scan layout final072408mich el a d on , sr dc [email protected] co-directors, wellness /cv rds...

Winter 2011, Vol. 30, No. 1

■ CONTENTS

1Emotional Brain Training for TreatingObesity, Eating Disorders, and Stress

3From the Editor

527th Annual SCAN Symposium

6CPE article:Lutein and Zeaxanthin: EssentialNutrients for Eye Protectionand Visual Performance

11Influence of Vitamins E and C onthe Recovery from an Anterior Cruciate Ligament Injury and Surgery

14Worksite Health Promotion: Beyond “Biggest Loser” Challengesand T-shirts

17From the Chair

17Conference Highlights

19Reviews

20Sports Dietetics-USA Research Digest

22SCAN Notables

23Of Further Interest

24Upcoming Events

Treatments of obesity, eating disor-ders, and symptoms of stress arechanging. In this era of the brain, dis-coveries in neuroscience are siftingdown to the practice of dietetics. Thebrain can be conceptually dividedinto the thinking brain (neocortical)and the emotional brain (limbic andreptilian), and in our role as dietitians,we can impact the neocortical brainby providing clients with objectiveinformation on how and why theyshould alter their eating behaviors toimprove their health. However, whenthe emotional brain is in stress, fol-lowing through and complying withthose recommendations can be chal-lenging.

Emotional brain training (EBT)emerged from neurobiological dis-coveries that emotional circuits in thebrain were plastic and could berewired by experiences.1 The EBTmethod trains individuals to processdaily life stress more effectively byrewiring emotional circuits of self-regulation as a means to improveself-regulation and access to naturalrewards. This potentially offers a strat-egy to promote lasting improve-ments in stress symptoms. Withpsychological stress2-4 and stress-related conditions5-6 affecting many

S C A N ’ SPu lseEmotional Brain Training for TreatingObesity, Eating Disorders, and Stressby Laurel Mellin, MA, RD

individuals in the United States, theimplementation of evidence-based,neuroscience-centered interventionsto decrease stress could significantlyimpact public health. While healthcare has traditionally treated stresssymptoms as the problem and reliedheavily on medications, devices, andprocedures, EBT represents a newparadigm in health care: a focus ontreating the source of the stress itselfby wiring the emotional brain.

The History of EBT

We have long recognized that know-ing what to eat does not necessarilytranslate into lasting food behaviorchanges. Early in the development ofthe EBT method, our team at the Uni-versity of California, San Francisco(UCSF) became aware of the work ofHilde Bruch, a psychiatrist from Bay-lor College of Medicine who pub-lished a paper in 1940 showing that achild’s risk of developing obesity waslargely influenced by interactionswith his/her parent(s). According toBruch, children who were not ade-quately nurtured and those with lim-its that were either too harsh or toolax had an increased risk of obesity.We began teaching responsive par-enting skills at the UCSF clinic and

overeating flash across the brain intime measured in ten thousandths ofa second. Who can be responsible forwhat happens in that time frame? InEBT we recognize that all emotions,thoughts, and behaviors are juststrings of neurons that are continu-ally potentiated.9

By turning our attention to thewiring, we can go to the root cause ofa chronic stress response. What holdsus in a sense of safety in this worldare our homeostatic circuits (the neu-ronal circuits of self-regulation) thattake us through a stressful momentand carry us back to our natural stateof well-being. The allostatic circuits,on the other hand, do not have inter-nal self-correcting mechanisms, sothe stress buzzer gets stuck in the“on” position.10 In allostatic states, thebrain reward circuitry cannot accessthe natural rewards. The brain is re-ward-driven, and defaults to access-ing artificial rewards that promotechemical highs and lows rather thanthe natural rewards, which are sus-tainable and adaptive (e.g., intimacy,spirituality exercise, music, dance). InEBT, we teach people how to identifyand weaken or erase allostatic cir-cuits and how to identify andstrengthen homeostatic circuits.

Concept 2: Wiring TriggersBrain States

When a wire is triggered, the brain re-sponds by shifting the area incharge.11 The lower-order areas reactquickly, so the brain defaults to them

2 | SCAN’S PULSEWinter 2011, Vol. 30, No. 1

observed that many of the childrenstopped wanting extra food. We ap-plied a similar intervention—The So-lution Method—to patients withadult obesity and stress symptoms.

More recently, brain imaging studieshave shown that the brain is highlyplastic and changes with experience.The response to daily life—self-regu-lation—is so integral to survival thatit is stored in unconscious memorysystems. Although most people re-port that they use exercise, read thepaper, or employ other means to easestress, the regulatory processing ofdaily life is an ongoing process,guided by wiring stored in the emo-tional brain. The strategy of EBT is toimprove the effectiveness of thatwiring.

Several reports of the efficacy of EBThave shown sustained beneficial ef-fects during and after treatment forobesity, blood pressure, blood sugar,depression, and exercise.7,8 Thus, theEBT method is grounded in axiomaticphysiology and there is evidence ofits health-promoting effects. This arti-cle reviews the four concepts of EBTand describes the method’s clinicalapplication to stress-related condi-tions, including obesity and eatingdisorders.

Concept 1: It’s Not Us, It’s Our Wiring

Instead of focusing on that doughnutand why one ate it, go deeper. Focuson the wires. The wires that trigger

ADA Dietetic Practice Group of Sports, Cardiovascular, and Wellness Nutrition (SCAN)

SCAN Web site: www.scandpg.org

SCAN OfficeKaren S. Cervenka, Executive Director1520 Kensington Rd., Suite 202Oak Brook, IL 60523800/249-2875; 866/381-7288 (fax) [email protected]

Chair Tara Coghlin-Dickson, MS, RD, [email protected]

Chair-Elect D. Enette Larson-Meyer, PhD, RD, CSSD, [email protected]

Past ChairGale Welter, MS, RD, CSSD, [email protected]

SecretaryKarla Campbell, MS, RD, [email protected]

TreasurerKathy B. Johnson, RD, MBA, [email protected]

Communications DirectorAdrienne Davenport, MPH, [email protected]

Continuing Education DirectorLynette Maxey, RD, [email protected]

Development DirectorHope Barkoukis, PhD, RDHope. [email protected]

Member Services DirectorCheryl Toner, MS, [email protected]

Chair, 2011 SymposiumEllen Coleman, MA, MPH, RD, [email protected]

Director, Disordered Eating & Eating Disorders Subunit Christina Scribner, MS, RD, [email protected]

Director, Sports Dietetics-USA SubunitMichele Macedonio, MS, RD, [email protected]

Co-Directors, Wellness /CV RDs Subunit Carol Lapin, MS, RD, [email protected]

Sharon Smalling, MPH, [email protected]

Editor-in-Chief, PULSE Mark Kern, PhD, RD, [email protected]

Web Editor Marie Dunford, PhD, [email protected]

DPG Delegate to ADA HOD Jenna Bell, PhD, RD, [email protected]

DPG Relations ManagerSusan [email protected]

Table 1. Emotional Brain Training (EBT) Five-Point System of Emotional and Behavioral Regulation: The five brain states Copyright ©2010 Laurel Mellin, Wiredfor Joy (Hay House). Reprinted with permission.

Stress Brain State Perception

1 Joyous 2 Balanced 3 A Little Stressed 4 De�nitely Stressed 5 Stressed Out!

As stress increases, the more primitive areasof the brain become dominant.

The Five Brain States

SCAN’S PULSEWinter 2011, Vol. 30, No. 1 | 3

when stress mounts. These moreprimitive areas of the brain experi-ence more extreme and maladaptivethoughts and behaviors. All aspectsof life are predictably affected, andeven though the specific characteris-tics vary, the extent to which they aremaladaptive remains the same. Asummary of these characteristics ap-pears in Table 1.

In Table 2, the numbers on the left in-dicate the five brain states. BrainState 1 occurs when a person is re-laxed and his/her reward circuitry is

balanced. In this state, eating a crisp,red apple is rewarding. The drive forsugary, fatty food is low and moodsare positive as the neocortex is incharge. As stress mounts the statechanges to Brain State 5, a full-blownstress response. In this state, theprimitive brain is in charge and thedrive for artificial rewards ramps up.Moods are negative.

The fact that wiring triggers brainstates that are internally consistentsupports the potential efficacy oftreating the brain state rather than

treating the characteristic of thatbrain state. For example, the interven-tion for compulsive eating (a symp-tom of a brain state) may be quitenarrow in traditional care, but in real-ity the compulsive eater’s drive forfood may be driven by various cir-cuits activated in that brain state—emotional, cognitive, and behavioralcircuits—all of which impact the ef-fectiveness of the intervention. Bytreating the brain state, a broaderspectrum of improvements mayoccur, potentiating the effectivenessof the intervention.

Concept 3: Brain States Become Persistent

The brain equates familiarity withsafety. Therefore, if an individual isfrequently in a brain state of stress,the brain misinterprets stress asgood, because it is familiar. For suchindividuals, the brain can easily getinto the “stress habit,” and in time therepeated episodes of stress increaseallostatic load—the wear and tear onthe mind and body caused by eachstress episode. The emotional setpoint of the brain can remain stuck inan allostatic state. The problem is notthe symptom of stress (e.g., overeat-

From The Editor

Mark Kern likes this.

by Mark Kern, PhD, RD, CSSD, Editor-in-Chief

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

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

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

Table 2. The Emotional Brain Training (EBT) Five-Point System of Emotional andBehavioral Regulation: Brain state characteristics. Copyright ©2010 Laurel Mellin,Wired for Joy (Hay House). Reprinted with permission.

The EBT Brain States Thoughts Feelings Relationships Spirituality Behavior

1 –Abstract Joyous Intimate Connected Optimal

2 – Concrete Balanced Companionable Aware Healthy

3 – Rigid Mixed Social Unaware Moderate

4 – Reactive Unbalanced Needy/Distant Disconnected Unhealthy

5 – Irrational Overwhelmed Merged/Disengaged Lost/Obsessed Destructive


ing, smoking, inactivity) but a brainthat is wired for stress.

Concept 4: We Can Change Our Wiring

If the root cause of the problem is ourwiring and if we know that the emo-tional brain is plastic12 and canchange through experiences, whynot target the neurobiological sourceof the chronic stress symptoms? Whynot support clients in learning thetools to rewire their own emotionalbrain? We can do that, but it will bechallenging because it requires a par-adigm shift. We have to learn the newtools, and not everyone will agreewith us. Yet the reward lies in attend-ing to the root cause—and that ispowerful.

Emotional brain training is remark-ably simple, but not easy. In EBT, indi-viduals learn to identify their brain

state on a five-point scale. For eachstate, a different brain area is domi-nant, requiring a different process inthe brain to return to optimal states.Clients learn how to identify theirbrain state and switch it back tostates of well-being. The tools mirrorthe evolutionarily-based processingof stress in a secure attachment.13 Thetraining offers lifestyle changes, ap-propriate use of health care, and afocus on changing the wiring in theemotional brain to promote lastingpost-treatment improvements instress-related outcomes.

Clinical Practice

EBT is administered to patientsthroughout a four-week introductorycourse; six additional courses for ad-vanced cases are also available. Theinitial course provides training in howto identify one’s brain state and

facilitate switching each state tohomeostasis. Some complete onlythe initial course because their emo-tional set point is in a higher stateand can be changed relatively easily.However, if the set point is in the allo-static range (Brain States 3- 5), morefocused and intensive practice overtime is typically required for signifi-cant improvements to occur. The ad-ditional courses utilize EBT kits,workbooks, pocket reminders, andaudio programs to allow for ad-vanced practice. All courses are facili-tated by certified EBT providers.These health professionals hold smallgroup (8 to 10 people) training sessions for 90 minutes weekly.

In recent years the program has ad-dressed changing learning styles andneeds, utilizing briefer workbooksand the addition of video training, social networking, and Web-basedtools. The goals are to create a robust

community and enhance the emo-tional salience and fun of the train-ing, both of which increasedopamine, which facilitates neuro-plasticity. For participants who com-plete the entire advanced program,the duration of training is approxi-mately one year and the goal is torewire the brain for the homeostaticstate (Brain State 1), in which onereaps an abundance of natural re-wards and, within the limits of genet-ics and choice, has freedom fromvarious external solutions (addictionsand compulsions).

Clinical Applications for Eating Disorders and Obesity

Most participants in EBT have experi-enced eating or weight issues. Thetreatment of both types of issues hasbeen integrated into advanced EBTcourses. The lifestyle component

focuses on physical activity, nutrition,sleep, meditation, and intimacy. Thefood system used in EBT is based onstress and reward, with participantsidentifying foods that ease stress andthose that increase it. It reflects a newemphasis on the addictive nature offood.

In using EBT to treat obesity and eat-ing disorders, one challenge is orient-ing participants to this newparadigm that asserts that obesitycan be a symptom of an allostatic setpoint and treatment involves chang-ing the set point. As the set pointchanges, the circuitry that promotesthese symptoms will be reconsoli-dated. By moving up the emotionalset point to states of balance and re-ward, a range of beneficial effectsmay result.

Among the most promising clinicalstrategies we have identified isrewiring circuits that form maladap-tive attachments. Rewiring “survivalcircuits” is a three-stage process, be-cause these circuits were encodedduring a full-blown stress response.The brain can create a false associa-tion between survival and some ex-ternal solution such as sugary food.The more a person attempts tochange the behavior without ad-dressing the emotional drives for thatbehavior, the more stressed an indi-vidual may become. That amplifiedstress can trigger the same circuitthat caused the overeating to beginwith. Instead of trying to suppressthe symptom in clients, we focus onturning their attention to erasing thecircuit14 that triggers those unstop-pable drives.

The goal is not just behavioral com-pliance, but the experience of notwanting or needing the extra food. Inthis method, the clinical strategy is toreframe the overeating as the reflec-tion of a wire and then to rewire thecircuit, instead of forcing behavioralchange, so that the drive to overeatfades.

.

5. Dallman, MF. Stress-induced obe-sity and the emotional nervous sys-tem. Trends Endocrinol Metab.2010;21:159-165.

6. AdamTC, Epel ES. Stress, eating andthe reward system. Physiol Behav.2007;91:449-458.

7. Mellin LM, Slinkard LA, Irwin CE, Jr.Adolescent obesity intervention: vali-dation of the SHAPEDOWN program.J Am Diet Assoc. 1987;87:333-338.

8. Mellin LM, Croughan M, Dickey L.The Solution Method: 2-year trends inweight, blood pressure, exercise, de-pression and functioning of adultstrained in developmental skills. J AmDiet Assoc. 1997;97:1133-1138.

9. Hebb DO. The Organization of Be-havior: A Neuropsychological Theory.New York City, NY: Wiley Publishing;1949

10. McEwen BS, Wingfield JC. What isin a name? Integrating homeostasis,allostasis and stress. Horm Behav.2010;57:105-111.

11. Perry BD. The memories of states:how the brain stores and retrievestraumatic experience. In: GoodwinJM, Attias R, eds. Splintered Reflections:Images of the Body in Trauma. NewYork City, NY: Basic Books, Inc.; 1999,pp 9-38.

12. Bowlby J. A Secure Base: Parent-Child Attachment and Healthy HumanDevelopment. New York City, NY: BasicBooks, Inc.; 1988.

13. Schiller D, Monfils MH, Raio CM, etal. Preventing the return of fear in hu-mans using reconsolidation updatemechanisms. Nature. 2010; Jan 7;463:49-53.

14. Ecker B, Toomey R. Depotentiationof symptom-producing implicitmemory in coherence therapy. J Con-struct Psych. 2008;21:87-150.

Concluding Remarks

Emotional brain training offers a neuroscience-based intervention inwhich registered dietitians and otherhealth professionals use positiveemotional plasticity to rewire theemotional brain to favor states of bal-ance and positive emotions. Regis-tered dietitians who are experiencedand trained in psychological toolsand counseling can become certifiedin the method and can facilitategroup training and coaching in themethod. This method represents anew paradigm in health care with thegoal of promoting broad spectrum,persistent improvements in a rangeof stress-related variables.

For more information about EBT research and certification, visitwww.ebt.org. A new book on EBT,Wired for Joy (Hay House, 2010), isavailable and the previous New YorkTimes bestseller, The Pathway, is alsorelevant to RDs.

Laurel Mellin, MA, RD, is an associateprofessor of family and communitymedicine and pediatrics at the Univer-sity of California, San Francisco and director of the university’s EmotionalBrain Training Center of Excellence, thenational coordinating center for re-search on EBT. She also directs The Insti-tute for Health Solutions, whichsponsors certification training in EBT,and is author of Wired for Joy (HayHouse, 2010).

References1. Mellin LM. Wired for Joy: A Revolu-tionary Method for Creating Happinessfrom Within. Carlsbad, CA: Hay House;2010.

2. Cohen S, Janicki-Deverts D, MillerGE. Psychological stress and disease.JAMA. 2007;298:1685-1687.

3. McEwen BS. Protective and damag-ing effects of stress mediators. N EnglJ Med. 1998;338:171-179.

4. van Praag HM, de Koet ER, van Os J.Stress, the Brain and Depression. Cam-bridge, UK: Cambridge UniversityPress; 2004.


27th Annual SCAN Symposium

Optimizing Performance, Wellness, and Health Through Nutrition

March 11-13, 2011Chicago, IL

SCAN’s 27th Annual Symposium promises to offer a fantastic education andnetworking experience for SCAN members and nonmembers alike.

■ Keynote speakers include sought-after experts Louise Burke andJohn Hawley. They will be joined by high-caliber invited speakers, including Stuart Phillips, Dan Riley, David Nieman, Ruth DeBusk, PhilMehler, Bob Murray, Doug Casa, Stella Volpe, and Jackie Buell.

■ The program will also feature pre-Symposium workshops from our three subunits: Sports Dietetics-USA, Wellness/CV RDs, and Disordered Eating & Eating Disorders.

For more details and to register, visit SCAN’s Web site (www.scandpg.org).Also, be sure to follow SCAN on Twitter (@SCANutritionDPG) and Facebook(SCAN: Sports, Cardiovascular, and Wellness Nutrition) for the latest updates.

Join Your Colleagues at this Must-Attend Event!

This article is approved by the Commis-sion on Dietetic Registration (CDR) for 1continuing professional education unit(CPEU), level 1. To apply for free CPEcredit, obtain a question/answer sheetthrough one of the following methods:(a) download it from SCAN’s Web site(www.scandpg.org), or (b) request itfrom the SCAN Office via phone:800/249-2875; fax: 866/381-7288; or e-mail: [email protected].

Learning ObjectivesAfter you have read this article, youwill be able to:■ Describe the functional roles oflutein and zeaxanthin in ocular tissueand their impact on vision.■ Discuss food sources, the bioavail-ability, and the suggested daily intakeof lutein and zeaxanthin.■ Explain how lutein and zeaxanthinconcentrations in macular tissue aremeasured.

Eye health and loss of vision as weage are of great concern, leadingmany to seek preventive measures byobtaining essential nutrients throughdiet and/or supplementation. Luteinand its sister molecule zeaxanthin areconsidered by many health care pro-fessionals to be essential eye nutri-ents needed daily to maintainhealthy vision and help reduce therisk of certain age-related eye condi-tions. Lutein and zeaxanthin arecarotenoids found naturally in darkgreen, leafy vegetables; corn; certainfruits (e.g., oranges, tangerines, gojiberries); and eggs. While lutein andzeaxanthin have traditionally beenassociated with reduced risk of cer-tain age-related eye conditions,emerging research suggests that theoptical and antioxidant properties ofthese nutrients can also improve visual function and performance,


CPE article

Lutein and Zeaxanthin: Essential Nutrients for EyeProtection and Visual PerformanceDiane E. Alexander, PhD, and Robert Wildman, PhD, RD, FISSN

thereby extending important bene-fits to a younger, healthier popula-tion. This article provides an overviewof the growing body of evidence sup-porting the link between levels oflutein and zeaxanthin in the eye andenhanced visual performance, whichis of particular importance to health-

conscious and active people whospend considerable time outdoorsexposed to sunlight.

Functions of Lutein andZeaxanthin

Carotenoids are red, orange, and yel-low lipid-soluble natural pigmentsthat share a common biochemicalstructure. More than 600 carotenoidshave been identified in nature andare produced by plants, algae, andbacteria to provide coloration andabsorb light energy. Humans andother mammals cannot producecarotenoids, even though these mol-ecules provide critical benefits formany organ systems. Therefore,carotenoids must be obtained solelyfrom the diet, and they share a place

on the growing list of nutraceuticalingredients.

Although no reference daily intake(RDI) has been established for mostcarotenoids, a case can be made forconsuming compounds in this classof nutrients every day. Of the 600carotenoids isolated, only a smallsubset is found in a typical humandiet.1 Of these dietary carotenoids,only lutein and zeaxanthin and theirmetabolites are found in the macula,the central portion of the retina re-sponsible for central vision and high-resolution visual acuity, suggestingan important functional role for thesemolecules in the eye.2 The high con-centrations of lutein and zeaxanthinin the macula are responsible for thecharacteristic yellow coloration, giv-ing rise to the term macularpigment.3

In the macula, lutein and zeaxanthinact as a pair of “internal sunglasses.”First, they attenuate short wave-lengths of light in the blue region ofthe visible light spectrum as they ab-sorb light maximally at a wavelengthof 460 nm.4 These wavelengths of vis-ible light are particularly damaging,because they are high energy andcan pass through outer structures ofthe eye such as the lens, which ab-sorbs ultraviolet wavelengths of light.In addition, these visible wavelengthsof high-energy blue light are efficientat generating reactive oxygenspecies (a principle type of free radi-cal) and they contribute to visualglare and photophobia.

The second function of lutein andzeaxanthin is to act as an antioxidantdefense to neutralize free radicals.Both the visible light filtering and an-tioxidant properties of lutein andzeaxanthin enable these moleculesto reduce damage to ocular tissues

.

table).8 Egg yolks provide a highlybioavailable source of lutein, proba-bly because of the associated lecithincontent, even though the lutein con-centration is relatively low.9 Other di-etary sources of lutein andzeaxanthin such as corn and orangescontain esterified forms of these mol-ecules, which are less bioavailable.This is important to note because thebiologically active forms of thesexanthophylls are free of fatty esters.

Following ingestion and absorption,lutein and zeaxanthin are depositedin a number of body tissues includingeye, skin, brain, breast, and cervix.However, lutein is found in the mac-ula at 10,000 times the concentrationof that in serum, and this tissue-spe-cific pooling is likely due to


in 1994.5, 6 The findings from bothstudies indicated that individualswith the highest dietary intake oflutein and zeaxanthin had a 57% riskreduction for AMD.5 Over the past 15years, many more observational stud-ies have supported these findings.7

Food Sources, Bioavailability,and Suggested Daily Intake

Because lutein and zeaxanthin arenot synthesized in the body, theymust be acquired from the diet eitherthrough foods or dietary supple-ments. These carotenoids are fat solu-ble, so their absorption is enhancedwhen consumed with a modestamount of fat. The richest sources oflutein are dark green, leafy vegeta-bles such as kale and spinach (see

that occurs from daily exposure tosunlight, indoor lighting, and environ-mental pollutants. Over time, thisdamage can lead to certain eye con-ditions such as age-related maculardegeneration (AMD) and cataract. Asmentioned previously, people whospend more time outdoors—espe-cially without eye protection—maybe at greater risk for these eye disor-ders than those who minimize theirexposure to sunlight.

The earliest research establishing thelink between lutein and zeaxanthinand eye health consisted of an epi-demiological study from the Eye Dis-ease Case-Control (EDCC) StudyGroup published in 1993 and a fol-low-up by Seddon and colleagues ona subset of EDCC patients published

Table. Food Comparisons (Lutein and Zeaxanthin Content)

Food Common Measure Content per Measure Amount Needed to Obtain 10 mg of Lutein and Zeaxanthin

Kale, cooked 1 c (130 g) 23.7 mg 0.42 c

Turnip greens, cooked 1 c (144 g) 12.2 mg 0.82 c

Collards, cooked 1 c (190 g) 14.6 mg 0.68 c

Spinach, cooked 1 c (180 g) 20.4 mg 0.49 c

Spinach, raw 1 c (30 g) 3.7 mg 2.70 c

Broccoli, cooked 1 c (156 g) 1.7 mg 5.88 c

Corn, cooked 1 c (210 g) 2.2 mg 4.55 c

Lettuce, romaine 1 c (56 g) 1.3 mg 7.69 c

Orange 1 orange (131 g) 0.17 mg 58.82 oranges

Green beans, cooked 1 c (125 g) 0.89 mg 11.24 c

Peach, fresh 1 peach (98 g) 0.89 mg 11.24 peaches

Corn on the cob 1 ear (77 g) 0.7 mg 14.29 ears

Carrots, raw 1 carrot (72 g) 0.18 mg 55.56 carrots

Blueberries, raw 1 c (145 g) 0.12 mg 83.33 c

Eggs 1 large egg (50 g) 0.17 mg 58.82 large eggs

Corn Chex cereal 1 c (30 g) 0.35 mg 28.57 c

Tangerine 1 tangerine (84 g) 0.12 mg 83.33 tangerines

Asparagus 4 spears (60 g) 0.46 mg 21.74 spears

Mustard greens 1 c (140 g) 8.3 mg 1.20 c

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

Based on the information at hand, di-etitians should encourage increasedconsumption of foods and beveragescontaining lutein and zeaxanthin. Al-though the vast majority of researchsubjects show an increase in luteinand zeaxanthin concentrations in themacula when increasing consump-tion of these carotenoids, some indi-viduals show no response; this islikely due to a variety of factors, in-cluding study design, health of theretina, saturation of carotenoid bind-ing proteins, and vehicle (food orsupplement).14 Furthermore, dietarysupplements may benefit popula-

tions where consumption is generallylow and individuals are either unableor unwilling to increase food intakein order to reach levels associatedwith eye health benefits. Supplemen-tation of carotenoids often raisesquestions regarding the impact onrelated nutrients. While some studiessuggest that high-dose carotenoidintake may competitively affect theabsorption of some othercarotenoids, the overall evidence ismixed.

Retinal Measurement ofLutein and Zeaxanthin

How are biological concentrations oflutein and zeaxanthin assessed? Overthe past few years a number of meth-ods for quantifying lutein and zeax-anthin macular tissue concentrationshave been developed. These tech-niques use a surrogate optical indica-tor of xanthophyll concentrations inthe eye: macular pigment opticaldensity (MPOD). MPOD is the meas-urement of the ability of the macularpigment to absorb or filter bluewavelengths of light; it is linearly re-lated to the amount of lutein andzeaxanthin in the macula. There are anumber of different techniques for

lutein- and zeaxanthin-specific bind-ing proteins.10 Increased lutein andzeaxanthin intake from food sourcesor supplements have been shown tosignificantly increase the concentra-tions of these xanthophylls in theserum and macula.7, 11 The most re-cent supplementation studies evalu-ating the benefits of lutein and/orzeaxanthin on eye health have used10 mg or more lutein per day.7 Thisdosage is well below the 2 mg/kg ac-ceptable daily intake (ADI) estab-lished by the Joint FAO/WHO ExpertCommittee on Food Additives(JECFA).12 The ADI is a measure of the

amount of a specific substance infood that can be consumed over alifetime without an appreciablehealth risk. In addition, there are noreported toxic effects of long-termexposure to lutein and zeaxanthinfrom dietary sources or supplementa-tion.

It is difficult to get all the critical eyenutrients from diet alone. In fact,many Americans have low concentra-tions of lutein and zeaxanthin in themacula because their diet is deficientin these nutrients. The average dailyintake of lutein and zeaxanthin in theUnited States from diet alone is esti-mated to be less than 2 mg, far belowintakes clinically proven to reducethe risk of certain age-related eyeconditions.13 Lutein and zeaxanthinconcentrations in the macula natu-rally deplete as people age, so it is essential to maintain proper levels of these eye nutrients every daythrough dietary sources or supple-ments. Studies have shown that thebioavailability of lutein and zeaxan-thin obtained from supplements andfortified foods is similar to that ob-tained from foods that naturally con-tain these nutrients.


measuring MPOD, and optometristsare increasingly recognizing the im-portance of MPOD and offering thistest in their offices.

Nearly half of all Americans have lowMPOD, indicating low concentrationsof lutein and zeaxanthin in the mac-ula.15 Lutein and zeaxanthin intakehas been associated epidemiologi-cally with a protective role againstage-related macular degeneration.Therefore, low MPOD is a risk factorfor AMD, meaning that nearly half ofthe American population—approxi-mately 133 million individuals—maybe at risk for developing AMD later inlife. In addition, risk factors for AMDsuch as older age, female gender,obesity, tobacco use, and family his-tory are associated with lowerMPOD.16 These associations suggestlow MPOD may not confer enoughprotection against light-induced ocu-lar damage, which over time maylead to increased risk of developingage-related eye conditions.

Lutein and Zeaxanthin andVisual Performance

More recently, research has estab-lished that the benefits associatedwith the blue light filtering and an-tioxidant properties of lutein andzeaxanthin extend beyond risk re-duction of age-related eye condi-tions. Macular pigment has beenshown to enhance visual functionand comfort as well. These improve-ments in visual performance may beattributed to biological and/or opti-cal mechanisms of the macular pig-ment. Biological mechanisms mayenhance visual function by improv-ing retinal health through absorbinghigh-energy blue wavelengths oflight and inactivating reactive oxy-gen species. In addition, opticalmechanisms, i.e., preferential absorp-tion of blue wavelengths of light, mayimprove visual function. Thus, MPODcan potentially serve as a biomarkernot only for predicting eye diseaserisk but also for assessing visual func-tion and performance.

Contrast Acuity

The optical properties of yellow in-traocular filters were originally re-viewed by Walls and Judd in 1933based on the observation that theseyellow filters (as opposed to red orgreen) are ubiquitous in nature.18

Such intraocular filters would in-crease visual range and enhance con-trast between an object and itsbackground. The enhancement of vis-ible range by macular pigment wasdescribed by Wooten and Hammondas the visibility hypothesis,15 whichpostulates that macular pigment mayimprove vision through the atmos-phere by preferentially absorbingblue haze (short-wave dominant airlight that produces a veiling lumi-nance when viewing objects at a dis-tance).

The visibility hypothesis was mod-eled empirically, and it was deter-mined that under ordinary daylightconditions subjects with high levelsof macular pigment would be able tosee about 30% farther in comparisonto subjects with little or no macularpigment.15 In a separate study, it wasfound that macular pigment en-hanced contrast, as revealed by indi-viduals with higher MPOD who wereable to better distinguish objects, es-pecially in low-light conditions.19

These benefits regarding contrastacuity are significant to anyone whohas ever struggled to see someonewalking along a dimly lit street or hashad difficulty picking out an object,such as a baseball, in the sky.

Conclusions

An accumulating body of evidencesuggests that the presence of luteinand zeaxanthin in the macula are crit-ical to both protecting the eyeagainst damage from certain wave-lengths of light and improving visualfunction through optical properties.It has been estimated that 43% of theU.S. population has low MPOD lev-els,11,15 suggesting that almost half of

Americans do not consume sufficientamounts of lutein and zeaxanthin intheir diet. Inadequate intake leads toreduced visual function, which formany may manifest as increased sen-sitivity to glaring light or decreasedability to distinguish objects clearly.

Recent studies indicate that lowMPOD is a risk factor for AMD. Ade-quate intake of lutein and zeaxanthinis critically important to increaseMPOD. Individuals can maintain ade-quate levels of lutein and zeaxanthinin the macula through increased con-sumption of fruits, vegetables, andhealthful fats. Because it is often diffi-cult to ensure adequate intake ofthese essential eye nutrients throughdiet alone, supplementation is a vi-able and convenient option for ob-taining 10 mg of lutein and 2 mgzeaxanthin on a daily basis. Such di-etary changes will help promotehealthy vision and may make it possi-ble for people to get closer to reach-ing their maximal visual performance


Glare Relief and Recovery

Blue wavelengths of visible light arescattered to a greater degree thanlonger wavelengths of light, and scat-tered light can produce glare and re-duce contrast in the retinal image.When the glare source is intense andnear the line of sight, it is known as“disability glare” because it can no-ticeably interfere with the visual task.Disability glare can present a signifi-cant hazard to drivers at night be-cause of the bright light fromoncoming headlights. Disability glarefrom the sun also can be a significantchallenge for athletes and outdoorenthusiasts who rely on their visionto help them perform at their best.

Results from a recent study providesupport that high levels of macularpigment reduce disability glare.Stringham and Hammond17 evalu-ated the impact of oral supplementa-tion with 10 mg lutein and 2 mgzeaxanthin daily for 6 months in 40healthy subjects on levels of macularpigment, glare tolerance, and photo-stress recovery time. MPOD increasedsignificantly from baseline after 4months of supplementation. After 6months of supplementation, the sub-jects’ ability to tolerate glaring lightimproved 58% (P < .0001), and thetime to recover sight following expo-sure to bright light (photostress) im-proved by 5 seconds or 14% (P =.0003). The improvements in glare tol-erance and photostress recovery timecorrelated significantly with increasesin macular pigment over the 6months of supplementation.

These data suggest that lutein andzeaxanthin act as an optical filter toabsorb wavelengths of light that re-duce visual function. Such improve-ments in visual performance areimportant for anyone, especially ath-letes. Vision, like speed and strength,is an important component to per-forming at the highest level. Reduc-ing recovery time from glare andenhancing visual function help pro-vide a competitive edge.


16. Nolan JM, Stack J, O’ Donovan O, etal. Risk factors for age-related macu-lopathy are associated with a relativelack of macular pigment. Exp Eye Res.2007;84:61-74.

17. Stringham JM, Hammond B. Macu-lar Pigment and Visual PerformanceUnder Glare Conditions. Optom VisSci. 2008;85:82-88.

18. Walls GL, Judd HD. The Intra-Ocu-lar Colour-Filters of Vertebrates. Br JOphthalmol. 1933;17:641-675.

19. Renzi LM, Snodderly DM, Ham-mond BR, Jr. Reduction of surroundsuppression and enhancement of dis-criminability by macular pigment. In-vest Ophthalmol Vis Sci. 50: E-AbstractA283, 2009.

potential, which is especially impor-tant for athletes and fitness enthusi-asts as they strive to achieve theirmaximal physical performance aswell.

Diane Alexander, PhD, is a technicalservice manager at Kemin Health, inDes Moines, IA, and an author andspeaker focused on educating the med-ical/ scientific community and generalpublic on ocular nutrition. Robert Wild-man, PhD, RD, FISSN, is an assistantprofessor in the Department of Familyand Consumer Sciences at Texas StateUniversity, in San Marcos, TX, and au-thor of several books including The Nu-tritionist: Food, Nutrition & OptimalHealth, Sports & Fitness Nutrition, andThe Handbook of Nutraceuticals &Functional Foods.

References1. Khachik F, Beecher GR, Goli MB, etal. Separation and quantitation ofcarotenoids in foods. Methods Enzy-mol. 1992;213:347-359.

2. Handelman GJ, Dratz EA, Reay CC,et al. Carotenoids in the human mac-ula and whole retina. Invest Ophthal-mol Vis Sci. 1988;29:850-855.

3. Beatty S, Boulton M, Henson D, et al.Macular pigment and age relatedmacular degeneration. Br J Ophthal-mol. 1999;83:867-877.

4. Snodderly DM, Brown PK, Delori FC,et al. The macular pigment. I. Ab-sorbance spectra, localization, anddiscrimination from other yellow pig-ments in primate retinas. Invest Oph-thalmol Vis Sci. 1984;25:660-673.

5. Seddon JM, Ajani UA, Sperduto RD,et al. Dietary carotenoids, vitamins A,C, and E, and advanced age-relatedmacular degeneration. Eye DiseaseCase-Control Study Group. JAMA.1994;272:1413-142

6. The Eye Disease Case-Control StudyGroup. Antioxidant status and neo-vascular age-related macular degen-eration. Arch. Ophthalmol.1993;111:104-109.

7. Literature Review: Macular pigmentand healthy vision. Optometry.2009;80:591-597.

8. Mangels AR, Holden JM, BeecherGR, et al. Carotenoid content of fruitsand vegetables: an evaluation of ana-lytic data. J Am Diet Assoc.1993;93:284-296.

9. Handelman GJ, Nightingale ZD,Lichtenstein AH, et al. Lutein andzeaxanthin concentrations in plasmaafter dietary supplementation withegg yolk. Am. J. Clin. Nutr. 1999;70:247-251.

10. Li B, Vachali P, Bernstein PS. Humanocular carotenoid-binding proteins.Photochem Photobiol Sci. In press;2010.

11. Bernstein PS, Delori FC, Richer S, etal. The value of measurement of mac-ular carotenoid pigment optical den-sities and distributions in age-relatedmacular degeneration and other reti-nal disorders. Vision Res. 2010;50:716-728.

12. Joint FAO/WHO Expert Commit-tee on Food Additives. Lutein fromTagetes erecta specifications preparedat the 63rd JECFA (2004). Food andNutrition Paper 52. 2004;12:35-37.

13. Centers for Disease Control andPrevention. National Center forHealth Statistics. National Health andNutrition Examination Survey Data2001-2002. Accessed Oct. 1, 2010 athttp://www.cdc.gov/nchs/about/major/nhanes/nhanes01-02.htm.

14. Moeller SM, Voland R, Sarto GE, etal. Women’s Health Initiative diet in-tervention did not increase macularpigment optical density in an ancil-lary study of a subsample of theWomen’s Health Initiative. J Nutr.2009;139:1692-1699.

15. Wooten BR, Hammond BR. Macu-lar pigment: influences on visual acu-ity and visibility. Prog Retin Eye Res.2002;21:225-240.

SCAN’S PULSE2009-2010 CPE Reviewers

The SCAN’S PULSE Editorial Board

would like to acknowledge those

who served as reviewers of our

continuing professional educa-

tion (CPE) articles during the

2009-2010 publishing year. Their

review made it possible to offer

SCAN members the opportunity

to earn a total of four free CPE

units from PULSE during this pe-

riod. Our appreciation goes to:

Ursula Hauk, RD

Michele Macedonio, MS, RD, CSSD

Andrea Ogden, RD

William Proulx, PhD, RD

Sarah Schutzberger, RD

Skeletal muscle dysfunction is amajor cause of morbidity in a varietyof pathophysiological and non-pathophysiological conditions. Mus-cle (i.e., quadriceps) dysfunction is apredominant impairment that com-monly follows an anterior cruciateligament (ACL) injury and surgery. Al-though attenuated mechanoreceptorfeedback from a ruptured or surgi-cally repaired ACL contributes tomuscle weakness, it is probable thatother pathophysiological mecha-nisms accentuate muscle weaknessand atrophy following ACL recon-struction. Specifically, oxidative stressinduces muscle weakness and atro-phy in experimental animal studies.

Oxidative Stress and Muscle Dysfunction

Oxidative stress is defined as the im-balance between oxidants and an-tioxidants, in favor of the former,leading to a disruption in redox sig-naling and control and/or moleculardamage.1 Molecular oxygen and ni-tric oxide convert into a variety of re-active oxygen and nitrogen speciesthat are capable of eliciting damage.The causative influence of oxidativestress on muscular weakness is wellcharacterized in isolated musclepreparations and in experimental hu-mans,2 but it is unknown whether ox-idative stress contributes to muscularweakness following an ACL injuryand surgery.

Similar to muscular weakness, muscleatrophy is another predominant im-pairment that continues to challengethe recovery from an ACL injury andsurgery. In experimental animal stud-ies, oxidative (or nitrative) stress oc-curs during various forms of disuseatrophy.3 The ability of vitamin Etreatment (intraperitoneal or intra-muscular injections) for diverse atro-phy-inducing conditions4-7 or for the


maintenance of antioxidantdefenses8 to ameliorate oxidativestress and disuse atrophy establishesthe fundamental basis that oxidativestress contributes to disuse atrophy,and that antioxidants or antioxidantsupplementation could provide a

complementary therapeutic ap-proach to abrogate muscle atrophy.Unfortunately, the causative influ-ence of oxidative stress in humans isunknown9 and there are only a fewstudies that relate oxidative stress todisuse atrophy in humans,10-12 withtheir results inconsistent.13

Vitamins E and C

Enzymatic and non-enzymatic an-tioxidant systems protect against thedeleterious events or reactions medi-ated by reactive oxidative or nitrogenspecies. Vitamins E and C are potentdietary antioxidants. Vitamin C (ascor-bic acid)14 is a water soluble antioxi-dant that scavenges a variety ofreactive oxygen and nitrogenspecies. Vitamin C is also a cofactorfor collagen synthesis and recycles vitamin E. Vitamin E is a fat-soluble,chain-breaking antioxidant15 that ex-ists in eight different natural forms:four tocopherols (T; �-T, �-T, �-T, and�-T) and four tocotrienols (T3; �-T3, ��-T3, �-T3, and �-T3). The most com-mon supplemental form of vitamin E

is �-T, while the predominant form ofvitamin E in the American diet is �-T,which is found, for example, in canolaor rapeseed oil.16,17 Nonetheless, be-cause of the preferential hepatic se-cretion by the �-T transfer protein,the most abundant form of vitamin Efound in plasma and tissues is �-T.

To date, there is little evidence identi-fying the therapeutic benefit of vita-min E and/or vitamin C on muscularstrength following injury or surgery.Importantly, vitamins E and C relateto muscular strength and physicalperformance in the elderly,16-18 apopulation that suffers from muscu-lar weakness. With this in mind, werecently conducted a randomized,double-blind, placebo-controlled ex-perimental design study involvingpatients undergoing elective ACL re-constructive surgery.19-21 Patients re-ceived either an antioxidant (AO)supplement consisting of vitamins E(RRR-��-tocopherol, 400 IU/d) and C(1,000 mg/d) or a matching placebo(PL). Supplements were taken dailywith a meal starting approximately2-weeks prior to and concluding 3months after surgery. Participantshad not taken any supplements for12 months prior to study enrollment.Several key results from this studyare discussed below.

Correlation Between PlasmaAscorbic Acid Concentra-tions and Strength Gains

As expected, at study enrollment theinjured limb was significantly weakerthan the non-injured limb and it re-mained weaker at 3-months post-surgery.20 Interestingly, strengthgains in the injured limb that oc-curred from study enrollment to 3-months post-surgery correlated withplasma ascorbic acid concentrationsmeasured at enrollment and prior tosupplementation.20 Although dietary

Influence of Vitamins E and C on the Recovery froman Anterior Cruciate Ligament Injury and Surgeryby Tyler Barker, PhD

intakes of ascorbic acid were not as-sessed and no participants had takenany supplements one year prior toenrollment, this finding contentiouslysuggests that higher vitamin C intakeprior to injury improves strengthgains after surgery. While thecausative influence of this associationawaits future resolve, this findingidentifies a compelling relationshipbetween a potent dietary antioxidantand recovery from ACL surgery.

Correlation Between a Biomarker of OxidativeStress and Muscular Strength Post-Surgery

Impairments in physical or muscularperformance is a common conse-quence of aging, which among otherfactors is mediated by oxidativestress, speculatively. To investigatethe relationship between muscularweakness and oxidative stress follow-ing ACL surgery, we examined thecorrelation between limb strengthand a reliable in vivo biomarker of ox-idative stress-induced damage (lipidperoxidation): plasma 8-isoprostaneprostaglandin F2� (8-iso PGF2��)concentrations.

The results showed that vitamin Eand C supplementation was ineffec-tive at lowering plasma 8-iso PGF2��concentrations 3-months post-sur-gery. However, peak isometric force ofthe injured limb inversely correlatedwith plasma 8-iso PGF2� concentra-tions in both groups (AO and PL)(Barker et al., unpublished observa-tion) (see Figure). Thus, lowering ox-idative stress might improvemuscular strength after ACL surgery.It is plausible that our dose and dura-tion of vitamin E supplementationwere too low and short, respectively,to effectively decrease oxidativestress as measured in the circula-tion.22 Nevertheless, this finding re-veals the first association betweenoxidative stress and muscularstrength following ACL surgery, andoffers preliminary data for futuretranslational- and clinical-based in-terventions intended to reduce ox-idative stress and improve muscularstrength following injury and surgery.

Influence of Vitamins E and C on Post-Surgery Strength Recovery

Although vitamin E and C supple-mentation did not lower a biomarkerof oxidative stress-induced damagein the circulation, the results showeda tendency to improve musclestrength 3 months after ACL surgery.Compared with the non-injured limb,the injured limb displayed an approx-imate two-fold increase in muscularstrength in the AO versus the PLgroup from study enrollment to 3months post-surgery.20 Although thisfinding did not reach statistical signif-icance, it does provide preliminaryand provocative evidence that vita-min E and C supplementation couldact therapeutically during the recov-ery from ACL surgery. Whether sup-plementation augmented muscular


strength or improved physical reha-bilitative capacity that resulted in afaster recovery after ACL surgery war-rants further investigation.

Influence of Vitamins E and Con Inflammatory Markersand Skeletal Muscle CalpainFollowing Limb Disuse

The patients in our study were non-weight-bearing on their injured limbthe first 5 days after surgery.19,20 Weobtained muscle biopsies from themid-vastus lateralis of the injuredlimb at two time points: 1) on the dayof surgery but before any surgicalprocedures, and 2) prior to resumingweight-bearing activities after sur-gery. Mid-thigh circumference meas-urements (6-in above themid-patella) of the injured and non-injured limbs were performed at

Figure LegendPlasma 8-isoprostane prostaglandin F2� (8-iso-PGF2�) concentrations (pg/mL)correlated (r = 0.54, P = .02) with peak isometric force (N/kg) of the injured(INJ) limb 3 months post-surgery for all subjects (n = 20) (Barker et al, unpub-lished observations). Single-leg peak isometric force measures were per-formed upon study enrollment and 3-months after surgery andsupplementation on a customized horizontal plyo-press with mounted forceplate. Peak isometric force measures were performed at 90º of knee and hipflexion. Plasma 8-iso-PGF2� concentrations were measured in fasting blooddraws obtained 3 months after surgery and supplementation. Plasma 8-iso-PGF2�was measured in heparinized plasma samples using liquid chromatog-raphy/mass spectrometry. This finding suggests that lower oxidative stressconcentrations in the blood associated with greater muscular strength afterACL surgery.


study enrollment (~2- to 3-wk beforesurgery) and approximately 8 daysafter surgery. Muscle fiber cross-sec-tional areas were not significantly dif-ferent across time or betweengroups.20 Mid-thigh circumferencesof the injured limb were smaller thanthat of the non-injured limb at studyenrollment and several days after sur-gery.20 Therefore, based on circumfer-ence measures, the injured limb wassmaller than the non-injured limbprior to surgery and prior to our pre-surgery biopsy.20

In the vastus lateralis muscle of theinjured ACL limb several days aftersurgery, we found an increase in in-ducible nitric oxide synthase (iNOS)and myeloperoxidase (MPO) in sub-jects who supplemented with vita-mins E and C.20 Inducible nitric oxidesynthase and MPO are inflammatory-derived sources of reactive oxygenand nitrogen species. In addition toincreasing iNOS and MPO, vitamin Eand C supplementation increasedcalpains following limb disuse afterACL surgery.20 Calpains are cysteineproteases that release sarcomericproteins for subsequent degradationby the proteasome. Importantly, cal-pain activation could be necessaryfor oxidative stress-induced muscleatrophy.23 Thus, reducing oxidativestress could attenuate calpain activa-tion and subsequently abrogate mus-cle atrophy. Nonetheless, despiteincreasing inflammatory markers andcalpains in skeletal muscle, vitamin Eand C supplementation did not ac-centuate muscle atrophy after ACLsurgery.

Summary

Several novel findings were observedin our study that could have thera-peutic implications on the rehabilita-tion from an ACL injury and surgery.First, plasma ascorbic acid concentra-tions prior to surgery and supple-mentation correlated with muscularstrength gains after surgery, and abiomarker of oxidative stress-in-duced damage (i.e., lipid peroxida-tion) correlated with muscularstrength 3-month post-ACL surgery.These results suggest that oxidative

stress and antioxidants relate to mus-cular strength and strength recoveryfollowing an ACL injury and surgery.Second, vitamin E and C supplemen-tation increased inflammatory medi-ators of reactive oxygen and nitrogenspecies and calpain without accentu-ating muscle atrophy. Finally, vitaminE and C supplementation tended toimprove muscular strength. Althoughvitamin E and C supplementationwas statistically ineffective at amelio-rating muscle atrophy and weaknessfollowing an ACL injury and surgery,

arguably, it is plausible that our doseand duration of vitamin E supple-mentation were too low and short,respectively, to induce its antioxidantproperties.22 Future studies investi-gating the therapeutic and causativeinfluence of vitamins E and C at dif-ferent doses and durations, alongwith other antioxidants, following anACL injury and surgery are clearlywarranted.

Tyler Barker, PhD, is a physiologist atThe Orthopedic Specialty Hospital. Hisresearch focus is developing comple-mentary and alternative therapeuticapproaches that attenuate muscularweakness and atrophy in variouspathological and physiological condi-tions in humans.

References1.Sies H, Jones DP. Oxidative stress. In:Fink G, ed. Encyclopedia of Stress. 2nded. San Diego, CA: Academic Press;2007;45-48.

2.Powers SK, Jackson MJ. Exercise-in-duced oxidative stress: cellular mech-anisms and impact on muscle forceproduction. Physiol Rev. 2008;88:1243-1276.

3. Powers SK, Kavazis AN, McClungJM. Oxidative stress and disuse

muscle atrophy. J Appl Physiol. 2007;102:2389-2397.

4. Kondo H, Miura M, Nakagaki I, et al.Trace element movement and oxida-tive stress in skeletal muscle atro-phied by immobilization. Am J PhysiolEndorcrin Metab. 1992;262:E583-E590.

5. Appell HJ, Duarte JAR, Soares JMC.Supplementation of vitamin E mayattenuate skeletal muscle immobi-lization atrophy. Int J Sports Med.1997;18:157-160.

6. Demiryurek S, Babul A. Effects of vi-tamin E and electrical stimulation onthe denervated rat gastrocnemiusmuscle malondialdehyde and glu-tathione levels. Int J Neurosci.2004;114:45-54.

7. Servais S, Letexier D, Favier R, et al.Prevention of unloading-induced at-rophy by vitamin E supplementation:links between oxidative stress andsoleus muscle proteolysis? Free RadicBiol Med. 2007;42:627-635.

8. Hudson NJ, Lehnert SA, Ingham AB,et al. Lessons from an estivating frog:sparing muscle protein despite star-vation and disuse. Am J Physiol RegulIntegr Comp Physiol. 2006;290:R836-R843.

9. Barker T, Traber MG. From animalsto humans: evidence linking oxida-tive stress as a causative factor inmuscle atrophy. J Physiol (Lond).2007;583:421-422.

10. Levine S, Nguyen T, Taylor N, et al.Rapid disuse atrophy of diaphragmfibers in mechanically ventilated hu-mans. N Engl J Med. 2008;358:1327-1335.

Worksite-based health promotion,also called worksite or corporatewellness, is a hot topic these days. Thehealth promotion industry has hit aboom in a major way, and it goes be-yond the ubiquitous “biggest loser”contest and t-shirt incentive. Todayworksite health programs encompassa variety of integrated strategies andinterventions in the workplace tohelp manage and control chronic dis-ease, overweight, and obesity—andultimately improve the company’sbottom line savings on health care.Programs can range from an assort-ment of “lunch-and-learn” classes andthe occasional health screening to acomprehensive program that in-cludes integrated health education, asupportive social and physical envi-ronment, an employee assistance

program (EAP), and regular worksitehealth screenings.1

The number and breadth of worksitewellness programs in the UnitedStates have increased substantiallyover the past two decades. In 1985,only 66% of companies with 50 ormore employees offered at least onehealth promotion activity to employ-ees. This grew to 81% by 1992 and to90% by 2002.1 Obesity—a top healthconcern in the nation—accountedfor an estimated $147 billion inhealth care expenses in 2008. This isespecially eye-catching to employers,because medical expenses for anobese employee are estimated to be42% higher than for a person at ahealthy weight.2

One reason for the increase in work-site health promotion is the com-bined trend that as Americans arespending more time in the work-place, employers are recognizing anopportunity to help reduce the inci-dence of some major medical condi-tions and therefore lower health careexpenditures. In addition, with onsitehealth screening and assessmentstaking a deeper look at employees’health status, employers are discover-ing the health risks that diminish pro-ductivity, increase health careexpenditures, and negatively impactthe company’s bottom line.3

In remarking on the growth of work-site wellness programs, Jennifer Price,RD, CWPC, wellness consultant forWillis North America, states: “After ex-


11. Dalla LL, Ravara B, Gobbo V, et al. Atransient antioxidant stress responseaccompanies the onset of disuse at-rophy in human skeletal muscle. JAppl Physiol. 2009;107:549-557.

12. Brocca L, Borina E, Pellegrino MA,et al. Qualitative and quantitativeadaptations of muscle fibers andmuscle protein pattern to 35-daysbed rest. Basic Appl Myol. 2009;19:117-126.

13. Glover EI, Yasuda N, TarnopolskyMA, et al. Little change in markers ofprotein breakdown and oxidativestress in humans in immobilization-induced skeletal muscle atrophy. ApplPhysiol Nutr Metab. 2010;35:125-133.

14. Frei B, England L, Ames BN. Ascor-bate is an outstanding antioxidant inhuman blood plasma. Proc Natl AcadSci USA. 1989;86:6377-6381.

15. Traber MG, Atkinson J. Vitamin E,antioxidant and nothing more. FreeRadic Biol Med. 2007;43:4-15.

16. Bartali B, Frongillo EA, Guralnik JM,et al. Serum micronutrient concentra-tions and decline in physical functionamong older persons. JAMA. 2008;299:308-315.

17. Ble A, Cherubini A, Volpato S, et al.Lower plasma vitamin E levels are as-sociated with the frailty syndrome:the InCHIANTI study. J Gerontol A BiolSci Med Sci. 2006;61:278-283.

18. Cesari M, Pahor M, Bartali B, et al.Antioxidants and physical perform-ance in elderly persons: the Invec-chiare in Chianti (InCHIANTI) study.Am J Clin Nutr. 2004;79:289-294.

19. Barker T, Leonard SW, Trawick RH,et al. Modulation of inflammation byvitamin E and C supplementationprior to anterior cruciate ligamentsurgery. Free Radic Biol Med.2009;46:599-606.

20. Barker T, Leonard SW, Hansen J, etal. Vitamin E and C supplementationdoes not ameliorate muscle dysfunc-

tion following anterior cruciate liga-ment surgery. Free Radic Biol Med.2009;47:1611-1618.

21. Barker T, Leonard SW, Trawick RH,et al. Antioxidant supplementationlowers circulating IGF-1 but not F2-isoprostanes immediately followingACL surgery. Redox Rep. 2009;14:221-226.

22. Roberts LJ, Oates JA, Linton MF, etal. The relationship between dose ofvitamin E and suppression of oxida-tive stress in humans. Free Radic BiolMed. 2007;43:1388-1393.

23. Smuder AJ, Kavazis AN, HudsonMB, et al. Oxidation enhances myofib-rillar protein degradation via calpainand caspase-3. Free Radic Biol Med.2010;49:1152-1160.

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


Resources for Practitionersin Worksite-Based HealthPromotion

CDC LEAN Works (Leading Employees to Activity and Nutrition)http://www.cdc.gov/LEANWorksIncludes an obesity cost calculatorto calculate a company’s return oninvestment (ROI); statistics and re-search; case studies; and other re-sources to help practitionersestablish a worksite wellness pro-gram

Health Enhancement ResearchOrganization (HERO) Scorecard(Best Practice Scorecard)www.the-hero.org/scorecard.htm

Health Reform Websitewww.healthreform.gov

National Business Group onHealth (NGBH) Wellness Scorecardwww.businessgrouphealth.org

National Institute for Occupational Safety and Health(NIOSH) Essential Elements forEffective Workplace Programswww.cdc.gov/niosh/worklife/es-sentials.html

Nutrition Entrepreneurs Dietetic Practice Group www.nedpg.org

hausting a variety of short-term solu-tions such as switching medical carri-ers, changing contribution strategies,and tweaking plan design, employersare now facing the only long-term so-lution left—to improve the health ofthe employee population to reducehealth risks and costs.” Indeed, afocus on reducing and preventingobesity in the workplace is time wellspent to help lower health care costs,decrease absenteeism, and improveproductivity overall.

Influence of Health Care Reform

The health care reform legislationpassed in 2010 may ignite further in-terest in worksite wellness activities.Providing a major emphasis onhealth promotion, the new law willauthorize a variety of new programsfor prevention and wellness. A fewways in which employers will be in-centivized include:4

■ Small employer corporate wellnessgrants to explore and implementworksite wellness programs■ Premium discounts for employeeswho participate in wellness programs ■ Subsidies for small employers toprovide health insurance coverage toemployees■ Tax credits for up to 35% of healthinsurance costs

What’s Needed for a Successful Program

As previously noted, worksite well-ness activities run the gamut, fromlunch-and-learn seminars to compre-hensive programs. Most organizedprograms begin with a health risk as-sessment (HRA). While the HRA is es-sential for program success, theassessment alone is ineffective inproducing behavior change and riskreduction.5 For the best outcomes, in-terventions should be multifacetedand meet the following criteria: 1) in-clude timely feedback on HRA resultsas well as programs to educate theemployee on health risks, 2) provideopportunities for skill building andthe tools to achieve behavior change;3) motivate employees; and 4) imple-ment opportunities at work to sup-

port healthful habits (e.g., providehealthful cafeteria and vending ma-chine options, encourage biking, pro-vide walking routes).

Other key elements are needed toimplement and sustain a successfulworksite wellness program, begin-ning with finding the right providerto deliver results.6,7 Common compo-nents noted in a review of effectiveprograms5 include: ■ Organizational commitment (lead-ership buy-in and support)■ Incentives for employees to partici-pate■ Effective screening and triage■ State-of-the-art theory and evi-dence-based interventions (via a vari-ety of offerings such as fitnesscenters; programs targeting weightmanagement and cardiovascularhealth; and clean commuting sup-port such as lockers, showers, and bi-cycle rack to encourageparticipation)■ Effective implementation (includ-ing targeting high-risk employees;ensuring program accessibility [viaInternet, onsite, or telephone]; andcommunicating effectively)■ Ongoing program evaluation

When all components are in place, or-ganizations have a better chance ofachieving high participation rates.This can work to improve the healthand well-being of employees as wellas improve the company’s financialpicture. Direct health care cost sav-ings of as much as 3% have beenachieved with participation rates ofat least 90%, although this savings isatypical in the current climate. Indi-rect health savings for productivityare estimated to be even higher.8

Bright Future for Registered Dietitians

The registered dietitian has an essen-tial role in delivering effective work-site health promotion programs. Thisrole extends far beyond lunch-and-learns. RDs with strong business acu-men can fully manage worksite-based interventions to improve thehealth of employees. Those who un-derstand the impact of health and

wellness programs on corporate finances can go far.

In addition to serving as in-housefood and nutrition experts, RDs canbecome involved in the design anddelivery of many other opportunities,including:■ Comprehensive worksite healthprograms■ Workplace and cafeteria education programs■ Cooking demonstrations■ Guidelines for healthful food at meetings, seminars, and cateredevents


■ Recipe and menu development■ Staff training ■ Web-based solutions that includenutrient analysis of menu items andhealthful promotions ■ Fit business tips■ Workplace breastfeeding/lactation programs

Health promotion programs can takeplace in a wide variety of settings, in-cluding corporations, manufacturingfacilities, schools, clinics, hospitals, su-permarkets, military bases, recre-ational centers, fitness centers, and alllevels of government (federal, city,state, and county). Employment

arrangements include positions thatare full time, part time, or offered toan independent contractor for spe-cial projects. With more than 6 millionfirms in the United States, there arenumerous opportunities for well-trained RDs.9

One key avenue for dietitians in-volves educating employers (small orlarge) on the value of employing anRD to take the lead in providing thesolution. Dietitians need to be able toconvince employers that hiring an RDwill yield a good return on invest-ment and that the RD is the bestprovider for the job. “Decision makersfor health promotion services oftendon’t have a health background,” saysDenice Ferko-Adams, MPH, RD, presi-dent and owner of Wellness Press. “Di-etitians need to make corporationsaware of how they can fit into anoverall wellness plan and why theyare the ideal leader for a health pro-motion team.” Agreeing with this ad-vice, wellness consultant Price notesthat she has seen many unqualifiedpractitioners approach employerswith “free” services and presentationsas a way to sell services and productssuch as nutrition supplements.

Skills and CompetenciesNeeded in Worksite Wellness

The key skills needed for success inwellness settings involve communi-cation, nutrition assessment andcounseling, motivation/facilitation ofchange in behavior, evaluation of in-dividual success, use of technology,and evaluation of program successand promotional activities.10 Thisbodes well for RDs, because many ofthe top essential skills in worksitehealth promotion are core compe-tencies in dietetics education pro-grams.

To be highly competitive in thehealth promotion industry, RDs arealso encouraged to pursue training inareas beyond dietetics and obtaincertifications from other professionalgroups, such as the American Collegeof Sports Medicine. “RDs trained inmotivational interviewing and thosewho have completed a certifiedcoaching program are ideal,” saysPrice. Such providers tend to thrive inthe worksite wellness setting. Acquir-ing this skill set also matches the cur-rent employer trend towardcustomized behavior change pro-grams and health coaching.

What’s Next?

The corporate wellness industry ispoised for growth in the next fewyears as employers seek solutions tohelp lower health care costs. Employ-ers are challenged to implement bestpractices, and RDs are well positionedto fill the gap.

Marisa Moore, MBA, RD, is employed byCSC and manages the nutrition work-site wellness program for employees atthe Centers for Disease Control andPrevention (CDC) in Atlanta, GA. She is

an ADA national spokesperson and theimmediate past president of the Geor-gia Dietetic Association.

References 1. Linnan L, Bowling M, Childress J, etal. Results of the 2004 National Work-site Health Promotion Survey. Am JPublic Health. 2008;98:1503-1509.

2. Finkelstein EA, Trogdon JG, CohenJW, et al. Annual medical spending at-tributable to obesity: payer- and serv-ice-specific estimates. Health Affairs.2009;28:w822-w831.

3. Task Force on Community Preven-tive Services. Recommendations forworksite-based interventions to im-prove workers’ health. Am J Prev Med.2010;38:S232-S236.

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

5. Goetzel RZ, Pronk NP. Worksitehealth promotion: how much do wereally know about what works? Am JPrev Med. 2010;38:S223-S225.

6. Goetzel RZ, Schechter D,Ozminkowski RJ, et al. Promisingpractices in employer health and pro-ductivity management efforts: find-ings from a benchmarking study. JOccup Environ Med. 2007;49:111-130.

7. O’Donnell M, Bishop C, Kaplan K.Benchmarking best practices in work-place health promotion. Art HealthPromot. 1997;1:1-8.

8. Thygeson NM. A health plan per-spective on worksite-based healthpromotion programs. Am J Prev Med.2010;38:S226-S228.

9. U.S. Census Bureau. Statistics of U.S.Businesses (SUSB): Latest SUSB An-nual Data. Available at: http://www.census.gov/econ/susb/; AccessedJune 23, 2010.

10. Hunt A, Hilgenkamp K, Farley R.Skills and competencies of dietitianspracticing in wellness settings. J AmDiet Assoc. 2000;100:1537-1539.


Student Engagement: Nurturing SCAN’s Passion, Ensuring a Bright Future

FromThe Chair

SCAN’s student opportunities include: ■ Local student assistance at the Annual SCAN Symposium■ Free 2011 Symposium registration for a limited number ofaccepted posters from SCAN student members■ Volunteer roles that match students with experiencedleaders—and facilitate a fast track to success■ Ability to focus on specific areas of interest and skillsthrough student subunit volunteer positions■ Opportunity to contribute to developing fact sheets■ SCAN Mentoring Program ■ Social media for published research ■ Student recognition and leadership development■ Coming soon: SCAN student grants

Student members of SCAN can tap into a network of infor-mation, resources, and national nutrition experts—all at aspecial, affordable student membership rate. ThroughSCAN’s newly revamped Web site, student members can engage in the three listservs, Twitter, Facebook, DiscussionForums, LinkedIn, and the Student Corner. Student supporton the Web site also includes student career path informa-tion, including lists of graduate schools and internships.

Clearly, student engagement is no longer an option—it’s anexpectation. Student engagement is the key to our future.Through SCAN opportunities, students and experiencedSCAN professionals work together in this meaningful way tobecome innovative, collaborative, and future leaders. Be apart of small changes—engage and make an impact!

A most impressionable experience early in my careerwas when an RD engaged me, serving as an architect tohelp create the environment in which I was soon to workand love. She gave me some of her time and afforded me ac-cess to a professional world I thought I wanted to be a partof. Having direct contact with a nutrition professional work-ing in my field of interest was of immeasurable value. Thementoring served as a determining factor for my career di-rection. She realized she had a shared responsibility in thetask of student learning. Her interest was in being a part ofthe bigger picture by engaging in a student’s growing envi-ronment to strengthen a shared passion and profession.

Just as this RD extended an invaluable service to me,

An-other connection with student members is hosting a discus-sion on the online Student Community of Interest (CoI);through the efforts headed by our director of member serv-ices, SCAN’s own experts have participated with great suc-cess. Writing articles for the ADA Student Scoop is anotherexcellent outreach opportunity.

Student engagement is a powerful and essential means ofdeveloping SCAN’s passion. Playing a part in it and witness-ing growth firsthand serves us all as a wise investment. Wecan all make student engagement significant, valuable, andreal—we can make learning a creation of meaning and ac-tion.

by Tara Coghlin-Dickson, MS, RD, CSSD

Conference Highlights

American College ofSports Medicine Annual MeetingJune 1-5, 2010Baltimore, MD

The American College of Sports Med-icine is the largest sports medicineand exercise science organization inthe world, with more than 35,000 in-ternational and national membersand certified professionals. ACSM isdedicated to advancing and integrat-

ing scientific research to provide edu-cational and practical applications ofexercise science and sports medicine.At 2010 ACSM Annual Meeting, morethan 5,400 exercise scientists, sportsdietitians, physicians, and health pro-fessionals gathered to share the lat-est research. Shown here are a few ofthe nutrition highlights. Abstracts ofthe presentations appeared in thesupplement to the May 2010 issue ofMedicine and Science in Sports and Ex-ercise. Additional highlights are avail-able at www.acsm.org (click on “newsreleases”).

Weight Loss and Management

■What are four keys to weight losssuccess? In a study involving 65 over-weight or obese men, the keys to suc-cessful weight loss were choosingsmaller portions, cutting back on sug-ary soft drinks, eating fewer high-fatsnack foods, and consuming less al-cohol (Abstract 647).■ Marathon training is not a goodway to lose weight, according to astudy of 64 participants in a 3-monthmarathon training program. Only


11% of participants lost weight, an-other 11% gained weight, and therest remained stable. Of the 7 whogained weight, 6 were women. Ingeneral, 74% of the women reportedeating more while training, comparedwith only 48% of the men. The goal ofrunning should be to improve per-formance, not to lose weight (Ab-stract 2436). ■ In investigating whether it mattersto lose weight quickly or slowly, researchers found that the pace ofweight loss was not important overthe long run. Whichever way athleteslost weight, they returned to thesame weight a year later. However,slow weight loss tends to preservemore muscles mass (Abstract 641).■ Among athletes who need tomake weight for a sport, will self-dehydrating to shed some poundshurt their performance? In a studywith boxers who sweated off 2% oftheir body weight, the boxers wereable to maintain their performanceas well as normal liver and renal func-tion. However, heatstroke was a con-cern (Abstract 1680).■ Why don’t obese people exercise?Based on a survey of overweight/obese collegiate students, faculty,and staff, two major reasons are “exer-cise is hard for me” and “exercisetakes too much of my time.” Helpingthis population with time-manage-ment skills might be a smart strategy(Abstract 2259).■ Walking up stairs can burn about10 kcal per minute, while taking theelevator burns only about 1.5 kcal perminute. Motivational signs that en-couraged people to take the stairs in-stead of the elevator increased stairusage from 51% to 60%, suggesting aclear need for more signs (Abstract2526).■ Body fat measurement using theBod Pod has been shown to be avalid and reliable method to measurebody composition, yet researchersare finding potential sources of errorthat can result in a lower estimate ofbody fatness. One source includesbody hair on the arms and legs. Astudy involving 20 men who weremeasured under four conditions(body hair, body hair covered withnylons, shaved with nylons, and

shaved) reported significant differ-ences between the test results. Moreresearch is needed before any spe-cific recommendations can be maderegarding arm and leg hair (Abstract2441).■ Skinfold calipers maintain a highranking as a tool for measuring bodycomposition. A study involving 50Caucasian men and women thatrank-ordered techniques using un-derwater weighing as the gold stan-dard indicated the sum of fourskinfolds (Jackson-Pollack) correlatedhighest, followed by Bod Pod, dualenergy X-ray absorptiometry, ultra-sound, and bioelectrical impedanceanalysis (Abstract 2439).

Physical and Mental Energy

■ Fatigue is associated with not justdepleted muscles but also a tiredmind. Inhibitory mechanisms in thebrain can contribute to a 25% reduc-tion in muscle contraction. Caffeinemight be able to help counter the fatigue (Abstract 732). ■ During rest, caffeinated drinks(with or without sugar) contribute to12% greater ratings for mental en-ergy compared with plain water (Ab-stract 1904).

Fueling Before and During Exercise

■ Consuming protein, such as yo-gurt, before lifting weights may en-hance recovery better thanconsuming a protein recovery drinkafterwards (Abstract 2862).■ Cyclists and triathletes who con-sumed 60 to 80 g carbohydrate perhour (240-320 kcal/h) performed bet-ter during a 2-hour endurance ridefollowed by a 20-minute time trialthan those who consumed 10 to 50 gor 90 to 120 g carbohydrate per hour.Each athlete should experiment withdifferent doses of carbohydrate dur-ing training to learn the right dose forhis/her body (Abstract 855).

Recovery Drinks

■ Fat-free chocolate milk is an excel-lent recovery drink. It stimulates

muscle building (Abstract 794) andreduces muscle breakdown (Abstract1135). Chocolate milk also replacesglycogen faster than a protein-freedrink (Abstracts 862 and 2816). ■ When compared with a placebo(matched for color, taste and carbohydrate content), antioxidant-rich pomegranate juice improves re-covery and decreases musclesoreness after muscle-damaging ex-ercise in trained men (Abstract 1931).

Fluids and Hydration

■ Is coconut water preferable to asports drink for replacing sweatlosses? While it is as effective as asports drink in replenishing body flu-ids, coconut water lacks taste appeal.The athletes in a study evaluatingthese drink preferred the standardsports drink. A fluid is only helpful if itis consumed (Abstract 2289). ■ During an hour of simulated bikeracing, Ironman triathletes lost about1.5 L of sweat and drank about 0.5 Ltoo little fluid to replace that loss. Al-though they were able to performwell for the 1-hour exercise test, med-ical problems would arise if theywere to exercise for 14 hours with asimilar fluid deficit (Abstract 940).■ After hard exercise, is it better todrink a large amount of water at onetime to replace sweat losses—orsmaller amounts of water every 30minutes for 4 hours? Either works; theimportant thing is to consume 150%more than what was lost via sweat.Athletes who know their sweat ratehave a helpful tool to manage hydra-tion (Abstract 2290). ■ Staying well hydrated on a dailybasis is important to optimize per-formance, and winter athletes com-monly need to be taught to drinkmore throughout the day. Urine sam-ples of high school alpine skiers indi-cated that 11 of 12 were dehydratedpre-competition (Abstract 1149).■ A survey of National CollegiateAthletic Association hockey playersindicated that they arrived at practiceunder-hydrated and ended the exer-cise session with an even larger fluiddeficit. Cumulative dehydration cantake its toll on performance (Abstract2484).


■ A study involving racing cyclistscompared the effects of consumingtwo caffeinated beverages (Red BullEnergy Drink versus Coca-Cola withextra caffeine to match the 160 mgcaffeine in Red Bull) 55 minutes priorto a 25-mile simulated road race. Thecyclists performed similarly with RedBull and Coke. Caffeine and sugar arepopular energizers among athletes(Abstract 2457).■ Among 51 cyclists who partici-pated in the Hotter ‘N Hell Hundredbike event in Texas, two became hy-ponatremic. In comparison to theother cyclists, they had higher sweatrates and higher fluid intakes. Theyalso finished faster than many others.Interestingly, one had a high sodiumintake and one a lower intake, butthey both ended up with hypona-tremia (Abstract 2487).

Iron Deficiency Anemia

■ The incidence of iron deficiencyanemia in the general population ofmen is 2%. A survey of male crosscountry and distance runners aged18 to 22 years found that 21% of themen were iron deficient—10 timesgreater than expected (Abstract2821). ■ The incidence of iron deficiencyanemia is 14% in the general popula-tion of women but about 50%among female athletes. Researchers

found that taking an iron supplementfor the 7 days during menses helpsmaintain a strong iron status (Ab-stract 2822).

Benefits of Exercise

■ Persistent fatigue affects 96% ofcancer survivors. Low-intensity exer-cise (cardiovascular and lifting) canreduce fatigue. Cancer patients canbenefit from participating in super-vised exercise programs (Abstract1414).■ Among 269 cancer patients whoexercised for at least 3 months, thecancer survival rate was 93%. This ishigher than the national average of66%. In the breast cancer group, exer-cisers have a 95% survival rate com-pared with the national average of89% (Abstract 1635). ■ Although physical educationclasses seem to be the easiest to cutduring a budget crisis, the reality isthat students who are physically ac-tive perform better on standardizedachievement tests. What’s good forthe body is good for the brain (Ab-stract 2148).■ Strength training is key to havinglean muscle pull on bones. This canhelp stop the development of osteo-porosis (Abstract 2664). ■ Athletes with anorexia would bewise to do resistance exercise. Havingstrong muscles pulling on bones can

enhance bone strength and poten-tially reduce the risk of stress frac-tures (Abstract 2650). ■ Loss of bone density affects menas well as women. A survey of 35-to-50-year-old men and women re-vealed that 42% of men and 28% ofwomen had low bone mineral den-sity. These shocking results indicatethat men as well as women need totake steps to maintain their bonehealth and reduce their risk for devel-oping osteoporosis (Abstract 2657).■ NHANES (National Health and Nu-trition Examination Survey) informa-tion from 5,618 people suggeststhose who do muscle-strengtheningexercises are 28% less likely to havedyslipidemia than those who do not.Strength training twice a week is im-portant in maintaining good health(Abstract 2385). ■ Physical activity can help olderadults (ages 60-99 y) maintain theiryouthfulness. Because women tendto be more active than men, they ex-perience less physical decline (Ab-stract 2347).

Contributed by Nancy Clark, MS, RD,CSSD, who is PULSE’s “ConferenceHighlights” editor and has a privatepractice at Healthworks in ChestnutHill, MA, where she counsels both ca-

sual and competitive athletes.

Reviews

SavorThich Nhat Hanh and Lilian Cheung,DSc, RDHarperOne, Harper Collins Publishers,10 East 53rd St., New York City, NY10022www.harpercollins.com2010, hardcover, 292 pp, $25.99,ISBN 978-0-06-169769-2

Savor offers a thorough explorationof the interconnected relationshipsbetween psychological, emotional,physical, and behavioral approachesto weight loss. Advocating a mindfulliving approach that involves what

the authors refer to as InEating, InMoving, and InBreathing, ThichNhat Hanh and Dr. Lilian Cheungfocus on Buddhist meditations andteachings of mindfulness to practiceliving in the present moment—trans-forming habitual and mindless ac-tions that inhibit weight loss.

The book is divided into three parts.Part I: A Buddhist Perspective onWeight Control offers a fundamentalprimer on Buddhist teachings as theauthors describe the practice and im-portance of mindfulness and offer in-sight into how and why we developthoughts, emotions, and habitual be-

haviors. Readers learn how the FourNoble Truths apply to weight loss andare encouraged to get in touch withtheir bodies, emotions, environment,and behaviors to develop a personal“mission statement for healthyweight and well-being.”

Part II expands upon these teachingsto describe “mindful action plans.”Through a series of questions and ex-amples, the authors encourage read-ers to reflect upon their own barriersto mindful eating and exercise to cre-ate a 10-week mindful living planthat incorporates specific goals forapproaching eating, moving, and

Antioxidant Supplementation andEndurance TrainingAdaptationYfanti C, Akerström T, Nielsen S, et al.Antioxidant supplementation doesnot alter endurance training adapta-tion. Med Sci Sports Exerc. 2010;42:1388-1395.

Reactive oxygen and nitrogenspecies production that occurs withexercise may negatively impact per-formance; however, this same processappears to be critical in stimulatingdesired training adaptations. The pur-


pose of this study was to investigatewhether vitamin C and E supplemen-tation during endurance training at-tenuates the expected increases intraining adaptation and performancein physically active men. In this 12-week, double-blind, placebo-con-trolled study, 21 men (ages 18-40 y)completed a 5-day-per-week inten-sive cycle training protocol. Elevenparticipants received 500 mg vitaminC and 400 IU vitamin E daily for 16weeks (AO group); the remaining 10participants received placebo tablets(PL group). Plasma levels of vitamin Cand E were monitored along with di-

etary intake. Performance and oxida-tive capacity were assessed usingaerobic and metabolic parametersthat included maximal oxygen con-sumption (VO2max), maximal poweroutput, workload at lactate threshold,skeletal muscle glycogen content,and mitochondrial enzymes (citratesynthase and beta-hydroxyacacyl-CoA dehydrogenase). Plasma levels ofvitamins C and E increased signifi-cantly (P<.05 and P<.001 respec-tively) in the AO group and remainedunchanged in the PL group. Bothgroups had significant improvementsfrom baseline in the aerobic and

Sports Dietetics-USA Research Digest

breathing with mindful and presentintention.

In Part III: Individual and Collective Ef-fort, the authors identify the inter-connectedness of individuals withtheir surrounding social environ-ment, physical environment, and soci-ety. Taking one day at a time, studentsof this mindful living approach areencouraged to work at the grass-roots level to develop supportgroups, incite change in the foodsupply, and promote access tohealthful physical activity.

With few exceptions, namely its ap-proach to alcohol and meat con-sumption, which are stronglyinfluenced by the rigidity of Buddhistteaching, the diet and exercise guide-lines in this book reference scientifi-cally supported recommendations ofthe Centers for Disease Control,American Heart Association, Ameri-can College of Sports Medicine, Har-vard School of Public Health, and thefederal government’s guidelines fordiet and exercise.

This book offers a great resource forthe psychologically focused practi-tioner. Therapists and dietitians whooften apply the concepts presentedin such books as Intuitive Eating,Mindless Eating, and The End ofOvereatingwill find that Savor offers a

more advanced approach to the artof mindfulness and its transformativepower. The wisdom of Zen masterThich Nhat Hanh and the skill of Dr.Cheung in translating science intopractice deliver concrete meditationsand practices that may prove usefulfor individuals in need of weight lossas well as those with an eating disor-der.

For those not familiar with the con-cept of mindfulness, this book maynot be the most approachable intro-duction to this idea. However, Savorpresents an essential, multifacetedapproach to weight loss: making themental and physical connectionsnecessary to tackle obesity. Researchshows that lifestyle change is essen-tial to achieving a healthful weight,but creating that change can be com-plicated and difficult. The mindful ap-proach presented in this book workswith readers from “the inside out.”Starting with self-evaluation andmeditation, the book guides readersto make external changes (i.e.,changes to eating and exercisehabits) along with internal reflectionson why, what, where, when, and withwhom they engage in eating, mov-ing, and breathing. Savor’s connec-tion between our externalenvironment and our internal feel-ings is an integral approach to mak-ing lifestyle changes, achieving a

healthful relationship with food andexercise, and sustaining weight loss.

Known as Thay by his students, ThichNhat Hanh is one of the world’s mostrenowned and respected Zen mas-ters. Grounded in the Buddhist princi-ples of nonviolence and compassion,Thich Nhat Hanh has organizedgrassroots efforts to promote peaceand improve community welfarearound the world. He has publishedscores of inspirational poems, essays,and prayers and lives in Plum Village,the meditation community hefounded in France in 1982.

Dr. Lilian Cheung is an expert attranslating nutrition science into ac-cessible resources for the community.As the director of health promotionand communication and editorial di-rector of the Nutrition Source Website of the Harvard School of PublicHealth, Dr. Cheung is skilled in the artof using mass media to improve thequality of nutrition messaging andpromote healthful lifestyles acrossmultiple demographics.

Reviewed by Kristine Spence, MS, RD,CD, sports dietitian and researcher atthe Orthopedic Specialty Hospital(TOSH) and adjunct faculty member atthe University of Utah, in Salt Lake City,UT.


metabolic parameters (P< .01), but nosignificant difference was detectedbetween groups. The results of thisstudy indicate that vitamin C and Esupplementation does not attenuatetraining adaptation or improve per-formance in physically active men. Inconclusion, athletes with normal vita-min C and E status will most likely experience neither positive nor nega-tive effects secondary to antioxidantsupplementation. This study wasfunded by a grant from the DanishNational Research Foundation, theDanish Medical Research Council, theCommission of the European Com-munities, the Greek State Scholar-ships Foundation, and the DanishMinistry of Culture Committee onSports Research.

Summarized by Ladd Harris, graduatestudent, Coordinated Master’s Pro-gram, Sports Dietetics Emphasis, Divi-sion of Nutrition, University of Utah,Salt Lake City, UT.

Effects of Caffeine andCarbohydrate on SoccerPerformanceGant N, Ali A, Foskett A. Influence ofcaffeine and carbohydrate coinges-tion on simulated soccer perform-ance. Int J Sport Nutr Exerc Met.2010;20:191-197.

Taken individually, caffeine and car-bohydrate (CHO) have been shown tobe ergogenic for prolonged en-durance and high-intensity intermit-tent exercise. However, thecoingestion of caffeine and CHO onexercise performance is unclear. Thepurpose of this study was to examinethe effect of a caffeinated CHO solu-tion on prolonged soccer activity. Inthis randomized, double-blind,crossover study, 15 male premier-grade soccer players ingested 8mL/kg body weight (BW) of a 6%CHO beverage (1.8 g/kg BW CHO)with 160 mg/L caffeine (CAF; 3.7mg/kg BW) or without caffeine (CON)one hour pre-exercise and 3 mL/kgBW every 15 minutes during exercise.After familiarization with testing pro-tocols, study participants completedtwo exercise trials separated by 7

days. Exercise trials consisted of 90minutes of intermittent shuttle run-ning (15-minute exercise bouts sepa-rated by 4-minute rests), counter-movement jumps (CMJ) during restperiods, and soccer passing tests.Heart rate, blood lactate, perceivedactivation, and rating of pleasure/dis-pleasure were measured before andduring exercise. Mean 15-minutesprint time was significantly faster(P<.04) with CAF versus CON(2.48±1.15 vs. 2.59±0.02 sec duringthe final sprint). Explosive leg power(CMJ height) (P<.03), heart rate(P<.01), and rate of pleasure (P<.01)were also significantly higher withCAF than CON. There were no differ-ences in blood lactate, body weightloss, perceived activation, or thirstdrive. The results of this study sug-gest that coingestion of CHO and caf-feine may have an ergogenic effecton leg power and sprint perform-ance. Athletes engaging in high-in-tensity intermittent sports maybenefit from consuming a moder-ately caffeinated sports drink.

Summarized by Kate Olsen, graduatestudent, Coordinated Master’s Pro-gram, Sports Dietetics Emphasis, Divi-sion of Nutrition, University of Utah,Salt Lake City, UT.

Fat-Free Milk Consumption andChanges in Body Composition Josse, AR, Tang JE, Tarnopolsky MA, etal. Body composition and strengthchanges in women with milk and re-sistance exercise. Med Sci Sports Exerc.2010;42:1122-1130.

Ingestion of milk-based protein fol-lowing intensive resistance trainingappears to enhance muscle mass ac-cretion in young males. Whether fe-males following the same regimerespond similarly has not been suffi-ciently tested. The objective of thisstudy was to determine if ingestionof fat-free milk or an isocaloric carbo-hydrate (CHO) drink resulted ingreater strength gains and increasesin lean muscle mass following 12weeks of resistance training in young,

healthy women. Prior to the study,participants were recreationally ac-tive but not recently engaging in re-sistance training. In single-blind,randomized fashion, female partici-pants consumed either 500 mL fat-free milk (MILK; n=10) or a 9%isocaloric maltodextrin beverage(CON; n=10) immediately followingand 1 hour after resistance training.Study participants performed awhole-body split routine 5days perweek alternating pushing, pulling,and leg exercises at 80% one repeti-tion maximum (1-RM). Body composi-tion via dual energy X-rayabsorptiometry scan and 1-RM test-ing were performed at pre- and post-training. The MILK group experiencedboth a decline in fat mass (P<.02) andincrease in lean mass compared withthe CON group (P<.01). Increases in 1-RM were observed in both groups forall exercises at post-training, with asignificant increase in the benchpress exercise for MILK subjects com-pared with CON subjects (P<.05). Theresults of this investigation indicatethat post-exercise ingestion of fat-free milk appears to favorably alterbody composition in young womenfollowing a resistance exercise train-ing program. Ingestion of fat-freemilk may provide a practical, inex-pensive recovery drink for increasinglean mass in women. This study wassupported by grants from the NaturalScience and Engineering ResearchCouncil of Canada, the Canadian In-stitutes of Health Research, and theDairy Farmers of Canada.

Summarized by James R, Stevens, MS,RD, adjunct instructor, Metro State College of Denver, CO.

Combined Effect ofOmega-3 Fatty Acids and Antioxidants on Oxidative StressMcAnulty SR, Nieman DC, Fox-Rabi-novich M, et al. Effect of n-3 fattyacids and antioxidants on oxidativestress after exercise. Med Sci SportsExerc. 2010;42:1704-1711.

Omega-3 fatty acids (n-3 FA) are potentially beneficial due to their


serves on dLife’s prestigious medicaladvisory board. She is also a nutri-tionist and certified diabetes educa-tor for the TheBestLife.com (BobGreene’s health and weight loss Website). Currently she is co-authoring achapter on anemia for the upcomingedition of Krause’s Food, Nutrition &Diet Therapy text book.

■ Kim Crawford, PhD, RD, CSSD, hasbeen appointed as the American Di-etetic Association representative tothe U.S. National Physical ActivityPlan (NPAP). In this role Kim attendedthe NPAP national launch in Washing-ton, DC, in spring 2010 and will beworking in cooperation with the pub-lic health sector to develop and up-date the NPAP as the plan progresses.Kim is the coordinator of graduatestudies in nutrition at the Universityof Pittsburgh, PA. She served an inte-gral role in the development of theBoard Certified Specialist in SportsDietetics (CSSD) exam.

If you have an accomplishment thatyou would like to be considered for anupcoming issue of PULSE, please con-tact Sumner Brooks, MPH, RD, at [email protected].

natives to the gym. In addition to heronline work, Courtney is in privatepractice at a gastroenterology clinicand an inpatient RD at Olympia Med-ical Center in Los Angeles, CA.

■ Roberta Wennick, MS, RD, has ful-filled her 20-year old dream to createan interactive recipe-building Website, www.Spin-A-Recipe.com. For justone basic recipe, the Web site createsdozens of healthy variations. In addi-tion to her latest online publication,Roberta has authored two books: IsYour Personality Type Making You Fat?and Drawing the Line on Calories,Carbs, and Fat. A nutrition consultant,culinary nutritionist, and freelancewriter based in Lynnwood, WA,Roberta also runs a private nutritioncounseling website called AdvantageDiets (www.advantagediets.com).

■ The first recipient of the SCANscholarship award in 1986, SusanWeiner, RD, MS, CDE, CDN, has sinceestablished a successful private prac-tice in New York as a dietitian and ex-ercise physiologist. Susan is acontributing medical producer fordLife (For Your Diabetes Life) TV and

by Sumner Brooks, MPH, RD

■ Julie Upton, MS, RD, CSSD, sur-vived on burgers, Cheese-Its, andSwedish Fish during her first ultra-endurance running event, the Gore-Tex Trans Rockies Run. This 6-day runcovered more than 115 miles of ter-rain in Colorado, involved over 25,000ft of climbing in elevations well over10,000 ft, and required technical sin-gle-track trails. Along with her team-mate, Julie finished the run withoutincident and looks forward to repeat-ing the challenge in the future. Julieis a nutrition communications spe-cialist focusing on consumer printand broadcast media in Tiburon, CA.

■ Founder of Nutrition for Body andMind, Courtney Walberg, RD, NASM-CPT, recently earned her personaltraining certification through the Na-tional Academy of Sports Medicine.Courtney combines her nutrition andpersonal training skills to author theonline nutrition content for “HouseCall MD” and develop workouts foractive individuals of all ages. Herfocus is on making exercise fun andmixing in outdoor workouts as alter-

SCAN Notables

anti-inflammatory, antithrombotic,and vasodilatory properties. How-ever, n-3 FA may contribute to lipidperoxidation, an effect possibly atten-uated with increased antioxidant in-take. The objective of this study wasto determine the effects of omega-3fatty acid and antioxidant supple-mentation on F2-isoprostane forma-tion, a marker for oxidative stress, inendurance athletes. Forty-eight maleand female trained cyclists were ran-domized into one of four groups: vi-tamin-mineral (VM ), n-3 FA (N3),vitamin-mineral and n-3 FA (VMN3),or placebo (P) ingested in double-blind fashion for 6 weeks. The N3 sup-plement provided 2,000 mgeicosapentaenoic acid (EPA) and 400mg EPA; the VM supplement pro-

vided 2,000 mg vitamin C, 800 IU vita-min E, 3,000 IU vitamin A, and 200mcg selenium. At the end of 6 weekssupplementation, participants com-pleted 3 consecutive days of cyclingtraining for 3 hours at 57% maximumwattage. Blood samples were ob-tained at baseline (0 wk), pre-exer-cise, and after the last training sessionfor measurement of F2-isoprostanes.At post-exercise, the N3 group experi-enced a significant increase (53%) inF2-isoprostanes compared with pre-exercise levels; this was significantlydifferent from the P (P=.02), VM(P=.008), and VMN3 (P=.05) groups.VM supplementation did not signifi-cantly decrease F2-isoprostane for-mation compared with P. Based onthe results of this study, supplemen-

tation with n-3 FA may contribute tooxidative stress via observed in-creases in F2-isoprostanes. This po-tentially adverse effect may be in partnegated by antioxidant supplemen-tation. However, when ingestedalone, antioxidants do not elicit fur-ther decreases in oxidative stress.Athletes should be advised on thepotential for increased oxidativestress with n-3 FA supplementation.This project was funded by theCooper Aerobics Center, Dallas, Tex.

Summarized by James R Stevens, MS,RD, adjunct instructor, Metro State Col-lege of Denver, CO.


Of Further Interest■ Cast Your Vote for SCAN LeadersBe sure to participate in the upcom-ing election for SCAN leaders. Onceagain, SCAN will use an electronicballot. To vote online, go to SCAN’sWeb site (www.scandpg.org) and onthe home page, click on the link thatsays “2011 Election Ballot.” Onlinevoting polls open February 1, 2011;the final date to vote is March 3,2011.

■ Take a Look at SCAN’s Annual ReportSCAN’s Annual Report for fiscal year2009-2010 is now available online.The report updates members andcorporate sponsors on SCAN’s pro-grams, initiatives, current volunteers,budget, and more. To access the pub-lication on SCAN’s Web site, go towww.scandpg.org/about-us/annual-reports.

■ News from Wellness/CVRDs SubunitCheck out these exciting offeringsfrom the Wellness/CV RDs:

• Webinars. Capturing tremendousresponse for the first three Well-ness/CV webinars launched in 2010(with nearly 1,000 RDs viewing justone of these presentations), SCANwill continue this popular series in2011. Watch for details on new webi-nars sponsored by Canola Oil in Feb-ruary, POM Wonderful in March, andothers. Go to www.scandpg.org/event-calendar and scroll down thepage.

• Corporate Wellness PowerPointand Handouts. This flexible, power-ful tool—Take Control of Your Health:Tips for Eating Healthy and Being Fitfor a Lifetime—features 52 slides withnotes and handouts (purchased sep-arately), including a sample contract

to use for services. The presentationprovides facts on good nutrition, fit-ness for life, and how employees’poor diets on can weaken a com-pany’s bottom line. Better yet, it canbe adapted for any type of nutritionand fitness presentation because theslides can easily be moved and ad-justed. You can easily replace thesample RD picture at the end withyour own. To purchase, go towww.scandpg.org, click on OnlineStore, and then Wellness/CV.

■ News from Sports DieteticsUSA (SD-USA)Here are some highlights from theSD-USA subunit:

• 2011 CSSD Exam Windows. Notethe 2011 windows for the Board Cer-tified Specialist in Sports Dietetics(CSSD) exam: February 7-28 (exceptFebruary 15) – application deadlinehas passed; July 11-29 — applicationpostmark deadline April 25, 2011. Foreligibility information and an applica-tion, go to www.cdrnet.org.

• Register Now for Sports NutritionWorkshop. A pre-SCAN SymposiumSports Nutrition Workshop, The Cas-cade of Concussion: Minimizing Risks,Reducing Serious Consequences, Stim-ulating Recovery, is slated for March11, 201l, 7:30 to 11:30 am, in Chicago,IL. To register, visit www.scandpg.org.

• SCAN’s Video: Sports Nutrition –Who Delivers? Leave a lasting im-pression! Show your audiences thisprofessionally produced video inwhich athletes tout the value ofsports dietitians. View it at www.scan-dpg.org and on YouTube.

• Sports Nutrition Fact Sheets. Usethese colorful sheets to educateclients, enhance your practice, andpromote your expertise. You can evenhave them customized with your

personalized business informationand message. Check them out atwww.scandpg.org/sports-nutrition/sports-nutrition-fact-sheets.

• SD-USA Score. The SD-USA e-newsletter is delivered to your inboxin a new format six times a year. Con-tact Amy Goodson, MS, RD, CSSD, [email protected] withyour ideas for topics.

• ADA’s Nutrition Care Manual®(NCM). The 2010 ADA Nutrition CareManual® (NCM) contains a “SportsNutrition and Performance” sectionwritten and updated by SD-USAmembers. New to the 2010 edition isorganization of the NCM using theNutrition Care Process. Subscribe tothe NCM at http://nutritioncaremanual.org.

• Help customers find you! List your-self on “Find a SCAN Dietitian” onwww.scandpg.org to increase yourreach to the public and potential employers.

• Join SD-USA. Sign up for SD-USA, afree SCAN member benefit, via theMember Profile on www.scandpg.org. Check the box forSports Dietetics-USA at the bottom of the Member Profile.


March 3-6, 2011International Association of Eating Disorder Professionals (IAEDP) Sympo-sium, Phoenix, AZ. For information:www.iaedp.com

March 11-13, 2011Join your colleagues at the 27th Annual SCAN Symposium, Optimiz-ing Performance, Wellness, and HealthThrough Nutrition. Chicago, IL. For information: www.scandpg.org

April 9-13, 2011Experimental Biology (EB) AnnualMeeting, Washington, DC. For infor-mation: http://experimentalbiology.org

April 13-16, 201115th Annual Health & Fitness Sum-mit, Anaheim, CA. For information:American College of Sports Medicine,www.acsm.org

May 31-June 4, 2011American College of Sports MedicineAnnual Meeting, Denver, CO. For information: www.acsm.org

July 11-29, 2011CDR Sports Dietetic Specialty Exami-nation (at various U.S. sites). Postmarkdeadline for applications is April 25,2011. For information: Commissionon Dietetics Registration: www.cdr-net.org

Upcoming Events

PRESORT STANDARD

U.S. POSTAGE

PAID

Rockford, IL

Permit No. 2495

The viewpoints and statements hereindo not necessarily reflect policiesand/or official positions of the American Dietetic Association. Opinions expressed are those of theindividual authors. Publication of anadvertisement in SCAN’S PULSE shouldnot be construed as an endorsementof the advertiser or the product by theAmerican Dietetic Association and/orSports, Cardiovascular, and WellnessNutrition.

Appropriate announcements are welcome. Deadline for the Summer2011 issue:March 1, 2010. Deadlinefor the Fall 2011 issue: June 1, 2011.

Manuscripts (original research, reviewarticles, etc.) will be considered forpublication. Guidelines for authors areavailable at www.scandpg.org. E-mailmanuscript to the Editor-in-Chief;allow up to 6 weeks for a response.

Send change of address to: AmericanDietetic Association, 120 S. RiversidePlaza, Suite 2000, Chicago, IL 60606-6995.

Subscription cost for nonmembers:$50 individuals/$100 institutions. Tosubscribe: SCAN Office, 800/249-2875.

Copyright © 2011 by the American Dietetic Association. All rights reserved. No part of this publicationmay be reproduced, stored in a retrieval system, or transmitted in anyform by any means, electronic, mechanical, photocopying, recording,or otherwise, without prior writtenpermission of the publisher.

SCAN’S PULSE

Publication of the Sports, Cardiovascular, and Wellness Nutrition(SCAN) dietetic practice group of the American Dietetic Association.ISSN: 1528-5707.

Editor-in-ChiefMark Kern, PhD, RD, CSSDExercise and Nutritional SciencesSan Diego State University5500 Campanile Dr.San Diego, CA 92182-7251619/594-1834 619/594-6553 - [email protected]

Sports EditorsKathie Beals, PhD, RDNanna Meyer, PhD, RD

Cardiovascular EditorSatya Jonnalagadda, MBA, PhD, RD

Wellness EditorRobert Wildman, PhD, RD, FISSN

Disordered Eating EditorsKaren Wetherall, MS, RDMichelle Barrack, PhD

Conference Highlights EditorNancy Clark, MS, RD

Reviews EditorNichole Dandrea, MS, RD

Sports Dietetics-USA Research Digest Editors

Stacie Wing-Gaia, PhD, RD, CSSDJames Stevens, MS, RD

SCAN Notables EditorSumner Brooks, MPH, RD

Managing EditorAnnette Lenzi Martin312/587-3781 312/751-0313 - [email protected]

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

Thrift-Remsen Printers

3918 South Central Ave.

Rockford, IL 61102-4290

scan layout final072408mich el a d on , sr dc [email protected] co-directors, wellness /cv rds...

Documents