SCAN’SPulse

Spring 2019, Vol. 38, No. 2 CONTENTS Exercise and the Human Gut Microbiome 1 Exercise and the Human Gut by Michael Crosier, PhD, RD Microbiome 3 The human microbiome is an excit- may contribute to the health effects From the Editor ing area of research. Although this of regular, moderate exercise. 6 field is in its infancy, scientists are Cellular Senescence-Associated rapidly gaining an understanding of Gut Bacteria Functions Arterial Dysfunction with Advancing the interactions between our cells Age: Translational Potential of and the microbes living in and on our Many aspects of health are linked Nutraceuticals as Senolytics body. We are inhabited with trillions with gut physiology, and our gut bac- 10 of microbes, the largest concentra- teria are important contributors to Implications of Higher-Risk Dietary tion residing in our distal gastroin- this interaction. For example, normal Supplements and Factors Predicting testinal (GI) tract, where the digestion and motility through the GI Their Use in Collegiate Athletes microorganism genome (gut micro- tract is dependent on gut bacteria.2 biome) is about 150 times greater Gut bacteria have the ability to pro- 14 than our own.1 While there is great duce a variety of vitamins, such as fo- From the Chair interindividual variation in bacterial late, vitamin K, and biotin, and are composition, the primary bacterial able to carry out biotransformations 15 phyla found in our guts are Bac- of bile acids, phytonutrients, and Conference Highlights teroidetes and Fermicutes.1 Within other xenobiotics.3 The fermentation 17 these phyla and others, thousands of of resistant carbohydrate in the distal Reviews different bacterial species, mostly GI tract results in the production of anaerobic, inhabit the GI tract.2 the short-chained fatty acids (SCFAs) 17 butyrate, propionate, and acetate. In Research Digest Research is showing a strong connec- addition to contributing to energy tion between our gut bacteria and metabolism,4 these SCFAs serve as 19 host physiology and is demonstrat- ligands for receptors that can activate Of Further Interest ing how this connection relates to various signaling pathways.5 The role risk of disease and overall health. In of SCFAs as signaling molecules influ- 21 Upcoming Events addition, researchers are learning ence physiologic processes such as more about the environmental influ- intestinal secretion of peptides in- ences shaping our microbiome, such volved in satiety and hepatic gluco- as changes throughout the lifecycle neogenesis.6,7 and diet. Although less is known about the effects of exercise on the Our immune system is also intimately human gut microbiome, studies have associated with our gut bacteria. Gut revealed positive changes in our gut bacteria enhance the barrier function bacteria in response to exercise. of the intestine.7 They can also stimu- These exercise-induced changes late the innate immune system and protect against pathogens through chronic diseases, including heart dis- Academy of Nutrition and Dietetics the production of bacteriocides and ease, diabetes, musculoskeletal ail- Dietetic Practice Group of Sports, competition with pathogenic bacte- ments, and potentially mental health Cardiovascular, and Wellness ria.3 conditions.15-17 In the gut, regular Nutrition (SCAN) moderate-intensity exercise has been Although the ideal bacterial compo- shown to reduce the occurrence of SCAN Website: www.scandpg.org sition to maximize health is not colorectal cancer and inflammatory known, high microbial diversity is as- bowel diseases.18-20 However, exercise sociated with improvements in can also lead to GI distress. It has SCAN Office health status, whereas decreased mi- been reported that between 30% to 120 S. Riverside Plaza, Suite 2190 crobial diversity is associated with an 90% of distance runners have experi- Chicago, IL 60606 Phone: 312/899-1775 increased risk for metabolic disease enced exercise-related intestinal [email protected] such as obesity and type 2 diabetes.2 problems.21 Running at high intensity Interim Executive Director: Adriana Legreid often produces GI upset such as Determinants of the Gut bloating, diarrhea, stomach pain, and SCAN Executive Committee Microbiome bleeding.22 High-intensity training Chair Lindzi Torres, MS, MPH, RDN, CSSD has been associated with reduced GI Microbial colonization begins imme- blood flow and hypoxia, potentially Chair-Elect diately at birth and fluctuates leading to mucosal injury and in- Jennifer Ketterly, MS, RD, CSSD throughout the lifecycle. The initial creased intestinal permeability.23,24 bacterial composition is influenced The integrity of intestinal tight junc- Past Chair Cheryl Toner, MS, RDN by mode of delivery, with infants de- tions can be disrupted by the physi- livered vaginally having a greater cal stress of exercise, potentially Treasurer concentration of Bacteriodetes than leading to systemic inflammation.25 Lynn Cialdella Kam, PhD, MA, MBA, RDN Firmicutes compared with infants de- Although an individual bout of in- livered via cesarean section.9 Bacteria tense exercise may increase inflam- Secretary Sherri Stastny, PhD, RD, CSSD diversity increases as solid food is in- mation, habitual exercise and fitness troduced.10 The microbiome typically leads to suppression of basal inflam- Director, Sports Dietetics—USA Subunit continues to change between adult- matory cytokines,26 and has been as- Elizabeth Abbey, PhD, RDN, CDN hood and elderly years. After age 65, sociated with preservation of a more the number of microbial species robust mucosal lining and lesser de- Director, Wellness/Cardiovascular 11 27 RDs Subunit tends to decrease. Changes in GI gree of intestinal permeability. In Mark Hoesten, RD physiology, such as changes in sali- type 2 diabetics, combined aerobic vary function and gut motility, affect and resistance training led to a de- Director of Events gut microbiota as we age.12 crease in several pro-inflammatory Enette Larson-Meyer, PhD, RD, CSSD, FACSM cytokines and an increase in the anti- Director of Communications In adults, diet is a major determinant inflammatory modulators inter- Cara Harbstreet, MS, RD of microbial composition. A high- leukins 4 (IL-4) and 10 (IL-10).28 fiber diet rich in fruits, vegetables, Director of Member Services legumes, and whole-wheat grain Intestinal and systemic effects of ex- Karen Reznik Dolins, EdD, RD, CSSD, CDN products has been shown to increase ercise may be related to changes in 2 SCAN Delegate to House of Delegates microbial diversity. The fecal micro- the gut microbiome. Research shows Jean Storlie, MS, RD biota of vegetarian and vegan sub- that exercise and fitness are associ- jects versus omnivores have lower ated with an increase in the microbial ______stool pH, likely due to a greater pro- diversity and increases in health-pro- duction of SCFA.13 Overall, a more moting bacterial populations.2 On Editor-in-Chief, SCAN’S PULSE Mark Kern, PhD, RD complex and diverse diet is associ- the other hand, frailty and poor exer- ated with a more diverse micro- cise capacity in the elderly is associ- To contact an individual listed above, go to biome.12 While less is known about ated with low fecal microbial www.scandpg.org/executive-committee/ how exercise affects our gut micro- diversity.29 Exercise-induced alter- biome, research has shown that phys- ations in gut bacteria may play a role ical stress alters the composition of in intestinal immune function and the gut microbiome.14 overall GI physiology. Fit individuals have been shown to have a micro- Effect of Exercise on the Gut biome enriched in butyrate-produc- and Gut Bacteria ing bacteria such as Clostridiales, Roseburia, and Lachnospiraceae,30 Regular moderate exercise provides and increased production of the protection against a number of SCFA butyrate is associated with in-

2 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 From The Editor

Keep Calm and Read PULSE by Mark Kern, PhD, RD, Editor-in-Chief

There are plenty of reasons to be stressed out with work and life, but reading a new issue of SCAN’s PULSE is not one of them. I’m hopeful that you can find a few precious moments to relax and read through the pages of this issue. If you do, you will come away with a little more knowledge and perhaps even a sense of relief that you’ve made progress in understanding a few of the complexities of our field.

In our previous (Winter) issue, we provided an article regarding diet and the gut microbiome. As a complement to that piece, our cover article by Michael Crosier, PhD, RD discusses the latest research on the role that exercise plays in determining the mi- crobiome. After that, Zachary Clayton, PhD offers his insight into processes of cellular ageing and describes possible ways that what we ingest may intervene to counter it. In our final feature article, you’ll learn from John Sassone, MS, RD and Michelle Bar- rack, PhD, RD, CSSD about the use of dietary supplements that could jeopardize the health or athletic eligibility of competitors and the issues that professionals working with those athletes should consider.

You should also spend some time reading through the other informative departments that we provide including “Reviews,” “Conference Highlights,” “Of Further Interest,” “From the Chair,” and “Research Digest.” And don’t fret when you’ve finished, because we’ll have another issue in your inbox for you to enjoy this summer.

testinal health.4 Other exercise-in- shown to alter the gut microbiome in Conclusion duced changes in the gut micro- humans.37 Professional rugby players biome that have been associated had a higher fecal microbiome diver- Along with diet, exercise is an easily with health benefits include im- sity compared with controls matched accessible tool that may contribute to proved insulin sensitivity,31 increased for body size, age, and gender. The gut microbiome diversity. Increased satiety,32 and improved mental higher diversity correlated to greater gut bacterial diversity and richness is health.33 exercise intensity and also greater associated with health benefits.4 Posi- protein intake. tive changes in our gut microbiome Different forms of exercise have been could potentially contribute to better shown to have differing effects on The mechanisms behind the effect of weight management and obesity- bacterial communities. In obese mice exercise on the gut microbiome is related sequelae, and to an improve- fed a high-fat diet, high-intensity in- not fully understood. As mentioned, ment in inflammatory and other GI terval training (HIIT) for 6 weeks in- exercise physically stresses the intes- disorders, such as colon cancer. More creased the diversity and tines. Also, both physical and psycho- research is needed to define the ef- Bacteroidetes:Firmicutes ratio of the logical stressors cause the release of fects that various types of exercise cecum and colon.34 Fecal microbiota various hormones, such as cortisol have on the intestinal microbiome. diversity was also increased.34 These and epinephrine, which have been What has been demonstrated to changes appear to be beneficial, as associated with changes in the gut date, however, is consistent with cur- they are in opposition to the changes microbiome.14 Studying the effects of rent guidelines, suggesting that indi- typically observed in obesity or when exercise on the gut microbiome in viduals should be physically active to consuming a high-fat diet.35 Another humans is challenging. Exercisers attain optimal health. study in mice found that both volun- often have dietary patterns and en- tary wheel running and forced tread- ergy intake that differ from those of Michael Crosier, PhD, RD is an associate mill running altered gut bacteria, but sedentary individuals, making inter- professor of food and nutrition at only forced treadmill running led to pretation of the effect of exercise on Framingham State University in increased bacterial richness.36 In addi- the gut microbiome difficult.12 An ad- Framingham, MA. tion, the study showed no alteration ditional confounding factor is the ef- in the ratio of the two main phyla, fect of exercise on body composition, References Bacteriodetes and Firmicutes. as fat mass may influence gut bacter- 1. J Qin, R Li, J Raes, et al. A human gut ial composition.35 microbial gene catalogue established Although most work has been done by metagenomic sequencing. Nature. on mice, exercise has also been 2010;464:7285, 59–65.

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 3 2. Monda V, Villano I, Messina A, et al. 12. Cresci G, Bawden E. The gut micro- 19. Sanchez NF, Stierman B, Saab S, et exercise modifies the gut microbiota biome: What we do and don’t know. al. Physical activity reduces risk for with positive health effects. Oxid Med Nutr Clin Pract. 2015;30:734-746. colon polyps in a multiethnic colorec- Cell Longev. 2017;2017:3831972. tal cancer screening population. BMC 13. Zimmer J, Lange B, Frick JS, et al. A Res Notes. 2012;5:312. 3. Flint H, Scott K, Louis P, et al. Nat. vegan or vegetarian diet substantially Rev. The role of the gut microbiota in alters the human colonic faecal mi- 20. Martin D. Physical activity benefits nutrition and health. 2012;9:577-589. crobiota. Eur J Clin Nutr. 2012;66:53– and risks on the gastrointestinal sys- 60. tem. South Med J. 2011;104:831–837. 4. Turnbaugh PJ, Ley RE, Mahowald MA, et al. An obesity-associated gut 14. Lyte M, Vulchanova L, Brown DR. 231. de Oliveira EP, Burini RC, Jeuk- microbiome with increased capacity Stress at the intestinal surface: cate- endrup A. Gastrointestinal complaints for energy harvest. Nature; 2006;444: cholamines and mucosa-bacteria in- during exercise: Prevalence, etiology, 1027–1031. teractions. Cell Tissue Res. 2011;343: and nutritional recommendations. 23–32. Sports Med. 2014; 44(Suppl 1):S79– 5. Parnell JA, Reimer RA. Prebiotic 85. fibres dose-dependently increase 15. Thomas DE, Elliott EJ, Naughton satiety hormones and alter Bac- GA. Exercise for type 2 diabetes melli- 22. Peters HPF, Vries WRD, Vanberge- teroidetes and Firmicutes in lean and tus. Cochrane Database Syst Rev. 2006; Henegouwen GP, et al. Potential ben- obese JCR:LA-cp rats. Br. J. Nutr. 2012; 19(3):CD002968. efits and hazards of physical activity 107: 601–613. and exercise on the gastrointestinal 16. Dunn AL, Trivedi MH, Kampert JB, tract. Gut. 2001;48:435–439. 6. Sleeth ML, Thompson EL, Ford HE, et al. Exercise treatment for depres- et al. Free fatty acid receptor 2 and sion. Am J Prev Med. 2005;28:1–8. 23. Oktedalen O, Lunde OC, Opstad nutrient sensing: a proposed role for PK, et al. Changes in the gastrointesti- fibre, fermentable carbohydrates and nal mucosa after long-distance run- short-chain fatty acids in appetite ning. Scand J Gastroenterol. 1992;27: regulation. Nutr. Res. Rev. 2010;23: The mechanisms 270–74 135–145. behind the effect 24. Pals KL, Chang RT, Ryan AJ, et al. Ef- 7 Scheppach W. Effects of short chain fect of running intensity on intestinal fatty acids on gut morphology and permeability. J Appl Physiol. 1997;82: function. Gut; 1994 35(suppl):S35– of exercise on the 571–576. S38. 25. Zuhl M, Schneider S, Lanphere K, 8. Grenham S, Clarke G, Cryan JF, et al. gut microbiome is et al. Exercise regulation of intestinal Braingut- microbe communication in tight junction proteins. Br J Sports health and disease. Frontiers in Physi- not fully Med. 2014;48:980–986. ology. 2011;2:1–15. 26. O’Sullivan O, Cornin W, Clarke SF, 9. Jakobsson HE, Abrahamsson TR, understood. et al. Exercise and the microbiota. Gut Jenmalm MC, et al. Decreased gut mi- Microbes. 2015;6:131–136. crobiota diversity, delayed Bacteri- odetes colonisation and reduced Th1 17. McGlory C, van Vliet S, Stokes T, et 27. Luo B, Xiang D, Nieman DC, et al. responses in infants delivered by cae- al. The impact of exercise and nutri- The effects of moderate exercise on sarean section. Gut. 2014;63:559–566. tion in the regulation of skeletal mus- chronic stress-induced intestinal bar- cle mass. J Physiol. 2018; Jul 16. doi: rier dysfunction and antimicrobial 10. Favier CF, Vaughan EE, De Vos WM, 10.1113/JP275443. [Epub ahead of defense. Brain, Behav Immun. et al. Molecular monitoring of succes- print] 2014;39:99-106. sion of bacterial communities in human neonates. Appl. Environ. Micro- 18. Khalili H, Ananthakrishnan AN, 28. Balducci S, Zanuso S, Nicolucci A, biol. 2002;68:219–226. Konijeti GG, et al. Physical activity and et al. Anti-inflammatory effect of ex- risk of inflammatory bowel disease: ercise training in subjects with type 2 11. O’Toole PW, Claesson, MJ. Gut prospective study from the Nurses’ diabetes and the metabolic syn- microbiota: changes throughout the Health Study cohorts. BMJ. drome is dependent on exercise lifespan from infancy to elderly. Int. 2013;347:f6633. modalities and independent of Dairy J. 2010;20:281–291. weight loss. Nutr, Metab Cardiovasc Dis. 2010;20:608-617.

4 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 Staya on Topo of Wellnesse Trendse

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29. Claesson MJ, Jeffery IB, Conde S, et 34. Denou E, Marcinko K, Surette MG, al. Gut microbiota composition corre- Studying the et al. High-intensity exercise training lates with diet and health in the eld- increases the diversity and metabolic erly. Nature. 2012;488:178-84. capacity of the mouse distal gut mi- effects of exercise crobiota during diet-induced obesity 30. Estaki M, Pither J, Baumeister P, et Am J Physiol Endocrinol Metab. al., Cardiorespiratory fitness as a pre- on the gut 2016;310: E982–E993. dictor of intestinal microbial diversity and distinct metagenomic functions. 35. Qian LL, Li HT, Zhang L, et al. Effect FASEB J. 2016; 30: 1027–1035. microbiome in of the gut microbiota on obesity and its underlying mechanisms: an up- 31. Evans CC, LePard KJ, Kwak JW, et date. Biomed Environ Sci. 2015;28:839- al. Exercise prevents weight gain and humans is 847. alters the gut microbiota in a mouse model of high fat diet-induced obe- challenging. 36. Allen JM, Berg Miller ME, Pence sity. PLoS One. 2014;9:e92193. BD, et al. Voluntary and forced exer- cise differentially alters the gut mi- 32. Queipo-Ortuno MI, Seoane LM, crobiome in C57BL/6J mice. J Appl Murri M, et al. Gut microbiota compo- 33. Kang SS, Jeraldo PR, Kurti A, et al. Physiol. 2015;118:1059-1066. sition in male rat models under differ- Diet and exercise orthogonally alter ent nutritional status and physical the gut microbiome and reveal inde- 37. Clarke SF, Murphy EF, O’Sullivan O, activity and its association with pendent associations with anxiety et al. Exercise and associated dietary serum leptin and ghrelin levels. PLoS and cognition. Mol Neurodegener. extremes impact on gut microbial di- One. 201;8:e65465. 2014;9: 36. versity. Gut. 2014;63:1913–1920.

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 5 Cellular Senescence-Associated Arterial Dysfunction with Advancing Age: Translational Potential of Nutraceuticals as Senolytics by Zachary S. Clayton, PhD

Advancing age is the primary risk fac- incompletely understood, cellular Senescent Cells as Drivers of tor for cardiovascular diseases (CVD), senescence has emerged as a key Cardiovascular Aging which remain the leading cause of mechanism of age-associated CV dys- morbidity and mortality in the devel- function. Strategies aimed at prevent- Cellular senescence, as previously oped world.1 The key process that ing the development of arterial stated, is a process by which cells irre- links aging to increased CVD is age- dysfunction with aging are likely to versibly lose the capacity to prolifer- related arterial dysfunction.2-4 Demo- have significant public health impact. ate, while developing a SASP. The graphic trends predict the number of SASP contributes to the breakdown older adults in the U.S. to double over Age-Related Arterial of tissues and likely contributes to the next four decades,5,6 and without Dysfunction: Potential Role the correlation between senescent intervention, this increase will lead to of Cellular Senescence cell accumulation and tissue dysfunc- a new epidemic of CVD and associ- tion with advancing age. Thus, senes- ated health care burden.5 Thus, iden- Cellular senescence is a multifaceted cent cells and the associated SASP tifying strategies to prevent or delay stress response that arrests cell prolif- are a potential link between aging age-related arterial dysfunction is a eration, essentially irreversibly. Cellu- and arterial dysfunction that may major biomedical priority.2,7,8 lar senescence also causes the provide avenues for prevention secretion of numerous proinflamma- The two most clinically important and/or treatment strategies. How- tory cytokines, chemokines, growth ever, the exact role of increased cellu- manifestations of age-related arterial factors, and proteases, termed the dysfunction are large elastic artery lar senescence in mediating arterial senescence-associated secretory aging is presently unknown. stiffening and impaired endothelial phenotype (SASP). Senescent cells in- function, which is largely mediated crease with age in many tissues, and Researchers have identified three key by the vascular protective vasodila- these changes are associated with senescence-associated proteins (p16, tory molecule nitric oxide (NO). The age-related arterial dysfunction, p21, p53) that show promise as tar- two major processes that mediate ar- largely through the SASP. terial stiffening and impaired en- gets for prevention of age-associated dothelial-dependent dilation (EDD) Recently, Rossman et al13 studied arterial dysfunction, particularly in- with aging are oxidative stress (e.g., sedentary and exercise-trained mid- creased endothelial cell expression of increased free radical production in dle-aged and older adults to deter- the tumor suppressor protein p16, arteries with unchanged or de- mine whether increased endothelial which is regulated by the SASP and creased antioxidant defenses) and cell senescence is associated with im- associated with vascular endothelial chronic, low-grade inflammation. Im- paired vascular endothelial function, dysfunction. Furthermore, age- portantly, oxidative stress and inflam- and whether exercise-induced im- related vascular endothelial dysfunc- mation amplify each other in provements in vascular endothelial tion is strongly associated with im- feed-forward fashion to impair arte- function are associated with de- paired NO-dependent dilation. Thus, rial function with aging, in part, by creased endothelial cell senescence. interventions that target the SASP decreasing the bioavailability of Results demonstrated that increased and enhance NO signaling may be NO.9,10 In addition, arterial stiffening endothelial cell senescence in seden- beneficial in preventing cellular is mediated by major structural tary aging is associated with im- senescence-associated arterial dys- changes in the arteries, including an paired vascular endothelial function. function. increase in collagen abundance, a re- Furthermore, results from this study duction and fragmentation of elastin, suggest an absence of age-related in- Senolytics for Improving and increased formation of advanced creases in endothelial cell senescence Vascular Aging glycation end products (AGEs), which among older exercising adults, which form cross-links between structural is linked with preserved arterial func- The establishment of a link between proteins.11, 12 tion. Taken together, these findings senescent cells, the resulting SASP, suggest that cellular senescence may While the mechanisms driving age- and arterial dysfunction opens av- be a target for treatment of age-re- enues for pharmaceutical and nu- related oxidative stress and inflam- lated vascular endothelial dysfunc- mation in CV tissues are currently traceutical interventions. Consistent tion. with a role for cellular senescence in

6 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 causing age-related dysfunction, the senescence, the resulting SASP, and against H2O2 and palmitic acid-in- clearance of senescent cells by acti- arterial dysfunction with advancing duced impairments of superoxide vating a drug-inducible “suicide” age are warranted. dismutase (SOD) production in gene enhances markers of health human umbilical vascular endothelial span and delays a multitude of age- The use of flavonoids as potential cells (HUVECs),18,19 and attenuated related phenotypes.14 Use of such a senolytics has gained increasing at- the increase in activation of the “suicide” gene, despite removing only tention due to the inverse association proinflammatory NF- B pathway in 30% of senescent cells, resulted in of flavonoids with coronary heart dis- HUVECs following palmitic acid treat- marked improvements in age-related ease risk, along with their anti-inflam- ment.19 Taken together, it is clear that adipose tissue, skeletal muscle, and matory and anti-oxidative properties. apigenin can preserve vascular func- ocular dysfunction.14 Thus, interven- Apigenin, a flavonoid compound dis- tion in vivo and reduce proinflamma- tions that decrease the burden of cel- tributed in cabbage, bell pepper, gar- tory signaling and the SASP in vitro; 17 lular senescence may have the lic, guava, celery, and parsley, has however, studies assessing the role of potential to attenuate or prevent shown promise in improving vascular apigenin in preventing senescence- 18, 19 other age-related dysfunctional phe- function and decreasing the associated arterial dysfunction in vivo 20 notypes. SASP ; however, there is little reliable are needed. information on the concentration of apigenin in the aforementioned Impaired vascular endothelial func- Senescent cells are removed by the foods. As such, apigenin-rich diets are tion in aging is associated with de- immune system, rather than through not feasible, given that the portion creased cellular nicotinamide apoptosis or necrosis; therefore, inter- and types of foods that should be adenine dinucleotide (NAD+) levels ventions aimed at improving anti- apoptotic, pro-survival mechanisms could be upregulated in senescent cells and ultimately lead to successful Use of such a “suicide” gene, despite elimination of senescent cells. Drugs that preferentially remove senescent removing only 30% of senescent cells, cells are termed senolytics. The first senolytics appearing in the literature was the combination of dasatinib resulted in marked improvements in and quercetin (D+Q), which pro- duced results suggesting a potential for improving vascular function in age-related adipose tissue, skeletal aged mice.15 Although D+Q has shown promise as a senolytic in ro- muscle, and ocular dysfunction.14 dent models, the translational bio- medical relevance of this intervention is limited, because dasatinib is a consumed to reduce the SASP and and elevated global protein acetyla- chemotoxic agent that cannot be enhance NO signaling is unclear. In- tion. Interventions aimed at increas- freely given to cancer-free humans. stead, development of apigenin as a ing cellular NAD+ levels (caloric Furthermore, quercetin alone is not dietary supplement may be benefi- restriction,21, 22 nicotinamide ribo- as effective in preventing cellular cial. side,23 nicotinamide mononu- senescence-associated age-related cleotide,24 resveratrol,25 and phenotypes.16 For these reasons, Work by Perrott et al demonstrated SRT172026 supplementation) have there is a need for establishing di- that apigenin decreases components shown promise for enhancing en- etary interventions that can attenu- of the SASP following irradiation-in- dothelial function in aged mice, as ate or prevent the SASP and arterial duced senescence in three different well as in middle aged/older adults. dysfunction with advancing age. 20 strains of human fibroblasts. Specif- Similar to aging, obesity results in de- ically, apigenin decreased pro-inflam- + Nutraceuticals to Enhance creased cellular NAD levels and ele- matory interleukin (IL)-1 , IL-6, and vated global protein acetylation, Arterial Function and Inhibit NF- B signaling as well as suppressed the SASP which are both associated with im- the expression and secretion of a paired cardiometabolic health.27 Re- newly identified SASP factor, C-X-X Independent of aerobic exercise re- cently, administration of apigenin motif chemokine ligand 10 search, no studies have explored was shown to ameliorate obesity-in- (CXCL10).20 Apigenin has also been lifestyle interventions as a means of duced metabolic dysfunction in shown to improve arterial function in 28 decreasing senescent cells and the mice. The improvements in meta- a mouse model of atherosclerosis18 resulting SASP in humans. Thus, es- bolic function following apigenin ad- and a rat model of type 2 diabetes.19 tablishing dietary interventions that ministration occurred through Furthermore, apigenin protected + can attenuate or prevent cellular inhibition of the NAD glycohydro-

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 7 lase CD38, resulting in enhanced lar dysfunction with advancing age United States: a policy statement NAD+ activity and decreased global and ultimately decreasing CVD risk. from the American Heart Association. protein acetylation.28 Interestingly, Circulation. 2011;123:933-944. enhancing SIRT1 activity, a known Zachary Clayton, PhD is currently a NAD+-dependent histone deacety- postdoctoral fellow in the Department 6. Olshansky SJ, Goldman DP, Zheng Y, lase, decreases redox-associated of Integrative Physiology at University Rowe JW. Aging in America in the senescence and the associated in- of Colorado Boulder. His postdoctoral twenty-first century: demographic flammatory phenotype.29,30 Thus, studies are focused on the role of cellu- forecasts from the MacArthur Foun- apigenin may decrease the SASP and lar senescence in regulating age-re- dation Research Network on an ultimately improve arterial function lated arterial dysfunction. Aging Society. Milbank Q. 2009;87: through a NAD+ dependent mecha- 842-862. nism. References 1. Benjamin EJ, Virani SS, Callaway CW, 7. Seals DR, Jablonski KL, Donato AJ. As an alternative to apigenin, narin- et al. Heart disease and stroke statis- Aging and vascular endothelial func- genin supplementation may also be a tics-2018 update: a report from the tion in humans. Clin Sci (Lond). safe and efficacious option. Narin- American Heart Association. Circula- 2011;120:357-375. genin, a bioactive flavonoid primarily tion. 2018;137:e67-e492. 8. Seals DR, Kaplon RE, Gioscia-Ryan found in grapefruit, has been shown 2. Lakatta EG, Levy D. Arterial and car- 19 RA, LaRocca TJ. You’re only as old as to enhance vascular function, pro- diac aging: major shareholders in car- your arteries: translational strategies tect against age-induced myocardial diovascular disease enterprises: Part I: 31 for preserving vascular endothelial damage, ischemic reperfusion in- aging arteries: a “set up” for vascular 32 33 function with aging. Physiology jury, and dyslipidemia as well as disease. Circulation. 2003;107:139- (Bethesda). 2014;29:250-264. decrease markers of cardiotoxicity 146. following administration of the chemotherapy drug doxorubicin,34 9. van der Loo B, Labugger R, Skepper which has been shown to increase . . . therapies such a JN, et al. Enhanced peroxynitrite for- cellular senescence. However, there is mation is associated with vascular currently no direct connection in the aging. J Exp Med. 2000;192:1731- literature between naringenin, the nutraceutical-based 1744. SASP, and age-related vascular dys- function. Therefore, studies aimed at 10. Bachschmid MM, Schildknecht S, determining the role of naringenin in senolytics show Matsui R, et al. Vascular aging: chronic regulating the SASP and age-related oxidative stress and impairment of arterial dysfunction are warranted. promise for redox signaling-consequences for Furthermore, there may be other less vascular homeostasis and disease. explored flavonoids that could func- Ann Med. 2013;45:17-36. tion similarly to apigenin and narin- attenuating genin as nutraceutical senolytics. 11. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and Future Directions age-related vascular therapy of arterial stiffness. Arte- rioscler Thromb Vasc Biol. 2005;25:932- Taken together, studies reported in 943. the literature make it clear that cellu- dysfunction. lar senescence plays a role in age-re- 12. Sell DR, Monnier VM. Molecular lated dysfunctional phenotypes, and basis of arterial stiffening: role of gly- 3. Hinderliter AL, Caughey M. Assess- endothelial cell senescence is cation—a mini-review. Gerontology. ing endothelial function as a risk fac- strongly associated with vascular en- 2012;58:227-237. dothelial dysfunction with advancing tor for cardiovascular disease. Curr Atheroscler Rep. 2003;5:506-513. age. Currently, there are no known 13. Rossman MJ, Kaplon RE, Hill SD, et senolytic-based therapies that can be al. Endothelial cell senescence with 4. Cahill PA, Redmond EM. Vascular broadly applied to older adults; thus, aging in healthy humans: prevention endothelium - Gatekeeper of vessel therapies such a nutraceutical-based by habitual exercise and relation to health. Atherosclerosis. 2016;248:97- senolytic show promise for attenuat- vascular endothelial function. Am J 109. ing age-related vascular dysfunction. Physiol Heart Circ Physiol. 2017;313: Flavanoids may be effective senolyt- H890-H895. ics and future studies are needed to 5. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the fu- assess the role of flavonoids in atten- 14. Baker DJ, Wijshake T, Tchkonia T, et ture of cardiovascular disease in the uating senescence-associated vascu- al. Clearance of p16Ink4a-positive

8 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 senescent cells delays ageing-associ- 23. Martens CR, Denman BA, Mazzo the development of diet-induced ated disorders. Nature. 2011;479:232- MR, et al. Chronic nicotinamide ribo- obesity. FASEB J. 2007;21:3629-3639. 236. side supplementation is well-toler- ated and elevates NAD. Nat Commun. 28. Escande C, Nin V, Price NL, et al. 15. Zhu Y, Tchkonia T, Pirtskhalava T, et 2018;9:1286. Flavonoid apigenin is an inhibitor of al. The Achilles’ heel of senescent the NAD+ ase CD38: implications for cells: from transcriptome to senolytic 24. de Picciotto NE, Gano LB, Johnson cellular NAD+ metabolism, protein drugs. Aging Cell. 2015;14:644-658. LC, et al. Nicotinamide mononu- acetylation, and treatment of meta- cleotide supplementation reverses bolic syndrome. Diabetes. 2013;62: 16. Hwang HV, Tran DT, Rebuffatti MN, vascular dysfunction and oxidative 1084-1093. Li CS, Knowlton AA. Investigation of stress with aging in mice. Aging Cell. quercetin and hyperoside as senolyt- 2016;15:522-530. 29. Hwang JW, Yao H, Caito S, Sundar ics in adult human endothelial cells. IK, Rahman I. Redox regulation of PLoS One. 2018;13:e0190374. SIRT1 in inflammation and cellular . . . there may be senescence. Free Radic Biol Med. 17. Shay J, Elbaz HA, Lee I, et al. Molec- 2013;61:95-110. ular mechanisms and therapeutic ef- fects of (-)-epicatechin and other other less explored 30. Truong VL, Jun M, Jeong WS. Role polyphenols in cancer, inflammation, of resveratrol in regulation of cellular diabetes, and neurodegeneration. defense systems against oxidative Oxid Med Cell Longev. 2015;2015: flavonoids that stress. Biofactors. 2018;44:36-49. 181260. could function 31. Da Pozzo E, Costa B, Cavallini C, et 18. Zhang K, Song W, Li D, Jin X. Api- al. The citrus flavanone naringenin genin in the regulation of cholesterol protects myocardial cells against age- metabolism and protection of blood similarly to apigenin associated damage. Oxid Med Cell vessels. Exp Ther Med. 2017;13:1719- Longev. 2017;2017:9536148. 1724. and naringenin as 32. Testai L, Da Pozzo E, Piano I, et al. 19. Ren B, Qin W, Wu F, et al. Apigenin The citrus flavanone naringenin pro- and naringenin regulate glucose and nutraceutical duces cardioprotective effects in lipid metabolism, and ameliorate vas- hearts from 1 year old rat, through cular dysfunction in type 2 diabetic activation of mitobk channels. Front rats. Eur J Pharmacol. 2016;773:13-23. senolytics. Pharmacol. 2017;8:71.

20. Perrott KM, Wiley CD, Desprez PY, 33. Mulvihill EE, Allister EM, Suther- Campisi J. Apigenin suppresses the 25. Gocmez SS, Scarpace PJ, Whidden land BG, et al. Naringenin prevents senescence-associated secretory MA, et al. Age impaired endothelium- dyslipidemia, apolipoprotein B over- phenotype and paracrine effects on dependent vasodilation is improved production, and hyperinsulinemia in breast cancer cells. Geroscience. by resveratrol in rat mesenteric arter- LDL receptor-null mice with diet-in- 2017;39:161-173. ies. J Exerc Nutrition Biochem. duced insulin resistance. Diabetes. 2016;20:41-48. 2009;58:2198-2210. 21. Rippe C, Lesniewski L, Connell M, et al. Short-term calorie restriction re- 26. Gano LB, Donato AJ, Pasha HM, et 34. Arafa HM, Abd-Ellah MF, Hafez HF. verses vascular endothelial dysfunc- al. The SIRT1 activator SRT1720 re- Abatement by naringenin of doxoru- tion in old mice by increasing nitric verses vascular endothelial dysfunc- bicin-induced cardiac toxicity in rats. oxide and reducing oxidative stress. tion, excessive superoxide J Egypt Natl Canc Inst. 2005;17:291- Aging Cell. 2010;9:304-312. production, and inflammation with 300. aging in mice. Am J Physiol Heart Circ 22. Edwards AG, Donato AJ, Physiol. 2014;307:H1754-1763. Lesniewski LA, et al. Life-long caloric restriction elicits pronounced protec- 27. Barbosa MT, Soares SM, Novak CM, tion of the aged myocardium: a role et al. The enzyme CD38 (a NAD glyco- for AMPK. Mech Ageing Dev. hydrolase, EC 3.2.2.5) is necessary for 2010;131:739-742.

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 9 Implications of Higher-Risk Dietary Supplements and Factors Predicting Their Use in Collegiate Athletes by John Sassone, MS, RD, and Michelle T. Barrack, PhD, RD, CSSD

In the United States, an estimated particular, those classified as a pre- been found in weight loss supple- 23,000 emergency room visits are as- workout supplement, may affect ments, including the drug 2, 4-dini- sociated with dietary supplement use health and eligibility status among trophenol (DNP), which causes each year.1 This occurrence is attrib- collegiate, Olympic, and professional uncoupling of oxidative phosphory- uted in part to the enactment of the athletes.1, 6-13 lation and has been linked to several 1994 Dietary Supplement Health and deaths.17 Pre-workout supplements Education Act (DSHEA), which signifi- Health Concerns have been shown to contain ingredi- cantly limited the regulation of di- ents, such as 1,3 dimethylamylamine etary supplements by the Food and Herbal supplements have been (DMAA), linked to fatal cardiovascular Drug Administration (FDA). As a re- found to contain heavy metals, which effects.18 Use of muscle-building sup- sult, it is possible that dietary supple- are dangerous ingredients that can plements have been associated with ments might contain dangerous promote hepatotoxicity and cause testicular cancer, and may contain un- listed ingredients, unlisted ingredi- adverse drug interactions.2,14,15 In fact, listed anabolic steroids or related ents, banned substances, or unla- according to the 2015 New England compounds linked to negative health outcomes.19 . . . 65.9% of supplement-related emergency Ineligibility Risks

The intentional or inadvertent con- department visits were attributed to tamination of dietary supplements with banned substances may affect ingestion of a single herbal or the eligibility status of collegiate, semi-professional, or professional athletes.11,20,21 This occurs when an 1 complementary nutritional product. athlete unintentionally uses a supple- ment containing a banned sub- stance, which then becomes beled contaminants such as toxic Journal of Medicine report by Geller et detected during a routine drug test. It metals.1,2 Therefore, the use of dietary al, after excluding emergency room is estimated that 6.4% to 8.8% of pos- supplements poses consequences to visits linked to children’s unsuper- itive drug tests are linked to contami- the general population, and this vised intake, 65.9% of supplement- nated dietary supplements.22 In an health hazard may be increasing; ac- related emergency department visits FDA study of 21 herbal weight loss cording to the Centers for Disease were attributed to ingestion of a sin- supplements containing the legal Control (CDC) National Center for gle herbal or complementary nutri- plant extract compound Acacia rig- Health Statistics (NCHS) Data Brief in tional product.1 Herbal substances dula, 9 of these supplements con- 2011, the use of dietary supplements have made the Consumer Reports tained an unlisted banned rose from 42% to 53% between 1988- “Dirty Dozen” list of potentially haz- non-natural amphetamine-like com- 1994 and 2003-2006.3 ardous supplements, with 10 herbal pound known as ß-methylphenyl- ingredients listed, including kava, ethylamine (BMPEA). Weight loss Competitive athletes exhibit even comfrey, and bitter orange. supplements have also been found to more frequent use of dietary supple- Various herbal substances have been contain banned ingredients such as ments—estimated at 61% or reported in the literature to have pos- amines, strong diuretics, and 2-ago- higher—and thus they may be at in- sible deleterious effects. Caffeinated nists.23-25 Moreover, a nutritional sup- creased risk.4,5 In addition to the po- supplements may be detrimental to plement for weight loss marketed as tential for deleterious health health, particularly if combined with an anabolic burner was reported to consequences, use of dietary supple- other stimulants;6 health effects, par- contain the banned steroid and 2- ments among collegiate athletes can ticularly among caffeine-sensitive in- agonist clenbuterol.24 compromise eligibility status. Supple- dividuals, include elevated heart rate, ments containing herbal ingredients hypertension, headache, and in se- Pre-workout supplements have been or caffeine, those classified for vere cases heart attack and death.9 found to contain banned listed ingre- weight loss, muscle-building, or, in Potentially harmful ingredients have dients such as DMAA labeled as “Ger-

10 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 anamine,” citrus aurantiums labeled of athletes taking higher-risk dietary Univariate logistic regression analy- as “bitter orange,” and BMPEA la- supplements and factors predicting ses evaluating single predictors of beled as “Acacia rigidula.”11,26-28 The their use.38 Among the sample, 46 higher-risk supplement use in the National Collegiate Athletic Associa- athletes (8.3%) met criteria for use of athlete sample indicated that factors tion (NCAA) has also banned muscle- ≥1 higher-risk supplements on ≥2 significantly contributing to the pre- building supplements that contain days per week over the past year. The diction of higher-risk supplement use peptide hormones and analogues.11 number of higher-risk supplements included BMI ≥30 (kg/m2) versus <30 In addition, muscle-building supple- taken by those reporting use ranged (kg/m2), status as a fourth-year (or ments have been found intentionally laced with anabolic steroids such as metandienone, stanozolol, bolde- In a study of 37 prohormone muscle- none, dehyrochloromethyltestos- terone, and others.24 In a study of 37 prohormone muscle-building supple- building supplements, 14 were found to ments, 14 were found to contain the banned steroids testosterone and contain the banned steroids testosterone nandrolone; this research also noted that a separate creatine supplement contained the banned steroids and nandrolone. testosterone and norAdione.29

Higher-Risk Supplement Use from 1 to 5 (mean 1.4 ± 0.1 supple- later) college student versus first-, in NCAA Athletes ments). Of the 46 higher-risk supple- second-, or third-year students, use of ment users, 35 (63%) took 1 ≥3 dietary supplements versus use of Factors related to the overall use of higher-risk supplements and 11 <3 dietary supplements on ≥2 dietary supplements include gender, (2.0%) reported use of 2 to 5 higher- times/week over the past year, and competitiveness of a sport, and sport risk supplements. The higher-risk nine motivations for taking dietary type. Higher use has been reported supplement subcategories used most supplements related to body compo- among athletes competing in an indi- frequently included herbal (3.6%) sition, performance, and recovery. The vidual sport versus team sport, partic- and pre-workout (5.0%). reported use of dietary supplements ipating in a power or sprint versus for the purpose of reducing body fat mid- or long-distance track and field Chi-square tests found no significant emerged as the strongest single pre- event, and involved in a sport with differences in the frequency of dictor of higher-risk supplement use weight categories.30-33 Dietary supple- higher-risk supplement use based on (odds ratio [OR]=11.1, 95% confi- ment use may also parallel the com- gender or sport type. However, use of dence interval [CI]=5.4, 22.90; how- petitiveness of the sport, with higher pre-workout supplements was re- ever, the OR and CI for the concurrent use reported among elite athletes.30,34 ported by a higher proportion of reporting of using dietary supple- Prior investigations also report differ- males compared with females (7% vs. ments to gain muscle mass and lose ences based on gender, with some in- 2.7%), and by athletes participating in body fat was significantly higher than vestigations reporting a higher use of sports that feature frequent utiliza- either factor alone (OR=23.8; 95% protein, amino acid, creatine, and tion of the phosphocreatine system CI=9.6, 59.2). weight gain supplements among (golf, baseball, and softball; 8.9%) male athletes and a higher use of cal- compared with sports that tend not The multiple regression model ad- cium, iron, multivitamin, and weight to heavily depend on that system justing for gender, sport type, and loss supplements among female ath- (4.5%, 0%). Athletes with a body mass BMI status indicated that the number lete.4,35,36 These findings represent a index (BMI) of ≥30.0 kg/m2 versus of supplements athletes took (≥2 preliminary understanding of supple- those with a BMI of < 30.0 kg/m2 re- times/wk over the past year), the re- ment use among collegiate ath- ported an increased overall use of ported motivation to increase ath- letes.34 However, until recently, there higher-risk supplements (22.2% vs. letic endurance, and the motivations was limited knowledge regarding the 7.6%), pre-workout supplements to both increase muscle mass and re- proportion of NCAA athletes who (18.5% vs. 4.3%) and muscle-building duce body fat emerged as concur- take higher-risk supplements, as well supplements (3.7% vs. 0%) respec- rent, independent predictors of as factors predicting use.34,37 tively. Also, athletes in their fourthor higher-risk supplement use. These later year of college compared with findings shed light on potential fac- A recent study involving 557 NCAA those in their first, second, or third tors that could be addressed when Division I collegiate athletes and pub- year reported an increased use of screening athletes for interventions lished in the Journal of Strength and higher-risk supplements (13.7% vs. or education regarding higher-risk Conditioning Research provides initial 6.4%), use of herbal supplements supplement use. insight by reporting the proportion (6.2% vs. 2.7%) and pre-workout sup- plements (9.6% vs. 3.4%). SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 11 Nutrition Education unintended ingestion of substances 8. Newmaster SG, Grguric M, Shan- Recommendations prohibited under anti-doping codes mughanandhan D, et al. DNA barcod- is a potential risk from supplement ing detects contamination and Advice by nutrition professionals for use. Education and protection of the substitution in North American safer dietary supplement use should athlete’s health and eligibility status herbal products. BMC Medicine. include education on the established are paramount for sports dietitians, 2013;11:222. dangers from supplements. Counsel- and athletes should seek qualified ing could start with recommenda- professional advice prior to dietary 9. Higgins JP, Tuttle TD, Higgins CL. En- tions to aim for nutrition from foods supplement use.45 ergy beverages: content and safety. first, as supplemental sources of Mayo Clin Proc. 2010;85:1033-1041. John Sassone, MS, RD is a registered some essential vitamins are possibly dietitian for UFC Gym and Longwood harmful and ineffective for disease 10. Pawar RS, Grundel E, Fardin-Kia AR, Management. Michelle Barrack, PhD, prevention.39 Functional on-the-go et al. Determination of selected bio- RD, CSSD is an associate professor of nourishments may include fresh and genic amines in Acacia rigidula plant Nutrition and Dietetics at California dried fruit, bagels, nuts and nut but- materials and dietary supplements State University, Long Beach. ters, sports drinks, chocolate milk, using LC-MS/MS methods. J Pharm protein powders, and amino acid References Biomed Anal. 2014;88:457-466. powders. Sports supplements such as 1. Geller AI, Shehab N, Weidle NJ, et al. beta alanine, L-citrulline, and creatine Emergency department visits for ad- 11. NCAA Sports Science Institute. may be beneficial for performance.40- verse events related to dietary sup- 2018-2019 Banned Drugs List. Avail- 42 Furthermore, it is recommended to plements. N Engl J Med. 2015;373: able at: http://www.ncaa.org/2018- provide athletes with education 1531-1540. 19-ncaa-banned-drugs-list. Accessed about dietary supplements, their lack November 25, 2018. of regulation in the U.S., and supple- 2. Saper RB, Kales SN, Paquin J, et al. ments associated with higher levels Heavy metal content of ayurvedic 12. Joseph JF, Parr MK. Synthetic an- of risk. Also, use of independent third- herbal medicine products. JAMA. drogens as designer supplements. party organizations that evaluate 2004;292:2868-2873. Curr Neuropharmacol. 2015;13:89- supplements such as the National 100. Sanitation Foundation (NSF), In- 3. Gahche J, Bailey R, Burt V, et al. Di- formed Choice, Consumer Lab, and etary supplement use among U.S. 13. Abushareeda W, Fragkaki A, Vona- the United States Pharmacopeia adults has increased since NHANES III parti A, et al. Advances in the detec- (USP)43,44 may aid in guiding athletes (1988-1994). NCHS Data Brief. 2011; tion of designer steroids in anti- to lower-risk products. Hydration 1-8. doping. Bioanalysis. 2014;6:881-896. guidelines and moderation of coffee and caffeinated energy drink con- 4. Froiland K, Koszewski W, Hingst J, et 14. Voelker R. Cardiac patients’ herbal sumption should also be suggested. al. Nutritional supplement use among supplement use deserves more care- college athletes and their sources of ful investigation. JAMA. 2010;303:824. Furthermore, according to a recent information. Int J Sport Nutr Exerc consensus statement, the Interna- Metab. 2004;14:104-120. 15. Chen GC, Ramanathan VS, Law D, tional Olympic Committee (IOC) rec- et al. Acute liver injury induced by ommends that dietitians provide a 5. Hoyte CO, Albert D, Heard KJ. The weight-loss herbal supplements. thorough nutrition analysis of an ath- use of energy drinks, dietary supple- World J Hepatol. 2010;2:410-415. lete before suggesting nutrition sup- ments, and prescription medications plementation. Although by United States college students to 16. Thyagarajan B, Alagusun- manufacturers frequently claim that enhance athletic performance. J Com- daramoorthy SS, Agrawal A. Atrial fib- their supplements directly or indi- munity Health. 2013;38:575-580. rillation due to over the counter rectly enhance performance, accord- stimulant drugs in a young adult. ing to the IOC, only a few have 6. Abbate V, Kicman AT, Evans-Brown J Clin Diagn Res. 2015;9:OD05-7. beneficial evidence. The IOC state- M, et al. Anabolic steroids detected in ment further elaborates that the ef- bodybuilding dietary supplements— 17. Grundling J, Dargan Pl, El-Zanfaly, fectiveness of supplement use may a significant risk to public health. M, et al. 2,4-dinitrophenol (DNP): a vary widely and may be affected by Drug Test Anal. 2015;7:609-618. weight loss agent with significant scenarios and factors including an acute toxicity and risk of death. J Med athlete’s genetics, microbiome, and 7. Hasegawa T, Takahashi K, Saijo M, et Toxicol. 2011;7:205-212. habitual diet. It is also recommended al. Isolation and structural elucidation that supplements used for enhanced of cyclopentynafil and N-octylnor- 18. Karnatovskaia LV, Leoni JC, Free- performance be trialed during train- tadalafil found in a dietary supple- man ML. Cardiac arrest in a 21-year- ing and before use in competition. ment. Chem Pharm Bull (Tokyo). old man after ingestion of The IOC statement also cautions that 2009;57:185-189. 1,3-DMAA-containing workout sup-

12 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 plement. Clin J Sport Med. 2015;25: 28. Yun J, Kwon K, Choi J, et al. Moni- 38. Sassone J., Muster M., Barrack e23-e25. toring of the amphetamine-like sub- Gardner M.T. Prevalence and predic- stances in dietary supplements by tors of higher-risk supplement use 19. Li N, Hauser R, Holford T, et al. Mus- LC-PDA and LC–MS/MS. Food Sci among collegiate athletes. J Strength cle-building supplement use and in- Biotechnol. 2017; 26:1185-1190. Cond Res. 2018, in press. creased risk of testicular germ cell cancer in men from Connecticut and 29. Baume, N, Mahler, N, Kamber, M, et 39. Hamishehkar H, Ranjdoost F, As- Massachusetts. Br J Cancer. 2015;112: al. Research of stimulants and ana- gharian P, et al. Vitamins: are they 1247-1250. bolic steroids in dietary supplements. safe? Adv Pharm Bull. 2016;6:467–477. Scan J Med Scie Sports. 2006;16:41-48. 20. Maughan, R. Contamination of di- 40. Hobson RM, Saunders B, Ball G, et etary supplements and positive drug 30. Giannopoulou I, Noutsos K, Apos- al. Effects of ßalanine supplementa- tests in sport. J Sports Sci. 2005;23: tolidis N, et al. Performance level tion on exercise performance: a meta- 883-839. affects the dietary supplement intake analysis. Amino Acids. 2012;43:25-37. of both individual and team sports 21. Van Thuyne W, Van Eenoo P, Del- athletes. J Sports Sci Med. 2013;12: 41. Suzuki T., Morita M., Kobayashi Y, et beke FT. Nutritional supplements: 190-196. al. Oral L-citrulline supplementation prevalence of use and contamination enhances cycling time trial perform- with doping agents. Nutrition Res Rev. 31. Kordi R, Ziaee V, Rostami M, et al. ance in healthy trained men: double- 2006;19:147-158. Patterns of weight loss and supple- blind randomized placebo-controlled ment consumption of male wrestlers 2-way crossover study. J Inter Soc 22. Denham, B. When contaminated in Tehran. Sports Med Arthrosc Rehabil Sports Nutr. 2016;13:6. dietary supplements cause positive Ther Technol. 2011;3:4. drug tests: methylhexaneamine as a 42. Kreider R, Kalman D, Antonio J, doping agent in sport. Int J Sport Pol- 32. Franchini E, Brito CJ, Artioli GG. and et al. International Society of icy Politics. 2017;9:677-689. Weight loss in combat sports: physio- Sports Nutrition position stand: safety logical, psychological and perform- and efficacy of creatine supplemen- 23. Cohen, P, Bloszies, C, Yee, C, et al. ance effects. J Int Soc Sports Nutr. tation in exercise, sport, and medi- An amphetamine isomer whose effi- 2012;9:52. cine. J Int Soc Sports Nutr. 2017;14:18. cacy and safety in humans has never been studied, ß-methylphenylethyl- 33. Tscholl P, Alonso JM, Dolle G, et al. 43. Dietary supplement safety. The amine (BMPEA), is found in multiple The use of drugs and nutritional public health and safety organization, dietary supplements. Drug Test Anal. supplements in top-level track and NSF.org.44. Dietary supplement verifi- 2016;8:328-333. field athletes. Am J Sports Med. cation program. United States Phar- 2010;38:133-140. macopeia, USP.org. 24. Geyer H, Parr MK, Koehler K, et al. Nutritional supplements cross-conta- 34. Knapik JJ, Steelman RA, Hoede- 44. Maughan R, Burke L, Dvorak J, et minated and faked with doping sub- becke SS, et al. Prevalence of dietary al. IOC consensus statement: dietary stances. J Mass Spectrom. 2008;43: supplement use by athletes: system- supplements and the high-perfor- 892-902. atic review and meta-analysis. Sports mance athlete. Br J Sports Med. Med. 2016;46:103-123. 2018;52;439-455. 25. Pawar R, Grundel E, Fardin-Kia A. et al. Determination of selected bio- 35. Robert-McComb JJ, Jordan SL. Er- 45. Maughan R, Burke L, Dvorak J, et genic amines in Acacia rigidula plant gogenic aids and the female athlete. al. IOC consensus statement: dietary materials and dietary supplements Active Female:Humana Press; supplements and the high-perfor- using LC–MS/MS methods. Pharm 2008;DOI:10.1007/978-1-59745-534- mance athlete. Br J Sports Med. Biomed Anal. 2014;88:457-466. 3_27. 2018;52;439-455.

26. Austin KG, Travis J, Pace G, et al. 36. Erdman KA, Fung TS, Doyle-Baker Analysis of 1,3 dimethylamylamine PK, et al. Dietary supplementation of concentrations in Geraniaceae, gera- high-performance Canadian athletes nium oil and dietary supplements. by age and gender. Clin J Sport Med. Drug Test Anal. 2014;6:797-804. 2007;17:458-464.

27. Jung, P, Earnest, Koozechian, M, et 37. Stuntz CP, Edwards, J.C., Kaye, M. al. Effects of ingesting a pre-workout Individual and social predictors of dietary supplement with and without performance-enhancing and dietary synephrine for 8 weeks on training supplement use among male NCAA adaptations in2017;14:1. Division III athletes. J Issues Intercolle- giate Athletics. 2014;7:187-206. SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 13 From The Chair

SCAN’s Time for Reflection by Lindzi S Torres, MPH, MS, RD, CSSD

“Without reflection, we go blindly on our way, creating more capability to allow SCAN to deliver our programming and unintended consequences, and failing to achieve anything information to you in a way we haven’t previously been useful.” — Margaret J. Wheatly able to do. We are especially excited about this initiative be - cause we know that our main communication with a major - ity of our membership is through digital platforms. For that With SCAN’s fiscal year coming to a close in just a couple of reason, developing a new and improved website—one that months (May 31), this is my final PULSE message to you as tailors the online experience to the needs of our member - Chair. For most organizations, leaders consider the end of ship—has been a high priority for your Executive Commit - the year an opportunity for reflecting on the previous tee. Be on the lookout for details regarding the launch of months as well as looking ahead—and SCAN is no excep - the new SCAN website. tion. Those of us who are privileged to be among SCAN’s leadership will be taking the time to reflect over the past Lastly, this year has also been special because the Execu - year and ensure that we move forward to continually best tive Committee is preparing to update SCAN’s three-year serve our members’ needs. I encourage each of you to also strategic plan, which serves as a critical blueprint for our en - take this time for self-reflection to examine your dietetics deavors. Beginning in June (the start of our new fiscal year), career and goals, and think about how SCAN can help you our strategic plan efforts will be led by our incoming Chair, reach them. Jen Ketterly. This will be exciting time for SCAN as we work to provide more focused programming along with new and One of the big efforts SCAN has undertaken over the past enhanced digital capabilities. several months has involved realigning our mission and vi - sion to be more inclusive of all types of physical movement As we move into the next membership year, initiate our so that we will not only focus on physical activity and ath - strategic planning efforts, and launch new platforms, we al - letics but also move into the human performance arena. At ways like to hear from our membership! Please feel free to the 2018 Food & Nutrition Expo™ (FNCE®) held last Octo - reach out to us at [email protected] or email me directly at ber, this new mission and vision was presented and well re - [email protected] . ceived by our members, and we aim to bring about more opportunities for our members through new and contin - It has been a privilege to serve as your Chair for the 2018- ued partnerships. For more information on our new mission 2019 fiscal year. As I reflect on my time as Chair, I find (as I and vision, SCAN members can refer to my message in the have learned through other volunteer positions) that you last issue of PULSE (Winter 2019) or check out the “About tend to get more out of it than you can give. I extend a big Us” tab on our website ( www.scandpg.org ). Under “About thanks to all of you who have given so much to me over the Us” you can also learn about previous SCAN efforts and re - past year. I’m honored to have served you in this capacity flections as discussed in our Annual Reports. and I can’t wait for you to see what your incoming Chair, Jen Ketterly, has planned next! I hope to see you at the upcom - Another initiative SCAN has been working on throughout ing 2019 SCAN Symposium, Navigating the Path of Wellness, the past several months is the development of a brand new April 26-28, in Phoenix! website. This website will be user-friendly and have full

14 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 Conference Highlights

Food & Nutrition Conference and Exposition™ (FNCE®) Washington, DC , October 20-23, 2018

This year’s Food & Nutrition Confer- pen if you got fat?“ By asking prob- The diet you choose and the kind ence and Exposition™ (FNCE®) of the ing questions, a sports RD can gain of food you eat has become linked to Academy of Nutrition & Dietetics was better insight into the fears that one’s personal identity. For example, filled with excellent speakers who block appropriate eating. “eating clean” and “going keto” are presented the latest nutrition re- statements as well as weight man- search. The following highlights Should athletes with eating disor- agement choices. might be of interest to SCAN mem- ders know what they weigh? Some bers. eating disorder recovery programs Clean eating has yet to be defined do not tell the clients their weights. by any professional organization. The Eating Disorders in Athletes Other programs want clients to definition used by media, food blog- know the number on the scale so the gers, and celebrities includes these An eating disorder is a way for an staff can help the athlete become words: unprocessed, no sugar, no ad- athlete to avoid emotions. Emotions desensitized to it. If an athlete ditives, no preservatives, no MSG, and have a function: they give informa- doesn’t want to know his or her few ingredients. While eating fewer tion about the situation at hand. By weight, ask, “Why do you prefer not ingredients may or may not make an avoiding experiences that create an knowing your weight? What do you athlete healthier, the real question to emotional response and make an imagine would happen if you knew ask your clean-eating athlete is: What athlete feel uncomfortable, the ath- the number?” are you seeking from your food? lete’s world gets smaller and smaller. Not feeling emotions can lead to Weight As dietitians, we take a pledge to long-term problems. “do no harm.” If we encourage peo- Millennials often use social media ple to “go on a diet” and that diet (in- A strategy to help athletes with for inspiration and motivation to get evitably) ends up with (health- eating disorders is to look at both the fit and healthy. Online communities harmful) weight-cycling, are we short- and the long-term advantages such as #Fitspo and #Fitspiration can doing harm? Is it time to teach our and disadvantages of eating vs. not easily lead to body dissatisfaction clients how to enjoy a healthy eating eating. Ask your client, “What are and compulsive exercise. Fitspo pattern (as opposed to going on a your reasons to change the disor- (short for Fitness Inspiration) usually diet)? dered eating behavior? What are the involves photos of super fit, lean reasons to not change it?” women, often accompanied by moti- When talking with clients about vating words or phrases like “never food and weight, RDs need to focus Athletes with eating disorders give up” or “strong is the new less on “What’s the matter?” and commonly fear gaining weight; they skinny.” By asking questions, an RD more on “What matters to you?” RDs may report they hate to “feel full.” can learn not only what attracts the should ask the client about stress, After all, if you are feeling full, that client to social media, but also how it sleep, and gut health, as well as food means you are not losing weight and impacts the client. intake, and then customize an eating you might even be gaining weight. plan for the individual client’s needs. The reality is that athletes with eat- While some dieters claim intermit- ing disorders need to learn to toler- tent fasting “works,” we need more Sustainability ate fullness—to eat a full meal and research on humans to determine if then be able to sit with the feelings any health changes (such as im- As athletes, we enjoy living on planet and fears that arise. proved blood glucose control) are Earth, breathing fresh air, and playing superior to the health changes in the mountains, streams, oceans, Recovery happens when athletes gained with standard calorie-re- and forests. We need to do our part with eating disorders are able to eat stricted diets. As with any weight to protect the health of planet Earth. foods they’ve been avoiding. Ask management program, the key to a In a presentation at FNCE, Frank Mit- your client, “What would happen if diet’s success is adherence. A ques- loehner, PhD, professor and air qual- you ate ______(feared food)?” The tion that remains unanswered is, ity specialist at the University of response will undoubtedly be, “I’d Does intermittent fasting lead to California-Davis, and Amy Myrdal get fat!” Next ask, “What would hap- binge-eating disorder? Miller, RD, of Farmer’s Daughter Con- SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 15 sulting, shared these insights that Athletes can help reduce food carbon footprint of animals from nudge you to think about how your waste by shopping carefully, using birth to being consumed. While eat- food and lifestyle choices impact the leftovers, and composting food ing less meat is not the cure-all for climate—and inspire you to make scraps. Colleges, restaurants, and carbon emissions, every little bit does some changes: other quantity food producers need help. For example, if every American to figure out how to find an earth- were to eat a vegan diet, GHGE would By 2050 (only 31 years from now), the friendly meaningful solution to deal- drop 2.6%. If all Americans honored global population will have grown ing with leftovers, such as by “Meatless Mondays,” the drop in from today’s 7.6 billion people to 10 donating to food pantries, if permit- GHGE in the U.S. would be 0.5%. To billion people, primarily due to longer ted. put this in perspective, switching lifespans rather than higher birth from a meat-based to a vegan diet for rates. This means we face an urgent one year equates to the GHGE of one need to increase food production, Up to 40% of the trans-Atlantic flight from the U.S. to curb greenhouse gas emissions Europe. (GHGE) to reduce our carbon foot- print, and invest in our future welfare. food we produce The best way to reduce GHGE is to burn less coal, oil, and natural gas. Up to 40% of the food we produce Using fossil fuels to create electricity gets wasted and of that, 43% gets gets wasted and of accounts for 30% of all GHGE. Trans- wasted in our homes. About 16% of portation and industry account for food waste happens at the farm (e.g., that, 43% gets 26% and 21%, respectively. Athletes sick animals not treated with antibi- can turn off electric lights when not otics; unharvested crops due to labor needed, ride bikes when possible in- shortages or odd-shaped produce), wasted in our stead of drive cars, and turn down and 40% happens in foodservice and thermostats. By chipping in and restaurants. Wasted food requires en- being responsible, we all can help ergy to be produced and transported homes. curb global warming and its result- to supermarkets (and landfills). All of ant oppressive heat that destroys that wasted food needlessly in- crops and interferes with our ability creases GHGE. RDs who work with athletes con- to enjoy an active lifestyle. suming a Paleo diet and others who Wasted food takes up 21% of pre- eat large amounts of protein should Conference Highlights editor and cious (and limited) landfill space. This educate them that farm animals pro- sports nutritionist Nancy Clark, MS, RD, represents the largest percentage of duce methane, so reducing the de- CSSD has a private practice in the all waste in U.S. landfills. As it rots, it mand for meat is another way to Boston area, where she counsels both creates the greenhouse gas methane. help the environment. While this is fitness exercisers and competitive ath- true, meat (and food) production is letes. Her best-selling Nancy Clark’s A significant contributor to food not the leading cause of GHGE, con- Sports Nutrition Guidebook is avail- waste is the “best used by” date on trary to what you might have read re- able at www.nancyclarkrd.com. For her food packages. Please educate your peatedly in the recent past. online workshops, visit www.Nutrition- athletes: the “best used by” date is Agriculture contributes to only 9% of SportsExerciseCEUs.com. not a “don’t eat this” expiration date, GHGE, and animal agriculture alone but rather a marker for quality and contributes to about 4% of all GHGE freshness. in America; this number includes the

16 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 Reviews

The Bloated Belly Whisperer and causes among different individu- come this problem. The simple expla- Tamara Duker Freuman, MS, RD, CDN als. The second chapter helps readers nations and definitions make this a St. Martin’s Press, 175 Fifth Ave., New navigate the rest of the book and great book to suggest to anyone. The York, NY provides a diagram of the human di- book is well-referenced throughout 800-221-7945, www.Thebloatedbelly- gestive system, definitions of impor- and the author has dedicated a sec- whisperer.com tant vocabulary, and a nine-question tion at the end of the book listing her 2018, softcover, 307 pp, ISBN 978-1- quiz to help readers identify the pos- evidence-based sources. Also pro- 250-19523-4 sible cause of their bloating. After tak- vided are sample recipes for readers ing the quiz, readers are guided to to try at home. Many people experience common di- prioritize the common topics ac- gestive issues such as abdominal quired from their quiz results. The Tamara Duker Freuman is a dietitian pain, diarrhea, constipation, irritable book then provides explanations of based in New York whose clinical bowel syndrome, and heartburn. One underlying causes of bloating, dis- practice focuses on management of common issue is abdominal bloating. cusses tests used by doctors to diag- digestive and metabolic diseases. She In The Bloated Belly Whisperer, Tamara nose, reviews medical treatments specializes in managing symptoms of Freuman pinpoints and highlights used, examines effective dietary irritable bowel syndrome (IBS), small the possible causes of bloating and remedies, and presents personal sto- intestinal bacterial overgrowth provides easy-to-comprehend defini- ries of patients. (SIBO), bloating, and other digestive tions, pictures, and diagrams to en- disorders. able readers to fully understand the The Bloated Belly Whisperer is a good causes of and remedies to bloating. read for anyone who experiences Reviewed by Kristina Morales, RD, clini- bloating, practitioners who work with cal dietitian for Laguna Hills Health The book begins with the author de- patients with digestive issues, and and Rehabilitation and consultant die- scribing her experience in her prac- anyone who simply wants to learn titian for HCSG, Real Community Serv- tice as she encounters many patients about this common digestion issue. ices, LLC, and Hilton Manor, LLC in who have digestive issues, specifically This book allows readers to deter- Orange County, CA. bloating. The introduction focuses on mine why they have abdominal bloating and its varying meanings bloating and discover ways to over-

Research Digest

Orthorexia and Special Diets eating (HE), and if cognitive restraint special diet and knowledge of HE Brytek-Matera A, Czepczor-Bernat K, is a predictor of strict eating patterns. was significant for individuals follow- Jurzak H, et al. Strict health-oriented Researchers used a cross-sectional ing the diet for health-related rea- eating patterns (orthorexic eating be- study design to analyze participants sons (P=.004). These results suggest haviours) and their connection with a in three groups: vegetarian (n= 39), that there are no differences in OEB vegetarian and vegan diet. Eat Weight vegan (n= 40), and control (n=41). between the vegetarian and vegan Disord. 2018; doi: 10.1007/s40519- The participants completed the Eat- groups, but the groups do exhibit 018-0563-5 ing Habits Questionnaire (EHQ) to as- more orthorexic eating behaviors sess feelings and behaviors related to than the control group. This could in- It is speculated that individuals fol- HE, and The Three-Factor Eating dicate that following a special diet lowing a special diet such as a vege- Questionnaire (TFEQ-R18) to assess such as a vegetarian or vegan diet tarian or vegan diet may exhibit more cognitive restraint. A one-way may increase the risk of developing orthorexic eating behaviors (OEB). ANOVA found significant differences an eating disorder. This study and fur- Past studies have indicated a relation- between groups regarding or- ther research could aid in creating ship between a vegetarian diet and thorexia nervosa and HE (P<.001), prevention programs for orthorexic disordered eating, as the diet may be knowledge of HE (P<.001), and feel- eating behaviors. This study was used to justify restrictive eating pat- ing positively about HE (P<.01). No funded by a National Science Centre terns. This study examined the preva- significant differences were found grant (2017/01/X/HS6/00007). lence of OEB in individuals following between groups in cognitive re- a special diet, knowledge of healthy straint. The relationship between Summarized by Emily Preib, graduate SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 17 student, Department of Nutrition and significantly correlated with log-LPS to questions related to the health Integrative Physiology, Coordinated (r=0.0598, P<.001). This study indi- and performance consequences of Master’s Program, Nutrition, Education, cates that serum LPS levels are in- RED-S. BEDA-Q, ESP, and SR results and Research Concentration, University versely related to Med-diet categorized participants into low EA of Utah, Salt Lake City, Utah. adherence, and may have a patho- (n=473) and adequate EA (n=527). genic and predictive role in MACE in Eight RED-S health consequences AF patients. LPS may be a trigger for (menstrual dysfunction, poor bone Serum Lipopolysaccharside, platelet activation, although the health, endocrine abnormalities, Cardiovascular Events, and study’s observational design cannot metabolic problems, hematological the Mediterranean Diet rule out other etiologies to the asso- impairments, psychological disorders, Pastori D, Carnevale R, Nocella C, et al. ciation between LPS and MACE. cardiovascular impairment, and gas- Gut-derived serum lipopolysaccha- trointestinal dysfunction) were more ride is associated with enhanced risk Summarized by Rebekah Nicholson, prevalent in low EA female athletes of major adverse cardiovascular graduate student, Department of Nutri- than in adequate EA female athletes events in atrial fibrillation: effect of tion and Integrative Physiology, Coordi- (P<.05). Seven RED-S performance adherence to Mediterranean diet. nated Master’s Program, Nutrition, consequences (decreased endurance, J Am Heart Assoc. 2017;6:e005784. Education, and Research Concentra- slowed training response, poor tion, University of Utah, Salt Lake City, judgement, decreased coordination, Research has established a relation- UT. decreased concentration, irritability, ship between the gut microbiome and depression) were also more and systemic inflammation, identify- prevalent in low EA female athletes ing molecules such as trimethy- Low Energy Availability than in adequate EA female athletes lamine N-oxide (TMAO) as Surrogates and RED-S Health (P<.05). Low EA is associated with the contributors to diseases involving and Performance Outcomes majority of RED-S health conse- atherosclerosis and thrombosis. Ackerman KE, Holtzman B, Cooper quences and with all RED-S perform- Lipopolysaccharide (LPS), another KM, et al. Low energy availability sur- ance consequences excluding injury molecule produced by gut micro- rogates correlate with health and risk. Further study is warranted to de- biota, is proatherogenic and may be performance consequences of Rela- termine the pathophysiology related influenced by diet. This prospective, tive Energy Deficiency in Sport. Br J to the associations between low EA observational study explored the re- Sports Med. 2018;0:1-6. and athletic health and performance lationship between serum LPS levels consequences. and clinical outcomes in patients The Female Athlete Triad and the with atrial fibrillation (AF). Addition- newly introduced syndrome Relative Summarized by Kennedy Springer, ally, researchers investigated the as- Energy Deficiency in Sport (RED-S), graduate student, Department of Nutri- sociation between LPS and which addresses the effects of energy tion and Integrative Physiology, Coordi- adherence to the Mediterranean Diet deficits in all athletes, are primarily in- nated Master’s Program, Nutrition, (Med-diet). Atrial Fibrillation patients fluenced by low energy availability Education and Research Concentra- (n=912) treated with vitamin K antag- (EA). Low EA may affect athletic tion, University of Utah, Salt Lake City, onists were monitored for major ad- health and performance. Therefore, UT. verse cardiovascular events (MACE). the purpose of this cross-sectional Baseline serum LPS, urinary 11-dehy- study was to evaluate the association Individualized Hydration dro-TxB2 (TxB2), and Med-diet adher- between low EA and RED-S outcomes Plans Improve Performance ence were assessed and compared in a large population of female ath- Outcomes in Athletes between patients who experienced a letes. Screening of patients present- Ayotte D and Corcoran MP. Individual- MACE and those who did not during ing with sports-related medical ized hydration plans improve per- the 3-year follow-up period. Log-LPS conditions at the Division of Sports formance outcomes for collegiate independently predicted MACE Medicine at Boston Children’s Hospi- athletes engaging in in-season train- (P=.009), and risk of MACE increased tal resulted in a total of 1,000 female ing. J Int Soc Sports Nutr Res. significantly across cohort LPS level participants (15-30 years), who aver- 2018;15:27. tertiles (mean 10.0, 50.0, and 145.0 aged ≥4 hours physical activity per pg/ml for 1st, 2nd, and 3rd tertile, re- week for the previous 6 months. Par- It is known that suboptimal hydration spectively; 3rd vs. 1st tertile P=.001). ticipants completed an online ques- resulting in 1% to 2% loss of body Med-diet adherence was significantly tionnaire to identify low EA using the mass during training and competi- and inversely correlated with log-LPS Brief Eating Disorder in Athletes tion can reduce athletic performance. (r= -0.144, P<.001). In particular, high Questionnaire (BEDA-Q), Eating Dis- The purpose of this study was to de- intake of fruits (P=.009) and legumes order Screen for Primary Care (ESP), termine whether a prescribed hydra- (P=.005) were significantly associated and self-reported current or past his- tion plan that considers both fluid with lower LPS values. Log-TxB , a tory of eating disorders or disordered 2 and sodium losses improves athletic marker for platelet activation, was eating (SR) as surrogates in addition

18 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 performance. Fifteen NCAA Division I after a moderate to hard training ses- awareness, and heart rate recovery and II ice hockey, lacrosse, and track sion (mean = 90 minutes at 78% to time. According to the results of this and field collegiate athletes were re- 79% of maximum heart rate; mini- study, athletes did not drink enough cruited for this randomized, crossover mum 45-minute training session). water or replace enough sodium study. Participants completed a quali- Sixty percent of the participants be- without a PHP. Understanding indi- tative assessment via interview to as- lieved that their current hydration vidual athlete sweat rates and sess hydration habits followed by an habits were effective and most par- sodium loss can develop hydration assessment of sweat loss. Participants ticipants reported feeling somewhat plans that optimize athletic potential. were then randomized to a prescrip- or very dehydrated after training. tion hydration plan (PHP) that consid- Compared with the NHP, PHP partici- Summarized by Emily Daniels, gradu- ered sweat and sodium loss, or were pants jumped 4.53 ± 3.80 inches far- ate student, Department of Nutrition instructed to follow their normal ad ther (P <.0001), tracked moving and Integrative Physiology, Coordi- libitum hydration habits (NHP). Partic- objects 0.36±0.60 m/second faster nated Master’s Program, Nutrition Edu- ipants underwent performance as- (P =.03), and exhibited a 10 to15 cation and Research Concentration, sessments including spatial minute faster heart rate recovery University of Utah, Salt Lake City, UT. awareness and attention and lower (P=.01) than the NHP group. In con- body anerobic power (standing long clusion, a PHP has potential to im- jump) tests immediately before and prove anaerobic power, attention and

Of Further Interest

News from Sports and certified athletic trainers (ATCs). ence in June. See “Upcoming Events” Dietetics—USA (SD-USA) Any SCAN member can apply to offer (page 21) in this issue for details. Subunit this presentation at any NATA-ap- Below are some highlights from the proved provider program. SCAN ben- News from Wellness/CV RDNs SD-USA subunit: efits from increased exposure, NATA Subunit members benefit by connecting with Here is an update from the Well- • New! Changes to the CSSD Exam a local nutrition expert, and you can ness/CV subunit: Window. The CSSD exam is now ad- benefit from potential referrals and ministered year-round! Visit the Com- an honorarium. Visit • Resource for Credentialed Health mission on Dietetic Registration www.scandpg.org/sports- and Wellness Coaching Programs. (CDR) website at nutrition/working-with-a-sports- Interested in becoming a certified www.cdrnet.org/certifications/board- nutritionist/promoting-a-sports- health and wellness coach? The In- certification-as-a-specialist-in-sports- dietitian/ for more information. ternational Consortium for Health dietetics for more information. and Wellness Coaching (ICHWC) is an • I’m a Sports RDN. As part of the organization that credentials pro- • Share Your Expertise with NSCA. Expanding the Arena Initiative, SCAN grams for health and wellness coach- The SCAN-NSCA Committee is look- wants to profile our greatest asset— ing similar to how CDR credentials ing for members who are interested our members! Do you work in a Dietetics programs. For those inter- in writing nutrition-based articles for unique role or with a specialized ested in becoming a certified health NSCA publications and/or are inter- niche of athletes as a sports RDN? and wellness coach, go to www.scan- ested in presenting at state and local Please contact Christina Figueroa at dpg.org/nutrition-info/wellness-pro- conferences and training events. [email protected] if you fessional-resources/ for a link to the Contact Derek Hughes at would like to share your story. list of ICHWC-approved training pro- [email protected] to get in- grams. For more information about volved. • Spring is Conference Time! Mark the organization itself, visit their web- your calendars for the upcoming con- site at https://ichwc.org/. • SCAN Speaking Opportunity. The ferences you won’t want to miss— SCAN-NATA (National Athletic Train- the SCAN Symposium in April; the • New Webinar on Health Coaching. ers’ Association) Committee has de- American College of Sports Medicine Health and wellness coaching is be- veloped a PowerPoint presentation (ACSM) Conference, with the “PINES coming more and more popular, and that highlights the collaborative 10 Experts, 10 Questions” session in dietitians are uniquely suited to this working relationship of sports RDNs May; and the Female Athlete Confer- role. Well-developed coaching skills

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 19 can positively affect patient out- Call for Abstractors for comes by helping clients work to- “Research Digest” ward positive behavior changes. Our The “Research Digest,” which ap- Mark Your Calendars new webinar, Health & Wellness pears in each issue of SCAN’S PULSE, Coaching for the RDN, is a great intro- provides summaries of published pa- SCAN Symposium 2019 duction to health and wellness pers relating to all of SCAN’s practice coaching and it can help you and areas: nutrition for sports and physi- Navigating the Path your clients. It is coming very soon cal activity, cardiovascular health, to Wellness and will be available in SCAN’s wellness, and disordered eating and e-library at www.scandpg.org/e- eating disorders. April 26-28, 2019 library. Be on the lookout! Pointe Hilton Tapatio Cliffs Resort You can contribute to the “Research Phoenix, Arizona • CV Reimbursement Trends/ Digest” by volunteering to abstract a Efforts. SCAN members RoseAnna recently published study on any of Holliday and Geeta Sikand are the above practice areas. For details Come to the 35th Annual SCAN SCAN’s new reimbursement co-rep- on this opportunity, contact Kary Symposium and put yourself on resentatives. If you’re interested in Woodruff, MS, RD, CSSD, co-editor of the path to adopting best prac- becoming involved in our efforts to “Research Digest,” at tices—and integrating them into increase awareness of reimburse- [email protected]. Be- your wellness, sports nutrition, ment issues/topics, please contact come a contributor to PULSE! and cardiovascular health en- the Wellness/CV director, Mark Hous- deavors. ton, at [email protected]. Manuscripts for PULSE We’ll gather at the Pointe Hilton • 2019 SCAN Symposium Preview. Welcome Tapatio Cliffs Resort in Phoenix at We hope you’ll plan to join us in SCAN’S PULSE welcomes the submis- the perfect time of the year to Phoenix, AZ, April 26-28 for the 2019 sion of manuscript to be considered enjoy the splendors of the SCAN Symposium, which has a well- for publication. In particular, PULSE is desert. ness-focused theme and emphasizes interested in receiving original re- integrating wellness with sports and search reports and review articles. Attendees will: cardiovascular nutrition. Manuscripts presenting practical guidelines, case studies, and other in-  Explore evidence-based ap- formation relative to SCAN will also proaches and techniques Looking for Past PULSE be considered. Articles?  Learn practical applications, If you’re doing research or simply Manuscripts must be prepared and skills, and knowledge to en- want to locate content that appeared submitted in accordance with hance your work in an archived issue of SCAN’S PULSE, PULSE’s Guidelines for Authors; only check out the annual “Index of Top- manuscripts that follow these guide-  Gain new tools to support ics” posted for each year on SCAN’s lines will be considered. The Guide- clients, patients, and athletes website. You’ll find the issue and lines for Authors can be accessed at  Obtain superb advice and in- page number for each feature article www.scandpg.org/nutrition- sights from experts (conveniently listed by practice area), info/pulse/. and each item in the “Conference  Comingle with colleagues Highlights,” “Reviews,” and “Research and make new friends Digest” departments. You can then instantly access the archived issue For more information and up- online. As a member benefit, all dates, watch for eblasts and visit PULSE issues and annual indexes are www.scandpg.org/symposium- available you for free at www.scan- 2019/. dpg.org/nutrition-info/pulse- newsletters.

20 | SCAN’S PULSE Spring 2019, Vol. 38, No. 2 UpcomingEvents SCAN’S PULSE Publication of the The viewpoints and statements herein April 6-9, 2019 Sports,Cardiovascular, and do not necessarily reflect policies Experimental Biology 2019, Orlando, Wellness Nutrition (SCAN) and/or official positions of the Academy FL. For information: dietetic practice group of the of Nutrition and Dietetics. Opinions http://experimentalbiology.org/2019/ Academy of Nutrition and Dietetics. expressed are those of the individual ISSN: 1528-5707. authors. Publication of an advertise- Home.aspx ment in SCAN’S PULSE should not be Editor-in-Chief construed as an endorsement of the April 26-28, 2019 Mark Kern, PhD, RD advertiser or the product by the Join your colleagues at the 35th An- Exercise and Nutrition Sciences Academy of Nutrition and Dieteics nual SCAN Symposium, Navigating San Diego State University and/or Sports, Cardiovascular, and the Path to Wellness, Phoenix, AZ. For 5500 Campanile Dr. Wellness Nutrition. more information: San Diego, CA 92182-7251 619/594-1834 Appropriate announcements www.scandpg.org/symposium-2019/ 619/594-6553 - fax are welcome. Deadline for the [email protected] Fall 2019 issue: July 1, 2019. May 16-19, 2019 Deadline for the Winter 2020 issue: National Lipid Association Scientific Sports Editors October 1, 2019. Manuscripts (original Sessions, Miami, FL. For information: Kristine Spence, MS, RD, CSSD research, review articles, etc.) willl be www.lipid.org/2019-sessions Michelle Barrack, PhD, RDN, CSSD considered for publication. Guidelines for authors are available at www.scan- Cardiovascular Editor dpg.org/nutrition-info/pulse/ Email May 28-June 1, 2019 Zachary Clayton, MS manuscript to the Editor-in-Chief; allow ACSM Annual Meeting, World Con- up to 6 weeks for a response. gress on Exercise is Medicine®, and Wellness Editors World Congress on the Basic Sciences Liz Fusco, MS, RD Subscriptions: For individuals not of Exercise and the Brain, Orlando, FL. eligible for Academy of Nutrition and For information: Conference Highlights Editor Dietetic membership: $50. For www.acsmannualmeeting.org/ Nancy Clark, MS, RD institutions: $100. To subscribe: SCAN Office, 800/249-2875 Reviews Editor June 6-8, 2019 Kristina Morales, RD Copyright © 2019 by the Academy Female Athlete Annual Conference, of Nutriton and Dietetics. All rights Boston. For information: For informa- Research Digest Editors reserved. No part of this publication tion: https://bostonchildrens.cloud- Stacie Wing-Gaia, PhD, RD, CSSD may be reproduced, stored in a retrieval cme.com/Aph.aspx?P=1&EID=910 Kary Woodruff, MS, RD, CSSD system, or transmitted in any form by any means, electronic, mechanical, SCAN Notables Editor photocopying, recording, or otherwise, September 30-October 2, 2019 Sarah Charton without prior written permission of the Annual National Wellness Conference, publisher. Kissimmee, FL. For information: Managing Editor www.nationalwellness.org Annette Lenzi Martin 708/445-0155 [email protected]

To contact an editor listed above, visit www.scandpg.org. (Click Nutrition Info tab, then “SCAN’s PULSE”)

SCAN’S PULSE Spring 2019, Vol. 38, No. 2 | 21 RethinkRRththint nk lunchtimelunnchtimnc me

LunchtimeLunchtime can be a challengchallenge,e, and as a dietitidietitian,an, you know thisthis can impact ovoverallerall hhealthealth anandd wewell-being.ll-being. IIncorporatingncorporating heart-healthyheart-healthy1 foodsfoods likelike California walnuts is a simsimple,ple, positive step your cclclientsients can tatake.ke.

WithWith good fats likelike omega-3 ALA ((2.5g/oz),2.5g/oz), prproteinotein (4g/oz) and fiber (2g/oz),(2g/oz), walnuts deliver a satisatisfyingsfying crunch to bowls,bowls, toaststoasts,, sasalads,lads, and other lunchtime ffavorites.avorites.

Walnuts.orgWalnuts.org has a ccollectionollection of easy recipes ttoo help inspire your clients to reviverevive their midday meal. ExploreExplore tthehe cocollectionllection herehere.

1SupportiveSupportive but not conclusive research shows that eating 1.5 ounces of wawalnutslnuts per dayday,, as part of a loloww saturatedsaturated fatfat andand lowlow cholesterolcholesterol diet,diet, andand notnot resulting inin increasedincreased caloriccaloric intake,intake, may rreduceeduce tthehe ririsksk ofof coronary heart ddisease.isease. One ounce of walnuts provides 18g of total fat, 22.5g.5g of monounsaturated fat, 13g of polyunsaturatedpolyunsaturated fat, including 2.5g of alpha-linolenic acid, the plant-basedplant-based omega-3omega-3..

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