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a ucla student wellness commission publication total wellness

summer 13 | vol 13 | issu

your guide to salad greens

health in your hands

+nutritious & delicious

tasty treatsways to wake up fromdaytime sleepiness



t o t a l w e l l n e s s

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from attacks of sleepiness throughout theday? Read up on ways to reduce the triggersof daytime sleepiness on pages 12-16.

We hope you have enjoyed Volume 13 ofTotal Wellness and gained insights that makethe responsibility for your own health moremanageable and less overwhelming. Missedour previous issues or want to revisit ourolder publications? Read them online athttp://issuu.com/totalwellnessmagazine .

Hungry for more? Stay tuned for our nextvolume of Total Wellness ! Volume 14 will belaunched this Fall Quarter and equippedwith new columns and a new staff. We areexcited to continue Total Wellness ’ dedicationto providing high-quality, reader-friendly,practical health education. Until then, stayconnected with Total Wellness through ourFacebook page (be sure to like us!), website(http://www.totalwellnessmagazine.org/ ), andemail ([email protected]).

Cheers to your health,

Shannon WongvibulsinDirector and Editor-in-Chief

editor’s note

Decisions, decisions,decisions. Each day,we are faced with somany choices. Fordecisions concerningour health, eachchoice can greatlyimpact our long-term wellbeing. Witha growing amountof self-help andhealth educationresources available,it can oftentimes

be confusing to navigate through all thisinformation, discern what sources arereliable, and comprehend what actions arenecessary for wellness.

Because the ultimate responsibility for ourhealth falls within our own hands, TotalWellness seeks to empower our readers witha depth and breadth of understanding onpertinent health topics. With a team ofwriters, editors, designers, and leadership aswell as a medical review board of healthcareprofessionals, Volume 13 of Total Wellness has

regularly featured our Eat Right, Get Active,Body in Focus, and Mythbusters Departments.We conclude this volume with the themeHealth in Your Hands as a reminder that youhave a great control over your own personalwellbeing and that Total Wellness is here tohelp you achieve your health-related goals.

Explore Health in Your Hands to uncover howyour nails can provide you with insightinto your health (pages 26-30), how to dealwith bloody noses (pages 10-11), and how

to properly clean your ears (pages 22-24).Learn about the differences between runningindoors versus outdoors (page 8-9) as wellas how to tend to common running injuries(page 34-39).

Mindful of your health but craving somethingdelicious? Discover some salad tips and tricks(pages 17-21) along with some dessert optionswith health benets (pages 40-44). Suffering

Total Wellness is a division of the StudentWellness Commission that is dedicatedto spreading awareness of and sharingknowledge on issues of student health andhealth care . By providing an understanding ofhealth and lifestyle issues , elucidating healthconcepts , providing recommendations forphysical, mental, and social well-being , andmaking visible and accessible various healthresources , programs, and events occurringat UCLA,Total Wellness seeks to empowerstudents with up-to-date and accurateknowledge on the appropriate managementof their health.



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ANGELA HAO Assistant Finance Director

leadership

KARIN YUENCo-Art Director

CINDY LA

Managing Editor

NABEEL QURESHIFinance Director

KEVIN SUNGWebmaster

ANNIE THERIAULTOutreach Director

JULIE ESCOBAR

Copy Editor

BARBARA WONGCo-Art Director

CHALISA PRARASRI

Assistant Editor-in-Chief




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I am proud to introduce myself asthe new UCLA Student WellnessCommissioner. Two years ago as aconfused and dazed freshman, Ipicked up a Total Wellness magazinefor the rst time from the WoodenCenter newsstand. The magazinewas full of interesting healtharticles - perfect for a health nutlike me - and backed by peer-reviewed, scientic journal articlesto prove the credibility of its claims.Once I realized it was a studentpublication, I jumped at the chanceto be a part of its creation.

Soon after, I started as a staff writer for Total Wellness , with myrst article centered on nutritious smoothie as quick meals -Issue 5, Volume 12: The Smoothies Solution. Since then, I’ve writtenfor nearly every magazine and seen rst-hand the dedicationand effort on the part of the writers, designers, editors, andreviewers. Now, as commissioner, I hope to support it in anyway I can and use the magazine to educate the student bodyregarding pertinent health topics. (And, hey, I might still write anarticle or two, like the IUD Q&A in this very magazine!)

Over the course of the 2013-2014 academic year, mycommissioner letters will serve as updates for SWC as a whole,such as with upcoming events, fairs, programs, and campaigns.Currently, SWC is working on 7000 in Solidarity: A CampaignAgainst Sexual Assault . The 7000 in Solidarity Campaign seeksto create a safe, inclusive campus for students of all gender

expressions and sexual orientations by educating our campuscommunity about sexual assault. Our goal is to promoteconsensual sex, effective bystander intervention, and access toUCLA resources that support survivors of sexual assault.

The campaign is based on the statistic that 1 in 3 women, and 1in 6 men will have survived sexual assault in college, meaningthat at UCLA, 7000 individuals will have experienced some formof sexual violence by the time they graduate. With 7000 survivorsat UCLA, we seek to engage our campus community to take astand against sexual assault. We realize the potential for us toshift the campus climate to one where sexual assault is nottolerable. To join the ght against sexual assault, please visit usac.ucla.edu./7000insolidarity/.

For now, I hope you enjoy this latest issue and take away from itnew information and tips to help you lead a healthy lifestyle!

Best,

Savannah BadalichSWC Commissioner

Sta WritersRyan Babadi, Savannah Badalich, Leslie Chang, Julia Duong, Julia DianaFeygelman, Samantha Leslie Fong, Sally SooHyun Kim, Harini Kompella,So a Levy, Lawrence Liem, Ti any Lin, Josephine Liu, Pavan Mann,Halee Michel, Samantha Mojica, Allison Newell, Lillie Luu Nguyen, JaclynPortanova, Anahit Poturyan

DesignNatalie Chong (intern), Karen Chu, Emily Hsu (intern), Jocelyn Kupets,Coco Liu, Ally Lucchi (intern), Allison Newell, Keziah Pagtakhan, CatrinaPang, Kristen Sadakane, Mary Sau, Jessica Sun, Annie Theriault, AlexandriaVillanueva (intern), Barbara Wong, Shannon Wongvibulsin, Karin Yuen

Advisory & ReviewWilliam Aronson, MDProfessor, UCLA School of Medicine

Susan Bowerman, MS, RD, CSSDAssistant Director, UCLA Center for Human Nutrition

Leah FitzGerald, RN, FNP, PhDAssistant Professor, UCLA School of Nursing

Dena Herman, PhD, MPH, RDAdjunct Assistant Professor, UCLA School of Public Health

Eve Lahijani, MS, RDNutrition Health Educator, UCLA Bruin Resource Center

Melissa Magaro, PhDClinical Psychologist, UCLA Counseling and Psychological Services

Lilia Meltzer, RN, NP, MSNLecturer, California State University, Long Beach

William McCarthy, PhDAdjunct Professor, UCLA School of Public Health

Rena Orenstein, MPH

Assistant Director, Student Health EducationAllan Pantuck, MD, MS, FACSAssociate Professor, UCLA School of Medicine

Ra Tachdjian, MD, MPHAssistant Clinical Professor, UCLA School of Medicine

Elisa Terry, NSCA-CSCSFITWELL Services Program Director, UCLA Recreation

Alona Zerlin, MS, RDResearch Dietitian, UCLA Center for Human Nutrition

total wellnessDirector and Editor-In-Chief Assisstant Editor-In-Chief Co-Art DirectorCo-Art DirectorManaging EditorCopy EditorFinance DirectorAssistant Finance DirectorOutreach DirectorWebmaster

Shannon WongvibulsinChalisa PrarasriBarbara WongKarin YuenCindy LaJulie Escobar Nabeel QureshiAngela HaoAnnie TheriaultKevin Sung

Total Wellness is a free, student-run, publication and is supported byadvertisers, the Arthur Ashe Student Health and Wellness Center, the OnCampus Housing Council (OCHC), the Student Wellness Commission (SWC),UCLA Recreation, and the Undergraduate Students Association (USAC).

Contact308 Westwood Blvd., Kerckho Hall 308Los Angeles, CA 90024Phone 310.825.7586, Fax 310.267.4732totalwellnessatucla@gmail.comwww.totalwellnessmagazine.org www.swc.ucla.edu

Subscription, back issues, and advertising rates available on request

Volume 13, Issue 5

© 2013 by Total Wellness Magazine . All rights reserved. Parts of this magazine may bereproduced only with written permission from the editor. Although every precautionhas been taken to ensure the accuracy of the published material, Total Wellness cannotbe held responsible for the opinions expressed or facts supplied by authors. We do notnecessarily endorse products and services advertised. The information in Total Wellnessis not intended as medical advice and should not replace the advice of your physician.Always consult a health care provider for clari cation.

words from the commissioner



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IN EVERY ISSUE 2 Editor’s Note 4 Words From the

Commissioner 6 In the News 7 Q&A46 Decoding the Nutrition

Label47 Credits

DEPARTMENTS

8 Running Outdoors vs.Running on a Treadmill

10 A Study on Bloody Noses

12 Ways to Wake Up

17 Salad Savvy: A Guide to

“Green” Eating

22 Hear This: How to ProperlyClean Your Ears

FEATURES26 The Nail Files: Preventing

and Decoding Your Nails’Puzzling Appearance

31 Clear Waters: Filters toPurify Your Water

34 Mindful Running40 Delightful DessertsON THE COVER

12 Ways to Wake Up17 Salad Savvy26 Nail Health40 Delightful Desserts

contents

C O V E R : K A I S T O L M A T S / I S T O C K P H O T O ; R I G H T : T A C O J I M / I S T O C K P H O T O

a ucla student wellness commission publication total wellness

summer13| vol13|issue5

your guide to salad greens

health in your hands

+nutritious & delicious

tasty treatsways to wake up fromdaytime sleepiness




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KIDNEY TESTS ANDSMARTPHONESA recent development at UCLA HenrySamueli School of Engineering and AppliedScience and California NanoSystemsInstitute makes it possible to conduct kidneytests with a lightweight portable deviceand transmit data through a smartphone

attachment. Because patients with kidneydisease must regularly provide uid samplesto labs or health centers in order to monitortheir health, this requires the patient to makea substantial number of o ce visits. In fact,many patients make multiple visits over thecourse of one day. The new device, basedon the detection of albumin in the urine andthe transmission of test results in seconds,has the potential to signi cantly decreasethe need for o ce visits by patients withdiabetes or chronic kidney ailments.

MORE THAN CAVITYPREVENTION: BRUSHING YOURTEETH AND CANCER PREVENTIONA recent study conducted by the University ofTexas Health Sciences Center and publishedin Cancer Prevention Research concludedthat poor dental health is an independent

risk factor for human papillomavirus(HPV) infections, which can contributeto oral cancers. Through the analysis ofapproximately 3,400 participants (ages 30 to69) from the 2009-2010 National Health andNutrition Examination Survey, the researchersfound that individuals who reported poororal health exhibited a 56% higher rateof HPV infection compared with thosewith good dental health . For this study, oralhealth data was determined based uponthe following factors: self-rating of overalloral health, presence of gum disease, useof mouthwash, and number of teeth lost.Although the authors of this study recognizethat further research is still necessary, theyindicate that bad oral health could resultin a potential “entry portal” for HPV sincemouth ulcers, mucosal disruption, and chronicin ammation can provide the wound sitenecessary for HPV infection.

MICROBES FOR HEALTHNew evidence recently published in Naturefrom research conducted at the NationalInstitute for Agricultural Research in Francesuggests that the microbes in our digestivesystems are important for functions beyondsimply aiding in food digestion. In fact, theseresearchers found that individuals with lessdiverse microbes are more likely to gainweight and develop conditions, such asinsulin resistance and in ammation, whichare risk factors for health problems like typeII diabetes, heart disease, and cancer . Thesendings support the notion that consuminga poor diet or antibiotics regularly can beassociated with health problems and theobesity epidemic through the impact of thesepractices on our gut microbes.

what’s happening in health?

AT UCLA

RESEARCH AND NEW FINDINGS

30percent of

adults get sixor less hoursof sleep per

night

90percent ofAmericansconsume

more sodiumthan the

recommendedintake

80thousand

deaths in theUS annuallyresult fromexcessive

alcohol use

NUMBERS

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CDC

L E F T N R D E R M H A M E D A D A T H / T K P H T H E N R K J N N /

TYLENOL: POTENTIAL FOR LIVERFAILURE AND DEATHSoon, Tylenol caps will have warning labelsindicating that the pain reliever has thepotential to cause liver failure and death.Although similar warnings are already printedon the product’s label, the purpose of thecap label is to inform consumers who maynot read the medication’s ne print. Sinceacetaminophen, Tylenol’s active ingredient,is estimated to result in approximately 500deaths and 55,000 to 80,000 emergencyroom visits annually , health o cials aimto decrease these numbers by alertingconsumers through this new warning label.



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The “intrauterine device” or IUD is asmall T-shaped device inserted into theuterus to prevent pregnancy. There arecurrently three types of IUDs available inthe United States: ParaGard, Mirena, andSkyla .

› is a copper IUD and does not a ect hormonelevels, thus avoiding potential symptoms and side e ectsassociated with hormonal forms of birth control. The US Foodand Drug Administration (FDA) has approved ParaGard for tento 12 years of use.

› is an IUD that releases a small amount of progestin-like hormone (Levonorgestril) locally into the uterus. Progestinis a hormone that prevents egg release, makes the uterinelining unfavorable for implantation, limits the sperm’s abilityto fertilize the egg, and thickens the cervical mucus to furtherhinder the sperm’s movement. Mirena is FDA approved for usefor ve years.

› , the newest IUD, was approved by the FDA in Februaryof 2013. It is essentially a mini-Mirena; it is smaller and goodfor three years.

what are the benets over the traditional birthcontrol pill?

According to a 2012 article published in the New EnglandJournal of Medicine , IUDs are 21.8 times more e ective thanthe birth control pill, patch, or ring. Compliance is not anissue because once the IUDs are inserted in the physician’so ce, there is no need to “remember” to take the pill daily,change the patch weekly, or change the ring every threeweeks. An added bene t speci c for the Mirena and SkylaIUDs is decreased menstrual bleeding. Additionally, IUDsare completely reversible. Once you decide you want to getpregnant, the IUD can be removed to restore fertility.

what are the cons?

IUDs provide no protection from sexually transmittedinfections and may cause irregular bleeding in the earlymonths after insertion and cramping and pain at insertion.Also, there is a two to ten percent chance of expelling theIUD within the rst year after insertion. In extremely rarecases - one in one thousand - the IUD can puncture/perforatethe uterus as stated in a 2013 article in the journal HumanReproduction ; however, this is usually associated with theprocedure of placing/inserting the IUD.

Q: What is an IUD?How does it work?

A: : › ParaGard can cause pelvic cramps and heavier periods,resulting in anemia.› Mirena can cause development of ovarian cysts, but thesegenerally resolve without treatment. About 12% of womenbecome amenorrheic (do not have any periods) while usingMirena; thus, Mirena can be used as a form of treatment forwomen who have heavy, irregular periods.› There is not enough data yet to detail Skyla.

how soon after getting an IUD can I have sex?

It depends on the IUD type and your menstrual cycle. With theParaGard IUD, it is immediately e ective after insertion.IUDs can be used as a form of emergency contraception, if theyare placed within 120 hours (5 days) of sexual intercourse.

how is an IUD inserted?

An IUD is inserted into the uterus through the vagina andcervix. It is inserted using specialized tools by your healthcareprovider. This is an o ce procedure and can be done duringany time of the menstrual cycle once a pregnancy has beenexcluded. However, placement of an IUD during menses hasbeen associated with a higher incidence of expulsion.

how is an IUD removed?

IUD removals are done in the o ce and are usually a simpleprocedure. This should only be performed by your healthcareprovider. You cannot remove the IUD by yourself, and attemptsto do so may cause injury and other complications.

how much does it cost?

IUDs are the least expensive long-term and reversible form ofbirth control. The total cost for the medical examination, thecost of the IUD, insertion of the IUD, and any o ce follow-upvisits can range from $500 to $1,000, depending on yourinsurance policy. However, keep in mind that the total cost ofthe IUD is spread out for three, ve, or ten years, depending onthe type of IUD. t w

got a question? We love curious readers. Sendyour question over to [email protected] and the answer may appear in a future issue.

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C K P H O T O

Running USA reported that there were 4,600,000road race nishers in 1990. In 2011, almost 14,000,000Americans signed up and nished countless 5Ks, 10Ks,half marathons, and marathons. There is no doubtthat running has quickly grown to become a popularform of exercise and recreation in the US. There hasalso been increasing debate on whether it is betterto run outdoors or to run on a treadmill. Althoughtreadmills are becoming more advanced in simulating

the experience of running on a track, die-hard long-distance runners still swear by running on the terrainof the great outdoors. So, is there really a difference?It turns out where you run may not only affect youphysically but psychologically as well. Runningoverground may lead to faster speeds and heightenedpositivity. However, running on a treadmill may helpa runner avoid injuries that running on a track or onconcrete can cause. Read on for a detailed breakdownof how the styles compare.

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running outdoors

running performanceSome studies suggest that running outdoors may lead tofaster speeds. Higher involvement of sensations from theenvironment, such as vision, auditory noise, and thermalsenses can cause a reduction of relevant sensory input, suchas exhaustion or pain. This may lead the runner to run fasteroutdoors without feeling as tired as he or she would on atreadmill. In a 2004 study published in Psychology of Sport andExercis e, 60 individuals who ran an average distance of at least15 miles per week were randomly placed into groups running ona treadmill or an outdoor route. Researchers found that runningon the treadmill resulted in signi cantly slower 5-km times thanon the outdoor route, with a mean time of 29.60 minutes fortreadmill runners and 25.56 minutes for outdoor runners. Similar results were previously found in a study published in1991 in Medicine and Science in Sports and Exercise , in whichsubjects consistently ran faster on the eld than on a treadmilleven when tested at light, medium, and di cult levels of intensity.Researchers hypothesized that these results may be due to theenvironmental e ect of running outdoors.



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vs. running on a treadmillmoodThe environment in which people run can also a ect their moodafterwards. In a study published in 1995 in Psychophysiology ,the outdoor run subjects were found to feel less anxious, lessdepressed, less hostile, less fatigued, and more invigorated afterrunning while indoor runners felt the exact opposite. Researchersconcluded that because the environment of the treadmill lackedthe visual, auditory, and thermal stimulation that the outdoorsprovided, subjects might have experienced some physical andemotional stress, causing the subjects to report more fatigue,depression, and anxiety after their run.

injurySeveral studies have shown that how the body is positionedwhen running overground can lead to more injuries than whenrunning on a treadmill. A 2003 study in the British Journal ofSports Medicine concluded that due to di erences in runningform, compressive strain and tension strain rates were 48% to285% higher during overground running than during treadmillrunning. In a study published in 1976 in Medicine and Science inSports , researchers found that the length of the runners’ stridesshortened when subjects ran on a treadmill as compared torunning overground. Another study published in 1995 in Medicineand Science in Sports and Exercise discovered that subjectssystematically planted their feet in atter positions, allowing moresurface area of their feet to make contact on the treadmill thanoverground. Because treadmill runners experience lessenedcompression and tension strain from running with shorterstrides and atter feet, treadmill runners are at a lower risk fordeveloping tibial stress fractures, more commonly known as“shin splints.”

air pollutionAir quality also plays a key factor in the bene ts or downsidesof running outdoors. Because runners are more likely to takedeeper inhalations and to breathe through their mouths insteadof their noses, the air they breathe bypasses the lters of thenasal passages which normally blocks airborne pollutants fromentering the body. While the South Coast Air Quality ManagementDistrict deems most of the West Los Angeles and Santa Monicaregion “good,” make sure to check the most recently updatedair quality map before heading out. Also make sure to avoidareas with high tra c congestion or outdoor smoking areas. Forthose living in areas where the air quality is less than “good” or“moderate,” such as in Downtown Los Angeles, the best way toavoid damage to the lungs may be to run indoors.

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For the runner whose main goal is aerobic tnessor burning calories, treadmill running may bepreferable to overground running, as it offers lessrisk of developing tibial stress fracture and isinsusceptible to weather changes or low air quality.However, for the runner whose major concernis speed improvement or a mood lift, runningoutdoors may be the most protable option.




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Nosebleeds are commonproblems for many individuals.In fact, a retrospective studypublished in 2005 in the AmericanFamily Physician found that 60%of the population has sufferedfrom nosebleeds at least onceduring their lives. Nosebleedsoccur more often in males,children less than ten years old,

and adults 50 and over. Mostcases do not require medicalattention; but it is important toknow how to prevent and treatcommon nosebleeds and whenit is necessary to seek medicalattention.

a study on bloody noses

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anterior nosebleeds: This is the most common type of nosebleed. Anterior nosebleeds occur when a blood vesselat the front of the nose is broken, which results in blood leaking through the nostrils. This type of bleeding is easily treated athome and usually does not require medical attention.

what are the different types of nosebleeds?

posterior nosebleeds: This type of nosebleed is rare and mostly found in elderly patients. Posterior nosebleeds occurwhen blood vessels in the back of the nose are broken and require admission to the hospital to stop the bleeding. This isdangerous because the blood moves to the back of the throat and can cause su ocation (when blood enters the windpipe).

M A I N I M A G E : T A L A J / I S T O C K P H O T O ; B O T T O M L E F T : J U S U N / I S T O C K P H O T O ; B O T T O M R I G H T : D N Y 5 9 / I S T O C K P H O T O

cases where nosebleeds should be seen by a healthcare

provider:If bleeding does not stop after 20 minutes while using the measures described on page 11under how to treat nosebleeds, it would be safer to seek medical treatment rather than tend tothe nosebleed yourself. The healthcare provider may need to cauterize the blood vessel (seal thesource of the bleeding) or put in nasal packing to put pressure inside the nose to stop the bleeding.

If the nosebleed is caused by trauma to the head, the healthcare provider may choose to check for askull fracture or a broken nose by taking an x-ray.

In cases where nosebleeds are frequent, it is also important to see a healthcare provider as they mayneed to cauterize a blood vessel or prescribe medications such as blood thinners.

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Blowing your nose after thebleeding has stopped: Blowingthe nose increases stress on theblood vessels and the risk ofloosening coagulants. This canlead to re-bleeding.

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what causes nosebleeds?

drugs: A 2008 retrospective study of nosebleeds,published in the Israeli Journal of Emergency Medicine , foundthat drugs such as aspirin and warfarin, which thin theblood and prevent clotting, may increase the frequency ofnosebleeds and make them more di cult to stop.

medical conditions: High blood pressure canincrease the risk for nosebleeds because blood vessels canburst from inside the nose due to pressure in the veins. Lesscommonly, genetic disorders such as hereditary hemorrhagictelangiectasia (Osler–Weber–Rendu disease) can alsoincrease the likelihood of nosebleeds as it is di cult forpeople with this condition to naturally stem the bleedingwith abnormal blood vessel formation.

trauma: The most common cause of nosebleeds istrauma to the nose. Trauma to the outside of the nose, suchas an injury to or near the nose, can break blood vessels. It isalso possible to injure the inside of the nose through nosepicking, repeated irritation from the cold air, strong noseblowing, and particles in the air, such as cigarette smoke.

nostril formation: If you are born with a deviatedseptum (when the cartilage in your nose leans to one side) orperforated septum (when the cartilage develops a hole) thepossibility of a nosebleed increases.

how to treat nosebleeds?nosebleeds can often be addressed with simple rst aid.here are some things you can do:

Gently compress the soft tissue of the nose (the nostril area) with your ngers for atleast ve minutes and up to 20 minutes.Plug the a ected nostril with gauze or cotton.Tilt the head forward to prevent blood from going into the throat and avoid nauseaand airway obstruction.If blood has traveled to the mouth, spit it out as swallowing may cause nausea.After bleeding has stopped, use a humidi er or vaporizer to keep the nose fromdrying out and bleeding again.

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Using an ice pack on your neck: In a 2003 study published byClinical Otolaryngology & AlliedSciences , researchers reportedthat using ice to treat nosebleedshad no signi cant di erencein the amount of blood ow ascompared to participants who didnot use ice.

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common mistakes made when treating nosebleeds:

Being exposed to dry air (suchas in a heated home): Your noseis more sensitive during andafter nosebleeds. Exposure to adry environment may irritate thenose and increase the chance ofre-bleeding.

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unknown: There are also instances where there is noapparent cause for bleeding. However, infrequent, mildnosebleeds should not provoke concern.




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ways to wake up

Sometimes, getting plenty of sleep is enough to start the day, but it is not always enough to get through the day. Though caffeinecan provide a quick x for afternoon fatigue, according to a 2008publication in Sleep Medicine Reviews , it can also disrupt normalsleep schedules, reduce sleep quality, and further induce daytimesleepiness. Although a 2007 study in the American Journal ofPhysiology: Endocrinology and Metabolism correlated two-hour longmidafternoon naps to an increase in alertness and performance,napping is not always a reasonable solution for students inclass or employees at work. Without a pick-me-up coffee or arejuvenating nap, it may seem that no force within can restrainthe urge to doze off into daydream-land. Fortunately, some short-term triggers of daytime sleepiness are resolvable, and their effectsmay be reversible. For further information on long-term causes ofpersistent fatigue, check out Fixing Fatigue in Issue 4, Volume 11.Read up for a few ways to wake up!

L E F T : A R I W A S A B I / I S T O C K P H O T O ; R I G H T : A N T A G A I N /



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The circadian rhythm is roughly a 24-hour cycle of changesin physical and behavioral state. For diurnal animals likehumans, this cycle is normally aligned with the environment sothat the pattern of sleep and wakefulness corresponds to darkand light, respectively. Altering a regular sleep schedule maymisalign the arrangement of the circadian and environmentalcycles, causing sleep disorders. A 2009 article in Sleep MedicineReviewsrevealed that people with irregular sleep-wake rhythmssuch as shift workers (night workers), late-night studyingstudents, and those who experience jet lag, are often a ictedby daytime sleepiness and other sleep problems like insomnia. Desynchronizing sleep and biological cycles may in turninduce sleepiness and wakefulness at inappropriate times,and these factors can also alter normal release of energy-related hormones in the body.

how it happens:melatonin and melanopsin: In 2013, the Handbook ofExperimental Pharmacology discussed the e ects of moleculesthat help regulate the circadian rhythm and control sleep.Melatonin , a chemical that facilitates sleep, is producednaturally at night, but its production is halted when the eyesdetect light. Upsetting this balance with light at night anddark in the day can cause wakefulness and sleepiness atirregular times of the day. Additionally, light can activate alight-absorbing pigment in the eye called melanopsin , which inturn causes arousal from sleep. A 2013 Proceedings of the RoyalSociety: Biological Sciences study revealed that melanopsin is

most sensitive to wavelengths of blue light, meaning blue lightis most e ective in waking up the body.

thyroid stimulating hormone: In 2005, a study in MedscapeNeurology revealed that the release of thyroid stimulatinghormone (TSH) , which is essential to maintaining the body’smetabolic rate (energy usage rate), is signi cantly decreasedin those who received only four hours of sleep for six dayscompared to the same people when they received 12 hoursof sleep for six days. Lower TSH levels due to a dramatic shiftin sleep cycle can decrease the amount of energy that isavailable, inducing lethargy at abnormal times.

triggers of daytime sleepiness

circadian rhythm upset

solution: Stick to one sleep schedule! Any imbalance in thesemetabolic molecules caused by a change in circadian rhythmmay lead to insu cient energy allocation throughout the dayand can warrant unwanted sleepiness. A good way to keep thecircadian rhythm in check is to align it with the environmentalrhythm by making a regular schedule of sleeping at night whenit’s dark, waking in the morning when it’s light, and eating atthe same times. This way, outputs and inputs of energy can beregulated and utilized for maximal alertness throughout the day.People who experience continual changes in their daily cycle,such as night shift workers, often take melatonin supplementsto induce sleep or reset their circadian cycles with bright light.However, supplements should always be properly discussedwith a doctor prior to usage.

A 1993 study published in Human Relations de nes boredomas “an unpleasant, transient a ective state in which theindividual feels a pervasive lack of interest in and di cultyconcentrating on the current activity.” Thus, boredom canactually decrease cognition and increase the sensation ofsudden sleepiness .

how it happens: disinterest: A tedious task at work or a monotonous lecturerin class can trigger boredom, which in turn reduces brainstimulation and alertness. In fact, a 1994 study in the BritishJournal of Psychology revealed that temperature e ectson alertness were minor in comparison to the e ects of anindividual’s interest. A bored participant was more likelyto have slower reaction times and to report feeling sleepy.Additionally, the afternoon “dip” in alertness was found tobe between three o’clock and three thirty, during whichboredom was particularly potent in inducing daytimesleepiness .

solution: Take a break, yawn, or do both! In a 2008 articlein Medical Hypotheses , yawning was proposed to increasearousal, alertness, and wakefulness by mechanical stimulationof the carotid body, which detects oxygen and carbon dioxidelevels in the blood. Thus, if a yawn is coming on, it may bebetter to let it carry out! Another way to increase oxygen to thebrain and become more alert is to do some type of physicalactivity, such as stretching in place or taking a walk aroundthe o ce or classroom. If the issue is with disinterest, ndingways to increase alertness and decrease sleepiness is crucial.Writing notes in di erent colors or working to music might justdo the trick. Even taking a quick break can help refresh themind.

boredom




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poor indoor lighting

A 2012 publication in Physiology and Behavior revealedthat brighter indoor light conditions increased alertness,attention to tasks, and heart rate, regardless of the timeof day or duration of light exposure. The participants in thestudy reported feeling less sleepy and more energetic in thehigh versus the low light conditions. They also had shorterreaction times on a vigilance task in high light, indicatinghigher physiological arousal. However, the computers that

students and workers often use provide a bright and closesource of light, signi cantly increasing the prevalence of eyestrain, burning, and itching after six hours of use, as revealedin the Journal of Clinical and Diagnostic Research in 2013.

how it happens: melatonin and melanopsin: As discussed in detail in theHow it Happens: Circadian Rhythm Upset section on page 13,light has been shown to suppress melatonin and activatemelanopsin . These may a ect wakefulness and provide thepower to ght the urge to doze o . Nevertheless, light thatis too bright or intense can tire the eyes, making the eyelidsfeel heavy and inducing overall tiredness.

solution: Turn up the right lights! Creating a good balanceof indoor lighting includes turning on ambient light anddimming focused light. For example, dimming the computerscreen and turning on the main light may help to reduceeye strain, and the bright surrounding light may inducewakefulness. If an individual desk light must be used tospare a roommate or co-worker from disruption, aiming itslightly to the side of the project at hand can reduce theintensity of the light. For more information about computerlighting and its e ect on eyes, read iStrain in Issue 3, Volume13!

high glycemic index meals

The glycemic index (GI) is a measure of how quickly bloodsugar (glucose) levels rise after eating a certain foodcontaining di erent kinds of carbohydrates. Researchreleased in 2007 in The American Journal of Clinical Nutritionfound that a high GI meal signi cantly reduced the timerequired for onset of sleepiness compared to a low GI meal,and that high GI meals are more likely to induce sleepinessfour hours after ingestion . For example, if an individual eatsa high GI lunch of a white bread sandwich and a soda at 11o’clock, he or she may feel the need to nap about four hourslater, around three o’clock. In comparison, a low GI meal ofkidney bean soup and grapefruit juice may be less likely to leadto dozing o .

how it happens:insulin response: Foods high in certain simple carbohydrates,such as white bread, have a high GI and rapidly increaseblood glucose levels. In response, the pancreas releasesexcess insulin, which in turn dramatically decreases bloodglucose levels a few hours later, leading to tiredness. Glucoseis a molecule that the body uses for energy, and a lack of it

after a high GI meal may cause the urge to nap. A clinical trialpublished by the Public Library of Science in 2013 revealedthat signi cantly less energy was available 180 to 300 minutesafter a low fat meal than after a low GI meal. A correspondingstudy found that low fat, high carbohydrate meals may havecaused subjects to feel more awake two to three hours aftereating than high fat, low carbohydrate meals did. This study,published in 1997 in Physiology and Behavior , thus related highfat intake to less energy availability and high carbohydrateintake to relatively more energy.

fat digestion: Similarly, in a 2010 study published in SleepMedicine , women who had a high fat or meat intake duringa meal reported feeling the need to nap afterwards,

indicating that these types of meals may induce sleepiness .InPhysiological Genomics , a 2007 publication discovered thatduring sleep, more enzymes involved in cholesterol synthesisand more proteins used in lipid transportation are produced.Though this study was done in rats, it may reveal that digestionof fat and cholesterol is linked to sleepiness and may becausing the urge to nap.

solution: Try eating low GI! Low GI foods, includingbeans, whole grains, and vegetables, contain complexcarbohydrates that are harder to break down and last longeras an energy source in the body. A 2011 study in Obesity

showed that low GI breakfast meals signi cantly reducedthe glucose and insulin response compared to high GI andhigh protein meals, meaning that post-meal blood glucoseremained high, and energy level was sustained. Low GI mealscan be better providers of energy after a meal and can helpprevent post-lunch doziness compared to high GI, high fat,high meat, or even low fat meals. Thus, nding a GlycemicIndex of foods online may be helpful in choosing energy-e cient foods throughout the day. However, seemingly similarfoods can have di erent GI values, so it is important to check aGI chart before chowing down.

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lack of sunlight

Sunlight is an excellent source of vitamin D, an essentialnutrient that can be absorbed through the skin. VitaminD de ciency can sometimes cause excessive daytimesleepiness. The sun also helps to set the natural circadianrhythm because it decreases production of melatonin,which is released during sleep. Simultaneously, it provides

light that triggers the activation of melanopsin, which works towake up the body, as described in How it Happens: CircadianRhythm Upset on page 13 and How it Happens: Poor IndoorLighting on page 14.

how it happens: vitamin d: In 2012, research published in the Journalof Clinical Sleep Medicine demonstrated a signi cantcorrelation between decreased vitamin D levels and asubsequent increase in sleepiness. The study also revealedthat members of di erent racial groups, particularly African-Americans, may be more susceptible to sleepiness due tovitamin D de ciency than others.

melatonin and serotonin: Environmental Health Perspectivesreleased an article in 2008 that discussed the bene ciale ects of sunlight on the regulation of sleep hormones suchas serotonin and melatonin (previously discussed in the Howit Happens: Circadian Rhythm Upset on page 13 and How itHappens: Poor Indoor Lighting on page 14). In this study, thoseexposed to sunlight or very bright arti cial light in the morningwere found to produce melatonin earlier the following night,making the transition to a sleep state easier. The 2008 articlerevealed that serotonin, another sleep hormone, is producedby mammalian skin cells during the daytime and convertedto melatonin at nighttime to aid the onset of sleepiness . Itfound that moderately high serotonin levels may result in amore positive mood and a calm, focused mental outlook.

solution: Soak up some sun! This is one way to ensure thatsunlight can do its job in regulating melatonin, serotonin,and vitamin D in the body. If the majority of the day is spentindoors in class or at work, try eating lunch outdoors or goingfor a walk to get adequate sun time. Too much unprotectedsun exposure, however, can be counterproductive andharmful. The heating e ects of the sun dry the body’s watersupply, sometimes leading to dehydration, which causesfatigue. In fact, a 2004 study in the British Journal of Nutrition found that subjects dehydrated for just 24 hours experiencedreduced alertness, greater di culty concentrating, and

lack of exercise

Though exercise may seem tiring, it can actually keep thebody awake and active throughout the day, if executedcorrectly. Too little exercise can induce a persisting inactivestate that decreases the amount of energy the body hasto stay awake and alert. Surprisingly, exercise that is toostrenuous may also have a negative e ect on alertness.

how it happens: cognitive function: Brain Research published a 2010 studythat emphasized the e ects of the complex, positivecorrelation between exercise and cognition, or alertness(which can be de ned as the opposite of sleepiness). Thestudy found that steady-state cycling exercise and fatiguingrunning exercise were both shown to increase cognitivefunction as well as enhance memory storage and retrievalafter a workout. In contrast, this mental performancesigni cantly improved during and after cycling, but running ona treadmill decreased mental performance during the activityand had little positive e ect afterwards.

response time: Other studies, such as one conducted in 2011for Physiology and Behavior , have concluded that acute,intermediate intensity exercise has a strong, bene ciale ect on reducing the time of response in memory tasks , buta low or possible detrimental e ect on accuracy of response.Additional research from Brain and Cognition in 2012 hadcoinciding results, nding that moderate intensity exerciseincreases mental arousal and a faster speed of processing,though the e ect on accuracy is indeterminable.

solution: Get physical, but not too much or too little!Exercising regularly may improve cognitive function,but it does not have to be intense in order for it to makea di erence. Simply taking the stairs up to the o ce orclassroom may be just what is needed to get through aparticularly tiring time of day. Biking instead of driving towork may not always be practical, but it can be a three-in-onesituation: a workout, transportation, and a way to beat tra c!If gym time cannot be scheduled, trying small exercises likestretches can be bene cial. Anything that will get the heartrate going might be the key to keeping unwanted daytimesleepiness away.

reported feeling more tired than when uids were permitted.Thus, it is crucial to drink water regularly and to stayadequately hydrated and awake. For more information ondehydration and sleepiness, see Fixing Fatigue in Issue 4,Volume 11. Prolonged and repeated exposure to sunlight canalso create a high risk of skin cancer, so avoiding excessiveoutdoor activity and applying sunscreen regularly areimportant habits to form.




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A busy student’s or employee’s routinecan be characterized by at least one, ifnot several, sleep-inducing activities:falling out of the circadian rhythm, notgetting enough sunlight, working in brightlight, eating heavy meals, exercisinginfrequently, ghting boredom, and evenfreezing room temperatures. Althoughthese various daily triggers can causeundesirable drowsiness, the tips and trickslisted above may help to reverse theireffects. However, these solutions may not beas effective on long-lasting, chronic fatiguethat is caused by more serious factors,such as a persistent lack of adequatesleep. Before reaching for a cup of coffee ornestling into a nice nap, dozy daydreamersshould try to assess their surroundings anddaily habits to look for sources of sleepiness. t w

low temperature

Body temperature, as a part of the circadian rhythm, alsofollows a daily pattern of highs and lows. The body’stemperature is highest during the active times of day becausethe body produces heat as it creates and uses energy. Whenthe body is resting, there is less activity and therefore lessheat production, causing a decrease in body temperaturethat has been correlated to sleepiness.

how it happens: thermoregulation: The Journal of Physiological Anthropologyreleased an article in 2012 detailing the e ects of the thermalenvironment on sleep stages, which were shown to be linkedto thermoregulation (how our bodies maintain temperaturehomeostasis), a mechanism that also helps to control sleep .It revealed that when bedding is used and clothing is worn inbed, heat and humidity exposure increases wakefulness anddecreases deep sleep. Cold exposure was not found to a ecta speci c sleep stage, but it was shown to decrease heart rateand thus, physiological activity.

decline in body temperature: In 1993, a study published inSleep provided information that body temperature dropsmore rapidly during sleep onset and remains lower thanthe temperature during wakefulness . Accordingly, resultsfrom research published in 2009 in Sleep Medicine Reviews are summarized in the gure below, graphing how bodytemperature decreases at nighttime during sleep.

core body temperature throughout the day & night

37.2

36.4

37.0

36.8

36.6

36.2

36.0

37.4

7PM 9PM 11PM 1AM 3AM 5AM 7AM9AM 11AM 1PM 3PM 5PM

t e m p e r a t u r e i n ° C

time

solution: Stay warm! Since warmth and coldness have beencorrelated to wakefulness and sleepiness respectively, agood way to prevent a daytime nap is to keep the cold at bay.If the lecture hall or o ce is often chilly, bring a sweater orwear layers. Though bundling up can feel cuddly and bed-like,it may have the opposite e ect and it could prevent drowsinessfrom taking over the afternoon.

L E F T : M A L E R A P A S O / I S T O C K P H O T O ;

food and sleep:energy compensation

Research from the Proceedings of the NationalAcademy of Sciences in 2013 provided evidencethat increased food intake after disruptionof the circadian rhythm is a physiologicaladaptation to provide the energy requiredto sustain wakefulness. A 2005 MedscapeNeurology article proposed that sleeprestriction may reduce leptin levels (appetitesuppressant) and elevate ghrelin levels(appetite stimulant) . This means that sleepdeprived people may be more likely to overeat.On the other hand, as summarized in a 2012article in Molecular and Cellular Endocrinology ,levels of glucose, a food energy molecule,may actually rise during sleep. Researchersattributed this counterintuitive phenomenonto lower brain and muscle activity during sleep,causing the unused, excess glucose to be storedrather than utilized for energy.

G R A P H A D A P T E D F R O M : S L E E P M E D I C I N E R E V I E W S ; V O

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Whether you are standing in line at thedining hall’s salad bar or wanderingthe produce aisle at the grocery store,

you may notice the variety of lettuceoptions awaiting you. And you maybe thinking: which kind of lettuce do Iwant? The iceberg lettuce? The classicromaine? It may seem that a salad is asalad, no matter what type of lettuceis used. But think again! It is true thatall lettuce types belong in the vegetablegroup, and that incorporating vegetablesinto one’s diet provides numerous healthbenets. According to a 2000 literaturereview published in the Journal of theAmerican Dietetic Association, consuming

salad savvy : a guide to “green” eating

vegetables can provide essential vitamins,minerals, and protective benets againstsome chronic diseases like heart disease,

diabetes, obesity, and certain types ofcancer such as stomach, breast, andprostate cancer. However, not all lettucetypes are created equal when it comes tonutritional content. Despite the generalhealth benets of lettuce, some typespack more nutritional punch thanothers. The main types of lettuce arelooseleaf, romaine, butterhead, andcrisphead. Read on to learn more aboutthese four types of greens and how tomaximize the nutritional content of yoursalad!




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Note: Knowing the de nitions behind nutrient claims is key to understanding a product’s nutritional content.› Claims such as “ excellent source ,” “rich source ,” or “high amounts ” mean the product contains 20% or more of the daily

value per serving .› Claims such as “ good source ” or “good amounts ” mean the product contains ten to 19% of the daily value per serving .

Incorporating a salad into one’s diet is a good way to reach the recommended daily intake of vegetables. According to theUnited States Department of Agriculture (USDA), the daily-recommended intake of vegetables is two to two and a halfcups for women and two and a half to three cups for men. Two cups of raw salad greens, whether it’s romaine or iceberglettuce, are equivalent to one cup of this daily-recommended intake of vegetables. Before diving into the speci cs behind

each type of lettuce, here is a general overview of the nutrients that lettuce can provide:

beta carotene : naturally occuring form of vitamin A, which helps maintain skin, eye, and immune system health

potassium: helps maintain blood pressure, uid balance, electrolyte levels, and muscle contractionvitamin c: aids in immune functioning and healing, in addition to keeping teeth and gums healthy

vitamin e: antioxidant that protects cell membranesvitamin k: allows blood clots to form when needed and helps synthesize proteinscalcium: promotes strong bones and teeth, helps muscles contract and blood vessels dilate

iron: aids in the formation of red blood cells and transportation of oxygen to tissues folate: helps the body form red blood cells and is important in prenatal care during pregnancy

ber: aids in digestive functioning, can help reduce cholesterol levels and reduce risk of heart disease

basic nutrients & dietary benets of lettuce

the guide ››the four types of lettuce

The most common type of crispheadconsumed is iceberg lettuce. The name“iceberg” was coined because Californiagrowers in the 1920’s shipped the lettucecovered in crushed ice!

characteristics: The crisphead consists of a solidhead of tightly wrapped leafs. It is crisp (hence the name“crisphead”), light in color, and has a bland, watery taste.

nutritional content: Of the four types of lettuce,crisphead is ranked the lowest, which can be attributed to

its structure. According to a 2009 study published in CurrentNutrition and Food Science , synthesis and absorption ofnutrients is dependent on exposure to light. The more thesurface area of the lettuce is exposed to light, the morenutrients there will be. Because crisphead lettuce leavesare tightly wrapped together, the leaves receive lesslight exposure and thus are lighter in color. This is whyit provides less nutrients compared to the other types. Italso contains the least amount of beta carotene in additionto low amounts of ber and vitamin K compared to theother types. A redeeming quality? Iceberg lettuce beats outlooseleaf lettuce for potassium content.

crisphead lettuce

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Green leaf lettuce (such as oak leaf)and red leaf lettuce are two subtypes oflooseleaf.

characteristics: Its head consists of loosely gathered

leaves. Green leaf lettuce is considered to be thegreenest and darkest of the lettuces, which explains whyit is a great source of beta carotene. The more green incolor the lettuce is, the more beta carotene it contains.

nutritional content: In addition to beta carotene ,looseleaf lettuce is high in vitamin K . It also contains agood amount of vitamin C .

looseleaf lettuce

Also known as cos lettuce, romaine isoften the main ingredient in Caesar andgarden salads.

characteristics: This lettuce grows in a vase-shapedhead and is often characterized by its long leaves andthick, white center rib down the center. This rib carriesmost of the plant’s water and ber and gives it itscharacteristic crunch.

nutritional content: An excellent source of betacarotene and vitamin K , romaine also contains thehighest amount of ber , vitamin C , and folate comparedto the other three types. These qualities make romaineone of the healthiest lettuce options you can choose.

romaine lettuce

Also known as Boston or Bibb lettuce.

characteristics: Identi ed by its “buttery” textured leaves,this type has small, round leaves that form loosely around thehead. This structure makes a head of butterhead lettuce looklike a green, blooming rose.

nutritional content: Butterhead reigns supreme invitamin K content. It is an excellent source of beta carotene and a good source of folate . Also, compared to the other types,butterhead has the most calcium and potassium .

butterhead lettuce




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In addition to the four main types of lettuce, there is a range of other options available that continue to grow in popularity.These days the produce shelves at the grocery store are teeming with a variety of baby greens, microgreens, and preparedsalad mixes.

“Baby greens,” such as baby spinach, are leaves that are picked before they are fully grown. “Microgreens,” which areseedlings of edible vegetables and herbs, are even younger than baby greens. Both are often served as a garnish to soups,sandwiches, and salads to enhance avor, color, and texture. In fact, baby greens and microgreens generally contain morenutrients than their full-grown counterparts! In a 2012 study published in the Journal of Agricultural and Food Chemistry ,researchers analyzed nutrient levels of 25 di erent microgreens and found that almost all of the microgreens were moredense in speci c nutrients than the mature leaves of the same plant!

One popular salad mix, mesclun , consists of a variety of di erent salad leaves. Mesclun salad traditionally consists ofa “mescla” or “mixture” of looseleaf lettuces along with more exotic, leafy greens like arugula, frisée, mizuna, andradicchio. Read on to learn more about some of these exotic, trending additions that can spice up your salad!

other types of leafy greens you can nd

Known as Popeye’s “leaf of choice,” this leafy green isoval or triangular in shape, typically dark green in color,and ranks highest (even above romaine lettuce!) in betacarotene , vitamin K , iron , and calcium .

This leafy green is classi ed as a cruciferous vegetable(meaning it belongs to the cabbage family) andoriginated in the Mediterranean. According to a2004 study published in Integrative Cancer Therapies ,cruciferous vegetables contain many nutrients,particularly glucosinolates , which are sulfur-containingchemicals that are currently being studied for theirprotective e ects against cancer. Arugula has a peppery,bitter taste and is often found in mesclun salad mix. It isa good source of beta carotene and vitamin K .

This deep red/purple leaf is often found in mesclunsalad mix and is typically sold as a round, compacthead. It also is characterized by its thick, white-veinedleaves and bitter to spicy taste. This unique leaf is anexcellent source of vitamin K .

Also classi ed as a cruciferous vegetable, this chewy andbrous plant comes in a variety of colors (green, darkgreen, and purple) and is rich in antioxidants . Its leavesare typically ru e-edged. Out of all the cruciferousvegetables, kale is richest in vitamins C and K and betacarotene , with one cup providing 134%, 684%, and206% respectively of the daily value for these nutrients.Not only that, but it provides a good amount of folateand potassium . Along with Swiss chard and spinach, kaleis one of the most nutrient packed greens out of thiswhole list.

spinach

arugula

radicchio

kale

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This antioxidant rich leaf is characterized by its shiny,green leaves. Its stem can range in color, from red toyellow to white. Not only is one cup of Swiss chard anexcellent source of vitamin C and beta carotene , butit also contains extremely high amounts of vitamin K ,providing 374% of the daily value for this important

nutrient.

This Japanese mustard green is known for its small

jagged-edged leaves and its strong avor. It is oftenfound in prepared salad mixes, particularly mesclunsalad. It is high in vitamin C and A and glucosinolates ,which help to prevent cancer.

Also known as curly endive and often used in mesclunsalad mix, this leafy green consists of curled leaveswith a yellow and green coloring. It is slightly bitter intaste and adds a nice crunch and texture to a salad.Nutritionally, it is an excellent source of vitamin K and A .

avoid creamy and saturated fat dressings. Try opting for healthy oil dressings (like olive or canolaoil) or vinaigrette, a dressing that consists of a mixture ofoils that are often avored with herbs or spices. Oil-baseddressings provide a healthy dose of essential unsaturatedfats, as long as they are used in moderation.

yea or nay on fat-free dressings? Opt for fat-based dressings over fat-free ones! This mayseem a bit counter-intuitive, since fat-free dressings aretypically low in calories and are assumed to be healthier foryou. But according to a 2012 study published in the Journalof Molecular Nutrition & Food Research , using fat-based

dressings actually enhances nutrient absorption of saladand vegetables , and having a dressing with no fat canactually diminish the bene ts of the greens you are eating!Using dressings made with monounsaturated fat required theleast amount of fat to get the most carotenoid absorption intothe bloodstream compared to saturated and polyunsaturateddressings. Carotenoids are phytochemicals found in plant-based foods and act as antioxidants for the body. Estimatesare that you only need a teaspoon or so of these fat-baseddressings to aid in the uptake of healthy carotenoids. Usingtoo much dressing can undermine these bene ts.

types of toppings:Avoid putting croutons, bacon bits, and mounds of cheese

on top of a salad because these ingredients can addcarbohydrates, fats, and calories that may be unnecessary.Using these in moderation is ne, but excessive quantitiescan diminish the nutrient bene ts of the lettuce. Try puttingsun ower seeds or walnuts as a source of protein andtexture. Lean meats such as chicken and turkey can addprotein to a salad. Fruits and vegetables are always excellentoptions for toppings that can add even more nutritionalpunch. Since dressings with monounsaturated fat enhancenutrient absorption, toppings with this type of fat have asimilar e ect. Such toppings include avocado and nuts (suchas cashews and macadamia nuts). A 2005 study published inThe Journal of Nutrition found that adding avocado to a saladenhanced carotenoid absorption compared to a salad with no

avocado. For this reason, avocado is one of the best additionsyou can make to a salad.

swiss chard

mizuna

frisée

Choosing a healthy type of lettuce as your base is one thing,but what you put on it is a whole other story. Toppings caneither enhance or diminish the nutrient content of the saladgreens. Here are some tips to keep in mind:

salad tips & tricks

Lettuces that are more green and dark in color (romaine, green leaf, red leaf, and butterhead) provide more nutritional punchthan lighter colored and tightly packed lettuces (such as crispheads like iceberg). The same goes for the more non-traditionalleafy options, particularly the greenest ones such as kale, swiss chard, and spinach. So the next time you hit the salad aisle ormake a trip to the dining hall, keep this in mind when looking for a salad that will give you the biggest nutritional bang for yourbuck or swipe!

the bottom line

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L E F T : S T O C K S H O P P H O T O G R A P H Y L L C / I S T O C K P H O T O ; R I G H T :

D E S I G N 5 6 / I S T O C K P H O T O ; C V E L T R I / I S T O C K P H O T O

People clean their ears forseveral reasons: better hearing,comfort, hygiene, and more.However, these individualsmight be using harmful tools oremploying dangerous methodsto keep their ears squeakyclean. So the question is, whatis the proper way for people toclean their ears? Well, contraryto popular belief, commonlypracticed methods such asusing Q-tips and candling areNOT the answer!

hear this: how to

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rst of all, what is wax?

Wax, also known as cerumen, forms in the ear as a resultof skin cells, dust, and secretions from ceruminous glands.Ceruminous glands are structures in the ear canal that secretelipids and other substances in the ear.

what is wax for?

Secretions from the ceruminous glands are part of the ear’sself-cleaning mechanism. These secretions protect the earfrom bacteria by:

1. Keeping the skin in the auditory canal lubricated.

2. Protecting the skin’s protective acid mantle which helpskill bacteria.

› According to a 2011 study published in Lipids , the studyfound over one thousand compounds in ear wax that helpprotect the skin by producing a low pH in the ear andproviding a hostile environment for bacteria.

3. Trapping dust, bacteria and other foreign particles toprevent them from entering further into the ear canal. › Movement also helps with this self-cleaning process

because actions such as speaking or eating move the lower jaw, which gradually pushes the wax out.

what determines how much ear wax youhave?

The amount of ear wax that one has may be determined bygenetics or age. People of older age may produce more earwax since the ceruminous glands shrink with age, causing theear wax to be dry. Dryness keeps the ear from cleaning itselfwell, so skin particles may accumulate as a consequence andresult in greater amounts of wax in the ear.

when should I clean my ears?

It is important to remember that ear wax is bene cial andis not a sign of poor hygiene, so one should not clean his orher ears too often. However, when too much wax builds up, itcan become impacted and form a plug. This can also happenwhen someone wears a hearing aid, uses earplugs, or does notuse the right ear-cleaning tools. One might want to remove ablockage of impacted ear wax to improve comfort and hearing.

what not to do:

There are commonly practiced, but risky ways to clean out theears:

- : Using a Q-tip not only puts one at risk for perforatingthe eardrum, but it can also just push the wax further intothe ear and make it more impacted. Also, the cotton tip canincrease the chance of bacterial infection.

› A 2004 study in the International Journal of PediatricOtorhinolaryngology concluded that using cotton-tipapplicators for cleaning ears seems to be the leading cause ofotitis externa in children, otherwise known as swimmer’s ear,an infection or in ammation of the external auditory canal.

› As with using Q-tips, using hair pins and other small objectsto remove ear wax can break the eardrum and/or push the earwax deeper into the ear canal.

*However, it is okay to clean ears using a Q-tip as long as one iscautious and aware of the risks.

: Candling is another method used to remove earwax.Para n, beeswax, and cloth are rolled into a cone shapewith the small end in the ear. An assistant lights the edges ofthe other end on re and the burning supposedly draws theears wax out of the ear and into the tube.

*However, a 2009 study published in The European Journal ofGeneral Practice showed that ear candling is not e ective andcan actually cause injury.




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bottom line

Overall, it may be risky to cleanears using a Q-tip or the candlingmethod. However, the ears can becleaned safely by using lubricants,applying the irrigation method, orseeing a doctor or professional. t w

here is how to use irrigationto remove ear wax:

1. Use body temperature water (anycooler or warmer can cause dizzinessor vertigo, where you feel as if you arespinning or moving or that the worldis spinning around you).

2. Hold your head upright and gently pull the outside of your ear upward tostraighten the ear canal.

3. Use a syringe (can be bought at thestore) and gently direct a small streamof water at the wall of the ear canalnext to the wax.

4. Tip your head to allow the water todrain. Then, you may need to repeatthe irrigation.

5. When the wax is removed, the earmust be dried thoroughly. This canbe done with a hairdryer on a lowsetting. However, when irrigating, itis important not to irrigate with a tool

for cleaning teeth, or if there is another possible ear condition. Also, it is notgood to irrigate too much.

L E F T : S U R A B K Y / I S T O C K P H O T O ; R I G H T :

how do I safely remove ear wax?

: Streaming water in the ear can soften the waxand make it easier to remove. Irrigation is not advisable forpeople who currently have, or have a history of, ear infection,ear surgery, eardrum injury, permanent ringing in the ears(tinnitus), or hearing in only one ear.

› It is important not to attempt removing ear wax ifexperiencing ear pain or discharge. These are signs that adoctor should be seen.

: Olive oil, almond oil, baby oil, mineral oil, sprays, or eardrops can also lubricate and loosen the ear wax. The numberof drops that should be used depends on the brand and adoctor’s recommendations. With this method, tilt the head sideto side for ve minutes to let the drops settle.

› A 2009 study published in The Cochrane Library showed thatthere may not be a di erence between various ear drops andhow e ective they are. Therefore, while using ear drops forremoving ear wax is better than doing nothing at all when ear

wax builds up, there are no particular types of ear drops thatare recommended.

: One can see a physician who uses specialtools such as a vacuum to safely remove ear wax. It is a goodidea to call a physician if the ear wax is tough, if the wax cannotbe removed, or if ear pain, fever, or hearing loss occurs.

which way is the best way to clean yourears?

A 2010 study published by the National Institute for HealthResearch (NIHR) compared the di erent ways of removingear wax. While it was shown that softeners such as oliveoil and sodium bicarbonate being used before irrigationmight be helpful, the study was inconclusive in regards towhich speci c softeners are better and whether mechanicalremoval or irrigation was more e ective in removing earwax.



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total wellness ›› on the cover

“Take care of your body; it’s the only

place you have to live.” – JIM ROHN




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the nail les: preventing and decoding yournails’ puzzling appearance

Fingernails, the keratinous skin appendages growing at the tips of ourngers, are often mistreated and ignored. Chewed on, broken, painted– they go through a lot. Paying attention to ngernail appearancecan provide insight on what’s going on inside our bodies , and mayreveal previously undiagnosed health issues. A 2010 study in Clinicsin Dermatology found that nail disorders comprise approximately tenpercent of dermatological conditions . Addressing them can preventunderlying issues from going unnoticed and worsening. While fun,a manicure isn’t always the cure! Find out what’s causing your nailweirdness and how to prevent it in the future.

L E F T : M E R Z A V K A / I S T O C K P H O T O ; R I G H T : O R I G I N A L

I L L U S T R A T I O N B Y K R I S T E N S A D A K A N E



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distal edge: the part of the nail extending beyond the nger, also called “free edge”nail plate: the “hard part” which most people simply refer to as “the nail”; it is made up of keratin, thesame substance that hair and the top layer of skin are made of nail grooves: the areas of skin on each side of the nail in which it is embeddedlunula: the moon-shaped visible portion of the matrix above the cuticle

cuticle: formally known as the eponychium, the cuticle is the small band of epithelium (skin) extendingonto the base of the nail

nail root: the base of the embedded nail below the skin, originating from the matrixmatrix: the tissue upon which the root of the nail (and slightly beyond) rests, containing nerves, lymph,and blood vesselsnail bed: the surface upon which the nail itself rests

minor conditions

onycholysis

what it looks like: Onycholysis causes gradual, painless

separation of the nail from its nail bed.

underlying cause: Non-medical onycholysis can actuallybe caused by slight or moderate trauma to the nail, suchas repetitive tapping or impact. It can also be caused byimproperly using tools that clean under the nail or overmoisturizing the ngertips or nails.

solution : For minor cases of onycholysis not caused bysystemic medical conditions, waiting for the nail to grow backis the most viable solution. Because the condition is not causedby a distinct source, there is nothing to treat holistically and thenail must simply repair itself.

beau’s lines (the mild type)

what it looks like: Beau’s lines appear as horizontal indents

or depressions across the length of the ngernail.underlying cause: Beau’s lines may be caused by injurydirectly to the nail. Injuring the nail causes it to temporarilystop producing nail cells, leading to grooves that are visible onthe nail. The hiatus of nail cell production can also be causedby illness, infection, or high fever.

solution: Soak nails in warm salt water or simply warmwater two to three times a day to reduce the lines. Usingan emollient (or ‘soothing’) cream after washing or after theabove soaking procedure may also help. Lastly, apply a mildantiseptic solution to nails. According to The Center for PodiatricCare and Sports Medicine , this keeps the nails from becoming

dried out and minimizes discomfort which may result from theaforementioned dryness and irregularity in shape.

acute paronychia

what it looks like: This condition makes the nail fold (areawhere the nail edge meets the nger) in amed, painful, red,and swollen. Sometimes, yellow pus appears under the cuticle.

underlying cause : Acute paronychia is usually causedby bacterial infection. The cold sore virus or yeast (a fungus

naturally found in our bodies which can grow out of controlunder certain circumstances) may also be at fault.

solution: Bacterial cases can be treated with oralantibiotics, while viral infections are treated with oralantifungal medications such as uconazole and topicalcreams, both of which can be prescribed by a doctor. Thesekill o the bacteria or virus causing the infection, in turnrelieving the symptoms of paronychia. An antiviral drug calledvalaciclovir is usually prescribed for viral cases because it cancure the infection within seven days.

chromonychia

what it looks like: “Chromonychia” is a Greek term meaning“color nail.” It can refer toany type of nail discoloration , butsymptoms of the less critical forms include black bands on thenails, white marks, or an orange-ish tint. The black bands canrange from thin lines to amorphous splotches. If the marks arewhite, they usually appear as thick horizontal bands.

underlying cause: Vitamin B12 de ciency is likely a rootcause of black bands, while white marks can be caused bydirect trauma to the nail. The orange staining is usually due tooveruse of nail polish without a protective base coat.

solution: Consume a diet rich in vitamin B12 by includingmore seafood, beef, and eggs. A good vegan option is forti edcereals or energy bars.As for the issue of staining:1. Combine equal parts three percent hydrogen peroxide withwarm water and soak for ve minutes. Hydrogen peroxidehas “been found to be e ective in bleaching or lightening”discolored nails according to a 2000 U.S. patent titled “Processfor bleaching chemically tanned skin and discolored nails.”2. After soaking, scrub with a toothbrush using baking soda paste(equal parts warm water and baking soda).

quick nail guide: the major parts




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critical conditions

nail pitting

what it looks like: Nail pitting appears as small, numerousdents or “pits.”

underlying cause: A 2004 study published in AmericanFamily Physician reported that nail pitting could be a sign ofmultiple systemic conditions including psoriasis (genetic skincondition), Reiter’s syndrome (bacterial arthritis), incontinentiapigmenti (a genetic skin disease), and alopecia areata (hairloss).

solution: As these are wide-ranging and complex diseases,treatment is varied. If you suspect having any of theseconditions, seeking medical attention as soon as possible isthe best way to go.

nail clubbing

what it looks like: According to a 2001 study publishedin The Journal of the American Medical Association , symptomsinclude but are not limited to: an angle of more than 165°between the nail bed and cuticle, increased roundness of thesurface of the nail, general thickening of the end of the nger,and shiny, linear streaks on the nail.

underlying cause: TheEuropean Journal of InternalMedicine found in 2008 that 60% of nail clubbing cases wereidiopathic , meaning “not having an underlying medical cause.”However, 40% are associated with various lung, heart, andgastrointestinal diseases, among others.

solution: Because this nail deformity can have so many

di erent causes, see a dermatologist to make sure yourcase is not disease-related. The dermatologist will ask aboutmedical history and may perform additional tests such as chestX-rays or a CT scan to rule out lung and heart disease.

koilonychia

what it looks like: Meaning “spoon nails” in Greek, nailsa ected with koilonychia are thin, at, or even concave.

underlying cause: Most commonly, koilonychia pointsto hypochromic anemia (paler than normal red blood cells),which is usually caused by iron de ciency, according to a 2003publication in Fitzpatrick’s Dermatology in General Medicine .

solution: Treating this issue from the inside is essential.Consume more foods rich in iron , such as meat, eggs, seafood,spinach, string beans, broccoli, whole grains, watermelon,strawberries, beans, and lentils, which are all excellent sources.Avoid ca einated beverages as they may slow iron absorption.Taking vitamin C and iron supplements can help nails growhealthily. Look for supplements that are non-constipating,as this is a common side e ect of iron supplementation.Finally, try not to bite nails as this may cause irritation andin ammation in the nail bed.

hutchinson sign and nail dystrophy

what it looks like: This condition usually begins as a vertical

pigment band the length of the nail plate. As the conditiondevelops, the band becomes wider, especially towards thecuticle. Pigmentation may range from light to dark brown.Bleeding and thinning, cracking, or distortion of the nail plateare more severe sign.

underlying cause: If you notice any of these symptoms, donot ignore them as they may indicate subungual melanoma , atype of skin cancer that appears under the nail.

solution: If diagnosed as subungual melanoma, the site ofthe cancer is surgically removed to treat the disease , and thesurgical defects can be repaired using skin grafting.



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bottom line

onychomycosis (aka nail fungus)

what it looks like: According to a 2012 reviewby UK’s National Health Service, the most commonsymptom of a fungal nail infection is thickeningand discoloration . The nail may turn white, black,yellow, or green. The condition is initially painless,but if left untreated, it can become uncomfortableand in rare cases, painful. The infection can causedi culty writing and leave the nails brittle andfragile, eventually resulting in the nail falling o . Theskin under and around the nail can become in amed,painful, and scaly. The nail bed sometimes presentswhite or yellow patches.

underlying cause: Onychomycosis is caused bythree main classes of organisms: dermatophytes(fungi that feed on nail tissue), yeasts, andnondermatophyte molds. All three cause similarsymptoms which is why onychomycosis must beproperly diagnosed by laboratory tests before beingtreated, suggests Charles Davis, MD and PhD clinicalprofessor at the University of Texas Health SciencesCenter at San Antonio.

solution: Recently, triazole and allylamine havebecome the drug standards as they provide shortertreatment courses and higher cure rates than formertreatments, with fewer relapses. According to a2011 article by the American Society for Microbiology ,triazole, during in vitro (test tube) experimentation, hasshown potent activity against dermatophyte pathogens(fungal agents causing the disease) of onychomycosis.Allylamines kill the fungus by inhibiting the productionof an enzyme that constitutes a component of thefungus’ membrane. A 2011 article in American FamilyPhysician reports that terbina ne, uconazole, anditraconazole have replaced the more traditionaltopical treatments because they penetrate the nailand nail bed more quickly and are generally saferas well. They work in a similar way to triazole, bysecreting a substance called squalene which decreasesproduction of ergosterol, a component of fungal cellmembranes.

and the more commonly encountered...

onychoschizia (aka nail splitting)

what it looks like: Visible symptoms include splitting(layering), brittle, soft, or thin nails. The condition is morecommon in women.

underlying cause: Nail splitting is rarely caused by asystemic disease. If toenails are healthy but ngernails presentonychoschizia, the factors are most likely external. The nailsare either being dehydrated or over moisturized. Repeatedwetting and drying may also be at fault. Too much moisturecan weaken the nails and soften them which can lead topeeling, while dehydration causes brittleness. Brittleness, inturn, can contribute to splitting.

solution: The American Osteopathic College ofDermatology recommends applying lotions that containalpha-hydroxy acids or lanolin after soaking nails inwater for ve minutes to restore them to a sustainabletexture. A 1998 study published in Cutis found that thesesubstances improve the appearance of splitting nails andreduce symptoms such as unusual dryness, rough texture, andadvanced aking and scaling.

subungual hematoma

what it looks like: According to a 2009 entry in Mosby’sMedical Dictionary , subungual hematoma is a collection ofblood beneath the nail. Throbbing pain can be a symptom.The nail will appear black or dark purple, either partially orentirely.

underlying cause: Subungual hematoma is mostcommonly caused by trauma to the nail. TheBritish Journal ofSports Medicine reported in 2004 that “jogger’s toe” can causethe condition as well, due to repeated impact of the longesttoe with the front of the shoe.

solution: The nail is usually treated by trephination,or drainage of the trapped blood. A 1991 study by theAmerican Journal of Emergency Medicine reports little to nocomplications with this procedure. The journal elaborated in a2006 article that this quick and convenient method, performedby a physician, provides substantial pain relief by controlledrelease of the trapped blood under the nail plate.

If home remedies do not lead to improvements in the condition, or if the condition appearsto be one of the more serious described above, seek professional help from a dermatologist.As a gold standard, eating a balanced, healthy diet and avoiding the ve major nail mistakes(read about these top nail care mistakes on page 30) will help keep nails in tip top shape.Always keep an eye out for any nail abnormalities because they are tell-tale indicators ofoverall health.



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Accordingto the U.S.

EnvironmentalProtection Agency(EPA), Americans

spend billions of dollarsevery year on home water

treatment units. Why?

In 2009, The New York Times compiled hundreds of thousandsof water pollution records to create

a comprehensive national database ofwater pollution violations; this revealedthat laws intended to protect our water

supplies were not being properly enforced,and thus, tap water may contain dangerous

chemicals . This database shows that water in LosAngeles contains one contaminant above legal limits

and ve other contaminants below legal limits, butabove health guidelines.

Therefore, water lters are extremely important inwater sanitation, which affects the overall healthquality of the population. There are several typesof water lters available with various structures

and functions. Read on to learn more aboutthe categories of water lters and how

each lter puries your waterdifferently.

clear waters: lters to purify your water |




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ion exchange Ion exchange lters remove dissolved salts in water byexchanging the mineral ions in water with its own ions.

People use di erent types of lters depending on the speci ccomposition of contaminants in the local water. Possibilitiesinclude harmful environmental runo composed of pesticides,herbicides, and fertilizers. Fertilizers may contain nitrates,calcium, magnesium, and arsenic. There are also additives inwater; chlorine is added to control microbes, and uoride is

added to promote stronger teeth. However, chlorine can reactwith organic compounds in water to form byproducts that arehazardous to health, and over uoridation can have long termnegative e ects on bones and teeth. The pipes that watertravels through before reaching your tap may also add dirt, rust,slime, sand, mud, copper, lead, and bacteria. No single type ofwater lter is able to remove all of the impurities mentionedabove, and thus, di erent types of lters exist.

what do water lters do?Two main categories of water lters are point-of-entry unitsand point-of-use units.

Point-of-entry units treat water before it gets distributedthroughout the entire house or building. These includewater softener tanks for entire houses.

Point-of-use units treat water right before it is about to beconsumed. These include common countertop lters, faucetlters, and under the sink units.

where are water lters placed?

T O P : A I R Y E L F / I S T O C K P H O T O .

types of water lters

activated carbon lter An activated carbon lter has a lter made of granulatedcarbon or solid carbon ltrate. The carbon particles have alarge surface area and have been processed to be very porous.The porous surface attracts and traps dirt and impurities, andthe liquid water is repelled and travels through the lter.

reverse osmosis In this lter, water is pushed through a ne semi-permeablemembrane, which separates the liquid and the concentrate.

distillation Distillers boil water to create steam, which cools andcondenses to form pure, mineral-free water droplets, which arethen collected for use.

ultraviolet disinfection An ultraviolet light may be installed to kill bacteria and othermicroorganisms.

name what is it?

›

›



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are they effective?› Look for lters labeled as meeting NSF (National

Sanitation Foundation) standard 53 . These lters havebeen independently tested to prove that they can reducelevels of health-related contaminants. NSF Internationalis a nonpro t organization that tests and certi es certainproducts to ensure that they meet public health and safety

standards.

Find out what’s in your water to determine what type oflter to use. Local drinking water information can be foundhere: http://water.epa.gov/drink/local/index.cfm/drink/local/ index.cfm. If a report cannot be found online, you cancontact your water supplier for more information.

›

common mistakes to avoid› Make sure to follow directions in the installation and use of

water lters.

Follow the timeline for replacement. For example, thesmaller activated carbon lters in water bottles should bereplaced every two months or 40 gallons. A water lter usedfor longer than intended may actually start to negativelya ect water quality by harboring bacteria.

Know what’s in your water so you can purchase thecorresponding lter and correct system.

t w

Activated carbon lters are used in countertop lters,faucet lters, and under the sink units. They are the mostcommonly used type of lter.

This lter removes bad tastes and odors, including the smellof chlorine. Some may also reduce the amount of heavymetals, disinfection byproducts, parasites, pesticides, andvolatile organic chemicals found in water. According to a 1995study in Applied and Environmental Microbiology , point-of-use powdered activated carbon lters signi cantly reducedbacterial density in rural domestic groundwater supplies afterrunning water through the lter for two minutes.

These are commonly used in under the sink point-of-use unitsin combination with activated carbon lters. Water is storedin a pressure tank after reverse osmosis and treated with anadditional activated carbon lter to further remove impurities.A 2002 study published in Water, Science, and Technologysuggests that there is a higher removal of microbes with thecombined system than with reverse osmosis alone. The largestdrawback of this lter is that it wastes lots of water; everypuri ed gallon wastes two gallons, so in order to obtain onegallon of puri ed water, three gallons must be ltered.

This type of lter removes most contaminants, includingcertain parasites, heavy metals, and other environmentalpollutants.

It is used in house point-of-entry units and removes calcium,magnesium, and uorides. This lter “softens” hard water. Hard water contains calciumand magnesium, which may harm pipes and decrease thee ectiveness of cleaning agents, such as soap. The ionexchange lter trades these minerals with strong positivecharges for those with smaller charges, such as sodium andpotassium. According to a 2005 study in Water EnvironmentResearch, the ion exchange ltration technique was highlye ective in reducing ammonia concentrations and bacterialpopulations of lake water, resulting in improved health of theoverall ecosystem and habitat.

This type of ltration is used in countertop or whole housepoint-of-entry units and can be combined with an activatedcarbon lter for further puri cation.

Distillation removes heavy metals, arsenic, uoride, and othersalts.

It is used in under the sink units and is usually combined withan activated carbon lter for further puri cation.

This type of lter removes bacteria and parasites from water. A2013 study published in Environmental Science and PollutionResearch International indicated that point-of-use ultravioletdisinfection systems used for 20 to 50 minutes were ableto inactivate E. coli and eliminate their disease-producingcapabilities.

common places of use what it lters

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34

Love to run? Or not a big fan but run for the exercise?You are not alone. Over 50 million people run or

jog at least once a day, according to Sporting GoodsManufacturers Association’s 2012 national survey.Additionally, 19 million individuals run or jog 100 ormore days a year. However, because running is a high-

impact sport, running-related injuries are prevalent. Theside effects of this popular exercise may affect all typesof runners from beginners to marathon champions.According to a study published in the 2012 International

Journal of Sports Physical Therapy, about 19% to 79% ofrunners may experience at least one injury each year.

mindful running |

R N A L L L U T R A T N B Y K R T E N A D A K A N E

The good news for runnersis that injuries from runningcan often be prevented andhave very similar treatmentmethods when caught early.Since most running injuriesare caused by recurringfactors, recognizing andpaying attention to the rstsign of sudden or persistentpain can greatly shorten arunner’s rehabilitation timeand prevent future injuries.



35

general treatmentmethods of common

running injuries

> take a well deserved break:Taking a break from running untilthe pain resolves is the rst stepto a speedy recovery. Dependingon the type of injury, the restingperiod will vary, but generally onecan gradually return to runnningwhen there is no pain in the

targeted area.

> consider over-the-countermedication: In addition to rest,taking medications such asacetaminophen (e.g. Tylenol)or ibuprofen (e.g. Advil, Motrin)can help reduce pain andin ammation.

> treat your body by stretchingand massaging: Stretchingtargeted areas to strengthenspeci c muscles is a way to

prevent future injuries andmanaging soreness. Massaging theinjured area with ice is anothergeneral method to relieve pain.

> try alternative forms ofexercise: Consider alternativeforms of exercise! Runninginjuries, if not severe, do not stopone from exercising entirely.There are other ways to beactive without straining one’sinjury. For example, cycling isa great alternative that is less

likely to cause injuries. It alsomay speed one’s recovery timeby strengthening the quadricepmuscles. Swimming is anothernon weight-bearing activity thatrunners can do to maintain theircardiovascular tness. Even goingon brisk walks, if possible, is agreat way to stay active whilerecovering.

common causes of running injuries:

training errors:According to the American Orthopaedic Society for Sports Medicine, training errors,such as inadequate stretching and insu cient rest between training sessions , arethe most common cause of running-related injuries.

minor deformities or areas of weakness:It is also important to pay attention to any anatomic abnormalities that may a ect thebody while running. Some runners may have minor deformities or weaknesses inspeci c areas that may cause increased pain while running. For example, ankle laxitycan lead to frequent ankle sprains and pain.

foot problems:In addition, an individual’s foot type can be related to foot problems. There are threebasic foot types: normal arch, at arch, and high arch. The types are based on theheight of the foot arch and a ects the pronation of the foot. Pronation is when theoutside part of your heel makes initial contact with the ground. A normal pronationis when the foot rolls inward about 15% which causes the foot to fully contactthe ground when you step. This allows your foot to support your body weight andhelps you push o evenly from the front of the foot. It is also critical to proper shockabsorption. Not everyone has the perfect pronation. The size of the runner’s arch cana ect its ability to roll, causing either underpronation (foot rolls inward less than15%) or overpronation (foot rolls inward more than 15%). Those who have at feettend to be overpronators. Overpronators have problems stabilizing the body andshock is not absorbed e ciently. The foot pushes o the ground using mainly thebig toe and second toe. Those who have high-arched feet tend to be underpronators.Underpronators also are a ected by unequal force distribution. The foot pushes othe ground using the smaller area of the foot such as the smaller toes on the outsideof the foot. Choosing the right running shoes may help alleviate over and underpronators. Overpronators are recommended to wear a motion-control shoe thatcontrols pronation and underpronators do best in a neutral-cushioned shoe thatallows for a natural foot motion.

when are you most prone to running injuries?

According to the American Orthopaedic Society for Sports Medicine, there are fourperiods of time when runners are most vulnerable to injury:

During the initial four to sixmonths of running

Upon returning to running afteran injury

When the quantity of running isincreased (distance)

When the quality of running isincreased (speed)

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Running is a high-impact exercise that primarily puts stress on thelower body and can result in a number of injuries. Below is a list ofthe most common injuries both novice and advanced runners maycome across. It is important that at the rst sign of pain, one paysattention to where the pain occurs and takes action to prevent furtherinjury. While many types of pain may feel and seem minor, do notignore them as these injuries can become more serious over time if

not properly treated. Most of the common running injuries can berelieved with proper rest. Common lower body areas that are prone torunning injuries:

at risk area: leg

chronic external compartment syndrome (CECS)

what is it? CECS is an exercise-induced muscle and nerve condition that causes painand swelling. If severe, CECS can cause disability in the a ected leg or arm muscles.

what causes it? This syndrome occurs when there is increased pressure withina muscle compartment (muscles and neurovascular structures bound by softconnective tissue and bone). During exercise, the blood supply to the working musclesincreases, which in turn makes the muscles expand. However, if the muscles swellgreater than they can expand, pressure builds up in the compartment. When thishappens, the pressure cuts o some of the muscle’s blood supply which leads toCECS. According to Cathy Fieseler, MD, director of Sports Medicine in the Trinity MotherFrances Health System and member of the Board of Directors of the American MedicalAthletic Association, once exercise has stopped, the swelling and pain also stops. Thus,usually when a runner meets with a physician about this problem, X-rays, bone scansand MRIs show normal results. If the history is suggestive of CECS, measuring thepressure within the compartments con rms the diagnosis, states Fieseler. Althoughanyone can develop CECS, runners are more likely to experience CECS due to therepetitive impact from running.

symptoms: CECS is characterized by an aching, burning, or cramping pain in thea ected limb. The a ected area may feel tight or numb. The pain typically follows apattern: 1) it begins soon after you start exercising the a ected limb, 2) it progressivelyworsens as long as you exercise, 3) it stops within 30 minutes after the a ected limbcomes to rest, and 4) over time, it may begin to persist longer after exercise, possiblylingering for a day or two.

additional treatment tips: According to a 2012 study published in Sports Health , theonly evidence-based treatment is activity modi cation and rest . If the pain is stillpersistent, surgical measures may be taken.

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at risk area: thigh/knee

iliotibial band syndrome (ITBS)

what is it? When you ex and extend your knee, the iliotibial band, which runsalong the outside of the thigh, can become irritated from repetitive rubbing over theoutside of the knee.

what causes it? There are several causes of this syndrome, including weak glutealmuscles, over-pronation (excessive inward rolling of the foot), and running onuneven surfaces. According to a 2012 study published in Sports Medicine , ITBS isthe most common injury of the lateral side of the knee in runners, with an incidenceestimated to be between ve percent and 14%.

symptoms: There is pain or aching on the outside of the knee , usually occurring inthe middle or at the end of a run.

additional treatment tips: In addition to decreasing your running mileage, trystretching the outer thigh and strengthening the hip abductors with lateral sidesteps, side leg lifts, and one-legged squats . Unlike some of the common runninginjuries, bicycling can aggravate ITBS. Try swimming or using an elliptical machine toexercise while recovering.

at risk area: knee

patellofemoral pain syndrome (PFPS) (runner’s knee)

what is it? Runners put heavy stress on their knees, areas that are very sensitive. Thekneecap, or patella, is a small bone in the front of your knee that moves with the kneeas it exes. The patella protects the other bones in the knee against collisions and falls.Runner’s knee involves pain around the front of the knee (patellofemoral pain).According to a 2012 review published in Sports Medicine , PFPS is most common inrunners who participated in ultramarathon races.

what causes it? Patellofemoral pain may be the result of irritation of the soft tissuesaround the front of the knee. Overuse, muscle imbalance, and inadequate stretchingare other contributing factors to patellofemoral pain. Furthermore, pain that beginsin another part of the body, such as the back or hip, may cause pain in the knee. Itshould be noted that in some people with runner’s knee, the kneecap may be out ofalignment. If this is the case, running on it may cause excessive stress and wear on thecartilage of the kneecap leading to pain and irritation around the area.

symptoms: The most common symptom is a dull ache (think of a constant ache, nota sharp pain) underneath the kneecap while walking down stairs, squatting or gettingup after sitting for long periods of time.

additional treatment tips: Relative rest and stretching and strengthening tocorrect for the muscle imbalance is important. Try stretching your hip exors. Also,performing lateral side steps and squats can strengthen your knees’ support muscles

such as the quadriceps and glutes. In addition, ice should be applied to the knees afterrunning. Light running is okay if this injury is mild, and Bryan Heiderscheit, PhD, PT,director of the University of Wisconsin Runners’ Clinic, recommends shortening yourstride length and landing with the knee slightly bent, a practice which can take up to30% of the load o the knee joint. In addition, uphill running can be bene cial as itworks the glutes. Gluteal muscles help control hip and thigh movement and preventthe knees from turning inward. However, running downhill should be avoided becauseit can exacerbate pain because it puts extra stress on your knee.




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at risk area: feet

plantar fasciitis

what is it? Plantar fasciitis occurs when the thick band of tissue on the bottom ofthe foot is overstretched or overused. According to a 2012 study published in SportsMedicine , plantar fasciitis is one of the main general running-related musculoskeletal

injuries.

what causes it? Long distance runners and runners who have foot arch problemssuch as at feet and high arches may experience this injury. Plantar fasciitis iscommonly known as an injury that causes small tears in or in ammation of thetendons and ligaments that extends from a runner’s heel to his or her toes. However,according to a 2006 review published in Physical Medicine and Rehabilitation Clinics ofNorth America, studies have suggested that plantar fasciitis is more of a degenerativeprocess rather than in ammation.

symptoms: Plantar fasciitis typically presents itself as heel pain from weight bearingactions . The heel pain may be dull or sharp. The bottom of the foot may also acheor burn. The worst pain is experienced with the rst steps in the morning or early inrunning. However, the pain often lessens with activity.

additional treatment tips: Try heel and foot stretching exercises before gettingout of bed. For example, stretch your foot by exing it up and down ten times beforestanding. Stretching or massaging before standing up can often reduce the pain.Also try to stretch before running to warm the foot and arch, which can help reducediscomfort early in the activity.

achilles tendinitis

what is it? Achilles tendinitis is when the Achilles tendon that connects the back ofyour leg to your heel becomes swollen and painful near the bottom of the foot.

what causes it? Achilles tendinitis may be more likely to occur if one is running onhard surfaces such as concrete, running too often, or wearing shoes with improper

support while running.

symptoms: Achilles tendinitis is characterized by pain in the heel and along thetendon when walking or running. The area may feel painful and sti in the morning. Inaddition, moving or touching the tendon may be painful. The area may also be swollenand worn. Standing up on one toe may be di cult to do. addition treatment tips: Stretching should be incorporated to improve theexibility of the calf muscles. For example, try a “wall stretch” where you stand facinga wall from several feet away. First, stagger your stance, placing one foot forward.Second, lean forward and rest your hands on the wall, keeping your heel, hip and headin a straight line. Attempt to keep your heel on the ground. Hold for ten to 20 secondsand then switch sides. Maintaining strength and exibility in the muscles of the calfwill help reduce the risk of tendinitis. Surgical treatment is frequently needed in the

event of complete rupture. It may take at least two to three months for the pain to goaway.

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delightful

Deliciously crafted, healthy dessertoptions can satisfy the vanilla lovers,the fruity avored fanatics, andeven the chocoholics. Healthy andgratifying ingredients can be combinedto satiate consumers’ taste buds andraise consumers’ spirits. Althoughdesserts can provide nutrients, theyshouldn’t replace meals or snacks.Alona Zerlin, MS, RD, and dietitian IIat the UCLA Department of Medicine,Center for Human Nutrition, stressesthe importance of eating desserts onlyafter substantial meals like dinner. Themeal consumed prior to the dessert canhelp lower the sugar load of the dessertwhile preventing the consumptionof too much dessert. The key toconsuming sweets is to eat them inmoderation and to incorporate healthyingredients when doing so.

desserts

the effect of desserts on moodDesserts have a potential mood boosting e ect.In a 2011 study in the Journal of BiologicalRegulators and Homeostatic Agents , the emotionalstatus and digestive process of one hundredindividuals who consumed a co ee- avorediced dessert was examined. A psycho-emotionalquestionnaire, which measured the subject’sbase emotional pattern, showed an associationbetween an increase in mood and pleasantdigestibility and palatability. The results found inthis study showed a positive correlation betweenpleasure from consuming an agreeable product

and the subject’s emotional status. In all, thisstudy unsurprisingly suggests that eatingsomething you nd delicious can improveyour mood . In addition to a possible moodimprovement related to the mind, the bodycan obtain nutrients from the consumption of ahealthy dessert.



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dark chocolateDark chocolate is typically composed ofcocoa, sugar, vanilla, and lecithin, a fatty

substance. Dark chocolate, unlike milkand white chocolate, usually doesn’t haveany added milk products. Some darkchocolate bars show a percentage of cocoaon their wrappers indicating the amountof ingredients that actually stem from thecocoa bean. This percentage is importantto consider. Typically, the higher thepercentage of cocoa in the bar, the healthierthe bar is.

BENEFITS:

antioxidantsCocoa beans are a naturalsinkhole for avanols, anatural antoxidant compoundfound in plants. Like otherantioxidants, they aid inrepairing damage to the bodyand protecting the bodyfrom environmental toxins.According to a 2008 studypublished in the Journal ofThrombosis and Thrombolysis ,the positive e ects of darkchocolate on cardiovasculardisease (CVD) may be due toits large antioxidant capacityand avonoid concentration .

Some potential mechanismsinvolved in the preventionof CVD include antioxidants’antihypertensive (prevention ofhigh blood pressure) and anti-thrombotic (prevention of bloodclotting) e ects.

anti-inammatory effectsDark chocolate may have anti-in ammatory e ects, whichcan be protective againstcertain diseases related tochronic systemic in ammation

such as obesity, diabetes,digestive system diseases,and Alzheimer’s disease. According to a study conductedfrom 2005 through 2007and published in The Journalof Nutrition , the percentageof adult subjects with bloodconcentrations of C-reactive

protein (CRP), a protein withinthe blood that rises in response

to in ammation, was found tobe higher in subjects that didnot consume dark chocolatecompared to those whodid. This suggests that darkchocolate may play a positiverole in modulating in ammationin the body.

TYPES TO LOOK FOR:

When shopping for chocolate,go dark. Scoping out the lesscommercialized, natural darkchocolates high in cocoa isimportant when trying tomaximize nutrients. Accordingto the University of Michigan’shealth system, consumersshould look for dark chocolatethat contains at least 60%cocoa. It is also suggestedthat consumers look for cocoamade from cocoa butter insteadof palm and coconut oils.According to the Universityof Michigan Health System,the saturated fat within cocoa

butter has been shown to havea neutral e ect on cholesterolunlike the saturated fat foundin both palm and coconut oils. Ifa chocolate bar meets theserequirements and also containsnuts, then this is just an addedbene t.

why choose dark chocolate?

It’s loaded with antioxidants: cocoa’santioxidant capacity and avanoidcontent were found to be greaterthan those of red wine, green tea,black tea, milk chocolate, apples,and cranberry juice , according to a2003 study published in the Journal ofAgricultural and Food Chemistry, a 2006systematic review published in Nutritionand Metabolism , and a 2008 studypublished in the Journal of Thrombosis

and Thrombolysis . In fact, it was foundthat cocoa’s avonoid content andantioxidant capacity was about:

› two times that of red wine.› two to three times that of green tea.› four to ve times that of black tea.› equivalent to that of vitamin C.› two and a half times that of milk chocolate.

why not milk chocolate?

According to a 2006 systematic reviewpublished in Nutrition and Metabolism ,milk is thought to inhibit the absorptionof avanoids in the intestines, soselecting dark chocolate over milkchocolate may lead to better avonoidabsorption.




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berry bowlsBerries can be paired with a sweettopping of honey, low fat or nonfat milk,

or yogurt to make for a tasty, nutritiousdessert. These fruits are sinkholes formany essential nutrients like potassium,dietary ber, vitamin C, and folic acid.In order to receive the ideal healthbene ts from berries, the ArthritisFoundation recommends consumingtwo to three types of fresh, dried, orfrozen berries every day.

BENEFITS:

folic acid and vitamin CAccording to the ArthritisFoundation, strawberries arehigh in folic acid, a type of

vitamin B that helps formhealthy, new cells . As for vitaminC, one cup of strawberriescontains more vitamin C than amedium orange. Vitamin C helpswith the growth and repair ofbody tissues along with themaintenance of healthy teethand gums.

antioxidantsAccording to the ArthritisFoundation, blueberries containanthocyanin , an antioxidant that

gives fresh fruits their vibrantcolors. Whereas other fruitstypically contain fewer typesof anthocyanin, blueberrieshave 20 di erent types. Moreanthocyanin means moreantioxidants and potentially moreantioxidant-related bene ts.According to a 2008 reviewpublished in the Journal ofAgricultural and Food Chemistry ,these compounds may positivelyin uence human health.According to this review, these

compounds may also metabolizeenzymes and counteract DNAoxidative damage .

berBerries supply dietary ber thatcan help with bowel function aswell as aid in the reduction ofblood cholesterol and help keepindividuals full. Additionally,

according to a 1994 studypublished in The American Journalof Clinical Nutrition, dietary berhelps to regulate digestion and

prevent constipation. Fiberhas also been associated withreduced blood pressure anda lower risk of coronary heartdisease. According to the ArthritisFoundation, blackberries,raspberries, and boysenberriescontain eight grams of ber percup.

TASTY TIPS:

Drizzling berries with anti-bacterial and anti-in ammatoryhoney can add taste and healthbene ts to a fruit bowl. Soakingberries in a bowl full of low-fator nonfat milk with a naturalsweetener like honey, makes atasty concoction. For a crunchyaddition, add low-fat granola.

L E F T : A N G I E P H O T O S / I S T O C K P H O T O ; R I G H T : K I R I N

_ P H O T O / I S T O C K P H O T O



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immunityA 2006 study in InternationalMicrobiology investigated the e ectsof di erent probiotic strains onimmunity and found that standardyogurt and a fermented productcontaining two new probioticstrains enhanced the immunesystem . Both products increased theactivity and number of phagocytes,cells that play an essential role in theimmune response.

CUSTOMIZE:

To customize yogurt, pair it with afavorite fruit or high- ber breakfastcereal. Other tempting toppingsinclude fresh-cut strawberriescombined with vanilla extract,pineapple, shredded coconut, andorange slices mixed with naturalorange marmalade. For a crunchytopping, add low-fat granola or darkchocolate bits.

yogurtThe grocery store o ers an immenseamount of yogurt options. In order tokeep your consumption of saturated fatlow while still receiving the bene ts ofdairy, low-fat or non-fat dairy productsare optimal. Low fat yogurt contains lesssaturated fat and cholesterol, with thesame amount of nutrients as regularyogurt.

BENEFITS:

calcium and proteinCalcium is a mineral needed tomaintain strong bones, enablemuscle movement, and help sendmolecular signals throughout thebody. Protein is a macromoleculeessential for the structure, function,and regulation of the body’s cells.Both calcium and protein canbe found in yogurt. According toWebMD one cup of nonfat “lite”raspberry yogurt contains 350 mg ofcalcium and eight grams of protein.This provides a third of one’s daily-recommended calcium intake as wellas 17% of one’s protein intake.

cholesterol-lowering effectA 2009 study in the Annals ofNutrition and Metabolism dealingwith mildly to moderatelyhypercholesterolemic subjectssuggested that probiotic yogurtmay reduce cholesterol levels. Thisstudy found that the consumptionof probiotic yogurt showed asubstantial decrease in totalcholesterol in comparison tostandard yogurt.



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For 24/7 health information and events on campus, check out our website: www.healthy.ucla.edu




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DECODING THE NUTRITION LABEL

what is it?

There is increased interest in nding sugar substitutes that donot pose the same risk of excess calories as sugar does. Onesource of interest is the stevia plant, which is native to SouthAmerica and has been used there as a sweetener for food andbeverages throughout history .

There are at least eight sweet components in the stevialeaves, collectively known as steviol glycosides. Glycosidesare molecules composed of a sugar and a non-sugar substance.These glycosides are extracted through a process similar tosteeping tea leaves. Two of the known components found instevia leaves, stevioside and rebaudioside A (Reb A) , are thesweetening compounds found in stevia-based sweetenersused today. Stevioside can be 100 to 300 times sweeter thansucrose (cane sugar), and Reb A can be 250 to 450 timessweeter than sucrose. The US Food and Drug Administrationannounced in 2009 that the use of highly puri ed steviosideand Reb A is “Generally Recognized as Safe (GRAS)” whenconsumed in proposed amounts.

health effects of steviol glycosides

› A 2003 study published in Clinical Therapeutics found thatwhen given 500 mg of stevioside three times daily for twoyears, adults with mild hypertension showed a signi cantdecrease in blood pressure compared with those given aplacebo. While this amount is large compared to what a typicalconsumer would use as a tabletop sweetener, stevioside’spossible health e ects may instigate further studies toinvestigate its use in potential treatments for high bloodpressure .› In a 2005 study published in Hormone and MetabolicResearch, diabetic rats given three doses of 0.2 mg/kgstevioside per day for ten days showed an improvement ininsulin sensitivity . An increase in sensitivity to insulin allows

glucose to be used and stored more e ciently.› In a 2010 study published in Appetite , when three groupsof subjects were given pre-meal snacks sweetened with eitherstevioside, aspartame (a synthetic non-nutritive sweetener), orsucrose, there was no signi cant di erence in degree of hungerat their next meal. Since both stevioside and aspartame arecalorie-free, subjects who consumed snacks containing thesecompounds consumed fewer calories than subjects in thesucrose group, and had the same level of hunger at the nextmeal as the sucrose group. Thus, stevioside may be bene cialin reducing calorie intake and aiding in weight loss .

Although there have been some health concerns regardingthe genotoxicity (measure of a substance’s ability to causegenetic mutation) of steviol glycosides, a recent 2013 reviewpublished in Food and Chemical Toxicology has evaluatedthe validity of studies that have posed these concerns andalso of more recent studies determining the safety of steviolglycosides. The review concluded that studies that foundpositive results in causing mutation were either poorlysummarized or performed using high concentrations of

steviol glycosides that are atypical of an average person’sconsumption .

The review also evaluates several laboratory analysesperformed after 2008 that contributed to the FDA’s approvaland follow the Organization for Economic Co-operation andDevelopment (OECD) guidelines. In a 2009 comprehensivestudy published in Food and Chemical Toxicology , Reb A wasfound to be non-mutagenic (did not show the ability to causemutation). The 2013 review states that one can con dentlyapply this study to stevioside because all steviol glycosides aremetabolized in a similar manner.

Therefore, the FDA does not object to consumption ofstevioside and Reb A so long as consumers yield tothe acceptable daily intake (ADI) of 0 to 4 mg/kg bw/d(milligrams per kilogram of body weight per day) or about 29packets of stevia-based tabletop sweeteners such as Truviaor PureVia for a 150 lb person .

In a 2010 review published by the Yale Journal of Biologyand Medicine , non-caloric sweeteners were shown to falselyactivate reward systems in the brain and contribute toincreased appetite and an increased craving for sweets. This,in turn, may contribute to weight gain. Thus, there is concernin using arti cial sweeteners because repeated exposureincreases one’s preferences and cravings for sweetness .

Stevia is commonly used as an alternative sweetenerwith both potential health benets and risks.Although there have been some health concerns, theFDA has deemed stevia-derived products as GRAS.A key requirement in the testing of stevia derived

products is the percent purity (percentage of purestevioside or Reb A) of the product. In the GRASnotices, the products were deemed generally safe forconsumption so long as the highly puried steviosideand/or Reb A composed at least 95% of the product.You can make sure the stevia-derived product you useis on the GRAS list by visiting the FDA website. t w L E

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health concerns

stevia |

Stevioside has been studied for its possible health e ects inhypertension, type II diabetes, and obesity.

Although Reb A is the most preferred among the steviolglycosides for its sweetness potency and least o -taste,it can be bitter at high concentrations. Thus, stevia basedsweeteners are often blended with other non-caloricsweeteners such as aspartame, sucralose, and saccharin, as

well as caloric sweeteners such as sugar alcohols .

how do stevia-based sweeteners taste?



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We would like to acknowledgethe following people for theircontributions to this edition. Wewould also like to make specialmention of the following UCLAphysicians, professors andfaculty members who donatedtheir time and expertise toensuring the accuracy ofcontent published in thefollowing articles:

q&aMichelle Hoh , MD, Associate ClinicalProfessor of Medicine, UCLA Family

Medicine Practice, Iris Cantor/UCLAWomen’s Health Center

running outdoors vs. runningon a treadmillElisa Terry , NSCA-CSCS, FITWELLServices Program Director, UCLARecreation

a study on bloody nosesLeah FitzGerald , RN, FNP-C, PhD,Assistant Professor, UCLA School ofNursing

ways to wake upTalin Babikian , PhD, ABPP ClinicalNeuropsychologist and AssistantClinical Professor, David Geffen Schoolof Medicine at UCLA

salad savvy: a guide to“green” eatingSusan Bowerman , MS, RD, CSSDAssistant Director, UCLA Center forHuman Nutrition

hear this: how to properly

clean your earsAlison Grimes , AuD, Head of AudiologyClinic at UCLA Medical Center,Assistant Clinical Professor in Headand Neck Surgery

the nail les: preventing anddecoding your nails’ puzzlingappearanceLeah FitzGerald , RN, FNP-C, PhD,Assistant Professor, UCLA School ofNursing

clear waters: lters to purifyyour waterHannah Landecker , PhD, AssociateProfessor, Institute for Society andGenetics, Department of Sociology,UCLA

mindful runningElisa Terry , NSCA-CSCS, FITWELLServices Program Director, UCLARecreation

delightful dessertsAlona Zerlin , MS, RD, ResearchDietitian, UCLA Department ofMedicine, UCLA Center for HumanNutrition

decoding the nutrition labelSusan Bowerman , MS, RD, CSSDAssistant Director, UCLA Center forHuman Nutrition

copy-edits and review Julie Escobar , Chalisa Prarasri , andShannon Wongvibulsin

layout revisionsBarbara Wong , Shannon Wongvibulsin ,and Karin Yuen

cover & table of contentsDesigned by Barbara Wong & Shannon Wongvibulsin

R

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