffeine: Sleep and daytime sleepiness.” Sleep Med Rev. (2008). 10. “Effects of Habitual Coffee Consumption on Cardiometabolic Disease, Cardiovascular Health, and All-Cause Mortality.” J Am Coll Cardiol. (2013). 11. “Objective measurement of mood change induced by contemporary music.” J Psychiatr Ment Health Nurs. (1998). 12. “The influence of music on mood and performance while driving.” Ergonomics. (2012). 13. “Effects of music on mood during bench stepping exercise.” Percept Mot Skills. (2000). 14. “The effect of exercise on depression, anxiety and other mood states: A review.” J Psychosom Res. (1993). 15. “How to increase serotonin in the human brain without drugs.” J Psychiatry Neurosci. (2007). 16. “2008 Physical Activity Guidelines for Americans.” health.gov. (2008). 17. “Music and Mood.” healthychildren.org. (2013). 18. “Healthy Diet Can Improve Mood.” psychcentral.com. (2013). 19. “ Many apples a day keep the blues away – Daily experiences of negative and positive affect and food consumption in young adults.” Br J Health Psychol. (2013). 20. “Spontaneous facial expressions of emotion of congenitally and noncongenitally blind individuals.” J Pers Soc Psychol. (2009). 21. “Cosmetic Use of Botulinum Toxin-A Affects Processing of Emotional Language.” Psychol Sci. (2010).
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No one is happy all the time, which is normal, but some simple practices tend to be healthy habits that can also improve mood. Nutrition also plays an important role in physical and mental health, and as explained in this article, elements like caffeine and salutary foods (fruits and veggies) can help to significantly lift mood. Less of a commitment than healthy eating is smiling. Even when it feels like the last thing that could possibly help, smiling can trick the mind into creating a sense of joy. It doesn’t hurt to try, right? Finally, listening to energizing music and exercising is a combination that has long been known to have mood-boosting power. A useful tip for staying motivated is to listen to music only while exercising. That way, it becomes something to look forward to and provides a reward for staying active. Used in conjunction, this medley of habits can help ward off bad moods and develop a more pleasant daily life. tw
body in focus
only just a number by rebecca tang | design by barbara wong
Q: just how accurate are energy expenditure readings (determined by calories burned, heart rate, and distance) in popular exercise machines like treadmills and ellipticals? A:
treadmills: A 2002 study in Measurement in Physical Education and Exercise Science showed that for treadmills, heart rate was accurate at rest and during moderate activity, but decreased in accuracy during vigorous exercise.1 ellipticals: A 2006 Naval Health Research Center study on the calorie count of 3 different elliptical brands indicated that machine reports were higher than actual energy expenditure when tested.2
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Q: what factors can contribute to the machine reading’s inaccuracy?
A: Bodily factors, including weight and body fat percentage,
monitors reliable indicators of energy expenditure as well?
A: pedometers: A 2009 study in Medicine & Science in
Sports & Exercise found that pedometers, when worn around the hip, in a shirt pocket, or around the neck, yielded little error in the number of steps walked, suggesting that placement of the pedometer (other than when worn around the pocket area of pants) had little effect on accuracy.3 However, a 2012 study in the European Journal of Applied Physiology revealed that while the pedometer was relatively accurate in step-count measurement, it was not as accurate in reading distance and energy expenditure.4
A: In addition to counting steps, pedometers can be used
accelerometers: A 2010 study in Measurement in Physical
to reduce sedentary behavior and motivate physical activity in individuals, according to a 2008 study in the International Journal of Behavioral Nutrition and Physical Activity.12
heart rate monitors: A 1998 study in the Journal of
Yet, the quality of such machines, as well as their prices, may give buyers second thoughts. Low-end machines can cost as little as $2, but tend to run out of power soon. High-end models, which can cost as much as $350, have longer lifespans than their low-end counterparts, but may also offer features such as predicting the weather or calculating barometric pressure that may not be necessary for a workout.13
Education and Exercise Science showed that the accuracy of accelerometers (devices used to measure speed changes) varied greatly. As a result, further studies are necessary to examine the usefulness and limitations of these devices.5
Sports Sciences found that professional equipment like the electrocardiogram and Holter devices (both of which measure heart beat regularity) were accurate. However, due to cost, size, and complexity, these machines are not appropriate for everyday wear. The study also showed that lightweight heart rate monitors were just as accurate as the ECG and Holter devices.6
Q: with the growth of media technology in recent years, just how reliable are mobile applications in determining energy expenditure?
A: A 2008 conference published in the Sensor, Mesh and total wellness ▪ winter 2014
Q: Are pedometers and heart rate monitors worth
Ad Hoc Communications and Networks tested the 3-axis accelerometer mobile device application, which was designed to measure energy expenditure. The study showed that the mobile device application was just as accurate when compared to another reference device, a medical calorie counter.7 Furthermore, a 2009 study from Association for Computing Machinery tested BALANCE, another mobile-phone system that calculates caloric expenditure while walking or jogging on the treadmill. The test determined that the accuracy of the system was within 87% of the actual value.8
Overall, exercise machine readings can sometimes be inaccurate, since aspects such as age, weight, and muscle mass may distort readings. Yet, considering these as ballpark measures during the next gym session will contribute to a rewarding workout. tw
References 1. “Validity of Seven Commercially Available Heart Rate Monitors.” Meas Phys Educ Exerc Sci. (2002). 2. “A Comparison of Three Models of Elliptical Trainer.” Nav Health Res Ctr. (2006). 3. “Validity of the Omron HJ-112 Pedometer During Treadmill Walking.” Med Sci Sports Exerc. (2009). 4. “The validity of two Omron pedometers during treadmill walking is speed dependent.” Eur J Appl Physiol. (2012). 5. “Technical Reliability Assessment of the Actigraph GT1M Accelerometer.” Meas Phys Educ Exerc Sci. (2010). 6. “Heart rate monitors: State of the art.” J Sports Sci. (1998). 7. “A Calorie Count Application for a Mobile Phone Based on METS Value.” Sensor, Mesh Ad Hoc Comm. (2008). 8. “BALANCE: towards a usable pervasive wellness application with accurate activity inference.” Assoc Comp Mach. (2009). 9. “Calories Burned on a Treadmill.” healthstatus.com. (2013). 10. “Metabolism and weight loss: How you burn calories.” mayoclinic.com. (2011). 11. “Energy cost of walking and running at extreme uphill and downhill slopes.” J Applied Physiol. (2002). 12. “The effect of a pedometer-based community walking intervention ‘Walking for Wellbeing in the West’ on physical activity levels and health outcomes: a 12-week randomized controlled trial.” Int J Behav Nutr Phys Activity. (2008). 13. “How Much Does a Pedometer Cost?” livestrong.com. (2009).
right: squaredpixels/istockphoto; aldra/istockphoto
Q: are pedometers, accelerometers, and heart rate
as well as external conditions like machine incline and stride length, all contribute to possible inaccuracy. The more the individual weighs, the more calories he or she will burn.9 › Individuals with more muscle or more body mass in general burn more calories, even when resting.10 › Walking or running uphill burns more calories than on level surfaces. Even going downhill, according to a 2002 study in the Journal of Applied Physiology, results in more expended energy, due to changes in body movements in order to compensate for the incline.11 › A shorter stride indicates that the individual is moving the legs more in order to cover the same distance, thus burning more calories.10
total wellness ›› on the cover
total wellness ▪ winter 2014
“Music gives a soul to the universe, wings to the mind, flight to the imagination, and life to everything.” – PLATO
music to my ears by chalisa prarasri | design by karin yuen
flight to the imagination, and life to everything.” Were the philosopher alive today, he would marvel at the distance we have gone to support and extend his statement. Because there is ample evidence to suggest that music can benefit the body as well as the mind, he might want to add “music gives constitution to the body” into his list of benefits as well. In any case, Plato was quite right about the effect that music can have on overall wellbeing. Scientists have been studying the subject for at least the last century, and the following article examines some (but not all) of the surprising benefits music can have for health.
HOW TO READ THIS ARTICLE: So many different molecules and experimental methods were used in the research of music that it can get pretty confusing. If you see an asterisk* next to some words, take a look at the “The Basics” box next to each section for an explanation, or just check out the “What does it all mean?” section for a breakdown without all the technical jargon.
left: mattjeacock/istockphoto; right: original illustrations by karin yuen
total wellness ▪ winter 2014
The story of life ebbs and flows with the tones of the world; crowded rooms, whispering breezes, friendly words, and raucous laughter are all sounds that contribute to the pleasure of living and the memories that stick with us. But music, more so than just the sounds of everyday, might be the binding to our storybooks. It fills what otherwise might be silence; it accompanies us through our days. Music is everywhere. We carry it with us in our pockets. We find it when we gather together. We even sometimes produce it ourselves in the shower. As Plato put it, “Music gives a soul to the universe, wings to the mind,
KEEP IN MIND - THIS IS ONLY SCIENCE: Check out the studies yourself (in the “References” section on the last page) before making any big changes to your lifestyle based on this article. The exact effects of music on the mind and body are still scientific mysteries, and what is presented in this article are just bits and pieces of this intricate puzzle. In science, conclusions are not sure facts – and what one study says may be discounted later by another study with better methodology or better controls. Music in particular is extremely difficult to control – there are so many factors to consider, such as components of the music itself (volume, tempo, genre), individual reactions to music (familiarity, memories, emotional response), or conditions when the music is played (with others, alone, during exercise), that most studies do not even get close to providing adequate controls! With that in mind, enjoy the following article for what it is – a limited, but surprisingly expansive window into what science has suggested so far about music and the human experience.
music for pleasure: There is no question that most
people find music pleasurable. Why else would we listen to it? Scientists have been trying to understand the cause of this pleasure for a while, and they’ve found some interesting results. the research: Brain imaging studies have suggested that listening to music activates many brain areas related to reward (or pleasure), including the dopamine* and opioid* systems of the brain.3 One interesting finding is that when people are given a drug that counteracts the effects of opioids, responses to music that are usually considered pleasurable (such as thrills, chills, and changes in heart rate) are reduced in some subjects.4 what does it all mean?: Music is likely pleasurable because it affects our brains in a way that is similar to how other rewarding things like food, drugs, and sex do.5
music for comfort: Listening to sad music may be comforting during hard times.
› Dopamine System: A system of areas in the brain
› Opioid System: A system of areas of the
brain that are affected by opioids such as opium, morphine, and heroin (all highly addictive drugs that reduce pain and cause euphoria). When not activated by drugs, this system helps us process pain.2
what does it all mean?: Some hypothesize that sad music can help us feel better by causing the release of a comforting hormone called prolactin. However, much more research is required to confirm and extend this.
total wellness ▪ winter 2014
that are hypothesized to play a part in reward-based incentive learning (that is, learning to make choices that lead to a reward). This system also plays a large role in movement control.1
the research: It is suggested that sad music can comfort us by increasing levels of a hormone called prolactin. Prolactin is present in tears of sadness (but not tears from eye irritation or from tears of happiness) and is thought to tranquilize and console us when we are sad. Some speculate that sad music tricks our brains into releasing prolactin, thus making us feel better when we are sad.3 Though it has yet to be shown that prolactin levels actually increase in response to sad music, studies have suggested that different types of music can change the levels of prolactin in healthy people.5
on time THE BASICS:
› Temporal Bisection Task: An experimental
procedure used to figure out whether people underestimate or overestimate time. Participants are asked to memorize a “short” and a “long” period of time (this is done using sounds or lights that last certain durations). They are then presented a similar stimulus, but with a duration between the “short” and “long” ones they memorized. Subjects are asked to determine which one of the memorized stimuli it is closest to. The data from several trials, from several participants can be mathematically analyzed to determine whether the subjects were more likely to underestimate or overestimate time.6
› Atonal Music: Music made with sounds that do
not reflect those of conventional music, such as “minimalistic music” or music played in uncommon scales. Untrained listeners usually perceive this kind of music as unpleasant.7
music on time perception: Many studies have suggested that music makes time fly.
on pain self-chosen music on pain tolerance: Listening to
a personal music collection can improve how well people are able to withstand painful conditions. the research: In a series of studies, participants were asked to put their hands in extremely cold water until they could not stand it anymore (this is known as the “cold presser technique”). In one study, people were able to keep their hands in the water for longer while listening to music they selected themselves compared to when they listened to “relaxing music” chosen by the experimenter. These people also reported that they felt like they had more control over their pain while listening to their own music. In another similar study, participants kept their hands in the water for longer and reported feeling like they had more control over their pain when listening to their choice of music compared to when they endured the pain in silence or while looking at well-known paintings.9 what does it all mean?: These studies don’t just suggest that listening to music can improve pain tolerance and control over pain; they also tell us that listening to personal, familiar, or preferred music may be better for pain than either music or art chosen by someone else. The researchers hypothesize that this may happen because listening to personal music can better distract us from pain or make the painful situation feel more comfortable and familiar.
what does it all mean?: In short, these studies suggest that time flies while listening to music! However, it is still unknown whether other factors (enjoyability, familiarity, volume, or speed) have any further effects on this underestimation.
original illustrations by karin yuen
total wellness ▪ winter 2014
the research: Several studies conducted since the 1970s have repeatedly suggested that listening to music leads to an underestimation of time. For example, in a recent experiment conducted in 2010, a temporal bisection task* was used to compare time perception while listening to either sad or happy computer-generated music. How participants judged time while listening to music was compared to how they judged time while listening to atonal music*. It was found that people tended to underestimate time intervals when listening to music (compared to when they listened to the atonal music), regardless of whether this music was happy or sad. Further, many experiments have tried to figure out whether how much someone likes or is familiar with the music or how loud or fast the music is can have an effect on time perception, but the results so far have been conflicting.8
on cognition THE BASICS:
› Spatial-Temporal Reasoning: An organism’s
ability to mentally visualize things in space and time and see how these things move and fit together.10
mozart for spatial-temporal reasoning?*: Some
highly publicized studies have suggested that listening to a Mozart sonata for 10 minutes before taking a test can improve results. This controversial finding is known as “The Mozart Effect.” the research: In a famous study published in 1993, healthy subjects listened to Mozart’s Sonata for Two Pianos K. 448 for 10 minutes before taking a spatial reasoning IQ test. Listening to Mozart was compared to listening to relaxation instructions or sitting in silence. The people who listened to Mozart before testing had higher average spatial IQ scores by 8 to 9 points than people who listened to relaxation instructions or silence. However, this effect lasted only 10 to 15 minutes after the music ended. Also, these enhancing effects were specific to spatial-temporal reasoning, not general intelligence, as some media reports have claimed. These results were very controversial in the scientific community, however. Some researchers were able to repeat the experiment and get similar results, but other researchers found little to no effect of Mozart when they repeated this experiment.11 Some hypothesize that if the Mozart effect exists at all, then it may be due to an increase in arousal rather than due to some component of Mozart itself. This stance is supported by an experiment in which participants performed better in a spatial-temporal reasoning task after listening to fast-paced Mozart or “happy” Mozart pieces compared to when they listened to slow or “sad” Mozart pieces. Furthermore, the better-scoring participants reported feeling more positive emotionally, suggesting that positive arousal due to happy or upbeat music may be the cause of the increase in performance rather than the mere act of listening to the music prior to testing.12
background music for thinking: Listening to
background music (music that does not draw our attention) is thought to either improve cognition or have no effect on it. the research: Many studies conducted in the last few decades have investigated the effects of background music on different types of cognition. Some studies found no effect of background music on tasks, while other studies have found that background music can improve performance to some extent in certain tasks. Some tasks in which music appeared to improve performance include general intelligence tests, arithmetic tests, and reading comprehension tests. In one example, people who listened to dance music while playing a driving simulation game had faster average response times. Keep in mind, however, that in most cases, the effect of music on cognitive performance was not large.13 what does it all mean?: Music that is played in the background has the potential to improve cognition to some extent in certain situations, as long as the music is not distracting (that is, the music does not compete for attentional resources). However, the effect is likely not large.
melodies for memory: Listening to music while
memorizing something may actually help us remember it later (if we listen to the same music again). the research: The ability of music to help with remembering certain things has been tested in many situations. This memory enhancement occurs when someone listens to a certain song, melody, or rhythm while memorizing something, and then hears that music again while trying to remember that thing. For example, in some studies, college students were better able to remember a list of random numbers when the music was paired with the numbers. Researchers suggest that this may occur because the rhythm of music can help us split information into smaller, more manageable pieces.14 what does it all mean?: Music can help to improve memory by acting as a prompt. That is, if we hear a certain melody or rhythm (or both) while memorizing something, listening to the same music later can help us recall what we memorized.
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what does it all mean?: It is unlikely that Mozart makes us smarter, as some have claimed. Research is controversial, but trends slightly toward supporting the idea that listening to Mozart for a few minutes before getting to work may help improve spatial-temporal reasoning specifically (not necessarily other types of cognition), but this effect seems to be short-lasting (10 to 15 minutes) and very small. Moreover, the effect of Mozart on cognition is more likely due to its ability to excite the listener and provoke feelings of pleasantness rather than due to Mozart itself, suggesting that any sort of pleasantly arousing music can have the same effect. In any case, further research is still needed to understand the true nature of the “Mozart effect”.
on the stomach
on exercise music for different types of exercise: Many studies
› EGG (electrogastrography): A process where
electrodes are attached to subjects’ abdomens to measure electrical activity in the stomach (gastric myoelectrical activity).15
› Gastric Myoelectrical Activity: Another term
for electrical activity in the stomach. This electrical activity regulates normal stomach function and is necessary for it to properly empty food into the intestines for further digestion.15
canon in d major and stomach emptying:
Listening to enjoyable music may lead to improved stomach function.
total wellness ▪ winter 2014
the research: In this study, healthy adults listened to Pachelbel’s Canon in D Major for 30 minutes before EGG*. The researchers found that listening to Canon in D led to increased gastric myoelectrical activity* in the participants who said they enjoyed the music, but not in participants who did not enjoy it. In fact, the effects of music were found to be comparable to those of a drug used to stimulate gastric emptying (5-HT4 receptor agonists). However, one concern with this study is that it was not controlled with other sounds (such as static or silence), and that the sample size was small.15 what does it all mean?: Because poor gastric myoelectrical activity is associated with gastric disorders as well as symptoms such as nausea and vomiting, this study suggests that listening to music may be able to help the body by improving stomach emptying. Better research is needed to confirm these results, though.
have suggested that music can improve exercise performance depending on how and when it is used. the research: In 2 endurance experiments (1 where subjects held a weight in front of them for as long as they could, and another where subjects gripped something with their hands for as long as they could), it was found that listening to music during the task increased endurance for both tasks. Interestingly, in the experiment with the weight, listening to music for a while before holding the weight led to even better endurance than just listening to music during the task. In another experiment where participants rowed 500 meters as fast as possible, listening to alternating slow and fast parts of Beethoven’s 7th Symphony led to faster completion times than listening to music that was purely fast or purely slow.16 what does it all mean?: It seems that music can help improve performance in endurance exercises, especially if the music is turned on before the exercise begins. Also, music seems to improve performance better when the music’s tempo alternates between fast and slow (rather than purely fast or purely slow music), at least when performing a high-intensity exercise such as rowing at maximum speed.
music for motivation and effort: Music may help exercise by increasing the amount of work done without a perceived increase in effort.
the research: In one study, participants cycled on a machine for 20 minutes at their own pace in 4 different listening conditions, and the distance traveled was measured. The 4 conditions were “fast,” “moderately fast,” and “slow” contemporary electronic dance music, and no music. Fast and moderately fast music led to an increase in the distance traveled by around half a kilometer (around 0.3 miles) compared to the slow music and no music conditions. Furthermore, it was found that moderately fast music led to a statistically significant decrease in perceived exertion compared to the slow music and no music conditions, and while fast music led to a similar decrease, it was not statistically significant in this case.17 what does it all mean?: Listening to music (especially moderately fast music) may cause us to perform better without even realizing it!
original illustrations by karin yuen
remixes for exercise recovery: Listening to dance
remixes after intense exercise may speed up recovery from intense exercise. the research: In this study, college-aged men listened to dance remixes of popular Western songs after intense exercise. They reported feeling less exhausted in the first 15 minutes after exercise than men who didn’t listen to music. Also, those who listened to music were more likely to move around voluntarily (rather than staying still) after exercise than those who didn’t.18 what does it all mean?: Listening to upbeat music after a hard workout may improve feelings of exhaustion immediately afterwards and could even keep away our desire to laze around.
› Group Drumming: Different genes in our
bodies are turned on and off in different situations, meaning that some bodily compounds are synthesized more or less in different conditions. In this case, genes can turn on in response to stress, causing some of the negative effects associated with too much stress. When scientists say that gene expression is increased, they mean that the gene is turned on more.19
› Antibodies: Immune system proteins that
circulate in the bloodstream, attaching to pathogens and alerting the immune system to attack them.20
› IgA (Immunoglobulin A): An important antibody that is secreted in saliva and other bodily fluids like mucous. IgA is one of the body’s first defenses against bacteria and viruses.21
› IL-6 (Interleukin-6): A molecule in the body
that can both increase and decrease inflammation depending on the situation (so it regulates inflammation).21
choir singing on antibodies: Three separate studies
have suggested that singing in a choir can lead to an increase in a certain type of antibody* (IgA), thus potentially improving immune function. the research: In these studies, saliva was taken from professional chorale singers during rehearsals and during performances. After the saliva was analyzed, it was found that IgA* concentrations increased by 150% during rehearsals and by 240% after performances. Additionally, performers who said they felt more positive and relaxed during the performance (but not during rehearsals) tended to also show greater increases in IgA concentrations in their saliva. How stressed the singers said they felt about the performance did not seem to affect this immune response. One issue with these studies, however, was that there was no control group; IgA concentrations were compared within the same individuals. Thus, there is a possibility that some aspect of group singing that did not involve the music itself led to the observed changes.21 what does it all mean?: It appears that singing in a group can improve immune function by increasing antibody concentrations! Not only that, but singing in a group in front of other people (and feeling good about it) may improve immune function even more. However, since the studies suggesting this did not have adequate controls, the results should be taken with a grain of salt.
relaxing music on inflammation and antibodies: Several studies investigating the effects of “relaxing” music chosen by experimenters have found that just passively listening to the music can lead to better immune function.
the research: Studies in healthy adults have found that listening to “relaxing” music can lead to a decrease in IL-6* and an increase in IgA* concentrations (compared to when participants sat in silence). Interestingly, the increases in IgA concentrations were observed regardless of whether the music was happy or sad.21 what does it all mean?: Together, these studies suggest that passively listening to “relaxing” music can lead to a change in the regulation of inflammation in the body and also increased concentrations of antibodies in the body. Better yet, whether you listen to happy or sad “relaxing” music, you can still experience better immunity through an increase in certain antibodies.
total wellness ▪ winter 2014 33
› Dementia: A condition in which patients
are cognitively impaired. This affects things like memory, thinking, language, personality, and judgement.22
› CVD (Cerebrovascular Disease): Also known
as stroke, this occurs when blood flow to the brain stops. This is similar to a heart attack, but it occurs in the brain. Lack of blood kills brain cells, causing brain damage.23
› Heart Failure: When the heart stops working.
This may occur suddenly or over a period of time.24
music listening and music therapy on disease incidence: Studies have suggested that attending music
therapy sessions or participation in leisure activities like listening to music can reduce the incidence of heart failure and dementia, respectively. the research: In a study conducted on elderly Japanese patients with CVD* and dementia*, it was found that at least 10 weeks of weekly 45-minute music therapy sessions (consisting of Japanese pop music, nursery rhymes, folk songs, and hymns) led to a reduced rate of heart failure events.25 Another study that followed elderly people without dementia over 7 years found that people who spent more time doing things for leisure (such as listening to music) were less likely to develop dementia.*26
the bottom line Though much research has been conducted to try to understand the potential effects of music on wellbeing, we still only have bits and pieces of a vast puzzle. A lot of evidence suggests that music can play a role (albeit small in most circumstances) in giving “wings to the mind” (through emotional regulation, affected time perception, better pain tolerance, and better cognition) and providing “constitution for the body” (through better stomach function, improved exercise performance, better immunity, better sleep, and better disease outcomes). But just remember to take these results with a grain of salt, as nothing is yet conclusive in this field. tw References 1. “Dopaminergic reward system: a short integrative review.” Int Arch Med. (2010). 2. “Reward Processing by the Opioid System in the Brain.” Physiol Rev. (2009). 3. “Current Advances in the Cognitive Neuroscience of Music.” Ann N Y Acad Sci. (2009). 4. “Thrills in response to music and other stimuli.” Physiol Psychol. (1980). 5. “The Effect of Music on the Production of Neurotransmitters, Hormones, Cytokines, and Peptides.” Music Med. (2011). 6. “Human Performance on the Temporal Bisection Task.” Brain Cogn. (2010). 7. “The influence of music on consumers’ temporal perceptions: Does time fly when you’re having fun?” J Consum Psychol. (1992). 8. “Changes in the representation of space and time while listening to music.” Front Psychol. (2013). 9. “Music, health, and well-being: A review.” Int J Qual Stud Health Well-being. (2013). 10. “What is Spatial-Temporal Reasoning?” wisegeek.com. (2013). 11. “The Mozart effect.” J R Soc Med. (2011). 12. “Multiple Intelligences, the Mozart Effect, and Emotional Intelligence: A Critical Review.” Educ Psychol. (2006). 13. “The Effect of Music on Cognitive Performance: Insight From Neurobiological and Animal Studies.” Behav Cogn Neurosci Rev. (2005). 14. “Effects of Melodic Complexity and Rhythm on Working Memory as Measured by Digit Recall Performance.” Music Med. (2011). 15. “Effects of music on gastric myoelectrical activity in healthy humans.” Int J Clin Pract. (2007). 16. “Music in the exercise domain: a review and synthesis (Part I).” Int Rev Sport Exerc Psychol. (2012). 17. “Music During Exercise: Does Tempo Influence Psychophysical Responses?” psycho.philica.com. (2013). 18. “The impact of music on metabolism.” J Nutr. (2012). 19. “What is gene expression?” news-medical.net. (2013). 20. “Antibodies.” rcsb.org. (2001). 21. “The neurochemistry of music.” Trends Cogn Sci. (2013). 22. “Dementia.” ncbi.nlm.nih.gov. (2011). 23. “Stroke.” ncbi.nlm.nih.gov. (2013). 24. “Heart Failure Overview.” ncbi.nlm.nih.gov. (2013). 25. “Effects of Music Therapy on Autonomic Nervous System Activity, Incidence of Heart Failure Events, and Plasma Cytokine and Catecholamine Levels in Elderly Patients with Cerebrovascular Disease and Dementia.” Int Heart J. (2009). 26. “Influence of leisure activity on the incidence of Alzheimer’s Disease.” Neurology. (2001).
what does it all mean?: These studies suggest that musicrelated activities can reduce the risk for certain dangerous conditions (such as heart failure and dementia) in elderly people, thus potentially extending the lifespan and increasing quality of life. Keep in mind that these studies were highly specific, however, so this conclusion still needs to be confirmed.
on sleep sleep better.
the research: Check out the article (Musical Beats for Sleep and Stress Relief) following this one to read about the effects of music on sleep and stress. what does it all mean?: To sum it up, sleeping with certain types of music (especially relaxing or sedative music) playing in the background may help improve sleep quality, potentially by increasing the time spent in deep sleep. Scientists believe that this may be because of the stress-reducing or relaxing effects of some types of music.
original illustrations by karin yuen
total wellness ▪ winter 2014
music on sleep quality: Listening to music may help us
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
How Can Music be Used to Strengthen the Body, Mind, and Spirit?
Ping Ho, MA, MPH: Founder and Director of UCLArts and Healing
Music, Mind & Brain
Robert Bilder, PhD, ABPP: Chief of Medical Psychology â€“ UCLA Neuropsychology; Director of UCLA Healthy Campus Initiative's Mind Well
Music Therapy in Medicine
Talin Babikian, PhD, ABPP: Assistant Research Professor, Clinical Neuropsychologist in Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine Raffi Tachdjian, MD, MPH: Physician in UCLA Health System; President & Founder of Children's Music Fund Performances & Experiential Sessions
Betsy Metzgar: Laughter Yoga: Laugh Your Way to Wellness Robert Een & Students: The Moving Voice - Workshop on Breath and Voice Ross Anthony/Rainplay: Enchanting Musical Experience with Guided Meditation
total wellness â–Ş winter 2014
& The Release of Issue 2, Volume 14 of Total Wellness Magazine Sign up for the event today at http://www.totalwellnessmagazine.org/ 1st 100 people to register will get free lunch at the conference. Plus free t-shirts, pens, gift-cards, and more will be raffled off at the event!
musical beats for
sleep & stress relief
stressed and a mess
effects of stress
With midterms, finals, and the overall stressinducing problems of college, stressing out seems to be an integral part of university life. Work, lack of sleep, and personal problems can all contribute to feelings of stress.1
Stress can contribute to problems with sleep and a change in academic performance.2 It can also lead to more serious problems like depression, heart problems, and anxiety. For people with chronic stress, the immune, digestive, and reproductive systems stop working normally.3 Because of the negative consequences of stress, scientists have searched for ways to understand and reduce stress. In fact, studies suggest that listening to certain genres of music can have a combative effect on stress and a positive effect on sleep!
left(in order): pixelembargo/istochphoto; original illustration by jessica sun; danleep/istockphoto; right(in order): danleap;istockphoto; original illustration by jessica sun
total wellness â–Ş winter 2014
by pauline yang| design by jessica sun
music effects on stress doing a simple, everyday thing such as listening to music can have a number of effects, including: reducing the physical effects of stress:
reducing anxiety in college or other academic environments:
A 2013 study published in Public Library of Science One evaluated the effects of listening to music on stress. The scientists concluded that music can reduce the strain on the psychobiological stress system and help the autonomic nervous system, the system responsible for functions like heart rate and digestion, recover faster. Therefore, listening to music can help ease feelings like tension and fatigue caused by stress.4
A 2001 study in Journal of Music Therapy assessed the effects of classical music on undergraduate students in a high-pressure situation. In this study, the researchers measured the subjects’ subjective anxiety, systolic blood pressure, and heart rate. They found that the stress-induced increases of the subjects’ anxiety, blood pressure, and heart rate were prevented by exposing the subjects to music. After the study was concluded, the scientists concluded that their findings supported claims that music can reduce the effects of stressors.5
listening to music can also reduce stress in patients:
listening to enjoyable music can lead to better academic performance:
A review in Cochrane Summaries published in 2009 compared the findings of 23 randomized controlled trials that studied listening to music and its effects on patients with coronary heart disease. The results suggest that listening to music can have a moderate effect on the anxiety of the patients, reducing heart rate, respiratory rate, and blood pressure. However, most of the studies tested the effects of pre-recorded music, and scientists speculate that music therapy with live and interactive music could possibly have a different outcome, although more research is needed.6
In Behavioural Brain Research, a study from 2013 assessed the correlation of listening to music and academic performance. In this study, students chose to take courses involving music over other artistic courses. Researchers discovered that the students who chose to take music classes had higher grades on average. Although the reasons for the students’ higher grades are not definitive, the scientists determined that music could contribute to higher grades.7
music therapy Music therapy is the evidence-based practice of using music in a therapeutic sense to address physical, emotional, social, and cognitive needs.8 According to the American Music Therapy Association, it is “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”
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In a 2001 study in Alternative Therapies, researchers studied the effects of group drumming music therapy on stress-related hormones. Through a single trial experiment with 4 music groups and 2 control groups, researchers found that group drumming increased natural cell killer activity. They concluded that the act of group drumming has potential to direct certain areas of the neuroendocrine and neuroimmune parameters, the parameters that control the hormonal and immune system, away from the body’s natural stress response. 9 However, group drumming is a comprehensive therapy that includes many factors, such as social interaction and teacher-guided activity, so it is not certain that the music part of this therapy is responsible for the noted effects.
tunes for your mood In these studies conducted to see the relationship between music and stress, most researchers had the subjects listen to classical music. However, try listening to different songs to help you stress less and sleep well! From the famous classical to the obscure and calming – try listening to these tracks to help you relax!
To see what type of music calms you, test out the iso principle theory: match your music to your mood and gradually change it to shift your emotions. Start by listening to different calming types of music such as:
deep sleep: In a 2013 study published in the Journal
of Alternative and Complementary Medicine, young adults with different levels of sleep sensitivity were evaluated when they slept. The control group did not listen to any music while sleeping, while the other group listened to sedative music. From the results, the researchers found that the group that listened to sedative music had a prolonged period of deep sleep in the second stage of the sleep process, where heart rate starts to slow, and third stage of the sleep process, as the body transitions from a light to deep sleep.10
sleep quality: In a review conducted by the
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International Journal of Nursing Studies in 2013, the results of 10 randomized studies were analyzed to determine the effect of music therapy on adults. From the studies, which passively applied music to improve sleep quality in adults, they found that the subjects who listened to music while sleeping experienced better quality sleep. This was subjectively measured using questionnaires and a polysomnography, a test that records bodily functions during the sleep cycle. The study concluded that music could possibly aid in the sleep quality of patients with sleeping problems, although further research is needed.11 t w
Für Elise – Ludwig van Beethoven What a Wonderful World – Nat King Cole La Vie en Rose – Edith Piaf Wish You Were Here – Pink Floyd Plasticities – Andrew Bird Zebra – Beach House Tiger Mountain Peasant Song – Fleet Foxes
› › › ›
Classical artists like Beethoven or Mozart Music with wind instruments Drumming music Ocean sounds
References 1. “Stress Management- Causes of Stress.” webmd.com. (2011). 2. “Study finds lack of sleep, excessive computer screen time, stress and more hurt college students’ grades.” 1.umn. edu. (2008). 3. “Q&A On Stress for Adults: How it affects your health and what you can do about it. ” nimh.gov. (2011). 4. “The Effect of Music on the Human Stress Response.” PLoS One. (2013). 5. “Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females.” J Music Ther. (2001). 6. “Music to Reduce Stress and Anxiety for coronary heart disease patients.” Cochrane Summaries. (2009). 7. “Music and Academic Performance.” Behav Brain Res. (2013). 8. “What is Music Therapy.” musictherapy.org. (2013). 9. “Composite Effects of Group Drumming Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal Subjects.” Alternative Therapies. (2001). 10. “Sedative Music Facilities Deep Sleep in Young Adults.” J Altern Complement Med. (2013). 11. “Music therapy improves sleep in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies.” Int J Nurs Stud. (2013).
left(in order): liangpv/istochphoto; original illustration by jessica sun
music and sleep
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the importance of posture by elsbeth sites| design by natalie chong
total wellness â–Ş winter 2014
left: rollover/istockphoto; right: svetikd/istockphoto
Mothers around the world have said it for centuries: Stop slouching! It seems like common knowledge that no one wants drooping shoulders and a low hanging head, but itâ€™s sometimes unclear how poor posture develops. Here is some scientific evidence that supports your motherâ€™s argument that you should sit up straight!
what causes poor posture? Poor posture can be defined as an inefficient balance of the body over its base of support, or an alteration of normal body movement and therefore increased stress and strain on supporting structures.1 Genetics plays a role in the curvature of the spine, but more often poor posture occurs as a result of repeated or long-term activities.2 Unfortunately for office workers, students, as well as just about everyone nowadays, computer use is one of the leading causes of improper posture. According to the National Statistical Office, with an increasing number of people in possession of a computer and with internet access, the average weekly time that a person will spend at a computer has dramatically increased from 5.9 hours in 1997 to 14.6 hours in 2003, with 56.2% of computer owners using their machines for 10 or more hours each week.2
how can poor posture affect my physical wellbeing? turtle neck
Among the effects of using a computer on the musculoskeletal system, staring at a monitor located below the height of eyesight for a long time makes the head move forward and requires an exaggerated curve in the lower spine and upper vertebrae in order to maintain balance. This has been dubbed forward head posture, or turtle neck posture.2
overall muscle imbalance
Forward head posture may affect not only the neck but can also cause back pain and headaches, and possibly lead to overall imbalance in the musculoskeletal system.3 Because of this imbalance, certain areas such as the bones and joints in the lower back have to support more weight than they were designed to. These muscles must then work harder to compensate, which may eventually lead to back strain and injury.4
can posture affect mental wellbeing? A 1992 study published in the Shinrigaku Kenkyu (Japanese Journal of Psychology) suggests that posture exerts a strong influence on oneâ€™s emotions. The study consisted of one group which assumed various postures and another group which only imagined the postural changes. Subjects estimated their mood and emotions with 34 adjectives (such as feeble or lifeless) on a 3 point scale. Their data suggests a correlation between negative feelings and a weak posture, especially when the subject had a hunched back and a hanging head.5
poor posture may make positive thinking more difficult
A 2004 study in Applied Psychophysiology and Biofeedback assessed whether it was easier to generate positive or negative thoughts in either an upright or slumped position. Participants rated which type of thought was easiest to generate in the 2 postures. Significantly more participants (92%) indicated it was easier to generate positive thoughts in the upright position. This study suggests that positive thoughts are more easily recalled in the upright posture.6
strong posture may help in enduring pain or distress
A 2012 study published in the Journal of Experimental Social Psychology found that by simply adopting more dominant poses, people felt more powerful, in control, and able to tolerate distress. Out of the individuals studied, those who used the most dominant posture were able to comfortably handle more pain than those assigned a more neutral or submissive stance.7
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weak posture may induce negative feelings
how can I improve my posture? look for ergonomically designed equipment
get up and move
There is an entire field of science called ergonomics devoted to designing workplace equipment. The field focuses on maximizing productivity by reducing operator fatigue and discomfort. For example, in an ergonomic chair the seat height, seat depth, and lumbar support are all specifically engineered to promote good posture.8
As muscles tire, slouching becomes more likely. In order to maintain a relaxed but supported posture, change positions frequently. Take a break from sitting in an office chair every half hour for 2 minutes in order to stretch, stand, or walk.11
move your computer monitor
A 1998 study in the Journal of Dance Medicine and Science examined the dynamic posture (posture while moving) of ballet dancers after training with pilates. The participants of the experimental group were found to be more stable in the upper body region than the control group. This suggests that training with pilates-based exercises can improve dynamic posture.12
According to the Occupational Safety and Health Administration (OSHA), the center of the computer monitor should normally be located 15° to 20° below horizontal eye level and 20 to 40 inches away from the eye.9
core strengthening exercises The consensus seems to be that having strong abdominal, oblique, and back muscles acts as a girdle of sorts that holds your torso erect. Try an exercise like the single leg extension, designed to train your core muscles to work together to stabilize your pelvis.
› core stabilizer: single leg extension starting position: Lie on your back with your knees bent, feet planted flat on the floor, and hands behind your neck providing support. Press your lower back into the floor, and curl your head up off the floor. Exhale strongly and pull your navel in towards your spine. Slowly pull 1 knee into your chest, keeping your lower back pressed into the floor, while extending your other leg straight out, 45° off the floor. Keep your abdominal muscles pulled in and your lower back on the floor. If your lower back begins to arch off the floor, extend your leg higher toward the ceiling. Switch legs. Try starting out with 5 to 10 extensions on each side.10
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take home message: Sitting in front of the computer for long periods of time is a leading cause of poor posture, but there are steps that can be taken to sit up straighter and avoid the negative effects of slouching. Look for ergonomically designed office equipment, check out OSHA’s guidelines for a posture-friendly workspace, and strengthen your core muscles to keep your spine straight and happy. t w
References 1. “Good Posture, Bad Posture - Sway Back.” sportsinjurybulletin.com. (2007). 2. “The Effect of the Forward Head Posture on Postural Balance in Long Term Computer Based Worker.” Ann Rehabil Med. (2012). 3. “Incidence of Common Postural Abnormalities in the Cervical, Shoulder, and Thoracic Regions and their Association with Pain in Two Age Groups of Healthy Subjects.” Phys Ther. (1992). 4. ”Proper Posture to Prevent Arthritis Pain.” health.howstuffworks.com. (2013). 5. “Effects of inclination of trunk and head on emotional awareness.” Shinrigaku Kenkyu. (1992). 6. “The effects of upright and slumped postures on the recall of positive and negative thoughts.” Appl Psychophysiol Biofeedback. (2004). 7. ”It hurts when I do this (or you do that): Posture and pain tolerance.” J Exp Soc Psych. (2012). 8. “Choosing the Right Ergonomic Chair.” spine-health.com. (2013). 9. “OSHA Ergonomic Solutions: Computer Workstations.” osha.gov. (2013). 10. “Exercises for Better Posture.” webmd.com. (2013). 11. “Ten Tips for Improving Posture and Ergonomics.” spine-health.com. (2013). 12. “The Effect of Pilates-based Training on Dancers’ Dynamic Posture.” J Dance Med & Sci. (1998).
left: rollover/istockphoto; right: catherine lane/istockphoto
ge ne tti ng ou w sy r h ch in st e an fo rm em al g th es ca in ed: re
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es ign by m
ar ys au
The Patient Protection and Affordable Care Act (PPACA), or commonly known as the Affordable Care Act (ACA) or “Obamacare,” has been in the media for the past few years sparking numerous debates. It is easy
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to get lost with the shorthanded names and various points of views. Read on to get straight to the facts and see how this recent law affects college students.
Unlike other countries, the United States does not have a single health care system. Instead, the American health care system is financed and delivered by different sectors such as public (federal, state, and county governments) or private (employer benefits, individual contribution). Because healthcare is not guaranteed in the United States, the people are responsible for getting the insurance they need. This has caused a number of problems, including a high percentage of uninsured people in the United States. According to the 2012 Current Population Survey Report issued by the United States Department of Health and Human Services, about 48.6 million people are uninsured in the US.1 Of the uninsured, 17% are 19 to 25 years old and 21.1% are 26 to 34 years old.1 However, the National Health Interview Survey suggests that more than 3 million young adults gained health insurance due to the ACA.1
so what is the patient protection and affordable care act (PPACA)? On March 23, 2010, President Obama signed the PPACA, which puts in place comprehensive insurance reforms that will roll out in the course of set time periods (see timeline below). In addition, on June 22, 2010, President Obama announced new interim final regulations (an immediate implementation of a rule by Federal agencies without prior public comment on a rulemaking proposal, usually due to an overwhelming need for the rules) called the Patient’s Bill of Rights that includes a set of protections that apply to health coverage.2 Similar to how our Bill of Rights in the US Constitution protects the American people, this Patient’s Bill of Rights protects patients’ rights in the private health insurance market.
Open enrollment begins
January 2014 Coverage begins
*PPACA makes health insurance more affordable for lower income individuals and families by providing subsidies based on household income and family size and through expansion of MediCal (in California) eligibility.4
the 10 essential health benefits The 10 essential health benefits are a set of health care service categories that must be covered by certain plans, starting in 2014.5 Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace (and Medicaid for those states that are expanding their Medicaid programs).5
1 2 3 4 5
Maternity and newborn care
6 7 8 9
Mental health and substance use disorder services (including behavioral health treatment)
10 Pediatric services, including oral and vision care
Ambulatory patient services Emergency services Hospitalization
Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management
how does the health care law protect you? health insurance marketplace in every state (known as Covered California in California)6 › This is a new way for individuals, families, and small businesses to get health coverage. › The Marketplace allows for affordable care (see more information about the Marketplace on the following page).
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no more worries on preexisting health conditions7 › Being sick does not keep someone
from getting coverage because insurance companies are required to cover those with pre-existing health conditions. › Once someone has insurance, the plan cannot refuse to cover treatment
for pre-existing conditions. Coverage for your pre-existing conditions begins immediately.
free preventive care8 › All plans run by the Marketplace and
many other plans must cover many preventative service without charging you any extra fees. › Some common preventative care services that are free include blood pressure screening, cholesterol screening, depression screening, diabetes type 2 screening, diet counseling, obesity screening and counseling, HIV screening, sexually transmitted infection prevention counseling, tobacco use screening, and immunization vaccines.
helps you understand the coverage you are getting9 › You have the right to get an easy-to-
understand summary about a health plan’s benefits and coverage: insurance companies and group health plans must provide you with a short, plainlanguage Summary of Benefits and Coverage (SBC) and a Uniform Glossary of terms used in health coverage and medical care.
holding insurance companies accountable10 › The law holds insurance companies accountable for rate increases. › Insurers must justify any premium increase of 10% or more before the rate takes effect.
First open enrollment closes
All Americans have access to affordable health care
a marketplace for what? A marketplace for insurance! The “Marketplace” is where people who do not receive insurance through their place of employment can shop for health insurance.15 Many of those eligible to shop in the Marketplace will also qualify for subsidies to make their insurance more affordable, depending on their income and family size.15 Most Californians are already insured through their place of employment, or through government programs such as Medicare and Medi-Cal, so they do not need to shop in the new Marketplace.15 Insurance plans in the Marketplace are offered by private companies and all cover the same benefits (the essential health benefits are listed below). No plan can turn someone away or charge someone more because of an illness or medical condition.15 Those who do not have coverage and those who want to explore new options with a chance of getting lower costs on monthly premiums can shop in the Marketplace.
new consumer protections11
The law: › Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick. › Protects your choice of doctors. › Guarantees your right to appeal when a health plan denies payment for a treatment or service.
may be able to get insured under a parent’s plan. › This right applies to all health plans that offer dependent coverage, whether one gets coverage through his or her employer or buys it oneself.
so how does all this affect college students? According to the Centers for Medicare and Medicaid Services (CMS), over a million students are covered through student health plans offered by colleges, universities, or other institutions of higher education.17 However, keep in mind that 17% of the uninsured are college-aged adults.1 For those who do have student health plans, the plans are not the same for all students. Thus, in February 2011, the Department of Health and Human Services (HHS) issued a final rule that ensures students have access to coverage and benefits from the PPACA’s Patient’s Bill of Rights, preventive services coverage, and other consumer protections such as no annual limits.17 For those who are not covered, there are multiple options to get coverage. A parent with health insurance can share a plan with his or her children until they reach age 26. Children can join or remain on their parent’s plan even if they are married, not living with their parents, not attending school, not financially dependent on their parents, or eligible to enroll in their employer’s plan.18
ending lifetime and yearly limits13 › The healthcare law requires no lifetime
or yearly dollar limits on coverage of essential health benefits. › However, insurance companies can still put a lifetime and yearly dollar limit on spending for health care services that are not considered to be essential health benefits. The basic punch line of this law is that those who do not have coverage can use something called the Marketplace to find affordable insurance. Those who already have coverage do not have to do anything, but gain new protections under the law. Finally, those who choose not to get coverage may have to pay a penalty on their tax return.14
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young adult coverage12 › Those who are under 26 years old
All insurance plans are offered by private companies, but the Marketplace is run by the state or the federal government.16 California’s Marketplace, called Covered California, was established by the state, but is an independent organization.16
other benefits that affect college students
birth control benefits
The law requires everyone to have health insurance. Those who can afford health insurance and do not have coverage in 2014 may have to pay a fee (penalty) and also have to pay for all of their health care.22 The penalty in 2014 is calculated one of two ways, in which you will pay whichever of these amounts is higher: 1% of your yearly household income or $95 per person for the year.22 The fee increases every year: in 2015 it is 2% of income or $325 per person; in 2016 and later years it is 2.5% of income or $695 per person.22
Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a healthcare provider.19 These plans must cover the services without charging copayment, coinsurance, or deductible when they are provided by an in-network provider.19 Furthermore, all Food and Drug Administrationapproved contraceptive methods prescribed by a woman’s doctor are covered.19 However, plans are not required to cover drugs to induce abortions and services related to a man’s reproductive capacity, like vasectomies.19
choice to buy a “catastrophic” plan
People under 30 years of age and some people with limited incomes may buy this health plan, which protects a person from very high medical costs.20 A catastrophic plan has lower premiums (but higher deductibles) than other individual plans. Students should know that catastrophic plans will cover only 3 doctor’s visits and preventive care upfront, after which there is no coverage until the enrollee meets a $6,350 deductible. In some cases, a catastrophic plan may offer the cheapest upfront cost for coverage.21
what UCLA offers
Insurance companies want young and healthy people (i.e. college students) most as their customers.4 It is our choice where to get our coverage, so explore your options! Visit www.healthcare.gov for more information about the law. t w
References 1. “Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report.” aspe.hhs.gov. (2012). 2. “What is an ‘interim final rule’?” answers.hhs.gov. (2009). 3. “Key Features of the Affordable Care Act.” hhs.gov. (2013). 4. “Five things you need to know about the Affordable Care Act and UC SHIP.” studenthealth.ucla.edu. (2013). 5. “Essential Health Benefits.” healthcare.gov. (2013). 6. “What is the Marketplace in my state?” healthcare.gov. (2013). 7. “What if I have pre-existing health conditions?” healthcare.gov. (2013). 8. “What are my preventative care benefits?” healthcare.gov. (2013). 9. “Summary of Benefits and Coverage.” healthcare.gov. (2013). 10. “Rate Review & the 80/20 Rule.” healthcare.gov. (2013). 11. “How does the health care law protect me?” healthcare.gov. (2013). 12. “How does the health care law protect me: Adult Coverage.” healthcare.gov. (2013). 13. “Ending Lifetime & Yearly Limits.” healthcare.gov. (2013). 14. “How does the Affordable Care Act help people like me?” healthcare.gov. (2013). 15. “Get Covered: A one-page guide to the Health Insurance Marketplace.” healthcare.gov. (2013). 16. “What is the Health Insurance Marketplace.” healthcare.gov. (2013). 17. “Student Health Plans and the Affordable Care Act.” cms.gov. (2012). 18. “Can children stay on a parent’s plan until age 26?” healthcare.gov. (2013). 19. “What are my birth control benefits?” healthcare.gov. (2013). 20. “Can I buy a ‘catastrophic’ plan?” healthcare.gov. (2013). 21. “Helping Students Understand Health Care Reform and Enroll in Health Insurance.” clasp.org. (2013). 22. “What if someone doesn’t have health coverage in 2014?” healthcare.gov. (2013).
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left: levking/istockphoto; right: drb images/istockphoto
UCLA offers its own student health insurance called UC Student Health Insurance Plan (SHIP). Students can waive this option if they have their own private insurance or if they are on their parent’s coverage. UC SHIP covered the standards required by the PPACA, such as guaranteed coverage to all students with no waiting periods or exclusions of pre-existing conditions.4 According to the Ashe Center, the health center on campus, if the UC SHIP plan was available in the Marketplace, it would be categorized as one of the highest level of coverage, but at the price of a lower level plan.4
College students can get coverage through their parents’ plans, choose UC SHIP, or check out the Marketplace. Be sure to enroll by March 31, 2014 so you will not have to pay the penalty!
nail biting, hair pulling, skin picking, oh my! by sofia levy | design by barbara wong
Do you ever catch yourself biting your nails when you’re bored or anxious? Do you feel a strong need to pick at your skin or pull your hair? Nervous habits such as nail biting, hair pulling, and skin picking, which can also be called Body-Focused Repetitive Behaviors (BFRBs), can individually or collectively be detrimental to one’s body, daily life, and self-esteem. A person may engage in one or all of these behaviors, and while they do often occur together, they each have their own possible causes and treatments. Some habits may simply be benign, or they can be more serious reflections of underlying issues. Either way, here are some helpful facts about these behaviors and some tips for how to stop them.1
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Body-focused repetitive behaviors (BFRBs) is an umbrella term for recurrent, problematic, and destructive behaviors that are directed towards one or more regions of the body and can include nail biting, hair pulling, or skin picking.2-3
who typically suffers from BFRBs? While they can occur in the general population,4 BFRBs have only recently started receiving attention in research and in general.1,3
what causes BFRBs? BFRBs have been associated with obsessive-compulsive disorder (OCD)5 and higher perception of somatic (body) activity, such as itching skin.1 A 2008 study in Annals of Clinical Psychiatry reported that they might be related to stereotypic movement disorder (SMD), which is characterized by nonfunctional repetitive movements. This study also showed that someone can engage in more than one BFRB, as 70% of a sample of people who pulled their hair also reported picking their skin and biting their nails. In addition to these BFRBs co-occurring, BFRBs might occur due to underlying disorders, as more BFRBs were reported in people who had anxiety, depression, and stress.4 Not to mention, a 2012 study in Biomed Central conducted in Karachi, Pakistan showed that medical students were prone to BFRBs, with a prevalence of 22%, and it is known that medical students tend to endure much stress and even anxiety.6 These behaviors have also been thought to be a maladaptive emotional regulation mechanism, as claimed in a study published in Clinical Psychology Review in 2013.2
what can be done to prevent BFRBs?
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Since BFRBs are apparently related to anxiety and stress, stress-relieving activities may prevent people from engaging in BFRBs and prevent them from having to turn to professional help. However, there are more formal and specific treatment options for each BFRB discussed in this article.
BFRBs can be normal, healthy, and/or temporary, but they can also be severe, damaging, and/or symptoms of more serious underlying conditions such as depression, anxiety, obsessive compulsive disorder, and more. If these habits are harmless, stress-relieving activities might be effective in stopping the behaviors. However, if these habits are more detrimental, one can seek out professional help, which can involve techniques such as habit reversal training, to steer away from these habits. 48
examples of BFRBs nail biting Nail biting is a well-known BFRB and is not always a pathological condition. It is usually temporary and does not last very long in healthy individuals. However, the distinction between healthy and unhealthy or pathological and non-pathological nail biting is not entirely clear.7 A 2011 study in the Iranian Journal of Medical Sciences suggests that nail biting occurs in 20 to 33% of children ages 7 to 10, 45% of adolescents, and 21.5% of male adults. It also claims that nail biting is not related to gender but rather to whether or not a family member is a nail biter.7 why can nail biting be concerning? Nail biting can be a pathological condition where there is higher intensity, frequency, and duration of the nail biting. It can also be classified as a self-injurious behavior, and there is evidence for a correlation between nail biting and psychiatric disorders.7 how to stop nail biting? The study in the Iranian Journal of Medical Sciences also showed that solving the symptoms of nail biting and using superficial treatments might not be as effective as targeting the various underlying reasons for the nail biting.7 In addition, treatment for the habit is much more complex than just focusing on stopping it. In fact, treatment can include psychotherapy and analyzing the nature and function of nail biting, but punishment is not an effective treatment.7 Habit reversal training, a form of behavioral therapy, could be an effective treatment for nail biting, but training must be at least 1 minute for possible short-term effects and up to 3 minutes of treatment for potential long-term effects.8 Habit reversal training can include awareness training, relaxation training, competing response, aversive stimulus, self-control intervention, and pharmacotherapy.7
left: georgepeters/istockphoto; right: bagi1998/istockphoto
what are BFRBs?
skin picking Skin Picking Disorder, also known as Dermatillomania or Excoriation Disorder, is just now receiving serious attention as a Diagnostic and Statistical Manual (DSM) psychiatric disorder and has been shown to be as common as many other psychiatric disorders.14 According to an article published in 2009 in Current Psychiatry Reports, Pathological Skin Picking (PSP) affects approximately 2 to 5.4% of the population and is classified as an impulse disorder. It is similar to OCD behaviors and other BFRBs such as TTM and nail biting, but unfortunately, appropriate treatments are limited even though PSP is common.
hair pulling Trichotillomania (TTM) affects up to 4% of the population.9 It is characterized by chronic hair pulling resulting in noticeable hair loss; it often starts with a “tension” and results in “gratification” and “relief” after the hair is pulled.9 Both children and adults suffer from the disorder,10 but hair pulling occurs more frequently in childhood and adolescence. A 2012 study in The Primary Care Companion to CNS Disorders shows that childhood onset of TTM is common but might have neurobiological differences from later, postpubertal onset of TTM, which might be strongly associated with more severe TTM.11 why can hair pulling be concerning? In addition to effects that TTM has on one’s appearance and selfesteem, a case published in 2013 in the International Journal of Trichology also demonstrated that TTM can occur due to body dysmorphic disorder – a preoccupation with an imagined or actual slight defect in the appearance of a body part; researchers interviewed a patient who endured social stigma against her red hair color and engaged in TTM to cope with her insecurities due to the stigma.12
how to stop skin picking? Treatment for skin picking disorder can include cognitive behavioral therapy such as habit reversal therapy, and pharmacotherapy such as serotonin reuptake inhibitors.14,19 t w
References 1. “Body-focused repetitive behavior problems. Prevalence in a nonreferred population and differences in perceived somatic activity.” Behav Modif. (2002). 2. “Emotion Regulation and Other Psychological Models for body-focused repetitive behaviors.” Clin Psychol Rev. (2013). 3. “Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children.” Child Psychiatry Hum Dev. (2012). 4. “Is Trichotillomania a stereotypic movement disorder? An analysis of body-focused repetitive behaviors in people with hair-pulling.” Ann Clin Psychiatry. (2008). 5. “Animal modes of obsessive-compulsive spectrum disorders.” CNS Spectr. (2013). 6. “Prevalence of body-focused repetitive behaviors in three large medical colleges of Karachi: a cross-sectional study.” BMC Res Notes. (2012). 7. “Nail Biting; Etiology, Consequences and Management.” Iran J Med Sci. (2011). 8. “Evaluating the duration of the competing response in habit reversal: a parametric analysis.” J Appl Behav Anal. (2001). 9. “Trichotillomania.” Semin Cutan Med Surg. (2013). 10. “Habit reversal training in trichotillomania: guide for the clinician.” Expert Rev Neurother. (2013). 11. “Age at onset in trichotillomania: clinical variables and neurocognitive performance.” Prim Care Companion CNS Disord. (2012). 12. “A childhood case of trichotillomania associated with body dysmorphic disorder and stigmatization due to outstanding red hair.” Int J Trichology. (2013). 13. “Comprehending trichotillomania.” Int J Trichology. (2012). 14. “Skin Picking Disorder.” Am J Psychiatry. (2012). 15. “Update on pathological skin picking.” Curr Psychiatry Rep. (2009). 16. “Skin Picking Behaviors: An Examination of the prevalence and severity in a community sample.” J Anxiety Disord. (2009). 17. “Skin picking disorder is associated with other body-focused repetitive behaviors: findings from an internet study.” Ann Clin Psychiatry. (2012). 18. “Primary Psychiatric Conditions: dermatitis artefacta, trichotillomania and neurotic excoriations.” Indian J Dermatol. (2013). 19. “Pathological Skin Picking.” American J Drug Alcohol Abuse. (2010).
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how to stop hair pulling? Treatments for TTM include cognitive behavioral therapy such as habit reversal training and pharmacological treatment (particularly serotonin uptake inhibitors, although their effectiveness is not clear).9 Habit reversal may be effective for treatment as it shows the most empirical support. It can target the client’s particular needs and can include targeting stimulus control, awareness training, selfmonitoring, and understanding the situations and components that lead to the hair pulling.10 A study published in the International Journal of Trichology in 2012 showed that it could also be helpful to look at hair cues and attentional disengagement from these cues in relation to TTM.13
why can skin picking be concerning? Recent cognitive testing showed that people with PSP showed impaired inhibitory control.15 Also, a study published in the Journal of Anxiety Disorders in 2009 showed that skin picking can lead to medical complications and is associated with OCD, anxiety, and depression, which supports that skin picking is associated with emotional regulation.16 In addition, an internet study published in Annals of Clinical Psychiatry in 2012 suggested that skin picking disorder (SPD) is perhaps related to other BFRBs, as it commonly co-occurs with them, and that SPD and hair pulling disorder may run in the same families.17 In relation to skin picking, Dermatitis Artefacta (DA) is characterized by self-induced skin lesions and is classified as a primary psychiatric disorder along with TTM. One with DA should see a dermatologist for treatment.18
decoding the nutrition label by peter chu | design by karin yuen
Creatine is one of the most extensively studied nutritional supplements used in muscle uptake, and it is known for helping increase the capacity for highintensity exercise.1 It is readily available as a dietary supplement that is approved by the US Food and Drug Administration, and here, we’re going to decode this mysterious substance for those of you who want to know what it is, what it does, and whether or not you may want to think about using it.
what is creatine?
Creatine is a nitrogenous organic acid produced by the liver. It supplies the body, particularly muscle cells, with energy in the form of 3 amino acids: arginine, glycine, and methionine. It is transported by the blood and used by muscles when the body needs more energy than usual. Although creatine is already present in the body, both naturally and consumed through diet, it can also be obtained from supplements.2 Creatine is generally used by athletes to increase their energy levels, which may lead to both improved athletic performance and the ability to train at more intense levels.2
the loading phase and the maintenance phase
A 1996 study in the Journal of Applied Physiology followed men who ingested 20 g of creatine per day for 6 days. A 20% higher creatine concentration in their muscles was maintained with 2 g of creatine per day for 30 days. This method has been shown to speed up the process of “creatine loading” of the body’s skeletal muscles for more rapid benefits.3 A similar but more gradual increase in total muscle creatine concentration can be completed over 28 days at a rate of 3 g per day. Without the maintenance dose, creatine gradually declined back to original levels.
total wellness ▪ winter 2014
Another study published in Medicine and Science in Sports and Exercise in 2000 revealed that creatine supplements can increase muscle phosphocreatine content, which is important for the energy metabolism of muscle. More phosphocreatine in the muscles fosters performance during anaerobic exercise. For example, short periods of extremely powerful activity, such as lifting a weight that you may only be able to lift 3 times, can be enhanced. However, try to stay humble; although creatine may boost how much weight you can lift, maintain a healthy self-awareness of your own body and know its limits. Meanwhile, creatine supplementation has not been shown to increase aerobic exercise performance.4
be stronger than yesterday
In 1997, there was a study published in the Journal of Applied Physiology of 19 young female volunteers who performed 10 weeks of resistance training 3 hours per week while loading and maintaining their creatine intake. During creatine supplementation, the heaviest weight lifted using chosen muscle groups increased 20 to 25%. In addition, the endurance of their arm muscles increased 10 to 25%. These women’s fat-free mass, which includes anything that contributes to weight that is not fat, increased 60%.5
the good stuff › Approved for usage by both the International Olympic
Committee as well as the National Collegiate Athletic Association.2 › A 2007 review published in the Journal of the International Society of Sports Nutrition asserts that there is no scientific evidence that the short or long-term use of creatine is harmful to healthy individuals.1 › Minimally impacts long-term creatine concentrations and renal function in young healthy adults.6
taken with a grain of salt › A study published in 1998 in the Journal of Applied
Physiology had 8 active, untrained men perform a 20-second maximal sprint after 5 days of creatine supplementation. The creatine supplementation increased total muscle creatine content, but did not induce improved sprint performance.7 However, a 2005 review in Sports Medicine concluded that activities that involve sprinting generally lead to improved sports performance following creatine ingestion.8 This illustrates individual variability in creatine effects on different users. › May result in weight gain partially due to water retention due to the simultaneous uptake of water and creatine into the muscles.4 › Creatine comes with certain mild side effects, including stomach pain, nausea, muscle cramping, and diarrhea.2 According to the University of Mississippi Medical Center, taking in more than the dose instructed may damage the liver and kidneys or cause dizziness and high blood pressure as well.9
Creatine is generally safe to use for otherwise healthy individuals and may be what you need to get over that plateau in your strength training regimen. You can either load your creatine, taking a greater amount for several days before entering the maintenance phase with a lower daily dose, or you can increase the amount of creatine in your muscles gradually by taking a constant smaller daily dose. It is advisable, however, to drink more fluids while using creatine in order to replace the water being retained in the muscles. Also, the effects of creatine, like those of many substances, may vary from one individual to another. Keep in mind that creatine may not assist those of you who are into aerobic exercise, but may be helpful when trying to bulk up. t w References 1. “International Society of Sports Nutrition Position Stand: Creatine Supplementation and Exercise.” J Int Soc Sports Nutr. (2007). 2. “What is creatine? What are the benefits of creatine?” medicalnewstoday.com. (2013). 3. “Muscle Creatine Loading in Men.” J Appl Physiol. (1996). 4. “The Physiological and Health Effects of Oral Creatine Supplementation.” Med Sci Sports Exerc. (2000). 5. “Long-term creatine intake is beneficial to muscle performance during resistance training.” J Appl Physiol. (1997). 6. “The Effect of Creatine Intake on Renal Function.” Ann Pharmacother. (2005). 7. “Effect of Creatine Supplementation on Sprint Exercise Performance and Muscle Metabolism.” J Appl Physiol. (1998). 8. “Creatine supplementation and exercise performance: recent findings.” Sports Med. (2005). 9. “Creatine.” umm.edu. (2013).
left: lee rogers/istockphoto
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:
Alison Grimes, AuD, Head of Audiology Clinic: UCLA Medical Center, Assistant Clinical Professor in Head and Neck Surgery, UCLA David Geffen School of Medicine
Evelyn Chung, DDS, Clinical Associate Professor, Hospital Dentistry, Advanced Prosthodontics, UCLA School of Dentistry
eating your way to new healthy habits
Eve Lahijani, MS, RD, Nutrition Health Educator, UCLA Bruin Resource Center
Helen Lavretsky, MD, Associate Professor, Department of Psychiatry, UCLA David Geffen School of Medicine
mood boosting habits
Julie Skrupta, AADP, CHHP, Board Certified Holistic Health Coach
only just a number
getting informed: new changes in our healthcare system
Gerald F. Kominski, MD, PhD, Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health
nail biting, hair pulling, skin picking, oh my!
Elisa Terry, NSCA-CSCS, FITWELL Services Program Director, UCLA Recreation
Melissa Magaro, PhD, Clinical Psychologist, Affective Disorders Program Coordinator, UCLA Counseling and Psychological Services
health is music to my ears
decoding the nutrition label
Robert Bilder, PhD, ABPP, Michael E. Tennenbaum Family Professor of Psychiatry and Biobehavioral Sciences, Professor of Psychology, UCLA College of Letters & Science, UCLA David Geffen School of Medicine Kendra Knudsen, BS, Psychobiology with Disability Studies Minor, UCLA Mind Well Program Coordinator
musical beats for sleep & stress relief
Ping Ho, MA, MPH, Founding Director, UCLArts and Healing/Arts and Healing Initiative
the importance of posture
David Fish, Associate Director for the Pain Medicine Fellowship Program, Physical Medicine and Rehabilitation, UCLA David Geffen School of Medicine
Alona Zerlin, MS, RD, Research Dietitian, UCLA Department of Medicine, UCLA Center for Human Nutrition
copy-edits and review
Leslie Chang, Julie Escobar, Tiffany Lin, Chalisa Prarasri, and Shannon Wongvibulsin
Barbara Wong, Shannon Wongvibulsin, and Karin Yuen
cover & table of contents
Designed by Barbara Wong and Karin Yuen
total wellness â–Ş winter 2014
what your tongue can say about your health
namaste: promoting mental wellness through yoga
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