SCAN’S Pulse Winter 2011, Vol. 30, No. 1

■ CONTENTS 1 Emotional Brain Training for Treating Emotional Brain Training for Treating Obesity, Eating Disorders, and Stress Obesity, Eating Disorders, and Stress 3 From the Editor by Laurel Mellin, MA, RD

5 Treatments of obesity, eating disor - individuals in the United States, the 27th Annual SCAN Symposium ders, and symptoms of stress are implementation of evidence-based, changing. In this era of the brain, dis - neuroscience-centered interventions 6 coveries in neuroscience are sifting to decrease stress could significantly CPE article: down to the practice of dietetics. The impact public health. While health Lutein and Zeaxanthin: Essential brain can be conceptually divided care has traditionally treated stress Nutrients for Eye Protection into the thinking brain (neocortical) symptoms as the problem and relied and Visual Performance and the emotional brain (limbic and heavily on medications, devices, and 11 reptilian), and in our role as dietitians, procedures, EBT represents a new Influence of Vitamins E and C on we can impact the neocortical brain paradigm in health care: a focus on the Recovery from an Anterior by providing clients with objective treating the source of the stress itself Cruciate Ligament Injury and Surgery information on how and why they by wiring the emotional brain. should alter their eating behaviors to 14 improve their health. However, when The History of EBT Worksite Health Promotion: the emotional brain is in stress, fol - Beyond “Biggest Loser” Challenges lowing through and complying with We have long recognized that know - and T-shirts those recommendations can be chal - ing what to eat does not necessarily 17 lenging. translate into lasting food behavior From the Chair changes. Early in the development of Emotional brain training (EBT) the EBT method, our team at the Uni - 17 emerged from neurobiological dis - versity of California, San Francisco Conference Highlights coveries that emotional circuits in the (UCSF) became aware of the work of 19 brain were plastic and could be Hilde Bruch, a psychiatrist from Bay - Reviews rewired by experiences. 1 The EBT lor College of Medicine who pub - method trains individuals to process lished a paper in 1940 showing that a 20 daily life stress more effectively by child’s risk of developing obesity was Sports Dietetics-USA Research Digest rewiring emotional circuits of self- largely influenced by interactions 22 regulation as a means to improve with his/her parent(s). According to SCAN Notables self-regulation and access to natural Bruch, children who were not ade - rewards. This potentially offers a strat - quately nurtured and those with lim - 23 egy to promote lasting improve - its that were either too harsh or too Of Further Interest ments in stress symptoms. With lax had an increased risk of obesity. psychological stress 2-4 and stress- We began teaching responsive par - 24 related conditions 5-6 affecting many enting skills at the UCSF clinic and Upcoming Events observed that many of the children overeating flash across the brain in ADA Dietetic Practice Group of Sports, stopped wanting extra food. We ap - time measured in ten thousandths of Cardiovascular, and Wellness Nutrition (SCAN) plied a similar intervention—The So - a second. Who can be responsible for SCAN Web site: www.scandpg.org lution Method—to patients with what happens in that time frame? In adult obesity and stress symptoms. EBT we recognize that all emotions, SCAN Office Karen S. Cervenka, Executive Director thoughts, and behaviors are just 1520 Kensington Rd., Suite 202 More recently, brain imaging studies strings of neurons that are continu - Oak Brook, IL 60523 9 800/249-2875; 866/381-7288 (fax) have shown that the brain is highly ally potentiated. [email protected] plastic and changes with experience. Chair The response to daily life—self-regu - By turning our attention to the Tara Coghlin-Dickson, MS, RD, CSSD lation—is so integral to survival that wiring, we can go to the root cause of [email protected] it is stored in unconscious memory a chronic stress response. What holds Chair-Elect systems. Although most people re - us in a sense of safety in this world D. Enette Larson-Meyer, PhD, RD, CSSD, FACSM [email protected] port that they use exercise, read the are our homeostatic circuits (the neu - paper, or employ other means to ease ronal circuits of self-regulation) that Past Chair Gale Welter, MS, RD, CSSD, CSCS stress, the regulatory processing of take us through a stressful moment [email protected] daily life is an ongoing process, and carry us back to our natural state Secretary guided by wiring stored in the emo - of well-being. The allostatic circuits, Karla Campbell, MS, RD, CSSD tional brain. The strategy of EBT is to on the other hand, do not have inter - [email protected] improve the effectiveness of that nal self-correcting mechanisms, so Treasurer wiring. the stress buzzer gets stuck in the Kathy B. Johnson, RD, MBA, FADA 10 [email protected] “on” position. In allostatic states, the Several reports of the efficacy of EBT brain reward circuitry cannot access Communications Director Adrienne Davenport, MPH, RD have shown sustained beneficial ef - the natural rewards. The brain is re - [email protected] fects during and after treatment for ward-driven, and defaults to access - Continuing Education Director obesity, blood pressure, blood sugar, ing artificial rewards that promote Lynette Maxey, RD, CDE depression, and exercise. 7,8 Thus, the chemical highs and lows rather than [email protected] EBT method is grounded in axiomatic the natural rewards, which are sus - Development Director physiology and there is evidence of tainable and adaptive (e.g., intimacy, Hope Barkoukis, PhD, RD Hope. [email protected] its health-promoting effects. This arti - spirituality exercise, music, dance). In cle reviews the four concepts of EBT EBT, we teach people how to identify Member Services Director Cheryl Toner, MS, RD and describes the method’s clinical and weaken or erase allostatic cir - [email protected] application to stress-related condi - cuits and how to identify and Chair, 2011 Symposium tions, including obesity and eating strengthen homeostatic circuits. Ellen Coleman, MA, MPH, RD, CSSD disorders. [email protected] Concept 2: Wiring Triggers Director, Disordered Eating & Eating Concept 1: It’s Not Us, Brain States Disorders Subunit Christina Scribner, MS, RD, CSSD It’s Our Wiring [email protected] When a wire is triggered, the brain re - Director, Sports Dietetics-USA Subunit Instead of focusing on that doughnut sponds by shifting the area in Michele Macedonio, MS, RD, CSSD and why one ate it, go deeper. Focus charge. 11 The lower-order areas react [email protected] on the wires. The wires that trigger quickly, so the brain defaults to them Co-Directors, Wellness /CV RDs Subunit Carol Lapin, MS, RD, CSSD [email protected] Sharon Smalling, MPH, RD The Five Brain States [email protected]

Editor-in-Chief, PULSE Stress Brain State Perception Mark Kern, PhD, RD, CSSD [email protected] 1 Joyous Web Editor 2 Balanced Marie Dunford, PhD, RD 3 A Little Stressed [email protected] 4 De nitely Stressed DPG Delegate to ADA HOD 5 Stressed Out! Jenna Bell, PhD, RD, CSSD [email protected] As stress increases, the more primitive areas DPG Relations Manager of the brain become dominant. Susan DuPraw [email protected] Table 1. Emotional Brain Training (EBT) Five-Point System of Emotional and Behavioral Regulation: The five brain states Copyright ©2010 Laurel Mellin, Wired for Joy (Hay House). Reprinted with permission. 2 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 From The Editor

Mark Kern likes this. by Mark Kern, PhD, RD, CSSD, Editor-in-Chief

I’m not referring to my letter here, but rather to this issue of PULSE . This wasn’t one of those issues that easily falls into place, so I’m really happy with the way it turned out. Maybe it’s just more rewarding when everything comes together after a little extra work, but that could just be the emotional part of my brain talking. And that brings me to our cover article by Laurel Mellin, MA, RD, who describes her thoughts on how dietitians can help their clients train the emotional regions of the brain for com - bating disordered eating and eating disorders as well as stress.

After you’ve warmed up your brain with that article, you should read our free continuing professional education (CPE) article contributed by Diane E. Alexander, PhD, and PULSE’s newest wellness editor, Robert Wildman PhD, RD, FISSN. The article pro - vides a review of the latest research on some key nutrients for optimal eye health and function. In this issue you’ll also find a cutting-edge article by Tyler Barker, PhD, who reviews the latest research on vitamins C and E for injury and surgery recovery in athletes, and a very practical article on worksite-based health promotion from Marisa Moore, MBA, RD.

Be sure to also take a look at our book review on mindful living, peruse our summaries in SD-USA’s Research Digest and in Conference Highlights, and discover the latest notable accomplishments of our members. After you’ve finished reading this issue, maybe I’ll see a comment on SCAN’s Facebook page indicating that, like me, you like this issue, too.

when stress mounts. These more balanced. In this state, eating a crisp, treating the characteristic of that primitive areas of the brain experi - red apple is rewarding. The drive for brain state. For example, the interven - ence more extreme and maladaptive sugary, fatty food is low and moods tion for compulsive eating (a symp - thoughts and behaviors. All aspects are positive as the neocortex is in tom of a brain state) may be quite of life are predictably affected, and charge. As stress mounts the state narrow in traditional care, but in real - even though the specific characteris - changes to Brain State 5, a full-blown ity the compulsive eater’s drive for tics vary, the extent to which they are stress response. In this state, the food may be driven by various cir - maladaptive remains the same. A primitive brain is in charge and the cuits activated in that brain state— summary of these characteristics ap - drive for artificial rewards ramps up. emotional, cognitive, and behavioral pears in Table 1. Moods are negative. circuits—all of which impact the ef - fectiveness of the intervention. By In Table 2, the numbers on the left in - The fact that wiring triggers brain treating the brain state, a broader dicate the five brain states. Brain states that are internally consistent spectrum of improvements may State 1 occurs when a person is re - supports the potential efficacy of occur, potentiating the effectiveness laxed and his/her reward circuitry is treating the brain state rather than of the intervention.

Concept 3: Brain States Become Persistent

The EBT Brain States The brain equates familiarity with safety. Therefore, if an individual is Thoughts Feelings Relationships Spirituality Behavior frequently in a brain state of stress, 1 –Abstract Joyous Intimate Connected Optimal the brain misinterprets stress as 2 – Concrete Balanced Companionable Aware Healthy good, because it is familiar. For such individuals, the brain can easily get 3 – Rigid Mixed Social Unaware Moderate into the “stress habit,” and in time the 4 – Reactive Unbalanced Needy/Distant Disconnected Unhealthy repeated episodes of stress increase allostatic load—the wear and tear on 5 – Irrational Overwhelmed Merged/Disengaged Lost/Obsessed Destructive the mind and body caused by each stress episode. The emotional set Table 2. The Emotional Brain Training (EBT) Five-Point System of Emotional and point of the brain can remain stuck in Behavioral Regulation: Brain state characteristics. Copyright ©2010 Laurel Mellin, an allostatic state. The problem is not Wired for Joy (Hay House). Reprinted with permission. the symptom of stress (e.g., overeat - SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 3 ing, smoking, inactivity) but a brain facilitate switching each state to focuses on physical activity, nutrition, that is wired for stress. homeostasis. Some complete only sleep, meditation, and intimacy. The the initial course because their emo - food system used in EBT is based on Concept 4: We Can Change tional set point is in a higher state stress and reward, with participants Our Wiring and can be changed relatively easily. identifying foods that ease stress and However, if the set point is in the allo - those that increase it. It reflects a new If the root cause of the problem is our static range (Brain States 3- 5), more emphasis on the addictive nature of wiring and if we know that the emo - focused and intensive practice over food. tional brain is plastic 12 and can time is typically required for signifi - change through experiences, why cant improvements to occur. The ad - In using EBT to treat obesity and eat - not target the neurobiological source ditional courses utilize EBT kits, ing disorders, one challenge is orient - of the chronic stress symptoms? Why workbooks, pocket reminders, and ing participants to this new not support clients in learning the audio programs to allow for ad - paradigm that asserts that obesity tools to rewire their own emotional vanced practice. All courses are facili - can be a symptom of an allostatic set brain? We can do that, but it will be tated by certified EBT providers. point and treatment involves chang - challenging because it requires a par - These health professionals hold small ing the set point. As the set point adigm shift. We have to learn the new group (8 to 10 people) training changes, the circuitry that promotes tools, and not everyone will agree sessions for 90 minutes weekly. these symptoms will be reconsoli - with us. Yet the reward lies in attend - dated. By moving up the emotional ing to the root cause—and that is In recent years the program has ad - set point to states of balance and re - powerful. dressed changing learning styles and ward, a range of beneficial effects needs, utilizing briefer workbooks may result. Emotional brain training is remark - and the addition of video training, ably simple, but not easy. In EBT, indi - social networking, and Web-based Among the most promising clinical viduals learn to identify their brain tools. The goals are to create a robust strategies we have identified is rewiring circuits that form maladap - tive attachments. Rewiring “survival circuits” is a three-stage process, be - cause these circuits were encoded during a full-blown stress response. The brain can create a false associa - tion between survival and some ex - . ternal solution such as sugary food. The more a person attempts to change the behavior without ad - state on a five-point scale. For each community and enhance the emo - dressing the emotional drives for that state, a different brain area is domi - tional salience and fun of the train - behavior, the more stressed an indi - nant, requiring a different process in ing, both of which increase vidual may become. That amplified the brain to return to optimal states. dopamine, which facilitates neuro - stress can trigger the same circuit Clients learn how to identify their plasticity. For participants who com - that caused the overeating to begin brain state and switch it back to plete the entire advanced program, with. Instead of trying to suppress states of well-being. The tools mirror the duration of training is approxi - the symptom in clients, we focus on the evolutionarily-based processing mately one year and the goal is to turning their attention to erasing the of stress in a secure attachment. 13 The rewire the brain for the homeostatic circuit 14 that triggers those unstop - training offers lifestyle changes, ap - state (Brain State 1), in which one pable drives. propriate use of health care, and a reaps an abundance of natural re - focus on changing the wiring in the wards and, within the limits of genet - The goal is not just behavioral com - emotional brain to promote lasting ics and choice, has freedom from pliance, but the experience of not post-treatment improvements in various external solutions (addictions wanting or needing the extra food. In stress-related outcomes. and compulsions). this method, the clinical strategy is to reframe the overeating as the reflec - Clinical Practice Clinical Applications for tion of a wire and then to rewire the Eating Disorders and Obesity circuit, instead of forcing behavioral EBT is administered to patients change, so that the drive to overeat throughout a four-week introductory Most participants in EBT have experi - fades. course; six additional courses for ad - enced eating or weight issues. The vanced cases are also available. The treatment of both types of issues has initial course provides training in how been integrated into advanced EBT to identify one’s brain state and courses. The lifestyle component

4 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 Concluding Remarks 27th Annual SCAN Symposium Emotional brain training offers a neuroscience-based intervention in Optimizing Performance, Wellness, and Health which registered dietitians and other Through Nutrition health professionals use positive emotional plasticity to rewire the March 11-13, 2011 emotional brain to favor states of bal - Chicago, IL ance and positive emotions. Regis - tered dietitians who are experienced SCAN’s 27th Annual Symposium promises to offer a fantastic education and and trained in psychological tools networking experience for SCAN members and nonmembers alike. and counseling can become certified in the method and can facilitate ■ Keynote speakers include sought-after experts Louise Burke and group training and coaching in the John Hawley. They will be joined by high-caliber invited speakers, method. This method represents a including Stuart Phillips, Dan Riley, David Nieman, Ruth DeBusk, Phil new paradigm in health care with the Mehler, Bob Murray, Doug Casa, Stella Volpe, and Jackie Buell. goal of promoting broad spectrum, persistent improvements in a range ■ The program will also feature pre-Symposium workshops from of stress-related variables. our three subunits: Sports Dietetics-USA, Wellness/CV RDs, and Disordered Eating & Eating Disorders. For more information about EBT research and certification, visit For more details and to register, visit SCAN’s Web site (www.scandpg.org). www.ebt.org. A new book on EBT, Also, be sure to follow SCAN on Twitter (@SCANutritionDPG) and Facebook Wired for Joy (Hay House, 2010), is (SCAN: Sports, Cardiovascular, and Wellness Nutrition) for the latest updates. available and the previous New York Times bestseller, The Pathway, is also relevant to RDs. Join Your Colleagues at this Must-Attend Event!

Laurel Mellin, MA, RD, is an associate professor of family and community 5. Dallman, MF. Stress-induced obe - 11. Perry BD. The memories of states: medicine and pediatrics at the Univer - sity and the emotional nervous sys - how the brain stores and retrieves sity of California, San Francisco and tem. Trends Endocrinol Metab . traumatic experience . In: Goodwin director of the university’s Emotional 2010;21:159-165. JM, Attias R, eds. Splintered Reflections: Brain Training Center of Excellence, the Images of the Body in Trauma . New national coordinating center for re - 6. AdamTC, Epel ES. Stress, eating and York City, NY: Basic Books, Inc.; 1999, search on EBT. She also directs The Insti - the reward system. Physiol Behav. pp 9-38. tute for Health Solutions, which 2007;91:449-458. sponsors certification training in EBT, 12. Bowlby J. A Secure Base: Parent- and is author of Wired for Joy (Hay 7. Mellin LM, Slinkard LA, Irwin CE, Jr. Child Attachment and Healthy Human House, 2010). Adolescent obesity intervention: vali - Development. New York City, NY: Basic dation of the SHAPEDOWN program. Books, Inc.; 1988. References J Am Diet Assoc . 1987;87:333-338. 1. Mellin LM. Wired for Joy: A Revolu - 13. Schiller D, Monfils MH, Raio CM, et tionary Method for Creating Happiness 8. Mellin LM, Croughan M, Dickey L. al. Preventing the return of fear in hu - from Within . Carlsbad, CA: Hay House; The Solution Method: 2-year trends in mans using reconsolidation update 2010. weight, blood pressure, exercise, de - mechanisms. Nature . 2010; Jan 7; pression and functioning of adults 463:49-53. 2. Cohen S, Janicki-Deverts D, Miller trained in developmental skills. J Am GE. Psychological stress and disease. Diet Assoc. 1997;97:1133-1138. 14. Ecker B, Toomey R. Depotentiation JAMA . 2007;298:1685-1687. of symptom-producing implicit 9. Hebb DO. The Organization of Be - memory in coherence therapy. J Con - 3. McEwen BS. Protective and damag - havior: A Neuropsychological Theory. struct Psych. 2008;21:87-150. ing effects of stress mediators. N Engl New York City, NY: Wiley Publishing; J Med . 1998;338:171-179. 1949

4. van Praag HM, de Koet ER, van Os J. 10. McEwen BS, Wingfield JC. What is Stress, the Brain and Depression . Cam - in a name? Integrating homeostasis, bridge, UK: Cambridge University allostasis and stress. Horm Behav. Press; 2004. 2010;57:105-111.

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 5 CPE article Lutein and Zeaxanthin: Essential Nutrients for Eye Protection and Visual Performance

Diane E. Alexander, PhD, and Robert Wildman, PhD, RD, FISSN

This article is approved by the Commis - thereby extending important bene - on the growing list of nutraceutical sion on Dietetic Registration (CDR) for 1 fits to a younger, healthier popula - ingredients. continuing professional education unit tion. This article provides an overview (CPEU), level 1. To apply for free CPE of the growing body of evidence sup - Although no reference daily intake credit, obtain a question/answer sheet porting the link between levels of (RDI) has been established for most through one of the following methods: lutein and zeaxanthin in the eye and carotenoids, a case can be made for (a) download it from SCAN’s Web site enhanced visual performance, which consuming compounds in this class (www.scandpg.org), or (b) request it is of particular importance to health- of nutrients every day. Of the 600 from the SCAN Office via phone: carotenoids isolated, only a small 800/249-2875; fax: 866/381-7288; or subset is found in a typical human e-mail: [email protected]. diet. 1 Of these dietary carotenoids, only lutein and zeaxanthin and their Learning Objectives metabolites are found in the macula, After you have read this article, you the central portion of the retina re - will be able to: sponsible for central vision and high- ■ Describe the functional roles of resolution visual acuity, suggesting lutein and zeaxanthin in ocular tissue an important functional role for these and their impact on vision. molecules in the eye. 2 The high con - ■ Discuss food sources, the bioavail - centrations of lutein and zeaxanthin ability, and the suggested daily intake in the macula are responsible for the of lutein and zeaxanthin. characteristic yellow coloration, giv - ■ Explain how lutein and zeaxanthin ing rise to the term macular concentrations in macular tissue are pigment. 3 measured. In the macula, lutein and zeaxanthin act as a pair of “internal sunglasses.” Eye health and loss of vision as we . First, they attenuate short wave - age are of great concern, leading lengths of light in the blue region of many to seek preventive measures by the visible light spectrum as they ab - obtaining essential nutrients through conscious and active people who sorb light maximally at a wavelength diet and/or supplementation. Lutein spend considerable time outdoors of 460 nm. 4 These wavelengths of vis - and its sister molecule zeaxanthin are exposed to sunlight. ible light are particularly damaging, considered by many health care pro - because they are high energy and fessionals to be essential eye nutri - Functions of Lutein and can pass through outer structures of ents needed daily to maintain Zeaxanthin the eye such as the lens, which ab - healthy vision and help reduce the sorbs ultraviolet wavelengths of light. risk of certain age-related eye condi - Carotenoids are red, orange, and yel - In addition, these visible wavelengths tions. Lutein and zeaxanthin are low lipid-soluble natural pigments of high-energy blue light are efficient carotenoids found naturally in dark that share a common biochemical at generating reactive oxygen green, leafy vegetables; corn; certain structure. More than 600 carotenoids species (a principle type of free radi - fruits (e.g., oranges, tangerines, goji have been identified in nature and cal) and they contribute to visual berries); and eggs. While lutein and are produced by plants, algae, and glare and photophobia. zeaxanthin have traditionally been bacteria to provide coloration and associated with reduced risk of cer - absorb light energy. Humans and The second function of lutein and tain age-related eye conditions, other mammals cannot produce zeaxanthin is to act as an antioxidant emerging research suggests that the carotenoids, even though these mol - defense to neutralize free radicals. optical and antioxidant properties of ecules provide critical benefits for Both the visible light filtering and an - these nutrients can also improve many organ systems. Therefore, tioxidant properties of lutein and visual function and performance, carotenoids must be obtained solely zeaxanthin enable these molecules from the diet, and they share a place to reduce damage to ocular tissues 6 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 that occurs from daily exposure to in 1994. 5, 6 The findings from both table). 8 Egg yolks provide a highly sunlight, indoor lighting, and environ - studies indicated that individuals bioavailable source of lutein, proba - mental pollutants. Over time, this with the highest dietary intake of bly because of the associated lecithin damage can lead to certain eye con - lutein and zeaxanthin had a 57% risk content, even though the lutein con - ditions such as age-related macular reduction for AMD. 5 Over the past 15 centration is relatively low. 9 Other di - degeneration (AMD) and cataract. As years, many more observational stud - etary sources of lutein and mentioned previously, people who ies have supported these findings. 7 zeaxanthin such as corn and oranges spend more time outdoors—espe - contain esterified forms of these mol - cially without eye protection—may Food Sources, Bioavailability, ecules, which are less bioavailable. be at greater risk for these eye disor - and Suggested Daily Intake This is important to note because the ders than those who minimize their biologically active forms of these exposure to sunlight. Because lutein and zeaxanthin are xanthophylls are free of fatty esters. not synthesized in the body, they The earliest research establishing the must be acquired from the diet either Following ingestion and absorption, link between lutein and zeaxanthin through foods or dietary supple - lutein and zeaxanthin are deposited and eye health consisted of an epi - ments. These carotenoids are fat solu - in a number of body tissues including demiological study from the Eye Dis - ble, so their absorption is enhanced eye, skin, brain, breast, and cervix. ease Case-Control (EDCC) Study when consumed with a modest However, lutein is found in the mac - Group published in 1993 and a fol - amount of fat. The richest sources of ula at 10,000 times the concentration low-up by Seddon and colleagues on lutein are dark green, leafy vegeta - of that in serum, and this tissue-spe - a subset of EDCC patients published bles such as kale and spinach (see cific pooling is likely due to

Table. Food Comparisons (Lutein and Zeaxanthin Content)

Food Common Measure Content per Measure Amount Needed to Obtain 10 mg of Lutein and Zeaxanthin Kale, cooked 1 c (130 g) 23.7 mg 0.42 c Turnip greens, cooked 1 c (144 g) 12.2 mg 0.82 c Collards, cooked 1 c (190 g) 14.6 mg 0.68 c Spinach, cooked 1 c (180 g) 20.4 mg 0.49 c Spinach, raw 1 c (30 g) 3.7 mg 2.70 c Broccoli, cooked 1 c (156 g) 1.7 mg 5.88 c Corn, cooked 1 c (210 g) 2.2 mg 4.55 c Lettuce, romaine 1 c (56 g) 1.3 mg 7.69 c Orange 1 orange (131 g) 0.17 mg 58.82 oranges Green beans, cooked 1 c (125 g) 0.89 mg 11.24 c Peach, fresh 1 peach (98 g) 0.89 mg 11.24 peaches Corn on the cob 1 ear (77 g) 0.7 mg 14.29 ears Carrots, raw 1 carrot (72 g) 0.18 mg 55.56 carrots Blueberries, raw 1 c (145 g) 0.12 mg 83.33 c Eggs 1 large egg (50 g) 0.17 mg 58.82 large eggs Corn Chex cereal 1 c (30 g) 0.35 mg 28.57 c Tangerine 1 tangerine (84 g) 0.12 mg 83.33 tangerines Asparagus 4 spears (60 g) 0.46 mg 21.74 spears Mustard greens 1 c (140 g) 8.3 mg 1.20 c

Source: USDA National Nutrient Database for Standard Reference, Release 22

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 7 lutein- and zeaxanthin-specific bind - Based on the information at hand, di - measuring MPOD, and optometrists ing proteins. 10 Increased lutein and etitians should encourage increased are increasingly recognizing the im - zeaxanthin intake from food sources consumption of foods and beverages portance of MPOD and offering this or supplements have been shown to containing lutein and zeaxanthin. Al - test in their offices. significantly increase the concentra - though the vast majority of research tions of these xanthophylls in the subjects show an increase in lutein Nearly half of all Americans have low serum and macula. 7, 11 The most re - and zeaxanthin concentrations in the MPOD, indicating low concentrations cent supplementation studies evalu - macula when increasing consump - of lutein and zeaxanthin in the mac - ating the benefits of lutein and/or tion of these carotenoids, some indi - ula. 15 Lutein and zeaxanthin intake zeaxanthin on eye health have used viduals show no response; this is has been associated epidemiologi - 10 mg or more lutein per day. 7 This likely due to a variety of factors, in - cally with a protective role against dosage is well below the 2 mg/kg ac - cluding study design, health of the age-related macular degeneration. ceptable daily intake (ADI) estab - retina, saturation of carotenoid bind - Therefore, low MPOD is a risk factor lished by the Joint FAO/WHO Expert ing proteins, and vehicle (food or for AMD, meaning that nearly half of Committee on Food Additives supplement). 14 Furthermore, dietary the American population—approxi - (JECFA). 12 The ADI is a measure of the supplements may benefit popula - mately 133 million individuals—may be at risk for developing AMD later in life. In addition, risk factors for AMD such as older age, female gender, obesity, tobacco use, and family his - tory are associated with lower MPOD. 16 These associations suggest low MPOD may not confer enough protection against light-induced ocu - lar damage, which over time may lead to increased risk of developing amount of a specific substance in tions where consumption is generally age-related eye conditions. food that can be consumed over a low and individuals are either unable lifetime without an appreciable or unwilling to increase food intake Lutein and Zeaxanthin and health risk. In addition, there are no in order to reach levels associated Visual Performance reported toxic effects of long-term with eye health benefits. Supplemen - exposure to lutein and zeaxanthin tation of carotenoids often raises More recently, research has estab - from dietary sources or supplementa - questions regarding the impact on lished that the benefits associated tion. related nutrients. While some studies with the blue light filtering and an - suggest that high-dose carotenoid tioxidant properties of lutein and It is difficult to get all the critical eye intake may competitively affect the zeaxanthin extend beyond risk re - nutrients from diet alone. In fact, absorption of some other duction of age-related eye condi - many Americans have low concentra - carotenoids, the overall evidence is tions. Macular pigment has been tions of lutein and zeaxanthin in the mixed. shown to enhance visual function macula because their diet is deficient and comfort as well. These improve - in these nutrients. The average daily Retinal Measurement of ments in visual performance may be intake of lutein and zeaxanthin in the Lutein and Zeaxanthin attributed to biological and/or opti - United States from diet alone is esti - cal mechanisms of the macular pig - mated to be less than 2 mg, far below How are biological concentrations of ment. Biological mechanisms may intakes clinically proven to reduce lutein and zeaxanthin assessed? Over enhance visual function by improv - the risk of certain age-related eye the past few years a number of meth - ing retinal health through absorbing conditions. 13 Lutein and zeaxanthin ods for quantifying lutein and zeax - high-energy blue wavelengths of concentrations in the macula natu - anthin macular tissue concentrations light and inactivating reactive oxy - rally deplete as people age, so it is have been developed. These tech - gen species. In addition, optical essential to maintain proper levels niques use a surrogate optical indica - mechanisms, i.e., preferential absorp - of these eye nutrients every day tor of xanthophyll concentrations in tion of blue wavelengths of light, may through dietary sources or supple - the eye: macular pigment optical improve visual function. Thus, MPOD ments. Studies have shown that the density (MPOD). MPOD is the meas - can potentially serve as a biomarker bioavailability of lutein and zeaxan - urement of the ability of the macular not only for predicting eye disease thin obtained from supplements and pigment to absorb or filter blue risk but also for assessing visual func - fortified foods is similar to that ob - wavelengths of light; it is linearly re - tion and performance. tained from foods that naturally con - lated to the amount of lutein and tain these nutrients. zeaxanthin in the macula. There are a number of different techniques for

8 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 Glare Relief and Recovery Contrast Acuity

Blue wavelengths of visible light are The optical properties of yellow in - scattered to a greater degree than traocular filters were originally re - longer wavelengths of light, and scat - viewed by Walls and Judd in 1933 tered light can produce glare and re - based on the observation that these duce contrast in the retinal image. yellow filters (as opposed to red or When the glare source is intense and green) are ubiquitous in nature. 18 near the line of sight, it is known as Such intraocular filters would in - “disability glare” because it can no - crease visual range and enhance con - ticeably interfere with the visual task. trast between an object and its Disability glare can present a signifi - background. The enhancement of vis - cant hazard to drivers at night be - ible range by macular pigment was cause of the bright light from described by Wooten and Hammond oncoming headlights. Disability glare as the visibility hypothesis, 15 which from the sun also can be a significant postulates that macular pigment may challenge for athletes and outdoor improve vision through the atmos - enthusiasts who rely on their vision phere by preferentially absorbing to help them perform at their best. blue haze (short-wave dominant air light that produces a veiling lumi - Results from a recent study provide nance when viewing objects at a dis - support that high levels of macular tance). pigment reduce disability glare. Stringham and Hammond 17 evalu - The visibility hypothesis was mod - ated the impact of oral supplementa - eled empirically, and it was deter - tion with 10 mg lutein and 2 mg mined that under ordinary daylight zeaxanthin daily for 6 months in 40 conditions subjects with high levels healthy subjects on levels of macular of macular pigment would be able to pigment, glare tolerance, and photo - see about 30% farther in comparison Americans do not consume sufficient stress recovery time. MPOD increased to subjects with little or no macular amounts of lutein and zeaxanthin in significantly from baseline after 4 pigment. 15 In a separate study, it was their diet. Inadequate intake leads to months of supplementation. After 6 found that macular pigment en - reduced visual function, which for months of supplementation, the sub - hanced contrast, as revealed by indi - many may manifest as increased sen - jects’ ability to tolerate glaring light viduals with higher MPOD who were sitivity to glaring light or decreased improved 58% ( P < .0001), and the able to better distinguish objects, es - ability to distinguish objects clearly. time to recover sight following expo - pecially in low-light conditions. 19 sure to bright light (photostress) im - These benefits regarding contrast Recent studies indicate that low proved by 5 seconds or 14% ( P = acuity are significant to anyone who MPOD is a risk factor for AMD. Ade - .0003). The improvements in glare tol - has ever struggled to see someone quate intake of lutein and zeaxanthin erance and photostress recovery time walking along a dimly lit street or has is critically important to increase correlated significantly with increases had difficulty picking out an object, MPOD. Individuals can maintain ade - in macular pigment over the 6 such as a baseball, in the sky. quate levels of lutein and zeaxanthin months of supplementation. in the macula through increased con - Conclusions sumption of fruits, vegetables, and These data suggest that lutein and healthful fats. Because it is often diffi - zeaxanthin act as an optical filter to An accumulating body of evidence cult to ensure adequate intake of absorb wavelengths of light that re - suggests that the presence of lutein these essential eye nutrients through duce visual function. Such improve - and zeaxanthin in the macula are crit - diet alone, supplementation is a vi - ments in visual performance are ical to both protecting the eye able and convenient option for ob - important for anyone, especially ath - against damage from certain wave - taining 10 mg of lutein and 2 mg letes. Vision, like speed and strength, lengths of light and improving visual zeaxanthin on a daily basis. Such di - is an important component to per - function through optical properties. etary changes will help promote forming at the highest level. Reduc - It has been estimated that 43% of the healthy vision and may make it possi - ing recovery time from glare and U.S. population has low MPOD lev - ble for people to get closer to reach - enhancing visual function help pro - els, 11,15 suggesting that almost half of ing their maximal visual performance vide a competitive edge.

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 9 potential, which is especially impor - 7. Literature Review: Macular pigment tant for athletes and fitness enthusi - and healthy vision. Optometry. SCAN’S PULSE asts as they strive to achieve their 2009;80:591-597. maximal physical performance as 2009-2010 CPE Reviewers well. 8. Mangels AR, Holden JM, Beecher GR, et al. Carotenoid content of fruits The SCAN’S PULSE Editorial Board Diane Alexander, PhD, is a technical and vegetables: an evaluation of ana - would like to acknowledge those service manager at Kemin Health, in lytic data. J Am Diet Assoc. Des Moines, IA, and an author and 1993;93:284-296. who served as reviewers of our speaker focused on educating the med - continuing professional educa - ical/ scientific community and general 9. Handelman GJ, Nightingale ZD, tion (CPE) articles during the public on ocular nutrition. Robert Wild - Lichtenstein AH, et al. Lutein and 2009-2010 publishing year. Their man, PhD, RD, FISSN, is an assistant zeaxanthin concentrations in plasma professor in the Department of Family after dietary supplementation with review made it possible to offer and Consumer Sciences at Texas State egg yolk. Am. J. Clin. Nutr. 1999;70:247- SCAN members the opportunity University, in San Marcos, TX, and au - 251. to earn a total of four free CPE thor of several books including The Nu - units from PULSE during this pe - tritionist: Food, Nutrition & Optimal 10. Li B, Vachali P, Bernstein PS. Human Health, Sports & Fitness Nutrition, and ocular carotenoid-binding proteins. riod. Our appreciation goes to: The Handbook of Nutraceuticals & Photochem Photobiol Sci. In press; Functional Foods. 2010. Ursula Hauk, RD Michele Macedonio, MS, RD, CSSD References 11. Bernstein PS, Delori FC, Richer S, et 1. Khachik F, Beecher GR, Goli MB, et al. The value of measurement of mac - Andrea Ogden, RD al. Separation and quantitation of ular carotenoid pigment optical den - William Proulx, PhD, RD carotenoids in foods. Methods Enzy - sities and distributions in age-related Sarah Schutzberger, RD mol. 1992;213:347-359. macular degeneration and other reti - nal disorders. Vision Res. 2010;50:716- 2. Handelman GJ, Dratz EA, Reay CC, 728. et al. Carotenoids in the human mac - 16. Nolan JM, Stack J, O’ Donovan O, et ula and whole retina. Invest Ophthal - 12. Joint FAO/WHO Expert Commit - al. Risk factors for age-related macu - mol Vis Sci. 1988;29:850-855. tee on Food Additives. Lutein from lopathy are associated with a relative Tagetes erecta specifications prepared lack of macular pigment. Exp Eye Res. 3. Beatty S, Boulton M, Henson D, et al. at the 63rd JECFA (2004). Food and 2007;84:61-74. Macular pigment and age related Nutrition Paper 52. 2004;12:35-37. macular degeneration. Br J Ophthal - 17. Stringham JM, Hammond B. Macu - mol. 1999;83:867-877. 13. Centers for Disease Control and lar Pigment and Visual Performance Prevention. National Center for Under Glare Conditions. Optom Vis 4. Snodderly DM, Brown PK, Delori FC, Health Statistics. National Health and Sci. 2008;85:82-88. et al. The macular pigment. I. Ab - Nutrition Examination Survey Data sorbance spectra, localization, and 2001-2002. Accessed Oct. 1, 2010 at 18. Walls GL, Judd HD. The Intra-Ocu - discrimination from other yellow pig - http://www.cdc.gov/nchs/about/maj lar Colour-Filters of Vertebrates. Br J ments in primate retinas. Invest Oph - or/nhanes/nhanes01-02.htm. Ophthalmol. 1933;17:641-675. thalmol Vis Sci. 1984;25:660-673. 14. Moeller SM, Voland R, Sarto GE, et 19. Renzi LM, Snodderly DM, Ham - 5. Seddon JM, Ajani UA, Sperduto RD, al. Women’s Health Initiative diet in - mond BR, Jr. Reduction of surround et al. Dietary carotenoids, vitamins A, tervention did not increase macular suppression and enhancement of dis - C, and E, and advanced age-related pigment optical density in an ancil - criminability by macular pigment. In - macular degeneration. Eye Disease lary study of a subsample of the vest Ophthalmol Vis Sci. 50: E-Abstract Case-Control Study Group. JAMA. Women’s Health Initiative. J Nutr. A283, 2009. 1994;272:1413-142 2009;139:1692-1699.

6. The Eye Disease Case-Control Study 15. Wooten BR, Hammond BR. Macu - Group. Antioxidant status and neo - lar pigment: influences on visual acu - vascular age-related macular degen - ity and visibility. Prog Retin Eye Res. eration. Arch. Ophthalmol. 2002;21:225-240. 1993;111:104-109.

10 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 Influence of Vitamins E and C on the Recovery from an Anterior Cruciate Ligament Injury and Surgery by Tyler Barker, PhD

Skeletal muscle dysfunction is a maintenance of antioxidant is ␣-T, while the predominant form of major cause of morbidity in a variety defenses 8 to ameliorate oxidative vitamin E in the American diet is ␥-T, of pathophysiological and non- stress and disuse atrophy establishes which is found, for example, in canola pathophysiological conditions. Mus - the fundamental basis that oxidative or rapeseed oil. 16,17 Nonetheless, be - cle (i.e., quadriceps) dysfunction is a stress contributes to disuse atrophy, cause of the preferential hepatic se - predominant impairment that com - and that antioxidants or antioxidant cretion by the ␣-T transfer protein, monly follows an anterior cruciate supplementation could provide a the most abundant form of vitamin E ligament (ACL) injury and surgery. Al - found in plasma and tissues is ␣-T. though attenuated mechanoreceptor feedback from a ruptured or surgi - To date, there is little evidence identi - cally repaired ACL contributes to fying the therapeutic benefit of vita - muscle weakness, it is probable that min E and/or vitamin C on muscular other pathophysiological mecha - strength following injury or surgery. nisms accentuate muscle weakness Importantly, vitamins E and C relate and atrophy following ACL recon - to muscular strength and physical struction. Specifically, oxidative stress performance in the elderly, 16-18 a induces muscle weakness and atro - population that suffers from muscu - phy in experimental animal studies. lar weakness. With this in mind, we recently conducted a randomized, Oxidative Stress and double-blind, placebo-controlled ex - Muscle Dysfunction perimental design study involving patients undergoing elective ACL re - Oxidative stress is defined as the im - complementary therapeutic ap - constructive surgery. 19-21 Patients re - balance between oxidants and an - proach to abrogate muscle atrophy. ceived either an antioxidant (AO) tioxidants, in favor of the former, Unfortunately, the causative influ - supplement consisting of vitamins E leading to a disruption in redox sig - ence of oxidative stress in humans is (RRR -␣-tocopherol, 400 IU/d) and C naling and control and/or molecular unknown 9 and there are only a few (1,000 mg/d) or a matching placebo damage. 1 Molecular oxygen and ni - studies that relate oxidative stress to (PL). Supplements were taken daily tric oxide convert into a variety of re - disuse atrophy in humans, 10-12 with with a meal starting approximately active oxygen and nitrogen species their results inconsistent. 13 2-weeks prior to and concluding 3 that are capable of eliciting damage. months after surgery. Participants The causative influence of oxidative Vitamins E and C had not taken any supplements for stress on muscular weakness is well 12 months prior to study enrollment. characterized in isolated muscle Enzymatic and non-enzymatic an - Several key results from this study preparations and in experimental hu - tioxidant systems protect against the are discussed below. mans, 2 but it is unknown whether ox - deleterious events or reactions medi - idative stress contributes to muscular ated by reactive oxidative or nitrogen Correlation Between Plasma weakness following an ACL injury species. Vitamins E and C are potent Ascorbic Acid Concentra - and surgery. dietary antioxidants. Vitamin C (ascor - tions and Strength Gains bic acid) 14 is a water soluble antioxi - Similar to muscular weakness, muscle dant that scavenges a variety of As expected, at study enrollment the atrophy is another predominant im - reactive oxygen and nitrogen injured limb was significantly weaker pairment that continues to challenge species. Vitamin C is also a cofactor than the non-injured limb and it re - the recovery from an ACL injury and for collagen synthesis and recycles mained weaker at 3-months post- surgery. In experimental animal stud - vitamin E. Vitamin E is a fat-soluble, surgery. 20 Interestingly, strength ies, oxidative (or nitrative) stress oc - chain-breaking antioxidant 15 that ex - gains in the injured limb that oc - curs during various forms of disuse ists in eight different natural forms: curred from study enrollment to 3- atrophy. 3 The ability of vitamin E four tocopherols (T; ␣-T, ␤-T, ␥-T, and months post-surgery correlated with treatment (intraperitoneal or intra - ␦-T) and four tocotrienols (T3; ␣-T3, plasma ascorbic acid concentrations muscular injections) for diverse atro - ␤-T3, ␥-T3, and ␦-T3). The most com - measured at enrollment and prior to phy-inducing conditions 4-7 or for the mon supplemental form of vitamin E supplementation. 20 Although dietary

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 11 intakes of ascorbic acid were not as - Influence of Vitamins E and strength or improved physical reha - sessed and no participants had taken C on Post-Surgery Strength bilitative capacity that resulted in a any supplements one year prior to Recovery faster recovery after ACL surgery war - enrollment, this finding contentiously rants further investigation. suggests that higher vitamin C intake Although vitamin E and C supple - prior to injury improves strength mentation did not lower a biomarker Influence of Vitamins E and C gains after surgery. While the of oxidative stress-induced damage on Inflammatory Markers causative influence of this association in the circulation, the results showed and Skeletal Muscle Calpain awaits future resolve, this finding a tendency to improve muscle Following Limb Disuse identifies a compelling relationship strength 3 months after ACL surgery. between a potent dietary antioxidant Compared with the non-injured limb, The patients in our study were non- and recovery from ACL surgery. the injured limb displayed an approx - weight-bearing on their injured limb imate two-fold increase in muscular the first 5 days after surgery. 19,20 We Correlation Between a strength in the AO versus the PL obtained muscle biopsies from the Biomarker of Oxidative group from study enrollment to 3 mid-vastus lateralis of the injured Stress and Muscular months post-surgery. 20 Although this limb at two time points: 1) on the day Strength Post-Surgery finding did not reach statistical signif - of surgery but before any surgical icance, it does provide preliminary procedures, and 2) prior to resuming Impairments in physical or muscular and provocative evidence that vita - weight-bearing activities after sur - performance is a common conse - min E and C supplementation could gery. Mid-thigh circumference meas - quence of aging, which among other act therapeutically during the recov - urements (6-in above the factors is mediated by oxidative ery from ACL surgery. Whether sup - mid-patella) of the injured and non- stress, speculatively. To investigate plementation augmented muscular injured limbs were performed at the relationship between muscular weakness and oxidative stress follow - ing ACL surgery, we examined the correlation between limb strength and a reliable in vivo biomarker of ox - idative stress-induced damage (lipid peroxidation): plasma 8-isoprostane prostaglandin F 2␣ (8-iso PGF 2␣) concentrations.

The results showed that vitamin E and C supplementation was ineffec - tive at lowering plasma 8-iso PGF 2␣ concentrations 3-months post-sur - gery. However, peak isometric force of the injured limb inversely correlated with plasma 8-iso PGF 2␣ concentra - tions in both groups (AO and PL) (Barker et al ., unpublished observa - tion) (see Figure). Thus, lowering ox - idative stress might improve muscular strength after ACL surgery. It is plausible that our dose and dura - Figure Legend tion of vitamin E supplementation Plasma 8-isoprostane prostaglandin F 2␣ (8-iso-PGF 2) concentrations (pg/mL) were too low and short, respectively, correlated ( r = 0.54, P = .02) with peak isometric force (N/kg) of the injured to effectively decrease oxidative (INJ) limb 3 months post-surgery for all subjects ( n = 20) (Barker et al, unpub - stress as measured in the circula - lished observations). Single-leg peak isometric force measures were per - tion. 22 Nevertheless, this finding re - formed upon study enrollment and 3-months after surgery and veals the first association between supplementation on a customized horizontal plyo-press with mounted force oxidative stress and muscular plate. Peak isometric force measures were performed at 90º of knee and hip strength following ACL surgery, and flexion. Plasma 8-iso-PGF 2␣ concentrations were measured in fasting blood offers preliminary data for future draws obtained 3 months after surgery and supplementation. Plasma 8-iso- translational- and clinical-based in - PGF 2␣ was measured in heparinized plasma samples using liquid chromatog - terventions intended to reduce ox - raphy/mass spectrometry. This finding suggests that lower oxidative stress idative stress and improve muscular concentrations in the blood associated with greater muscular strength after strength following injury and surgery. ACL surgery.

12 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 study enrollment (~2- to 3-wk before stress and antioxidants relate to mus - muscle atrophy. J Appl Physiol. 2007; surgery) and approximately 8 days cular strength and strength recovery 102:2389-2397. after surgery. Muscle fiber cross-sec - following an ACL injury and surgery. tional areas were not significantly dif - Second, vitamin E and C supplemen - 4. Kondo H, Miura M, Nakagaki I, et al. ferent across time or between tation increased inflammatory medi - Trace element movement and oxida - groups. 20 Mid-thigh circumferences ators of reactive oxygen and nitrogen tive stress in skeletal muscle atro - of the injured limb were smaller than species and calpain without accentu - phied by immobilization. Am J Physiol that of the non-injured limb at study ating muscle atrophy. Finally, vitamin Endorcrin Metab. 1992;262:E583-E590. enrollment and several days after sur - E and C supplementation tended to gery. 20 Therefore, based on circumfer - improve muscular strength. Although 5. Appell HJ, Duarte JAR, Soares JMC. ence measures, the injured limb was vitamin E and C supplementation Supplementation of vitamin E may smaller than the non-injured limb was statistically ineffective at amelio - attenuate skeletal muscle immobi - prior to surgery and prior to our pre- rating muscle atrophy and weakness lization atrophy. Int J Sports Med. surgery biopsy. 20 following an ACL injury and surgery, 1997;18:157-160.

In the vastus lateralis muscle of the injured ACL limb several days after surgery, we found an increase in in - ducible nitric oxide synthase (iNOS) and myeloperoxidase (MPO) in sub - jects who supplemented with vita - mins E and C. 20 Inducible nitric oxide synthase and MPO are inflammatory- derived sources of reactive oxygen and nitrogen species. In addition to arguably, it is plausible that our dose 6. Demiryurek S, Babul A. Effects of vi - increasing iNOS and MPO, vitamin E and duration of vitamin E supple - tamin E and electrical stimulation on and C supplementation increased mentation were too low and short, the denervated rat gastrocnemius calpains following limb disuse after respectively, to induce its antioxidant muscle malondialdehyde and glu - ACL surgery. 20 Calpains are cysteine properties. 22 Future studies investi - tathione levels. Int J Neurosci. proteases that release sarcomeric gating the therapeutic and causative 2004;114:45-54. proteins for subsequent degradation influence of vitamins E and C at dif - by the proteasome. Importantly, cal - ferent doses and durations, along 7. Servais S, Letexier D, Favier R, et al. pain activation could be necessary with other antioxidants, following an Prevention of unloading-induced at - for oxidative stress-induced muscle ACL injury and surgery are clearly rophy by vitamin E supplementation: atrophy. 23 Thus, reducing oxidative warranted. links between oxidative stress and stress could attenuate calpain activa - soleus muscle proteolysis? Free Radic tion and subsequently abrogate mus - Tyler Barker, PhD, is a physiologist at Biol Med. 2007;42:627-635. cle atrophy. Nonetheless, despite The Orthopedic Specialty Hospital. His increasing inflammatory markers and research focus is developing comple - 8. Hudson NJ, Lehnert SA, Ingham AB, calpains in skeletal muscle, vitamin E mentary and alternative therapeutic et al. Lessons from an estivating frog: and C supplementation did not ac - approaches that attenuate muscular sparing muscle protein despite star - centuate muscle atrophy after ACL weakness and atrophy in various vation and disuse. Am J Physiol Regul surgery. pathological and physiological condi - Integr Comp Physiol. 2006;290:R836- tions in humans. R843. Summary References 9. Barker T, Traber MG. From animals Several novel findings were observed 1. Sies H, Jones DP. Oxidative stress. In: to humans: evidence linking oxida - in our study that could have thera - Fink G, ed. Encyclopedia of Stress . 2nd tive stress as a causative factor in peutic implications on the rehabilita - ed. San Diego, CA: Academic Press; muscle atrophy. J Physiol (Lond). tion from an ACL injury and surgery. 2007;45-48. 2007;583:421-422. First, plasma ascorbic acid concentra - tions prior to surgery and supple - 2. Powers SK, Jackson MJ. Exercise-in - 10. Levine S, Nguyen T, Taylor N, et al. mentation correlated with muscular duced oxidative stress: cellular mech - Rapid disuse atrophy of diaphragm strength gains after surgery, and a anisms and impact on muscle force fibers in mechanically ventilated hu - biomarker of oxidative stress-in - production. Physiol Rev. 2008;88: mans. N Engl J Med. 2008;358:1327- duced damage (i.e., lipid peroxida - 1243-1276. 1335. tion) correlated with muscular strength 3-month post-ACL surgery. 3. Powers SK, Kavazis AN, McClung These results suggest that oxidative JM. Oxidative stress and disuse

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 13 11. Dalla LL, Ravara B, Gobbo V, et al. A 16. Bartali B, Frongillo EA, Guralnik JM, tion following anterior cruciate liga - transient antioxidant stress response et al. Serum micronutrient concentra - ment surgery. Free Radic Biol Med. accompanies the onset of disuse at - tions and decline in physical function 2009;47:1611-1618. rophy in human skeletal muscle. J among older persons. JAMA. 2008; Appl Physiol. 2009;107:549-557. 299:308-315. 21. Barker T, Leonard SW, Trawick RH, et al. Antioxidant supplementation 12. Brocca L, Borina E, Pellegrino MA, 17. Ble A, Cherubini A, Volpato S, et al. lowers circulating IGF-1 but not F2- et al. Qualitative and quantitative Lower plasma vitamin E levels are as - isoprostanes immediately following adaptations of muscle fibers and sociated with the frailty syndrome: ACL surgery. Redox Rep. 2009;14:221- muscle protein pattern to 35-days the InCHIANTI study. J Gerontol A Biol 226. bed rest. Basic Appl Myol. 2009;19: Sci Med Sci. 2006;61:278-283. 117-126. 22. Roberts LJ, Oates JA, Linton MF, et 18. Cesari M, Pahor M, Bartali B, et al. al. The relationship between dose of 13. Glover EI, Yasuda N, Tarnopolsky Antioxidants and physical perform - vitamin E and suppression of oxida - MA, et al. Little change in markers of ance in elderly persons: the Invec - tive stress in humans. Free Radic Biol protein breakdown and oxidative chiare in Chianti (InCHIANTI) study. Med. 2007;43:1388-1393. stress in humans in immobilization- Am J Clin Nutr. 2004;79:289-294. induced skeletal muscle atrophy. Appl 23. Smuder AJ, Kavazis AN, Hudson Physiol Nutr Metab. 2010;35:125-133. 19. Barker T, Leonard SW, Trawick RH, MB, et al. Oxidation enhances myofib - et al. Modulation of inflammation by rillar protein degradation via calpain 14. Frei B, England L, Ames BN. Ascor - vitamin E and C supplementation and caspase-3. Free Radic Biol Med. bate is an outstanding antioxidant in prior to anterior cruciate ligament 2010;49:1152-1160. human blood plasma. Proc Natl Acad surgery. Free Radic Biol Med. Sci USA. 1989;86:6377-6381. 2009;46:599-606.

15. Traber MG, Atkinson J. Vitamin E, 20. Barker T, Leonard SW, Hansen J, et antioxidant and nothing more. Free al. Vitamin E and C supplementation Radic Biol Med. 2007;43:4-15. does not ameliorate muscle dysfunc -

Worksite Health Promotion: Beyond “Biggest Loser” Challenges and T-Shirts by Marisa Moore, MBA, RD

Worksite-based health promotion, program (EAP), and regular worksite One reason for the increase in work - also called worksite or corporate health screenings. 1 site health promotion is the com - wellness, is a hot topic these days. The bined trend that as Americans are health promotion industry has hit a The number and breadth of worksite spending more time in the work - boom in a major way, and it goes be - wellness programs in the United place, employers are recognizing an yond the ubiquitous “biggest loser” States have increased substantially opportunity to help reduce the inci - contest and t-shirt incentive. Today over the past two decades. In 1985, dence of some major medical condi - worksite health programs encompass only 66% of companies with 50 or tions and therefore lower health care a variety of integrated strategies and more employees offered at least one expenditures. In addition, with onsite interventions in the workplace to health promotion activity to employ - health screening and assessments help manage and control chronic dis - ees. This grew to 81% by 1992 and to taking a deeper look at employees’ ease, overweight, and obesity—and 90% by 2002. 1 Obesity—a top health health status, employers are discover - ultimately improve the company’s concern in the nation—accounted ing the health risks that diminish pro - bottom line savings on health care. for an estimated $147 billion in ductivity, increase health care Programs can range from an assort - health care expenses in 2008. This is expenditures, and negatively impact ment of “lunch-and-learn” classes and especially eye-catching to employers, the company’s bottom line. 3 the occasional health screening to a because medical expenses for an comprehensive program that in - obese employee are estimated to be In remarking on the growth of work - cludes integrated health education, a 42% higher than for a person at a site wellness programs, Jennifer Price, supportive social and physical envi - healthy weight. 2 RD, CWPC, wellness consultant for ronment, an employee assistance Willis North America, states: “After ex -

14 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 hausting a variety of short-term solu - port healthful habits (e.g., provide tions such as switching medical carri - healthful cafeteria and vending ma - Resources for Practitioners ers, changing contribution strategies, chine options, encourage biking, pro - in Worksite-Based Health and tweaking plan design, employers vide walking routes). Promotion are now facing the only long-term so - lution left—to improve the health of Other key elements are needed to CDC LEAN Works (Leading the employee population to reduce implement and sustain a successful Employees to Activity and health risks and costs.” Indeed, a worksite wellness program, begin - Nutrition) focus on reducing and preventing ning with finding the right provider http://www.cdc.gov/LEANWorks obesity in the workplace is time well to deliver results. 6,7 Common compo - Includes an obesity cost calculator spent to help lower health care costs, nents noted in a review of effective to calculate a company’s return on decrease absenteeism, and improve programs 5 include: investment (ROI); statistics and re - productivity overall. ■ Organizational commitment (lead - search; case studies; and other re - ership buy-in and support) sources to help practitioners Influence of Health ■ Incentives for employees to partici - establish a worksite wellness pro - Care Reform pate gram ■ Effective screening and triage The health care reform legislation ■ State-of-the-art theory and evi - Health Enhancement Research passed in 2010 may ignite further in - dence-based interventions (via a vari - Organization (HERO) Scorecard terest in worksite wellness activities. ety of offerings such as fitness (Best Practice Scorecard) Providing a major emphasis on centers; programs targeting weight www.the-hero.org/scorecard.htm health promotion, the new law will management and cardiovascular authorize a variety of new programs health; and clean commuting sup - Health Reform Website for prevention and wellness. A few port such as lockers, showers, and bi - www.healthreform.gov ways in which employers will be in - cycle rack to encourage centivized include: 4 participation) National Business Group on ■ Small employer corporate wellness ■ Effective implementation (includ - Health (NGBH) Wellness grants to explore and implement ing targeting high-risk employees; Scorecard worksite wellness programs ensuring program accessibility [via www.businessgrouphealth.org ■ Premium discounts for employees Internet, onsite, or telephone]; and who participate in wellness programs communicating effectively) National Institute for ■ Subsidies for small employers to ■ Ongoing program evaluation Occupational Safety and Health provide health insurance coverage to (NIOSH) Essential Elements for employees When all components are in place, or - Effective Workplace Programs ■ Tax credits for up to 35% of health ganizations have a better chance of www.cdc.gov/niosh/worklife/es - insurance costs achieving high participation rates. sentials.html This can work to improve the health What’s Needed for a and well-being of employees as well Nutrition Entrepreneurs Successful Program as improve the company’s financial Dietetic Practice Group picture. Direct health care cost sav - www.nedpg.org As previously noted, worksite well - ings of as much as 3% have been ness activities run the gamut, from achieved with participation rates of lunch-and-learn seminars to compre - at least 90%, although this savings is hensive programs. Most organized atypical in the current climate. Indi - wellness programs on corporate programs begin with a health risk as - rect health savings for productivity finances can go far. sessment (HRA). While the HRA is es - are estimated to be even higher. 8 sential for program success, the In addition to serving as in-house assessment alone is ineffective in Bright Future for food and nutrition experts, RDs can producing behavior change and risk Registered Dietitians become involved in the design and 5 reduction. For the best outcomes, in - delivery of many other opportunities, terventions should be multifaceted The registered dietitian has an essen - including: and meet the following criteria: 1) in - tial role in delivering effective work - ■ Comprehensive worksite health clude timely feedback on HRA results site health promotion programs. This programs as well as programs to educate the role extends far beyond lunch-and- ■ Workplace and cafeteria employee on health risks, 2) provide learns. RDs with strong business acu - education programs opportunities for skill building and men can fully manage worksite- ■ Cooking demonstrations the tools to achieve behavior change; based interventions to improve the ■ Guidelines for healthful food 3) motivate employees; and 4) imple - health of employees. Those who un - at meetings, seminars, and catered ment opportunities at work to sup - derstand the impact of health and events

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 15 ■ Recipe and menu development Skills and Competencies an ADA national spokesperson and the ■ Staff training Needed in Worksite Wellness immediate past president of the Geor - ■ Web-based solutions that include gia Dietetic Association. nutrient analysis of menu items and The key skills needed for success in healthful promotions wellness settings involve communi - References ■ Fit business tips cation, nutrition assessment and 1. Linnan L, Bowling M, Childress J, et ■ Workplace breastfeeding/ counseling, motivation/facilitation of al. Results of the 2004 National Work - lactation programs change in behavior, evaluation of in - site Health Promotion Survey. Am J dividual success, use of technology, Public Health. 2008;98:1503-1509. Health promotion programs can take and evaluation of program success place in a wide variety of settings, in - and promotional activities. 10 This 2. Finkelstein EA, Trogdon JG, Cohen cluding corporations, manufacturing bodes well for RDs, because many of JW, et al. Annual medical spending at - facilities, schools, clinics, hospitals, su - the top essential skills in worksite tributable to obesity: payer- and serv - permarkets, military bases, recre - health promotion are core compe - ice-specific estimates. Health Affairs . ational centers, fitness centers, and all tencies in dietetics education pro - 2009;28:w822-w831. levels of government (federal, city, grams. state, and county). Employment 3. Task Force on Community Preven - tive Services. Recommendations for worksite-based interventions to im - prove workers’ health. Am J Prev Med. 2010;38:S232-S236.

4. Health Care.gov. http://www. healthcare.gov/learn/index.html.

5. Goetzel RZ, Pronk NP. Worksite health promotion: how much do we arrangements include positions that To be highly competitive in the really know about what works? Am J are full time, part time, or offered to health promotion industry, RDs are Prev Med. 2010;38:S223-S225. an independent contractor for spe - also encouraged to pursue training in cial projects. With more than 6 million areas beyond dietetics and obtain 6. Goetzel RZ, Schechter D, firms in the United States, there are certifications from other professional Ozminkowski RJ, et al. Promising numerous opportunities for well- groups, such as the American College practices in employer health and pro - trained RDs. 9 of Sports Medicine. “RDs trained in ductivity management efforts: find - motivational interviewing and those ings from a benchmarking study. J One key avenue for dietitians in - who have completed a certified Occup Environ Med. 2007;49:111-130. volves educating employers (small or coaching program are ideal,” says large) on the value of employing an Price. Such providers tend to thrive in 7. O’Donnell M, Bishop C, Kaplan K. RD to take the lead in providing the the worksite wellness setting. Acquir - Benchmarking best practices in work - solution. Dietitians need to be able to ing this skill set also matches the cur - place health promotion. Art Health convince employers that hiring an RD rent employer trend toward Promot. 1997;1:1-8. will yield a good return on invest - customized behavior change pro - ment and that the RD is the best grams and health coaching. 8. Thygeson NM. A health plan per - provider for the job. “Decision makers spective on worksite-based health for health promotion services often What’s Next? promotion programs. Am J Prev Med. don’t have a health background,” says 2010;38:S226-S228. Denice Ferko-Adams, MPH, RD, presi - The corporate wellness industry is dent and owner of Wellness Press. “Di - poised for growth in the next few 9. U.S. Census Bureau. Statistics of U.S. etitians need to make corporations years as employers seek solutions to Businesses (SUSB): Latest SUSB An - aware of how they can fit into an help lower health care costs. Employ - nual Data. Available at: http://www. overall wellness plan and why they ers are challenged to implement best census.gov/econ/susb/; Accessed are the ideal leader for a health pro - practices, and RDs are well positioned June 23, 2010. motion team.” Agreeing with this ad - to fill the gap. vice, wellness consultant Price notes 10. Hunt A, Hilgenkamp K, Farley R. that she has seen many unqualified Marisa Moore, MBA, RD, is employed by Skills and competencies of dietitians practitioners approach employers CSC and manages the nutrition work - practicing in wellness settings. J Am with “free” services and presentations site wellness program for employees at Diet Assoc. 2000;100:1537-1539. as a way to sell services and products the Centers for Disease Control and such as nutrition supplements. Prevention (CDC) in Atlanta, GA. She is

16 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 From The Chair

Student Engagement: Nurturing SCAN’s Passion, Ensuring a Bright Future by Tara Coghlin-Dickson, MS, RD, CSSD

A most impressionable experience early in my career SCAN’s student opportunities include: was when an RD engaged me, serving as an architect to ■ Local student assistance at the Annual SCAN Symposium help create the environment in which I was soon to work ■ Free 2011 Symposium registration for a limited number of and love. She gave me some of her time and afforded me ac - accepted posters from SCAN student members cess to a professional world I thought I wanted to be a part ■ Volunteer roles that match students with experienced of. Having direct contact with a nutrition professional work - leaders—and facilitate a fast track to success ing in my field of interest was of immeasurable value. The ■ Ability to focus on specific areas of interest and skills mentoring served as a determining factor for my career di - through student subunit volunteer positions rection. She realized she had a shared responsibility in the ■ Opportunity to contribute to developing fact sheets task of student learning. Her interest was in being a part of ■ SCAN Mentoring Program the bigger picture by engaging in a student’s growing envi - ■ Social media for published research ronment to strengthen a shared passion and profession. ■ Student recognition and leadership development ■ Coming soon: SCAN student grants Just as this RD extended an invaluable service to me, Student members of SCAN can tap into a network of infor - mation, resources, and national nutrition experts—all at a special, affordable student membership rate. Through An - SCAN’s newly revamped Web site, student members can other connection with student members is hosting a discus - engage in the three listservs, Twitter, Facebook, Discussion sion on the online Student Community of Interest (CoI); Forums, LinkedIn, and the Student Corner. Student support through the efforts headed by our director of member serv - on the Web site also includes student career path informa - ices, SCAN’s own experts have participated with great suc - tion, including lists of graduate schools and internships. cess. Writing articles for the ADA Student Scoop is another excellent outreach opportunity. Clearly, student engagement is no longer an option—it’s an expectation. Student engagement is the key to our future. Student engagement is a powerful and essential means of Through SCAN opportunities, students and experienced developing SCAN’s passion. Playing a part in it and witness - SCAN professionals work together in this meaningful way to ing growth firsthand serves us all as a wise investment. We become innovative, collaborative, and future leaders. Be a can all make student engagement significant, valuable, and part of small changes—engage and make an impact! real—we can make learning a creation of meaning and ac - tion. Conference Highlights

American College of ing scientific research to provide edu - Weight Loss and Management cational and practical applications of Sports Medicine exercise science and sports medicine. ■ What are four keys to weight loss Annual Meeting At 2010 ACSM Annual Meeting, more success? In a study involving 65 over - June 1-5, 2010 than 5,400 exercise scientists, sports weight or obese men, the keys to suc - Baltimore, MD dietitians, physicians, and health pro - cessful weight loss were choosing fessionals gathered to share the lat - smaller portions, cutting back on sug - The American College of Sports Med - est research. Shown here are a few of ary soft drinks, eating fewer high-fat icine is the largest sports medicine the nutrition highlights. Abstracts of snack foods, and consuming less al - and exercise science organization in the presentations appeared in the cohol (Abstract 647). the world, with more than 35,000 in - supplement to the May 2010 issue of ■ Marathon training is not a good ternational and national members Medicine and Science in Sports and Ex - way to lose weight, according to a and certified professionals. ACSM is ercise. Additional highlights are avail - study of 64 participants in a 3-month dedicated to advancing and integrat - able at www.acsm.org (click on “news marathon training program. Only releases”). SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 17 11% of participants lost weight, an - shaved) reported significant differ - muscle building (Abstract 794) and other 11% gained weight, and the ences between the test results. More reduces muscle breakdown (Abstract rest remained stable. Of the 7 who research is needed before any spe - 1135). Chocolate milk also replaces gained weight, 6 were women. In cific recommendations can be made glycogen faster than a protein-free general, 74% of the women reported regarding arm and leg hair (Abstract drink (Abstracts 862 and 2816). eating more while training, compared 2441). ■ When compared with a placebo with only 48% of the men. The goal of ■ Skinfold calipers maintain a high (matched for color, taste and running should be to improve per - ranking as a tool for measuring body carbohydrate content), antioxidant- formance, not to lose weight (Ab - composition. A study involving 50 rich pomegranate juice improves re - stract 2436). Caucasian men and women that covery and decreases muscle ■ In investigating whether it matters rank-ordered techniques using un - soreness after muscle-damaging ex - to lose weight quickly or slowly, derwater weighing as the gold stan - ercise in trained men (Abstract 1931). researchers found that the pace of dard indicated the sum of four weight loss was not important over skinfolds (Jackson-Pollack) correlated Fluids and Hydration the long run. Whichever way athletes highest, followed by Bod Pod, dual lost weight, they returned to the energy X-ray absorptiometry, ultra - ■ Is coconut water preferable to a same weight a year later. However, sound, and bioelectrical impedance sports drink for replacing sweat slow weight loss tends to preserve analysis (Abstract 2439). losses? While it is as effective as a more muscles mass (Abstract 641). sports drink in replenishing body flu - ■ Among athletes who need to Physical and Mental Energy ids, coconut water lacks taste appeal. make weight for a sport, will self- The athletes in a study evaluating dehydrating to shed some pounds ■ Fatigue is associated with not just these drink preferred the standard hurt their performance? In a study depleted muscles but also a tired sports drink. A fluid is only helpful if it with boxers who sweated off 2% of mind. Inhibitory mechanisms in the is consumed (Abstract 2289). their body weight, the boxers were brain can contribute to a 25% reduc - ■ During an hour of simulated bike able to maintain their performance tion in muscle contraction. Caffeine racing, Ironman triathletes lost about as well as normal liver and renal func - might be able to help counter the 1.5 L of sweat and drank about 0.5 L tion. However, heatstroke was a con - fatigue (Abstract 732). too little fluid to replace that loss. Al - cern (Abstract 1680). ■ During rest, caffeinated drinks though they were able to perform ■ Why don’t obese people exercise? (with or without sugar) contribute to well for the 1-hour exercise test, med - Based on a survey of overweight/ 12% greater ratings for mental en - ical problems would arise if they obese collegiate students, faculty, ergy compared with plain water (Ab - were to exercise for 14 hours with a and staff, two major reasons are “exer - stract 1904). similar fluid deficit (Abstract 940). cise is hard for me” and “exercise ■ After hard exercise, is it better to takes too much of my time.” Helping Fueling Before and drink a large amount of water at one this population with time-manage - During Exercise time to replace sweat losses—or ment skills might be a smart strategy smaller amounts of water every 30 (Abstract 2259). ■ Consuming protein, such as yo - minutes for 4 hours? Either works; the ■ Walking up stairs can burn about gurt, before lifting weights may en - important thing is to consume 150% 10 kcal per minute, while taking the hance recovery better than more than what was lost via sweat. elevator burns only about 1.5 kcal per consuming a protein recovery drink Athletes who know their sweat rate minute. Motivational signs that en - afterwards (Abstract 2862). have a helpful tool to manage hydra - couraged people to take the stairs in - ■ Cyclists and triathletes who con - tion (Abstract 2290). ■ stead of the elevator increased stair sumed 60 to 80 g carbohydrate per Staying well hydrated on a daily usage from 51% to 60%, suggesting a hour (240-320 kcal/h) performed bet - basis is important to optimize per - clear need for more signs (Abstract ter during a 2-hour endurance ride formance, and winter athletes com - 2526). followed by a 20-minute time trial monly need to be taught to drink ■ Body fat measurement using the than those who consumed 10 to 50 g more throughout the day. Urine sam - Bod Pod has been shown to be a or 90 to 120 g carbohydrate per hour. ples of high school alpine skiers indi - valid and reliable method to measure Each athlete should experiment with cated that 11 of 12 were dehydrated body composition, yet researchers different doses of carbohydrate dur - pre-competition (Abstract 1149). are finding potential sources of error ing training to learn the right dose for ■ A survey of National Collegiate that can result in a lower estimate of his/her body (Abstract 855). Athletic Association hockey players body fatness. One source includes indicated that they arrived at practice body hair on the arms and legs. A Recovery Drinks under-hydrated and ended the exer - study involving 20 men who were cise session with an even larger fluid measured under four conditions deficit. Cumulative dehydration can ■ Fat-free chocolate milk is an excel - (body hair, body hair covered with take its toll on performance (Abstract lent recovery drink. It stimulates nylons, shaved with nylons, and 2484). 18 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 ■ A study involving racing cyclists found that taking an iron supplement enhance bone strength and poten - compared the effects of consuming for the 7 days during menses helps tially reduce the risk of stress frac - two caffeinated beverages (Red Bull maintain a strong iron status (Ab - tures (Abstract 2650). Energy Drink versus Coca-Cola with stract 2822). ■ Loss of bone density affects men extra caffeine to match the 160 mg as well as women. A survey of 35-to- caffeine in Red Bull) 55 minutes prior Benefits of Exercise 50-year-old men and women re - to a 25-mile simulated road race. The vealed that 42% of men and 28% of cyclists performed similarly with Red ■ Persistent fatigue affects 96% of women had low bone mineral den - Bull and Coke. Caffeine and sugar are cancer survivors. Low-intensity exer - sity. These shocking results indicate popular energizers among athletes cise (cardiovascular and lifting) can that men as well as women need to (Abstract 2457). reduce fatigue. Cancer patients can take steps to maintain their bone ■ Among 51 cyclists who partici - benefit from participating in super - health and reduce their risk for devel - pated in the Hotter ‘N Hell Hundred vised exercise programs (Abstract oping osteoporosis (Abstract 2657). bike event in Texas, two became hy - 1414). ■ NHANES (National Health and Nu - ponatremic. In comparison to the ■ Among 269 cancer patients who trition Examination Survey) informa - other cyclists, they had higher sweat exercised for at least 3 months, the tion from 5,618 people suggests rates and higher fluid intakes. They cancer survival rate was 93%. This is those who do muscle-strengthening also finished faster than many others. higher than the national average of exercises are 28% less likely to have Interestingly, one had a high sodium 66%. In the breast cancer group, exer - dyslipidemia than those who do not. intake and one a lower intake, but cisers have a 95% survival rate com - Strength training twice a week is im - they both ended up with hypona - pared with the national average of portant in maintaining good health tremia (Abstract 2487). 89% (Abstract 1635). (Abstract 2385). ■ Although physical education ■ Physical activity can help older Iron Deficiency Anemia classes seem to be the easiest to cut adults (ages 60-99 y) maintain their during a budget crisis, the reality is youthfulness. Because women tend ■ The incidence of iron deficiency that students who are physically ac - to be more active than men, they ex - anemia in the general population of tive perform better on standardized perience less physical decline (Ab - men is 2%. A survey of male cross achievement tests. What’s good for stract 2347). country and distance runners aged the body is good for the brain (Ab - 18 to 22 years found that 21% of the stract 2148). Contributed by Nancy Clark, MS, RD, ■ men were iron deficient—10 times Strength training is key to having CSSD, who is PULSE’s “Conference greater than expected (Abstract lean muscle pull on bones. This can Highlights” editor and has a private 2821). help stop the development of osteo - practice at Healthworks in Chestnut ■ The incidence of iron deficiency porosis (Abstract 2664). Hill, MA, where she counsels both ca - ■ anemia is 14% in the general popula - Athletes with anorexia would be sual and competitive athletes. tion of women but about 50% wise to do resistance exercise. Having among female athletes. Researchers strong muscles pulling on bones can Reviews

Savor the authors refer to as In Eating, haviors. Readers learn how the Four Thich Nhat Hanh and Lilian Cheung, In Moving, and In Breathing, Thich Noble Truths apply to weight loss and DSc, RD Nhat Hanh and Dr. Lilian Cheung are encouraged to get in touch with HarperOne, Harper Collins Publishers, focus on Buddhist meditations and their bodies, emotions, environment, 10 East 53rd St., New York City, NY teachings of mindfulness to practice and behaviors to develop a personal 10022 living in the present moment—trans - “mission statement for healthy www.harpercollins.com forming habitual and mindless ac - weight and well-being.” 2010, hardcover, 292 pp, $25.99, tions that inhibit weight loss. ISBN 978-0-06-169769-2 Part II expands upon these teachings The book is divided into three parts. to describe “mindful action plans.” Savor offers a thorough exploration Part I: A Buddhist Perspective on Through a series of questions and ex - of the interconnected relationships Weight Control offers a fundamental amples, the authors encourage read - between psychological, emotional, primer on Buddhist teachings as the ers to reflect upon their own barriers physical, and behavioral approaches authors describe the practice and im - to mindful eating and exercise to cre - to weight loss. Advocating a mindful portance of mindfulness and offer in - ate a 10-week mindful living plan living approach that involves what sight into how and why we develop that incorporates specific goals for thoughts, emotions, and habitual be - approaching eating, moving, and

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 19 breathing with mindful and present more advanced approach to the art healthful relationship with food and intention. of mindfulness and its transformative exercise, and sustaining weight loss. power. The wisdom of Zen master In Part III: Individual and Collective Ef - Thich Nhat Hanh and the skill of Dr. Known as Thay by his students, Thich fort, the authors identify the inter- Cheung in translating science into Nhat Hanh is one of the world’s most connectedness of individuals with practice deliver concrete meditations renowned and respected Zen mas - their surrounding social environ - and practices that may prove useful ters. Grounded in the Buddhist princi - ment, physical environment, and soci - for individuals in need of weight loss ples of nonviolence and compassion, ety. Taking one day at a time, students as well as those with an eating disor - Thich Nhat Hanh has organized of this mindful living approach are der. grassroots efforts to promote peace encouraged to work at the grass- and improve community welfare roots level to develop support For those not familiar with the con - around the world. He has published groups, incite change in the food cept of mindfulness, this book may scores of inspirational poems, essays, supply, and promote access to not be the most approachable intro - and prayers and lives in Plum Village, healthful physical activity. duction to this idea. However, Savor the meditation community he presents an essential, multifaceted founded in France in 1982. With few exceptions, namely its ap - approach to weight loss: making the proach to alcohol and meat con - mental and physical connections Dr. Lilian Cheung is an expert at sumption, which are strongly necessary to tackle obesity. Research translating nutrition science into ac - influenced by the rigidity of Buddhist shows that lifestyle change is essen - cessible resources for the community. teaching, the diet and exercise guide - tial to achieving a healthful weight, As the director of health promotion lines in this book reference scientifi - but creating that change can be com - and communication and editorial di - cally supported recommendations of plicated and difficult. The mindful ap - rector of the Nutrition Source Web the Centers for Disease Control, proach presented in this book works site of the Harvard School of Public American Heart Association, Ameri - with readers from “the inside out.” Health, Dr. Cheung is skilled in the art can College of Sports Medicine, Har - Starting with self-evaluation and of using mass media to improve the vard School of Public Health, and the meditation, the book guides readers quality of nutrition messaging and federal government’s guidelines for to make external changes (i.e., promote healthful lifestyles across diet and exercise. changes to eating and exercise multiple demographics. habits) along with internal reflections This book offers a great resource for on why, what, where, when, and with Reviewed by Kristine Spence, MS, RD, the psychologically focused practi - whom they engage in eating, mov - CD, sports dietitian and researcher at tioner. Therapists and dietitians who ing, and breathing. Savor’s connec - the Orthopedic Specialty Hospital often apply the concepts presented tion between our external (TOSH) and adjunct faculty member at in such books as Intuitive Eating, environment and our internal feel - the University of Utah, in Salt Lake City, Mindless Eating, and The End of ings is an integral approach to mak - UT. Overeating will find that Savor offers a ing lifestyle changes, achieving a

Sports Dietetics-USA Research Digest

Antioxidant pose of this study was to investigate etary intake. Performance and oxida - Supplementation and whether vitamin C and E supplemen - tive capacity were assessed using Endurance Training tation during endurance training at - aerobic and metabolic parameters Adaptation tenuates the expected increases in that included maximal oxygen con - Yfanti C, Akerström T, Nielsen S, et al. training adaptation and performance sumption (VO 2max), maximal power Antioxidant supplementation does in physically active men. In this 12- output, workload at lactate threshold, not alter endurance training adapta - week, double-blind, placebo-con - skeletal muscle glycogen content, tion. Med Sci Sports Exerc . 2010;42: trolled study, 21 men (ages 18-40 y) and mitochondrial enzymes (citrate 1388-1395. completed a 5-day-per-week inten - synthase and beta-hydroxyacacyl- sive cycle training protocol. Eleven CoA dehydrogenase). Plasma levels of Reactive oxygen and nitrogen participants received 500 mg vitamin vitamins C and E increased signifi - species production that occurs with C and 400 IU vitamin E daily for 16 cantly ( P<.05 and P<.001 respec - exercise may negatively impact per - weeks (AO group); the remaining 10 tively) in the AO group and remained formance; however, this same process participants received placebo tablets unchanged in the PL group. Both appears to be critical in stimulating (PL group). Plasma levels of vitamin C groups had significant improvements desired training adaptations. The pur - and E were monitored along with di - from baseline in the aerobic and

20 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 metabolic parameters ( P< .01), but no days. Exercise trials consisted of 90 healthy women. Prior to the study, significant difference was detected minutes of intermittent shuttle run - participants were recreationally ac - between groups. The results of this ning (15-minute exercise bouts sepa - tive but not recently engaging in re - study indicate that vitamin C and E rated by 4-minute rests), counter- sistance training. In single-blind, supplementation does not attenuate movement jumps (CMJ) during rest randomized fashion, female partici - training adaptation or improve per - periods, and soccer passing tests. pants consumed either 500 mL fat- formance in physically active men. In Heart rate, blood lactate, perceived free milk (MILK; n=10) or a 9% conclusion, athletes with normal vita - activation, and rating of pleasure/dis - isocaloric maltodextrin beverage min C and E status will most likely pleasure were measured before and (CON; n=10) immediately following experience neither positive nor nega - during exercise. Mean 15-minute and 1 hour after resistance training. tive effects secondary to antioxidant sprint time was significantly faster Study participants performed a supplementation. This study was (P<.04) with CAF versus CON whole-body split routine 5days per funded by a grant from the Danish (2.48±1.15 vs. 2.59±0.02 sec during week alternating pushing, pulling, National Research Foundation, the the final sprint). Explosive leg power and leg exercises at 80% one repeti - Danish Medical Research Council, the (CMJ height) ( P<.03), heart rate tion maximum (1-RM). Body composi - Commission of the European Com - (P<.01), and rate of pleasure ( P<.01) tion via dual energy X-ray munities, the Greek State Scholar - were also significantly higher with absorptiometry scan and 1-RM test - ships Foundation, and the Danish CAF than CON. There were no differ - ing were performed at pre- and post- Ministry of Culture Committee on ences in blood lactate, body weight training. The MILK group experienced Sports Research. loss, perceived activation, or thirst both a decline in fat mass ( P<.02) and drive. The results of this study sug - increase in lean mass compared with Summarized by Ladd Harris, graduate gest that coingestion of CHO and caf - the CON group ( P<.01). Increases in 1- student, Coordinated Master’s Pro - feine may have an ergogenic effect RM were observed in both groups for gram, Sports Dietetics Emphasis, Divi - on leg power and sprint perform - all exercises at post-training, with a sion of Nutrition, University of Utah, ance. Athletes engaging in high-in - significant increase in the bench Salt Lake City, UT. tensity intermittent sports may press exercise for MILK subjects com - benefit from consuming a moder - pared with CON subjects ( P<.05). The ately caffeinated sports drink. results of this investigation indicate Effects of Caffeine and that post-exercise ingestion of fat- Carbohydrate on Soccer Summarized by Kate Olsen, graduate free milk appears to favorably alter Performance student, Coordinated Master’s Pro - body composition in young women Gant N, Ali A, Foskett A. Influence of gram, Sports Dietetics Emphasis, Divi - following a resistance exercise train - caffeine and carbohydrate coinges - sion of Nutrition, University of Utah, ing program. Ingestion of fat-free tion on simulated soccer perform - Salt Lake City, UT. milk may provide a practical, inex - ance. Int J Sport Nutr Exerc Met . pensive recovery drink for increasing 2010;20:191-197. lean mass in women. This study was Fat-Free Milk supported by grants from the Natural Taken individually, caffeine and car - Consumption and Science and Engineering Research bohydrate (CHO) have been shown to Changes in Body Council of Canada, the Canadian In - be ergogenic for prolonged en - Composition stitutes of Health Research, and the durance and high-intensity intermit - Josse, AR, Tang JE, Tarnopolsky MA, et Dairy Farmers of Canada. tent exercise. However, the al. Body composition and strength coingestion of caffeine and CHO on changes in women with milk and re - Summarized by James R, Stevens, MS, exercise performance is unclear. The sistance exercise. Med Sci Sports Exerc . RD, adjunct instructor, Metro State purpose of this study was to examine 2010;42:1122-1130. College of Denver, CO. the effect of a caffeinated CHO solu - tion on prolonged soccer activity. In Ingestion of milk-based protein fol - this randomized, double-blind, lowing intensive resistance training Combined Effect of crossover study, 15 male premier- appears to enhance muscle mass ac - Omega-3 Fatty Acids grade soccer players ingested 8 cretion in young males. Whether fe - and Antioxidants on mL/kg body weight (BW) of a 6% males following the same regime Oxidative Stress CHO beverage (1.8 g/kg BW CHO) respond similarly has not been suffi - McAnulty SR, Nieman DC, Fox-Rabi - with 160 mg/L caffeine (CAF; 3.7 ciently tested. The objective of this novich M, et al. Effect of n-3 fatty mg/kg BW) or without caffeine (CON) study was to determine if ingestion acids and antioxidants on oxidative one hour pre-exercise and 3 mL/kg of fat-free milk or an isocaloric carbo - stress after exercise. Med Sci Sports BW every 15 minutes during exercise. hydrate (CHO) drink resulted in Exerc . 2010;42:1704-1711. After familiarization with testing pro - greater strength gains and increases tocols, study participants completed in lean muscle mass following 12 Omega-3 fatty acids (n-3 FA) are two exercise trials separated by 7 weeks of resistance training in young, potentially beneficial due to their

SCAN’S PULSE Winter 2011, Vol. 30, No. 1 | 21 anti-inflammatory, antithrombotic, vided 2,000 mg vitamin C, 800 IU vita - tation with n-3 FA may contribute to and vasodilatory properties. How - min E, 3,000 IU vitamin A, and 200 oxidative stress via observed in - ever, n-3 FA may contribute to lipid mcg selenium. At the end of 6 weeks creases in F 2-isoprostanes. This po - peroxidation, an effect possibly atten - supplementation, participants com - tentially adverse effect may be in part uated with increased antioxidant in - pleted 3 consecutive days of cycling negated by antioxidant supplemen - take. The objective of this study was training for 3 hours at 57% maximum tation. However, when ingested to determine the effects of omega-3 wattage. Blood samples were ob - alone, antioxidants do not elicit fur - fatty acid and antioxidant supple - tained at baseline (0 wk), pre-exer - ther decreases in oxidative stress. mentation on F 2-isoprostane forma - cise, and after the last training session Athletes should be advised on the tion, a marker for oxidative stress, in for measurement of F 2-isoprostanes. potential for increased oxidative endurance athletes. Forty-eight male At post-exercise, the N3 group experi - stress with n-3 FA supplementation. and female trained cyclists were ran - enced a significant increase (53%) in This project was funded by the domized into one of four groups: vi - F2-isoprostanes compared with pre- Cooper Aerobics Center, Dallas, Tex. tamin-mineral (VM ), n-3 FA (N3), exercise levels; this was significantly vitamin-mineral and n-3 FA (VMN3), different from the P ( P=.02), VM Summarized by James R Stevens, MS, or placebo (P) ingested in double- (P=.008), and VMN3 ( P=.05) groups. RD, adjunct instructor, Metro State Col - blind fashion for 6 weeks. The N3 sup - VM supplementation did not signifi - lege of Denver, CO. plement provided 2,000 mg cantly decrease F 2-isoprostane for - eicosapentaenoic acid (EPA) and 400 mation compared with P. Based on mg EPA; the VM supplement pro - the results of this study, supplemen -

SCAN Notables by Sumner Brooks, MPH, RD natives to the gym. In addition to her serves on dLife’s prestigious medical online work, Courtney is in private advisory board. She is also a nutri - ■ Julie Upton, MS, RD, CSSD, sur - practice at a gastroenterology clinic tionist and certified diabetes educa - vived on burgers, Cheese-Its, and and an inpatient RD at Olympia Med - tor for the TheBestLife.com (Bob Swedish Fish during her first ultra- ical Center in Los Angeles, CA. Greene’s health and weight loss Web endurance running event, the Gore- site). Currently she is co-authoring a Tex Trans Rockies Run. This 6-day run ■ Roberta Wennick, MS, RD, has ful - chapter on anemia for the upcoming covered more than 115 miles of ter - filled her 20-year old dream to create edition of Krause’s Food, Nutrition & rain in Colorado, involved over 25,000 an interactive recipe-building Web Diet Therapy text book. ft of climbing in elevations well over site, www.Spin-A-Recipe.com. For just 10,000 ft, and required technical sin - one basic recipe, the Web site creates ■ Kim Crawford, PhD, RD, CSSD, has gle-track trails. Along with her team - dozens of healthy variations. In addi - been appointed as the American Di - mate, Julie finished the run without tion to her latest online publication, etetic Association representative to incident and looks forward to repeat - Roberta has authored two books: Is the U.S. National Physical Activity ing the challenge in the future. Julie Your Personality Type Making You Fat? Plan (NPAP). In this role Kim attended is a nutrition communications spe - and Drawing the Line on Calories, the NPAP national launch in Washing - cialist focusing on consumer print Carbs, and Fat. A nutrition consultant, ton, DC, in spring 2010 and will be and broadcast media in Tiburon, CA. culinary nutritionist, and freelance working in cooperation with the pub - writer based in Lynnwood, WA, lic health sector to develop and up - ■ Founder of Nutrition for Body and Roberta also runs a private nutrition date the NPAP as the plan progresses. Mind, Courtney Walberg, RD, NASM- counseling website called Advantage Kim is the coordinator of graduate CPT , recently earned her personal Diets (www.advantagediets.com). studies in nutrition at the University training certification through the Na - of Pittsburgh, PA. She served an inte - tional Academy of Sports Medicine. ■ The first recipient of the SCAN gral role in the development of the Courtney combines her nutrition and scholarship award in 1986 , Susan Board Certified Specialist in Sports personal training skills to author the Weiner, RD, MS, CDE, CDN, has since Dietetics (CSSD) exam. online nutrition content for “House established a successful private prac - Call MD” and develop workouts for tice in New York as a dietitian and ex - If you have an accomplishment that active individuals of all ages. Her ercise physiologist. Susan is a you would like to be considered for an focus is on making exercise fun and contributing medical producer for upcoming issue of PULSE, please con - mixing in outdoor workouts as alter - dLife (For Your Diabetes Life) TV and tact Sumner Brooks, MPH, RD, at Sum - [email protected].

22 | SCAN’S PULSE Winter 2011, Vol. 30, No. 1 Of Further Interest

■ Cast Your Vote for to use for services. The presentation personalized business information SCAN Leaders provides facts on good nutrition, fit - and message. Check them out at Be sure to participate in the upcom - ness for life, and how employees’ www.scandpg.org/sports- ing election for SCAN leaders. Once poor diets on can weaken a com - nutrition/sports-nutrition-fact- again, SCAN will use an electronic pany’s bottom line. Better yet, it can sheets. ballot. To vote online, go to SCAN’s be adapted for any type of nutrition Web site (www.scandpg.org) and on and fitness presentation because the • SD-USA Score. The SD-USA e- the home page, click on the link that slides can easily be moved and ad - newsletter is delivered to your inbox says “2011 Election Ballot.” Online justed. You can easily replace the in a new format six times a year. Con - voting polls open February 1, 2011 ; sample RD picture at the end with tact Amy Goodson, MS, RD, CSSD, at the final date to vote is March 3, your own. To purchase, go to [email protected] with 2011. www.scandpg.org, click on Online your ideas for topics. Store, and then Wellness/CV. • ADA’s Nutrition Care Manual® ■ Take a Look at SCAN’s (NCM). The 2010 ADA Nutrition Care ■ Annual Report News from Sports Dietetics Manual® (NCM) contains a “Sports SCAN’s Annual Report for fiscal year USA (SD-USA) Nutrition and Performance” section 2009-2010 is now available online. Here are some highlights from the written and updated by SD-USA The report updates members and SD-USA subunit: members. New to the 2010 edition is corporate sponsors on SCAN’s pro - organization of the NCM using the grams, initiatives, current volunteers, • 2011 CSSD Exam Windows. Note Nutrition Care Process. Subscribe to budget, and more. To access the pub - the 2011 windows for the Board Cer - the NCM at http://nutrition lication on SCAN’s Web site, go to tified Specialist in Sports Dietetics caremanual.org. www.scandpg.org/about-us/annual- (CSSD) exam: February 7-28 (except reports. February 15) – application deadline • Help customers find you! List your - has passed; July 11-29 — application self on “ Find a SCAN Dietitian ” on postmark deadline April 25, 2011. For www.scandpg.org to increase your ■ News from Wellness/CV eligibility information and an applica - reach to the public and potential RDs Subunit tion, go to www.cdrnet.org. employers. Check out these exciting offerings from the Wellness/CV RDs: • Register Now for Sports Nutrition • Join SD-USA . Sign up for SD-USA, a Workshop. A pre-SCAN Symposium free SCAN member benefit, via the • Webinars. Capturing tremendous Sports Nutrition Workshop, The Cas - Member Profile on www. response for the first three Well - cade of Concussion: Minimizing Risks, scandpg.org. Check the box for ness/CV webinars launched in 2010 Reducing Serious Consequences, Stim - Sports Dietetics-USA at the bottom (with nearly 1,000 RDs viewing just ulating Recovery , is slated for March of the Member Profile. one of these presentations), SCAN 11, 201l, 7:30 to 11:30 am, in Chicago, will continue this popular series in IL. To register, visit www.scandpg.org. 2011. Watch for details on new webi - nars sponsored by Canola Oil in Feb - • SCAN’s Video: Sports Nutrition – ruary, POM Wonderful in March, and Who Delivers? Leave a lasting im - others. Go to www.scandpg.org/ pression! Show your audiences this event-calendar and scroll down the professionally produced video in page. which athletes tout the value of sports dietitians. View it at www.scan - • Corporate Wellness PowerPoint dpg.org and on YouTube. and Handouts. This flexible, power - ful tool— Take Control of Your Health: • Sports Nutrition Fact Sheets. Use Tips for Eating Healthy and Being Fit these colorful sheets to educate for a Lifetime —features 52 slides with clients, enhance your practice, and notes and handouts (purchased sep - promote your expertise. You can even arately), including a sample contract have them customized with your

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Publication of the Sports, The viewpoints and statements herein March 3-6, 2011 Cardiovascular, and Wellness Nutrition do not necessarily reflect policies International Association of Eating (SCAN) dietetic practice group of the and/or official positions of the Disorder Professionals (IAEDP) Sympo - American Dietetic Association. American Dietetic Association. ISSN: 1528-5707. Opinions expressed are those of the sium, Phoenix, AZ. For information: individual authors. Publication of an Editor-in-Chief www.iaedp.com advertisement in SCAN’S PULSE should Mark Kern, PhD, RD, CSSD not be construed as an endorsement Exercise and Nutritional Sciences March 11-13, 2011 of the advertiser or the product by the San Diego State University Join your colleagues at the 27th American Dietetic Association and/or 5500 Campanile Dr. Sports, Cardiovascular, and Wellness Annual SCAN Symposium, Optimiz - San Diego, CA 92182-7251 Nutrition. ing Performance, Wellness, and Health 619/594-1834 Through Nutrition. Chicago, IL. For 619/594-6553 - fax Appropriate announcements are information: www.scandpg.org [email protected] welcome. Deadline for the Summer Sports Editors 2011 issue: March 1, 2010. Deadline April 9-13, 2011 Kathie Beals, PhD, RD for the Fall 2011 issue: June 1, 2011. Nanna Meyer, PhD, RD Experimental Biology (EB) Annual Manuscripts (original research, review Cardiovascular Editor Meeting, Washington, DC. For infor - articles, etc.) will be considered for mation: http://experimental Satya Jonnalagadda, MBA, PhD, RD publication. Guidelines for authors are Wellness Editor biology.org available at www.scandpg.org. E-mail Robert Wildman, PhD, RD, FISSN manuscript to the Editor-in-Chief; Disordered Eating Editors allow up to 6 weeks for a response. April 13-16, 2011 Karen Wetherall, MS, RD 15 th Annual Health & Fitness Sum - Michelle Barrack, PhD Send change of address to: American mit, Anaheim, CA. For information: Conference Highlights Editor Dietetic Association, 120 S. Riverside American College of Sports Medicine, Nancy Clark, MS, RD Plaza, Suite 2000, Chicago, IL 60606- www.acsm.org Reviews Editor 6995. Nichole Dandrea, MS, RD Subscription cost for nonmembers: May 31-June 4, 2011 Sports Dietetics-USA Research $50 individuals/$100 institutions. To American College of Sports Medicine Digest Editors subscribe: SCAN Office, 800/249-2875. Annual Meeting, Denver, CO. For Stacie Wing-Gaia, PhD, RD, CSSD James Stevens, MS, RD Copyright © 2011 by the American in formation: www.acsm.org SCAN Notables Editor Dietetic Association. All rights Sumner Brooks, MPH, RD reserved. No part of this publication may be reproduced, stored in a July 11-29, 2011 Managing Editor retrieval system, or transmitted in any CDR Sports Dietetic Specialty Exami - Annette Lenzi Martin form by any means, electronic, nation (at various U.S. sites). Postmark 312/587-3781 mechanical, photocopying, recording, deadline for applications is April 25, 312/751-0313 - fax or otherwise, without prior written [email protected] 2011. For information: Commission permission of the publisher. on Dietetics Registration: www.cdr - net.org To contact an editor listed above, visit www.scandpg.org (click Nutrition Info tab, then “SCAN’s PULSE”)

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