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Winter 2016, Vol. 35, No. 1

■ CONTENTS

1Soy for Healthy Living andActive People

3From the Editor

6CPE article:Tart Cherries: The “Bittersweet” Evidence in Exercise Recovery

10Discovering the Role of Yoga in Eating Disorder Treatment

13Efficacy of Nutrition Education Within a Cardiac Rehabilitation Program in Eliciting Heart HealthyDiet Changes

18From the Chair

18Conference Highlights

20Reviews

20Research Digest

22SCAN Notables

23Of Further Interest

24Upcoming Events

Half of Americans report putting a lotof thought into the healthfulness offoods and beverages,1 yet there is alack of knowledge on the benefits ofsoy. The 2014 International Food In-formation Council (IFIC) FoundationFood & Health Survey, an online sur-vey of 1,005 Americans, revealed thatmore than 90% of respondents rec-ognize the benefits of protein forhealth and wellness.2 While 1 in 4Americans choose soy as a proteinsource as part of their regular diet,only one third recognize the role ofsoy in promoting heart heath.1 Theseconsumer insights reveal a potentialgap in understanding the variety ofbenefits soy and soy protein can con-fer. This article provides registered di-etitian nutritionists (RDNs) withevidence-based guidance on how tohelp active clients understand thevalue of soy as well as dispels com-mon myths about soy.

Benefits of Soy for HealthyActive Living

Soy can be consumed as soybeans orin more concentrated forms such assoy meat analogs, beverages, or bars.Soy is a nutrient-dense source ofhigh-quality protein, vitamins, andminerals. Whole soybeans contain

S C A N ’ SPu lseSoy for Healthy Living and Active Peopleby Christine Rosenbloom, PhD, RDN, CSSD, FAND; Sarah Romotsky, RDN; and Alyssa Tindall, RDN

about 40% protein and soy proteinconcentrates or isolates contain 65%to 90% protein.3 Table 1 (p. 4) showsserving sizes of soy foods and gramsof protein per serving. There are a va-riety of ways soy can be incorporatedinto the daily diet of active individu-als (see Table 2, p. 5).

Soy and Muscle Protein Synthesis

Active people, from athletes to agingadults, desire to maintain or gain leanmass. Muscle produces power andstrength to support activity, thus im-proving muscle protein synthesis(MPS) is a worthy goal at any age. It isimportant to note, however, that leanmass accretion is also influenced bythe rate of muscle protein break-down, which should be consideredwhen interpreting changes in MPS.Most active people are likely alreadyaware of the benefits of consumingprotein for MPS. The research litera-ture suggests that the branchedchain amino acid, leucine, is one ofthe key amino acids that stimulatesMPS.4 Soy protein contains leucineand is effective at promoting MPS;however, one study has suggestedthat it may not be quite as effectiveas whey but more so than casein at 3

course of the day. A variety of proteinsources can be used to meet needsto support muscle recovery after ex-ercise by supplying adequate aminoacids to muscle to fuel repair. Soyprotein is well digested8 and is an ex-cellent option for vegetarian athletesbecause it is a complete protein (i.e.,it contains an adequate proportion ofall the essential amino acids). Includ-ing soy protein after training pro-vides skeletal muscle with aminoacids for repair and increased MPSrelative to training alone; however, aspreviously noted, soy protein alonemay not be quite as effective as ablend that takes advantage of differ-ing digestion rates when combinedwith dairy protein.7 Soy foods arealso typically high in calcium andzinc and are often fortified with vita-mins D and B12, which may be lack-ing in a vegetarian athlete’s diet.

Soy Protein and Satiety

Protein is known for its satiatingproperties.9 The protein leverage hy-pothesis9 predicts that an inverse re-lationship exists between proteinintake and total energy intake. Com-plete proteins such as soy appear tobe involved in hunger suppressionthrough several proposed mecha-nisms, including recognition of es-sential amino acid intake by thehypothalamus and changes in gas-trointestinal food regulation hor-mones.10 Furthermore, increasing soyintake may aid in weight manage-ment, maintenance of lean bodymass, and reducing heart diseaserisk.10,11

Soy and Heart Disease Risk Reduction

In 1999, the Food and Drug Adminis-tration approved the followinghealth claim for soy: “25 grams of soyprotein per day, as part of a diet lowin saturated fat and cholesterol, mayreduce the risk of heart disease.”RDNs often focus on prevention andlifestyle modification for their activeclients, and helping them to incorpo-rate soy may be a positive step. Nu-merous meta-analyses publishedrecently have confirmed the choles-

2 | SCAN’S PULSEWinter 2016, Vol. 35, No. 1

Academy of Nutrition and DieteticsDietetic Practice Group of Sports,

Cardiovascular, and Wellness Nutrition (SCAN)SCAN Web site: www.scandpg.org

SCAN Office3000 Bridge Ave., Suite #14Cleveland, OH 44113Phone: 216/503-0053; 800/[email protected]

Executive Director: Athan Barkoukis, MSAssistant: Christin N. Swingle, RD

SCAN Executive CommitteeChairEve Pearson, MBA, RD, CSSD

Chair-Elect

Karen Collins, MS, RDN, CDN, FAND

Past ChairCarol Lapin, MS, RD

TreasurerMark Hoesten, RD

SecretaryKait Fortunato Greenberg, RD

Director of CommunicationsHeather Mangieri, MS, RD, CSSD

Director of Member ServicesKate Davis, MS, RD, CSSD

Director, Disordered Eating & EatingDisorders SubunitSarah Gleason, RD, CEDRD

Director, Sports Dietetics—USA SubunitChristine Karpinski, PhD, RD, CSSD

Co-Directors, Wellness/CardiovascularRDs SubunitJudith Hinderliter, MPH, RD, CPTAmanda Clark, MA, RD, CHES

Director of EventsCheryl Toner, MS, RDN

Director of Volunteer CoordinationCatherine Diaz Theodorou, MS, RD

Editor-in-Chief, SCAN’S PULSEMark Kern, PhD, RD, CSSD

SCAN Delegate to House of DelegatesJean Storlie, MS, RD

DPG Relations ManagerMya Wilson, MPH, MBA

To contact an individual listed above, go towww.scandpg.org/executive-committee/

hours post-consumption.5 However,the timing of when MPS is measured(early or later following consump-tion) can impact results of studies inthis field of research. Digestion ratesvary across protein sources, whichhas led to publications that indicatethat soy may not be quite as effectiveas whey but more so than casein.5 Al-though it varies by brand, approxi-mately two scoops (40 g) of soyprotein powder provides almost 3 gof leucine, an amount demonstratedto stimulate MPS.4

Soy protein has also been shown tosupport lean mass accretion more ef-fectively than a carbohydrate-onlysnack and similarly to whey protein.6

In one study, researchers gave 26 un-trained healthy men and womensupplemental whey protein, soy pro-tein (1.2 g/kg body mass plus 0.3 g/gsucrose) or placebo (carbohydrateonly). Protein supplementation usedduring resistance training, regardlessof the source, increased lean massand strength when compared withan isocaloric placebo.6

In a double-blind randomized trial,Reidy and colleagues7 sought to de-termine whether a protein blend ofsoy and dairy was advantageous rela-tive to each protein alone. Subjectsperformed resistance leg exercise athigh-intensity, and were given wheyprotein (WP; ~18 g whey protein) or asoy-dairy blend (PB; 19 g protein)post-exercise. Both beverages con-tained enough essential amino acids(8.6 g) to maximally stimulate frac-tional synthetic rate (FSR), a measureof dietary protein assimilation intomuscle protein, and were similarly ef-fective, but the soy-dairy blend pro-longed FSR later into the recoveryperiod compared with the whey beverage.

Special Concerns of Vegetarian Athletes

Protein recommendations for vege-tarian athletes do not differ fromthose of omnivores, as long as theyare meeting their daily essentialamino acid needs through consump-tion of complete proteins over the

SCAN’S PULSEWinter 2016, Vol. 35, No. 1 | 3

terol-lowering benefits of soy pro-tein.12 In a recent review of lifestyleinterventions to manage hypercho-lesterolemia, Mannu and colleaguesreviewed research published in thepast 14 years and concluded that soywas an important food to include in ahealthful diet to lower cholesterollevels and reduce risk of heart dis-ease.13

In a recent clinical trial, researchersfound that a moderately high-proteindiet including 30 g soy protein maydecrease risk factors for metabolicsyndrome, thereby potentially reduc-ing risk of heart disease.11 Using arandomized crossover design, 15postmenopausal women were as-signed to “soy-protein” or “mixed ani-mal protein” diets, which weredesigned to have equal amounts ofprotein (22% of energy), and to beweight-maintaining, so that weightloss was not a factor in altering meta-bolic end points. Compared with theanimal protein diet, the soy proteindiet resulted in significantly im-proved insulin sensitivity and lowertotal and low-density lipoproteincholesterol (4% and 9%, respectively).Replacing 30 g of animal protein with

soy protein represents a practical, rel-evant strategy for improving risk fac-tors for metabolic syndrome.

Barriers to Consumption

RDNs may have more success gettingindividuals to consume soy if thefocus is less on the nutrients andmore on overcoming the barriers tousing soy. In a novel study of youngwomen (n=502, aged 20-35 y),Wansink and colleagues14 found that44% of the variance in whether tofuwas consumed or not was related tothe belief that it does not taste good,is hard to prepare, is too expensive,and that only a “good” cook can pre-pare tofu. Only 12% of respondentschose to consume tofu due to its nu-tritional benefits. The 2013 IFIC Func-tional Foods Survey1 revealed thatthe biggest perceived barrier to con-suming health promoting foods iscost; many consumers believe thathealthful foods are more expensive.Focusing on quick meal preparationsthat are easy to prepare, affordable,and convenient can help individualsconsume more healthful foods.14

There are many soy products that canreadily be incorporated into meals,

including flavored soymilk, soy-basedmeat alternatives, soy nuts and nutbutter, soy yogurt, soy cereal, and soybaked goods such as waffles andbread. The inclusion of soy at anymeal/snack time needn’t be anymore difficult than preparing andserving standard fare, given the vari-ety, quality, and convenience of soyfoods widely available.

Soy Myth-Busting

Myth #1: Should men avoid soy?

This controversy is driven by thepresence of isoflavones (also knownas phytoestrogens), which are foundin many plant sources including soy,nuts, and legumes. Isoflavones areoften referred to as phytoestrogensbecause they are similar in structureto estradiol, a form of estrogen,15 butisoflavones cannot be equated to es-trogen. Although there are commoncharacteristics, the effects ofisoflavones in the body are not equalto those of estrogen. The small differ-ences in structure can greatly affectthe activity of a compound in thebody.

What’s Your Angle?

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

As you can see from reading through the table of contents, we’ve covered the field of nutrition from many angles in this issueof PULSE. Regardless of whether your professional expertise lies in just one or two of our four signature areas (sports nutrition,cardiovascular health, wellness, or disordered eating and eating disorders), I think you’ll consider all of the articles presented inthese pages to be of interest.

On the cover you’ll find an article contributed by Christine Rosenbloom, PhD, RDN, CSSD, Sarah Romotsky, RDN, and Alyssa Tin-dall, RDN, on the role of soy in promoting wellness in active individuals. Our free CPE article by Karen Keane, MRes, and GlynHowatson, PhD, describes the potential impacts of tart cherries on several possible components of exercise recovery includingmuscle repair, sleep promotion, and reduction of infection risk. Lisa Diers, RD, who is also an experienced registered yogateacher, lends her perspective and summarizes research regarding the use of yoga as an adjunct for treating eating disorders.You also won’t want to miss the original research article by Heather Butscher, MS, RDN, Keisha Angell, MS, RDN, and RichardJosephson, MD, MS, on the role of nutrition education provided by RDNs on dietary changes among enrollees in a cardiac re-habilitation program.

As always, we’ve also included plenty of other information for you in our regular departments, so be sure to check out all theother angles. And if, while you’re reading this issue, you find that you’d like to angle for different topics in upcoming issues, feelfree to contact one of our editors with your suggestions.

FromThe Editor

soy protein has an effect on hor-mone levels. The study concludedthat neither isoflavone-rich proteinnor isoflavone supplements affectcirculating levels of total testos-terone, sex hormone-binding globu-lin, free testosterone, or the freeandrogen index.16

Myth #2: Is the iron in soy absorbed?

Another myth about soy is that the


Well-designed human studies showthat isoflavone exposure does notlower testosterone levels,16 One studyhas recently shown slight changes intestosterone (but not estradiol) im-mediately after exercise in youngmen who have above-average testos-terone, with no differences observedbetween dietary treatment groups anhour after consumption nor after 14days of consumption.17 A recentmeta-analysis was conducted to de-termine whether the consumption of

iron present in soybeans is poorly ab-sorbed. While soy is an iron-contain-ing food, many believe that thephytate content of soy reduces ironavailability. However, ferritin, the formof iron in soybeans, is absorbedwell.18 In a 10-week randomized con-trol trial, researchers gave pre-menopausal women two to threeservings of soy foods or non-soyfoods, matching foods for type (i.e.,soy milk for cow’s milk, soy burger forbeef burger, etc.).19 At the end of thetrial, there were no significant differ-ences in serum hemoglobin, iron, ortransferrin saturation, suggesting theiron in soy was adequately bioavail-able to prevent a reduction in ironstatus over the relatively short dura-tion of the study. This research sug-gests that the notion that soy foodsreduces iron status is a mispercep-tion. This is an important considera-tion for active women and vegetarianathletes who often struggle to con-sume adequate iron in their diets.

Myth #3: Should soy be avoided in individuals withbreast cancer?

Another misperception regarding soyprotein involves individuals withbreast cancer as well as those in re-mission. A recent review of the exist-ing literature by the AmericanInstitute for Cancer Research statesthat consuming three servings of soyfoods a day is not associated with in-creased cancer risk.20 In addition, theAmerican Cancer Society concludedthat breast cancer patients can safelyconsume up to three servings of tra-ditional soy foods per day, althoughthe group advised against the use ofmore concentrated sources ofisoflavones such as powders and sup-plements.21

Numerous human studies haveshown no negative side effects ofconsuming soy foods.22 Kahn and col-leagues analyzed breast tissue biop-sies before and after soy isoflavoneexposure for 6 months at a dose thatapproximates the upper quartile ofintake of soy-consuming Far EastAsians and found no indication ofcancer cell proliferation.23 The study,

Table 1. What Constitutes One Serving of Soy?

Soy Food Serving Size Grams of Protein

Edamame ½ c 14

Miso ½ c 16

Tempeh ½ c 16

Textured soy protein ½ c 11

Tofu, silken soft 1 slice (84 g) 4

Tofu, silken firm 1 slice (84 g) 5.8

Tofu, silken, extra-firm 1 slice (84 g) 6.2

Tofu, lite firm 1 slice (84 g) 5.3

Tofu, lite extra firm 1 slice (84 g) 5.9

Soy shake 8 oz 10

Soy pudding 8 oz 2-3

Soy cheese 1 slice 2-4

Soy butter 2 T 7

Soy chips 1 bag 7

Soy energy bar 1 bar 6-14

Soy milk 1 c 8

Soy nuts ¼ c 8

Soy yogurt 1 c 9

Soy burger 1 patty 14

Soy sausage patties 1 patty 10

Soy sausage links 2 links 9

Soy dogs 1 dog 7

Soy meatballs 5 meatballs 15

Sources: Agricultural Research Service; USDA; National Nutrient Database for StandardReference, Release 26; and product information from manufacturers’ Web sites

www.foodinsight.org/surveys/2014-food-and-health-survey. AccessedJuly 13, 2014.3. Agricultural Research Service.United States Department of Agricul-ture. National Nutrient Dababase forStandard Reference. Release 27.http://ndb.nal.usda.gov/ndb/search/list. Accessed May 19, 2015.4. Paddon-Jones D, Sheffield-MooreM, Zhang X-J, et al. Amino acid inges-tion improves muscle protein synthe-sis in the young and elderly. Am JPhysiol Endocrinol Metab.2004;286:E321-E328. 5. Tang JE, Moore DR, Kujbida GW, etal. Ingestion of whey hydrolysate, ca-sein, or soy protein isolate: effects onmixed muscle protein synthesis atrest and following resistance exercisein young men. J Appl Physiol.2009;107:987-992.6. Candow DG, Burke NC, Smith-Palmer T, et al. Effect of whey and soyprotein supplementation combinedwith resistance training in youngadults. Int J Sport Nutr Exerc Metab.2006;16:233-244. 7. Reidy PT, Walker DK, Dickinson JM,et al. Protein blend ingestion follow-ing resistance exercise promoteshuman muscle protein synthesis. J Nutr. 2013;143:410-416. 8. Paul GL. The rationale for consum-ing protein blends in sports nutrition.

J Am Coll Nutr. 2009;28(Suppl):464S -472S. 9. Westerterp-Plantenga MS, Lem-mens SG, Westerterp KR. Dietary pro-tein - its role in satiety, energetics,weight loss and health. Br J Nutr.2012;108(Suppl):S105-S112. 10. Deibert P, König D, Schmidt-Truck-saess A, et al. Weight loss without los-ing muscle mass in pre-obese andobese subjects induced by a high-soy-protein diet. Int J Obes RelatMetab Disord. 2004;28:1349-1352. 11. Van Nielen M, Feskens EJM, Riet-man A, et al. Partly replacing meatprotein with soy protein alters insulinresistance and blood lipids in post-menopausal women with abdominalobesity. J Nutr. 2014;144:1423-1429. 12. Anderson JW & Bush HM. Soy pro-tein effects on serum lipoproteins: aquality assessment and meta-analysisof randomized, control studies. Am JColl Nutr. 2011;30:79-91.13. Mannu GS, Zaman MJS, Gupta A,Rehman HU, Myint PK. Evidence oflifestyle modification in the manage-ment of hypercholesterolemia. CurrCardiol Rev. 2013;9:2-14. 14. Wansink B, Shimizu M, BrumbergA. Dispelling myths about a newhealthful food can be more motivat-ing than promoting nutritional bene-fits: the case of tofu. Eat Behav.2014;15:318-320.

conducted with pre- and post-menopausal women, found there wasno evidence of cell proliferation or in-creased breast density in eithergroup. Overall, consumption of soyfoods has not proved to be danger-ous for breast cancer patients; theycan experience and utilize the bene-fits of soy as part of a healthful, activelifestyle.

Conclusion

Active individuals can be encouragedto enjoy soy foods as part of a per-formance-enhancing diet in additionto promoting optimal health. Themajority of Americans are aware ofand interested in learning moreabout health-promoting foods suchas soy,1 and RDNs are well positionedto help translate the science andcommunicate the benefits of soyfood consumption.

Christine Rosenbloom, PhD, RDN, CSSD,is a nutrition professor emerita at Geor-gia State University; she is editor-in-chief of SCAN’s Sports Nutrition: APractice Manual for Professionals (5th

ed) and editor-in-chief of the Academyof Nutrition and Dietetics’ onlineSports Nutrition Care Manual. SarahRomotsky, RDN, is director of health &wellness at the International Food In-formation Council (IFIC) Foundation, inWashington, DC; her background in ad-vertising and marketing enables her tocreate compelling science-based com-munications on food and nutrition.Alyssa Tindall, RDN, worked as a nutri-tion specialist at GNC’s corporate head-quarters after completing her dietetics internship, and is currently en-rolled in the nutrition PhD program atPenn State University.

References

1. International Food InformationCouncil. 2013 Functional Foods Con-sumer Survey. Available at:www.foodinsight.org/2013_Func-tional_Foods_Consumer_Survey. Ac-cessed July 13, 2014.2. International Food InformationCouncil. 2014 Food & Health Survey.The Pulse of America’s Diet: From Be-liefs to Behaviors. Available at:


Table 2. Top Ten Soy Meal and Snack Ideas for Active Individuals

■ Tofu noodle bowl (good choice at Asian quick-service restaurant)

■ Frozen edamame with a soy sauce dip (good snack for salty sweaters)

■ Soy milk and whole grain cereal (good snack for vegetarian athlete)

■ Whole soy energy bars (for pre-workout fuel or post-workout recovery)

■ Isolated soy protein used in shakes (good for meal replacement or post-workout recovery)

■ Isolated soy protein smoothies (good for lactose-intolerant active individuals)

■ Soy yogurt (good for snacks)

■ Soy nuts (good for multi-event sports days as between heat snack)

■ Soy burger (good meal for vegetarian or weight-conscious athletes)

■ Soy pudding, soy cheese slices, or flavored soy milk (good for snacks)

15. Oseni T, Patel R, Pyle J, Jordan VC.Selective estrogen receptor modula-tors and phytoestrogens. Planta Med.2008;74:1656-1665. 16. Hamilton-Reeves JM, Vazquez G,Duval SJ, et al.. Clinical studies showno effects of soy protein orisoflavones on reproductive hor-mones in men: results of a meta-analysis. Fertil Steril. 2010;94:997-1007. 17. Kraemer WJ, Solomon-Hill G, VolkBM, et al.The effects of soy and wheyprotein supplementation on acutehormonal responses to resistance ex-ercise in men. J Am Coll Nutr.2013;32:66-74.


18. Messina M, Watanabe S, SetchellKDR. Report on the 8th InternationalSymposium on the Role of Soy inHealth Promotion and Chronic Dis-ease Prevention and Treatment. J Nutr. 2009;139:796S-802S. 19. Zhou Y, Alekel DL, Dixon PM, et al.The effect of soy food intake on min-eral status in premenopausal women.J Womens Health (Larchmt). 2011;20:771-780.20. American Institute for Cancer Re-search. Soy is Safe for Breast CancerSurvivors. New Review of the Re-search, November 2012. Available at:www.aicr.org/press/press-releases/soy-safe-breast-cancer-sur-

vivors.html. Accessed May 19, 2015.21. McCullough M. The Bottom Lineon Soy and Breast Cancer Risk. Ameri-can Cancer Society. Available at:www.cancer.org/cancer/news/ex-pertvoices/post/2012/08/02/the-bot-tom-line-on-soy-and-breast-cancer-risk.aspx. Accessed May 19, 2015.22. Messina MJ & Loprinzi CL. Soy forbreast cancer survivors: a critical re-view of the literature. J Nutr.2001;131(11 Suppl):3095S-3108S.23. Khan SA, Chatterton RT, Michel N,et al. Soy isoflavone supplementationfor breast cancer risk reduction: a ran-domized phase II trial. Cancer PrevRes. 2012;5:309-319.

CPE article

Tart Cherries: The “Bittersweet” Evidence in Exercise Recovery by Karen M. Keane, MRes, and Glyn Howatson, PhD

This article is approved by the Academyof Nutrition and Dietetics, an accred-ited Provider with the Commission onDietetic Registration (CDR), for 1 con-tinuing professional education unit(CPEU), level 1. To apply for free CPEcredit, take the quiz on SCAN’s Web site(www.scandpg.org/nutrition-info/pulse-newsletters/). Upon success-ful completion of the quiz, a Certificateof Completion will appear in your MyProfile (under the heading, My History).The certificate may be downloaded orprinted for your records.

Learning Objectives After you have read this article, youwill be able to:

■ Summarize the evidence in the lit-erature regarding the effects of tartcherries on muscle damage.■ Discuss research findings relevantto the effects of tart cherries on thequality and duration of sleep.■ Provide recommendations to ath-letes regarding the consumption oftart cherries to improve exercise re-covery and positively modulate sleep.

Research examining supplementa-tion with functional foods for healthand in exercise has gained momen-tum in recent years, with beetrootjuice, purple sweet potatoes, blueber-ries, pomegranate juice, green tea,and tart cherries receiving attentionregarding their purported applica-tions. Cherries, which have providedseveral avenues for research be-cause they contain high levels ofbioactive compounds, have beencompared favorably with other func-tional foods. Among the 20 mostcommonly consumed fruits, cherriesare suggested to have the fifth high-est total phenolic content.1 Data sup-port the presence of severalphytonutrients in Montmorency tartcherries including the flavonoidsisorhamnetin, kaempferol, quercetin,catechin, epicatechin, procyanidins,and anthocyanins.2 Tart cherries areone of the richest sources of antho-cyanins, which give them their richred color, and they also appear tohave the greatest antioxidant capac-ity.3 Mechanistically, it is thought thephenolic compounds within tartcherries act as “reactive oxygen

species” scavengers that reduce ox-idative stress.4 In addition, the anti-in-flammatory properties5 of tartcherries largely attributable to thehigh anthocyanin content have beenreported to be at a level comparableto several nonsteroidal anti-inflam-matory drugs.6

A growing body of scientific evidenceis consistently linking tart cherries toan array of important health benefits,as highlighted in a recent review.7 Ofparticular interest is the increasingnumber of peer-reviewed studiesthat have examined novel applica-tions of tart cherries relevant to exer-cise recovery and managingexercise-induced inflammation, man-aging oxidative stress, and positivelymodulating sleep. This work has notgone unnoticed, and tart cherries areroutinely used by elite athletic popu-lations in professional soccer, profes-sional and international rugby union,professional road cycling, the Na-tional Hockey League, and others.These study findings has had an im-pact on sales and the public intereston tart cherries as a functional food.

This article provides a review of thepotential use of tart cherries in exer-cise recovery.

Muscle Damage

Disruption of the structures in exer-cising muscle leads to a cascade ofevents resulting in impaired muscularfunction.8 Eccentric muscle actionsare accepted as the source of me-chanical stress that causes primarymuscle damage and the subsequentsecondary inflammatory cascade andimpaired muscle function.9 Connollyand colleagues10 were the first to in-vestigate the application of cherryjuice supplementation in a damagingexercise model. Using a double-blind,placebo-controlled, crossover design,they examined the effects of 12 fluidoz of a cherry juice blend (freshpressed tart cherries and apple juice),twice daily for 8 days on isometricelbow flexion strength, pain, andmuscle tenderness following a boutof eccentric elbow flexion contrac-tions (2 × 20 max contractions). Theresults showed that strength loss andpain were significantly less in thecherry juice trial versus placebo.Most notably, strength loss averagedover the 4 days after eccentric exer-cise was 22% with the placebo butonly 4% with the cherry juice. Al-though the investigators did notrecord measures of inflammation oroxidative stress, they speculated that


the differences were due to the anti-inflammatory and antioxidant prop-erties of the cherry juice.

Consequently, Howatson and col-leagues11 examined measures of in-flammation and oxidative stress tohelp elucidate the potential mecha-nisms of cherry juice supplementa-tion. In comparison to placebo,Montmorency tart cherry juice taken5 days before, the day of, and 2 daysafter running a marathon was effec-tive at accelerating recovery ofstrength, increasing total antioxidantcapacity, and reducing lipid peroxida-tion (lipid oxidative stress index), in-terleukin-6 (IL-6), high-sensitivityC-reactive protein (hsCRP), and uricacid (inflammation indices). This rep-resents a broad spectrum of activityin aiding recovery and providing pro-tection against the exercise-inducedinflammation and oxidative stress as-sociated with prolonged running.

In a more recent addition to the liter-ature, Bell and colleagues 12 exam-ined the impact of a tartMontmorency cherry concentrate onphysiologic indices of oxidativestress, inflammation, and muscledamage across 3 days of simulatedroad cycle racing. They reported thatlipid hydroperoxides, IL-6, and hsCRPresponses to trials were lower in thecherry group versus placebo. The at-tenuated oxidative and inflammatory

responses suggest that tart cherriesmay be efficacious in combatingpost-exercise oxidative and inflam-matory cascades that can contributeto cellular disruption. In addition,they demonstrated direct applicationfor tart cherries in repeated days cy-cling and conceivably other sportingscenarios in which back-to-back per-formances are required. Since 2010,there have been several otherstudies13-16 using different forms ofexercise stress that have demon-strated similar positive results whenexamining the relationship betweentart cherries and recovery. Table 1provides a summary of human stud-ies, including the aforementioned; in-terestingly, all of these studies showpositive effect on one or more aspectof exercise recovery.

What athletes can do: Drink a 10-ozglass of tart cherry juice before work-outs. Most of the exercise recoverystudies have provided participantswith two 8-oz or 12-oz bottles of tartcherry juice per day. Previous studieshave suggested that a loading phaseof 3 to16 days is effective when re-covering from metabolic and me-chanical stress.

Sleep

An often forgotten element of the re-covery process is sleep. Insomnia , de-fined as trouble sleeping on average

Table 1: Summary of Human Studies Examining the Effect of Tart Cherries on Exercise Recovery

Study Metabolic/ Function Soreness O2 Stress InflammationDamage(Met/Dam)

Connolly et al (2006) Dam Yes Yes - -

Kuehl et al (2010) Met/Dam - Yes - -

Howatson et al (2010) Met/Dam Yes No Yes Yes

Bowtell et al (2011) Dam Yes No Yes No

Kastello et al (2014) Dam Yes Yes No Yes

Bell et al (2014) Met - No Yes Yes

Bell et al (2015) Met Yes No No Yes

Total 5/5 3/7 3/5 4/5(100%) (43%) (60%) (80%)

more than three nights per week, canbe an annoyance for some, but long-lasting sleeplessness can seriously af-fect health, especially in the elderly.Insomnia is linked to a higher preva-lence of chronic pain, high bloodpressure, and type 2 diabetes, and adecline of cognitive function or an in-crease in dementia.17 An estimated50 to 70 million adults in the UnitedStates have a sleep or wakefulnessdisorder, with more than one quarterof the population reporting they donot get enough sleep.18 Athletes andindeed members of the wider popu-lations can suffer from disturbedsleep due to travelling across timezones, high training loads, shift work,over-reaching, and unexplained un-derperformance syndrome or someother underlying pathology such asinsomnia. Interestingly, in addition tothe aforementioned phenolic com-pounds, tart cherries contain rela-tively high concentrations ofmelatonin.19 Melatonin has a stronginfluence on the sleep-wake cycle inhumans and is associated with sleep-promoting properties.20 Moreover, astrong positive relationship betweenincreased melatonin and total sleeptime in healthy, young individuals hasbeen previously demonstrated.21

Previous research has indicated thattart Montmorency cherries mighthelp improve the quality and dura-tion of sleep, reduce the severity ofinsomnia, and increase overall sleepefficiency. In a small-scale pilot studyby Pigeon and colleagues,22 the effi-cacy of tart cherry juice consumptionon sleep indices in a population withlate-life insomnia was examined. Theinvestigators reported that sleep wasimproved when two 8-oz servings oftart cherry juice was consumed everyday for 2 weeks in older adults withmoderate insomnia. Specifically,there were modest improvements insubjective quality of sleep, includingimprovements in insomnia severityindex (8%) and sleep efficiency (5%).In addition, total sleep time increasedby 8%, equating to 90 minutes over atwo-week period among older adultswith insomnia. However, no objectivemeasures of sleep such as actigraphywere taken, and the potential mecha-

nisms responsible for the reportedsleep improvements (e.g., melatonin)were impossible to discern. The au-thors speculated that increased di-etary melatonin associated withconsumption of tart cherry juicemight be responsible for thechanges. An alternative hypothesisasserts that the anti-inflammatoryproperties of tart cherries may havesome influence on the pro-inflamma-tory cytokines involved in sleep regu-lation.22 These findings have beenreplicated more recently by Liu andcolleagues,23 who found that whenolder adults with insomnia consumedan identical dose, they increased theirsleep time by 85±17 minutes com-pared with placebo as measured bypolysomnography (PSG). In addition,expression of indoleamine 2,3 dioxy-genase (IDO) and PGE2 decreasedafter tart cherry juice consumption.IDO 2,3 dioxygenase degrades tryp-tophan (a precursor of serotonin).Tryptophan degradation is a knownpredictor of insomnia and is also re-lated to inflammation. Therefore, itwould appear that the compounds intart cherries could improve thebioavailability of tryptophan for sero-tonin synthesis, exerting an overallpositive effect on sleep and mood.

Similarly to the Pigeon et al study,24

Howatson and colleagues25 reportedimprovements in 20 healthy partici-pants with no sleep impairments. Inthis well-controlled placebo-con-trolled study, they reported improve-ments in total sleep time (9%) andsleep efficiency (7%) and a 78% re-duction in nap time following tartcherry consumption. The findings inthis study were attributed to the sig-nificantly higher melatonin contentin urine following cherry juice con-sumption compared with placebo.

What athletes can do: Drink two 8-ozservings of tart cherry juice daily.Enjoy a glass in the morning withbreakfast and incorporate another inthe evening routine to improve sleepquality and duration.

Upper Respiratory Tract Infections

Anecdotal evidence and scientific ob-servation suggest that after exercise,there is an increase among athletesin the reported incidence of symp-toms more commonly associatedwith infections of the upper respira-tory airways.26 As previously men-tioned, tart cherries are high innumerous phytochemicals that pos-sess anti-inflammatory and antiox-idative properties. Consequently, it isconceivable that tart cherries couldattenuate the exercise-induced“stress” response, immunity, andupper respiratory tract symptoms(URTS) to exercise. A recent pilotstudy27 provided the first encourag-ing evidence to support this premise.The study reported that despite noapparent change in cortisol or mu-cosal immunity between groups, run-ners who consumed tart cherry juicehad a lower CRP response at 24 hoursand 48 hours post–marathon andhad no incidence of reported URTSup to 48 hours after the marathon asopposed to the placebo group whohad a 50% prevalence of URTS, sug-gesting that cherries reduced the ex-ercise-induced inflammatoryresponse and the subsequent devel-opment of URTS compared withplacebo following the race. More re-search in this area is needed to cor-roborate these findings beforespecific recommendations can bemade.

Summary

Tart cherries and their constituentshave received growing attention forapplication in sport and exercise,with the beneficial effects appearingto be promising and supported by agrowing body of evidence. However,this evidence has only been shownwhen Montmorency tart cherrieshave been ingested, and it is worthyto note that other cultivars might nothave the same desired effects interms of exercise recovery. In addi-tion, there appears to be little ration-ale provided for the dosing strategiesemployed in the studies. In humanexercise studies, dosing strategies


ranged from 7 days pre-exercise to 4days post-exercise inclusive. In sum-mary, tart cherries appear to providean efficacious option for assistingwith recovery following strenuousexercise. Moreover, as with otherpolyphenolic-rich foods, tart Mont-morency cherries are worth explor-ing in other health paradigms andclinical pathologies, such as im-proved cardiovascular disease andaging.

Karen M. Keane is a PhD candidate inthe Department of Sport, Exercise andRehabilitation at Northumbria Univer-sity, Newcastle Upon Tyne, UK. GlynHowatson, PhD, is a reader as well as aresearch and innovation Lead in theDepartment of Sport, Exercise and Re-habilitation at Northumbria University,Newcastle Upon Tyne, UK.

References

1. Vinson JA, Su XH, Zubik L, et al. Phe-nol antioxidant quantity and qualityin foods: Fruits. J Agric Food Chem.2001;49:5315-5321.2. Kirakosyan A, Seymour EM, LlanesDEU, et al. Chemical profile and an-tioxidant capacities of tart cherryproducts. Food Chem. 2009;115:20-25.3. Elliott AJ, Scheiber SA, Thomas C, etal. Inhibition of glutathione-reduc-tase by flavonoids–a structure activ-ity study. Biochem Pharmacol.1992;44:1603-1608.4. Kelley DS, Rasooly R, Jacob RA, et al.Consumption of bing sweet cherrieslowers circulating concentrations ofinflammation markers in healthy menand women. J Nutr. 2006;136:981-986.5. Wang H, Nair MG, Strasburg GM, etal. Antioxidant and antiinflammatoryactivities of anthocyanins and theiraglycon, cyanidin, from tart cherries. J Nat Prod. 1999;62:294-296.6. Kim DO, Heo HJ, Kim YJ, et al. Sweetand sour cherry phenolics and theirprotective effects on neuronal cells. J Agric Food Chem. 2005;53:9921-9927.7. Bell PG, McHugh MP, Stevenson E,et al. The role of cherries in exerciseand health. Scand J Med Sci Sports.2014;24:477-490.8. Proske U, Morgan DL. Muscle dam-age from eccentric exercise: mecha-

nism, mechanical signs, adaptationand clinical applications. J Physiol.2001;537:333-345.9. Howatson G, van Someren KA. Theprevention and treatment of exer-cise-induced muscle damage. SportsMed. 2008;38:483-503.10. Connolly DAJ, McHugh MP,Padilla-Zakour OI. Efficacy of a tartcherry juice blend in preventing thesymptoms of muscle damage. Br JSports Med. 2006;40:679-683.11. Howatson G, McHugh MP, Hill JA,et al. Influence of tart cherry juice onindices of recovery followingmarathon running. Scand J Med Sci-ence Sports. 2010;20:843-852.12. Bell PG, Walshe IH, Davison GW, etal. Montmorency cherries reduce theoxidative stress and inflammatory re-sponses to repeated days high-inten-sity stochastic cycling. Nutrients.2014;6:829-843.13. Kuehl K, Perrier E, Elliot D, et al. Effi-cacy of tart cherry juice in reducingmuscle pain during running: a ran-domized controlled trial. J Int SocSports Nutr. 2010;7:17.14. Bowtell JL, Sumners DP, Dyer A, etal. Montmorency cherry juice reducesmuscle damage caused by intensivestrength exercise. Med Sci SportsExerc. 2011;43:1544-1551.15. Bell PG, Gaze DC, Davidson GW, etal. Montmorency tart cherry (Prunuscerasus L.) concentrate lowers uricacid, independent of plasma cyani-din-3-O-glucosiderutinoside. J Func-tional Foods. 2014;11:82-90.16. Kastello GM, Emilene MCB, Clark,R, et al. The effect of cherry supple-mentation on exercise-induced ox-idative stress. J Food Nutr Sci.2014;1:1-7.17. Dement WC, Mitler MM. It’s timeto wake up to the imporance of sleepdisorders. JAMA.1993;269:1548-1550.18. Institute of Medicine. Sleep Disor-ders and Sleep Deprivation: AnUnmet Public Health Problem. Wash-ington, DC: The National AcademiesPress; 2006. 19. Burkhardt S, Tan DX, ManchesterLC, et al. Detection and quantificationof the antioxidant melatonin inMontmorency and Balaton tart cher-ries (Prunus cerasus). J Agric FoodChem. 2001;49:4898-4902.

20. Hughes RJ, Sack RL, Lewy AJ. Therole of melatonin and circadianphase in age-related sleep-mainte-nance insomnia: assessment in a clin-ical trial of melatonin replacement.Sleep. 1998;21:52-66.21. Morris M, Lack L, Barrett J. The ef-fect of sleep/wake state on nocturnalmelatonin excretion. J Pineal Res.1990;9:133-138.22. Pigeon WR, Carr M, Gorman C, etal. Effects of a tart cherry juice bever-age on the sleep of older adults withinsomnia: a pilot study. J MedicinalFood. 2010;13:579-583.23. Opp MR. Cytokines and sleep: thefirst hundred years. Brain, Behavior,and Immunity. 2004;18:295-297.24. Liu Ann TR, Pan Weihong, JohnFinley, et al. Tart cherry juice increasessleep time in older adults with insom-nia. FASEB J. 2014;28(1).25. Howatson G, Bell PG, Tallent J, etal. Effect of tart cherry juice (Prunuscerasus) on melatonin levels and en-hanced sleep quality. Eur J Nutr.2012;51:909-916.26. Bonsignore MR, Morici G, Ric-cobono L, et al. Airway inflammationin nonasthmatic amateur runners. AmJ Physiol-Lung Cell Molec Physiol.2001;281:L668-L676.27. Dimitriou L, Hill JA, Jehnali A, et al.Influence of a Montmorency cherryjuice blend on indices of exercise-in-duced stress and upper respiratorytract symptoms following marathonrunning-a pilot investigation. J Int SocSports Nutr. 2015;12.


The popularity and accessibility ofyoga has grown exponentially in thepast decade. According to a study byYoga Journal, approximately 20 mil-lion Americans older than 18 yearspracticed yoga in 2012, constituting8.7% of the adult population.1 An in-dustry report by IBIS World estimatesthere are more than 30,000 yoga andPilates studios in the United States.2

Many of the 170+ eating disorder(ED) treatment facilities in the U.S.offer yoga or other mind-body basedactivities as a component of treat-ment.3 A 2006 study of 18 residentialED treatment programs in the nationfound that two thirds of the pro-grams offered yoga.4

Twenty million women and 10 mil-lion men in the U.S. suffer from an ED(all diagnosis considered) at somepoint in life.5 Some research indicatesthat 97% of patients admitted to in-patient ED treatment facilities alsomeet diagnostic criteria for greaterthan or equal to one comorbid disor-der.5 Of those patients, 94% evi-denced comorbid mood disorders(largely depression) and 56% evi-denced anxiety disorders.6

Preliminary research demonstratesthe positive effects that yoga mayhave on the management of anxietyand depression symptoms, includingimproved body awareness and re-sponsiveness, self-acceptance, emo-tion regulation, and increasedmindfulness.7 Given these findings,yoga may have a role as an adjunc-tive therapy when incorporated intoED treatment. Fortunately, with thegrowing popularity and accessibly ofyoga (via studios, pod casts, Internetvideos, DVDs, written materials), itcan more easily be incorporated intodaily living for ongoing recovery sup-port.

What Is Yoga?

The definition of yoga comes fromthe Sanskrit root meaning “to join.”Traditionally, yoga seeks to join sev-eral parts of an individual’s life into acoherent whole.8 Perhaps when tra-ditional yoga is incorporated into EDtreatment, it has the potential ofhelping clients rediscover and recon-nect their mind and body in a health-ful way.

Traditional yoga is integration: inte-gration of mind, body, breath, andspirit/soul. Yoga is a practice of spe-cific postures (asanas) linked withbreath while incorporating a focusedintention of moving inward for self-exploration and/or reflection. Thispractice provides an opportunity tobegin learning how one’s mind andbody may react to an array of life ex-periences, thus creating an aware-ness of behavioral and emotionalpatterns.8 Once yoga is learned onthe mat, positive change or a changein unhelpful behavior patterns canbegin.

How Yoga Differs From Exercise or Stretching

Yoga differs from exercise in its inten-tional and mindful movement usingparticular poses and breathing tech-niques to support an inward and re-flective focus as well as physicalbenefits. When exercising, someonemay not be fully present in mind andbody. An example would be watch-ing TV while running on the tread-mill. The body and mind are engagedin different ways. Yoga takes thephysical and adds the component oflistening to the body, self-accept-ance, forming the pose to the studentnot the student to the pose, movinginward, and cultivating both mindand body with the power of thebreath. In yoga, the mind is not sepa-

rate from the body nor is the bodyseparate from the mind. When yoga ispracticed with traditional methods, itis a practice of wholeness.

How Is Yoga Useful in Treating Eating Disorders?

How does yoga relate to ED treat-ment? An ED can serve as a distrac-tion from unwanted feelings,experiences, and stressors. The needsof the body are ignored to a great de-gree and the numbing of uncomfort-able sensations can occur through avariety of maladaptive coping mech-anisms. Of course, these coping skillsare highly dangerous and not sus-tainable. In order to live in recovery,one needs to learn how to cope withintense situations, life stressors, andemotions in a healthier way. Learningabout the patterns of the mind andbody, awareness of personal triggers,and early signs of urges or dysregula-tion could prevent, delay, or lessen EDsymptoms.

Because yoga embodies the connec-tion between body, mind, and breathand provides a canvas of sorts to ex-plore internal reactions in a nonjudg-mental way, it can serve, for many, asa nonthreatening tool to begin heal-ing the emotional and physical body.Bridging the gap between body andmind in this way can aid in develop-ing a nonreactive and curious stancein the face of otherwise harmfulthoughts, emotions, and behaviors.9

The practice of yoga through mindfulmovement, meditation, and breath-ing can serve as a “pause” button cre-ating space to choose how to rspondto stress or unhelpful coping mecha-nisms. At the heart of yoga is accept-ance and care for the body, whichmay ultimately be determined to behelpful in the recovery process. Thisfocus on body appreciation could behelpful in the recovery journey.7,9


Discovering the Role of Yoga in Eating Disorder Treatmentby Lisa Diers, RD, E-RYT

Another avenue by which yoga couldbe useful in ED treatment involvesregulation of the nervous system. Theprevalence of anxiety and depressionin those with an eating disorder issignificant6 and the seemingly posi-tive effect yoga may have on stress,anxiety, and depression could helppeople with EDs to manage thesesymptoms. There is evidence thatpractices such as yoga can stimulatean underactive parasympatheticnervous system and “increase the in-hibitory action of a hypoactive GABA(gamma-aminobutyric acid) systemin the brain pathways and structuresthat are critical for threat perception,emotional regulation, and stress reac-tivity.”10 One study further suggeststhat such practices as vagal nervestimulation in yoga, which activatesthe parasympathetic nervous system,could impact stress responses.11 Bystimulating the vagal nerve via chant-ing or specific postures (inversions),yoga may help decrease heart rateand lower blood pressure. These areeffective indicators of improvedstress response. The practice of yogaimproves resting vagal tone, whichmay help those with depression copemore effectively.12 Results from a re-cent pilot study on the effects of avinyasa yoga class, taken twiceweekly for 8 weeks, on affect andstress among college students sug-gested that yoga practice was associ-ated with acute improvements in thispopulation; positive affect scores(measured by the Positive and Nega-tive Affect Schedule) increased signif-icantly (P<.05) and negative affectdecreased significantly from pre- topost-yoga (P<.05).11 Further researchand stronger study designs regardingthe role of yoga in anxiety and stressmanagement is needed.13 With ade-quate funding to allow access tostrong measurements and study de-signs, these studies could shed lighton prescriptive yoga approaches thatcould target these common comor-bid conditions in ED and potentiallyhelp alleviate symptoms that impairED recovery.

Yoga in ED Treatment: Anecdotes from Professional Experience

Prior to becoming a registered yogateacher, I practiced as a dietitian spe-cializing in ED treatment for TheEmily Program. I learned much aboutrecovery from our clients, and had theprivilege to witness their experiencesfirsthand. Seven years ago, I beganteaching yoga in ED treatment at TheEmily Program. Even at that time, withonly two weekly yoga classes offeredby the agency, I saw the impact yogawas having at mealtime, groupprocess, and in individual sessions.What I observed profoundly shapedmy vision for yoga in ED treatment.Here are some anecdotal examples ofthe changes clients exhibited: ■ Renegotiation of trauma■ Use of positive coping skills tocalm down during high anxietyevents (grocery shopping, meals,symptom succession)■ Decreased manifestation of anxietyat mealtimes ■ Increased awareness of internalhunger and fullness cues■ Enhanced ability to challenge neg-ative body image, checking, and be-haviors■ Reclaiming positive movement(from over-exercising to under-exer-cising) ■ Appreciation of what the body iscapable of versus appearance ■ Facing fears and challenging oldbeliefs of self■ Having fun, laughter, joy, feelinghopeful■ Decreased isolation■ Increased awareness of and de-creased engagement in comparison(body and food)■ Increased awareness of and de-creased engagement in negative self-talk ■ Increase in deep breathing andgrounding techniques at mealtime■ Utilization of yoga to aid in diges-tion

Case Examples of Yoga Supporting ED Recovery

While shopping one day, a client no-ticed her anxiety level increasing as

she navigated the grocery store. Sheinconspicuously moved into a For-ward Fold (Uttanasana). This inver-sion slowed her heart rate and sheexperienced feeling more calm andcentered. She continued groceryshopping with success.

Another client struggled with theDownward Facing Dog pose (AdhoMukha Svanasana). Typically shewould experience disgust for herlegs when she was in this posture.After several weeks of practice, shemoved into the pose and appreci-ated the strength of her legs andtheir ability to support her invertedpractice, and she didn’t experiencethe usual judgmental thoughts.

At The Emily Program, yoga is inte-grated into all levels of treatment. Anaverage week contains more than 40yoga classes led and facilitated by 16registered yoga teachers across all lo-cations. Yoga teachers are registeredat the 200-hour level or higher andundergo extensive ED-sensitive yogatraining. Over the past 6 years TheEmily Program has developed yogain ED training for clinicians (yoga in-structors, therapists, dietitians) prac-ticing in ED treatment. Because ofthe comorbid conditions in the clientpopulation (anxiety, depression, per-sonality disorders, trauma, and more),careful consideration, thoughtfultechnique, specific language, trauma-sensitive options, and creating a safeenvironment are required of all ofour teachers. The poses are adaptedto meet the student, not the studentto the poses. Individuals of any levelof experience, mobility, and bodysizes can participate fully. Eating dis-orders do not discriminate and nei-ther does yoga. Systematic researchis needed to comprehensively testthe efficacy of yoga in this popula-tion.

Practical Application: Tips for Incorporation

Only those who are formally trainedand registered should teach yoga.However, if you are a clinician work-ing in ED treatment, showing yourclient a few grounding and centering


yogic techniques could provide help-ful tools to add to the recovery toolbox. Your client should be fully awareand willing to participate. For moreinformation on some suggestedposes, check out the following sites:www.emilyprogram.com/blog/tag/yoga, www.youtube.com/user/emi-lyprogram, or www.yogajournal.com

Following are postures and pur-ported benefits for consideration: ■ Mountain Pose (standing orseated)—for grounding and center-ing■ Downward-facing Dog (traditional,chair or wall)—activates parasympa-thetic vagal response ■ Alternate Nostril Breathing—bal-ances the autonomic nervous system■ Legs up the Wall—calming, de-creases swelling■ Wind-Relieving Pose—for relief ofconstipation and gas discomfort■ Supine Twist—for relief of consti-pation and gas discomfort ■ Heart Openers (on bolster)—counterbalance for withdrawal■ Crescent Moon Pose—stretches in-tercostal muscles, increasing capacityfor deeper breathing

Consider incorporating simplebreathing techniques (alternate nos-tril breathing; noticing the breath;deepening the breath) into or beforesessions and at mealtimes. Someclients have increased anxiety duringthe initial phases of breath integra-tion, so always guide with curiosityand a reminder that these are onlysuggestions, not requirements.

Be curious and ask your client abouttheir yoga practice:■ Why is the client practicing yoga?■ What is his/her intention? ■ Is he/she taking a class that bestmeets his/her current needs? ■ What does the client notice prior,during and after a practice? ■ Does the client have a helpful in-tention, mantra, or quote? ■ Can a yoga experience relate to anexperience with food, body, shape,exercise, emotion? ■ What is the client’s hydration be-fore, during and after a class? ■ Is the client adapting postures as

needed, or ignoring his/her body? ■ Does the studio have mirrors? ■ How is this affecting the client’sbody image and perception?■ What types of messages are beingintegrated into the class (weight-fo-cused, appearance, competition vs.acceptance, adaptation, modifica-tion)?■ Can the client or you discuss con-cerns or needs with the yogateacher?

Careful Considerations

Although the healing benefits ofyoga are promising, yoga should beincorporated and taught in athoughtful and skillful way. If incor-porated carelessly, it could be trau-matizing to the client. Clearcommunication of needs and out-comes between the yoga teacher,client, and treatment team is a mustto provide a safe experience.

The Future of Research

Studies are showing that yoga hasthe potential for producing positiveeffects on mental health, although ina 2013 review of studies on the effec-tiveness of yoga on EDs, Neumark-Sztainer suggests that more researchwith stronger designs are needed toprove yoga’s effectiveness as a sup-portive treatment and preventionmodality for people with EDs.14 An-other review on the effects of yogaon ED symptoms support the needfor additional research that is ofhigher quality and provides specificson technique and effects of posturesand amounts.15

At The Emily Program, in collabora-tion with the University of Min-nesota’s Division of Epidemiologyand Community Health, in theSchool of Public Health, two researchstudies furthering the exploration ofthe impact of yoga on EDs are in thedata analysis phase. One study in-volves the evaluation of The EmilyProgram’s popular yoga and bodyimage groups. This is a mixed-meth-ods (quantitative and qualitative)study evaluating the effects of theseinterventions on different aspects of

participants’ body image. The secondstudy is a small randomized, controltrial examining the effects of yoga onmealtime anxiety among clients inresidential treatment at The EmilyProgram’s Anna Westin House. Find-ings from both of these studies willcontribute to the limited empiricalevidence regarding the role of yogain ED treatment.

Summary

The popularity and health benefits ofyoga, together with the principles ofED-sensitive teaching, shed favorablelight on the potential advantages ofincorporating yoga into ED treat-ment. Through yoga postures andbreathing techniques that focus onautonomic nervous system regula-tion, neuromuscular re-patterning,observation, choice, behavior modifi-cation, distress tolerance, and a less-ened or nonreactive response tostressors, shifts in ED thoughts andactivities have the opportunity totake place.

Lisa Diers, RD, E-RYT, is director of nutri-tion and yoga services at The EmilyProgram, an ED program located inWashington, Minnesota, Ohio, andPennsylvania. In addition to overseeingnutrition and yoga, counseling clients,teaching, training, program develop-ment, and blogging, Lisa facilitates re-search to better understand and studythe science of both nutrition and yogain relation to ED treatment.

References

1. Yoga in America Market Study.Available at: http://www.yogajour-nal.com/article/press-releases/yoga-journal-releases-2012-yoga-in-america-market-study/. Accessed May 18,2015.2. Pilates & Yoga Studios in the US:Market Research Report. Available at:https://www.ibisworld.com/indus-try/pilates-yoga-studios.html. Ac-cessed May 18, 2015.3. Treatment Center Finder. Availableat: http://www.edreferral.com/treatmentframe.htm. Accessed May18, 2015.4. Frisch MJ, Herzog DB, Franko DL.


Residential treatment for eating dis-orders. Int J Eat Disord. 2006;39: 434-442. 5. Wade T, Keski-Rahkonen A, HudsonJ. Epidemiology of eating disorders.In: Tsuang M, Thohen M. Textbook inPsychiatric Epidemiology. New York,NY: Wiley; 2011:343-360.6. Blinder BJ, Cumella EJ, SanatharaVA. Psychiatric comorbidities of fe-male in patients with eating disor-ders. Psychosom Med. 2006;68:454-462. 7. Daubenmier JJ. The relationship ofyoga, body awareness, and body re-sponsiveness to self-objectificationand disordered eating. Psychology ofWomen Quarterly. 2005;29:207-219. 8. Kraftsow G. Nourishing the physi-cal. In: Kraftsow G. Yoga for Transfor-

mation. New York, NY: Penguin En-compass; 2002:45-60.9. Dittmann KA, Freedman MR. Bodyawareness, eating attitudes and spiri-tual beliefs of women practicingyoga. J Treat Prev. 2009;4,273-292. 10. Streeter CC, Gerbarg PL, Saper RB,et al. Effects of yoga on the auto-nomic nervous system, gamma-aminobutryric acid, and allostasis inepilepsy, depression, and post-trau-matic stress disorder. Med Hypoth.2012;78:571-579.11. Gaskins R, Jennings E, Thind H, etal. Acute and cumulative effects ofVinyasa yoga on affect and stressamong college students participat-ing in an eight-week yoga program: apilot study. Int J Yoga Ther.2014;24:63-70.

12. Shapiro D, Cooke I, Davydov, D, etal. Yoga as a complementary treat-ment of depression: effects of traitsand moods on treatment outcome.Evid Based Complem Alt Med.2007;4:493-502. 13. Li A, Goldsmith CA. The effects ofyoga on anxiety and stress. Alt MedRev. 2012 17:21-35. 14. Neumark-Sztainer D. Yoga andeating disorders: is there a place foryoga in the prevention and treat-ment of eating disorders and disor-dered eating behaviors? Adv EatDisord. 2014;2:136-145.15. Klein BA, Cook-Cottone C. The ef-fects of yoga on eating disordersymptoms and correlates: a review.Int J Yoga Ther. 2013;23:41-50.


Efficacy of Nutrition Education Within a Cardiac Rehabilitation Program in Eliciting Heart HealthyDiet Changesby Heather A. Butscher, MS, RDN; Keisha Angell, MS, RDN; and Richard A. Josephson, MD, MS

A leading cause of mortality in Amer-icans is coronary artery disease(CAD). It is estimated that more than13 million Americans have survived aheart attack. Secondary preventionefforts have been established to helpdecrease disease progression. One ofthese efforts involves lifestyle modifi-cations, shown to reduce the risk offuture cardiac events. Dietarychanges such as reducing saturatedfats and trans fat are included amongthese lifestyle changes.1

The relationships between consump-tion of total fat or specific types offatty acids and heart health of cardiacpatients have been well established.Overall, dietary recommendationstypically suggest limiting total andsaturated fat intake to help lowerlow-density lipoprotein cholesterol(LDL-C) and reduce the risk of CAD. 2-9

The American Association of Cardio-vascular and Pulmonary Rehabilita-

tion (AACVPR) recommends dietaryfat intake between 25% to 35% oftotal daily calories.10 The state of thescience overall suggests that currentdietary recommendations can helpreduce disease progression.

Data evaluating the efficacy of nutri-tion education within cardiac rehabil-itation programs are limited, but atleast one study has shown that nutri-tion education under the direction ofa registered dietitian nutritionist(RDN) can lead to long-lasting favor-able changes in diet, body weight,and serum cholesterol.11 According tothe results of this 1999 study, the in-tervention group significantly de-creased the intake of saturated fats,and the proportion of energy fromfat also decreased. 11 The currentstudy reported in this article is similarto the 1999 study in that it examinesthe relationship between nutritioneducation and diet outcomes of car-diac rehabilitation patients.

Methods

ParticipantsParticipants were selected from theUniversity Hospitals Case MedicalCenter (UHCMC) cardiac rehabilita-tion program if they were consideredby AACVPR and the American HeartAssociation Adult Treatment Panel III(AHA ATP III) to have a high fat (>30%of energy) intake (n=138). Individualswere excluded from the study if theyhad incomplete surveys (n=80). Atotal of 73 participants were includedin the final analysis. This study wasapproved by the UHCMC InstitutionalReview Board.

DesignThis retrospective study used datafrom cardiac rehabilitation partici-pants who attended nutrition classesduring 2008 through 2012. All classeswere taught by the same RDN and in-corporated the dietary guidelines of

Figure 1. Numerical Valuesfrom the DHS ScoresRecorded Pre- and Post-Cardiac Rehabilitation

*Significant difference (P<.05)

250

200

150

100

50

0 Group A* Group B* Group C* Combined

Pre Survey Score Post Survey Score*

Male

250

200

150

100

50

0 Group A* Group B* Group C* Combined

Pre Survey Score Post Survey Score*

Female

shows the categorical scores and di-etary fat intake used in the DHS.

This study examined the impact ofnutrition education in participantswith DHS fat scores indicating >30%of energy intake was from fat. Theaim was to investigate whether nutri-tion education as taught by an RDNwould change dietary fat intake, asassessed by DHS, among cardiac re-habilitation patients at a universitymedical center.

Statistical AnalysisThe data were summarized usingmeans ± standard deviation (SD).One-way ANOVA (analysis of vari-ance) models were used to comparebaseline characteristics amonggroups and differences both beforeand after education by sexes. Pairedt-tests were used to compare surveyscores pre- and post-interventionwithin groups. Data were analyzedusing the JMP 11.1.1 software. Sim-ple linear regression was used to as-sess the relationship betweenchange in survey scores and numberof classes attended. Spearman’s Rhowas used to calculate correlations be-tween pre-survey scores and thenumber of classes attended. Statisti-cal significance was set at P<.05.

Results

Participant CharacteristicsParticipants’ baseline characteristics,comorbidities, and entry diagnosiswere similar among all groups (Ta-bles 2 and 3). There was a difference(P=.041) in percentage of individualsreporting a family history of CAD

among participant group assign-ments (Table 4). Certain terms shownin the table are outdated, such asPTCA and angioplasty; in currentpractice, percutaneous coronary in-tervention replaces these formerterms.

Diet Habit Survey Scores andClass AttendanceBaseline scores were similar amongall groups and no differences weredetected between sexes. The meanDHS scores for men were 178.2(SD=37.6), 161.8 (SD=35.7), and 174.4(SD=29.5) for groups A, B, and C, re-spectively. The mean scores forwomen were 179.1 (SD=33.0), 166.3(SD=37.5), and 157.0 (SD=20.2) forgroups A, B, and C groups, respec-tively. The post-survey scores im-proved in groups A B, and C (P<.001,.007, .001, respectively), as shown inFigure 1. Categorical changes in per-centage of fat were not detectedamong groups A, B, or C or betweensexes (P= 0.307, 0.349, 0.646, respec-tively).

AHA ATP III and the TherapeuticLifestyle Change diet. Classes were 30minutes in length, and evaluationswere given to assess comprehension.

Twelve nutrition classes were pro-vided as part of the cardiac rehabili-tation program during 2008 to early2012. The total number of cardiac re-habilitation classes attended wasrecorded, but the exact number ofnutrition classes attended was not.Participants who attended >18 totalclasses were categorized as havingattended at least half of the nutritionclasses (group A), because the totalnumber of classes offered was 24. Inlate 2012, the curriculum was con-densed at participants’ request; thus,six nutrition classes were offered. Anexact number of nutrition classes at-tended was recorded during thistime. Group B subjects includedthese participants, who were catego-rized as attending <5 nutritionclasses with 60% attending >4 nutri-tion classes. The last group attendedno classes, and this group was usedas a reference group (group C).

All participants were administeredthe Diet Habit Survey (DHS) pre- andpost-nutrition education. The 40-question survey was created for theFamily Heart Study.1 Each questionrepresents a certain value that, whenadded collectively, predicts the per-centage of energy from fat in thediet. This tool has been validated as ascreening tool only to identify dietaryfat intake.1 The survey scores are cate-gorically ranked from a very high-fatdiet (>37% of energy) to a very low-fat diet (10% of energy). Table 1


Table 1. Diet Habit Survey Categorical Score and Dietary Fat Intake

Percent Fat Total Survey Total Survey (% of Total Score (Men) Score (Women)Kcal)

Category 1 >37 < 170 <147

Category 2 30 170-220 147-190

Category 3 25 221-227 191-235

Category 4 20 278-349 236-287

Category 5 10 350-389 288-330

Discussion

Our findings support our hypothesisthat nutrition education taught by anRDN during a cardiac rehabilitationprogram will improve DHS surveyscores among participants with initialscores that indicate >30% dietary en-ergy is derived from fat. DHS scoresimproved in both higher and lower

Lipid PanelThe baseline lipid concentrationswere similar among all groups. LDL-Cand triglyceride (TG) levels declined(P=.008 and .003, respectively) aftercardiac rehabilitation for all groups(Table 5). No differences in lipidpanel between male and female par-ticipants among all groups were de-tected (P>.05).

A change in survey score was not as-sociated with number of classes at-tended among all groups combined(P=.210) nor among individuals as-signed to the various participationgroups. Survey score changes werenot related to the total number ofclasses attended among all groups(r=.014).


Table 2. Baseline Characteristics for Cardiac Rehabilitation Participants

Group A (18+) Group B (2012) Group C (0) Total P-value(n=27) (n=23) (n=23) Participants

(n=73)

Age (y) 72.4 ± 10.0 72.8 ± 8.9 70.6 ± 9.5 72.0 ± 9.4 .686

Sex (%)Male 40.74 60.87 65.20 61.64 .907Female 59.26 39.13 34.78 38.36

Weight (kg)Pre 84.0 ± 38.8 84.0 ± 38.9 84.1 ± 40.4 93.1 ± 172.1 .439Post 81.2 ± 48.4 83.4 ± 39.8 83.3 ± 37.7 82.2 ± 42.1 .807

Body mass index Pre 28.8 ± 4.0 28.6 ± 4.6 29.5 ± 5.8 28.9 ± 4.8 .792Post 28.3 ± 4.1 28.5 ± 4.7 28.8 ± 5.5 28.5 ± 4.7 .807

Sedentary lifestyle (%) 74.1 87.0 78.3 79.5 .508

Stress (%) 7.4 0 0 2.7 .130

Smoker (%) 11.1 8.78 8.78 9.6 .945

Table 3. Entry Diagnosis for Cardiac Rehabilitation

Group A Group B (2012) Group C (0) All Groups P-value(18+) (n=27) (n=23) (n=23) (n=73)% % % %

Coronary artery 22 40 40 33 .510bypass graft

Myocardial infarction 33 26 13 25 .331

Percutaneous 33 22 40 32 .421transluminal coronary angioplasty (PTCA)

Stable angina 4 4 4 4 .991

Valve replacement 7 9 4 7 .825


attending groups (A and B), withgroup A showing the greatestchange in survey scores. These dataare similar to previous findings, sug-gesting that nutrition educationtaught by an RDN, as part of a cardiacrehabilitation program, does influ-ence changes in dietary intake.12.,13

Our results indicate that despitechanges in scores, there were no sig-nificant changes of categorical di-etary fat intake among all groups.

This result may be influenced by thefact that participants’ baseline dietaryfat intake was extremely high and thereality of decreasing total fat intaketo achieve a change in categoricalsurvey scores would be highly un-likely. Even though categoricalchange was not significant, dietaryimprovements were seen. Overall,there was a 47% improvement ofDHS scores among all participants.Results indicate that 12% of partici-

pants prior to cardiac rehabilitationwere consuming a diet consisting of<25% of energy from fat and after at-tending nutrition education classes30% were consuming a diet provid-ing <25% of energy from fat.

Number of classes attended were notassociated with a change in total di-etary fat among all participants. Thismay suggest that attending moreclasses may improve diet. Further

Table 4. Comorbidities and Family History of Male and Female Participants in Cardiac Rehabilitation

Obesity Diabetes Hypertension Hyperlipidemia Family History% % % % %

Group A (18+) 3 2 82 89 19(n=27)

Group B (2012) 13 30 9 91 35(n=23)

Group C (zero) 30 35 9 100 57(n=23)

Total 26 29 88 93 36(n=73)

P-value .196 .012 .480 .133 .041

Table 5. Lipid Panel Pre- and Post-Entry into Cardiac Rehabilitation

Lipid Panel Pre/Post Group A (18+) Group B (2012) Group C (Zero) All Groups P-value

Total cholesterol(TC)

Pre 159.3 ± 39.8 152.0 ± 49.9 154.9 ± 41.1 155.6 ± 43.1 .836

Post 156.0 ± 41.0 141.2 ± 43.3 138.2 ± 31.5 145.7 ± 39.3 .226

Low-density lipoprotein cholesterol (LDL-C)

Pre 95.0 ± 30.3 79.0 ± 35.9 81.4 ± 36.3 85.7 ± 34.3 .200

Post 91.3 ± 30.8 69.0 ± 29.9 69.1 ± 23.3 77.3 ± 30.0 .008

High-density lipoprotein cholesterol (HDL-C)

Pre 42.4 ± 12.6 45.9 ± 15.1 43.2 ± 14.7 43.7 ± 14.0 .659

Post 42.3 ± 12.7 48.0 ± 17.5 42.9 ± 10.0 44.3 ± 13.8 .292

Triglycerides (TG)

Pre 106.8 ± 52.1 143.2 ± 65.1 178.0 ± 90.3 140.7 ± 75.3 .453

Post 110.1 ± 48.6 123.6 ± 66.0 131.0 ± 64.5 120.9 ± 59.3 .003


studies are warranted to determinethe number of nutrition classesneeded to promote a positivechange.

Among all groups, TG concentrationsprior to entering cardiac rehabilita-tion were higher compared withthose recorded after completion ofthe program. Even though the pres-ent study was not aimed at loweringTG levels, dietary education and en-rollment in cardiac rehabilitation mayhave influenced the reduction of TGlevels in all groups. These differencesmay also be related to medicationprescribed as a result of participatingin cardiac rehabilitation.

Limitations

The primary limitation of this study isthe small sample size. Given this wasa retrospective study, many potentialsubjects had missing or incompletedata and therefore were excludedfrom the sample population. Anotherlimitation of this study is the inabilityto collect information regardingmedication prescriptions before, dur-ing, or after cardiac rehabilitation forall participants. Drug therapy is gen-erally considered effective in improv-ing lipid profiles in cardiac patients.Because medication-taking was notcontrolled, it is likely that drug ther-apy contributed to some improve-ments in lipids of participants in thisstudy.14

Finally, the class topics of the nutri-tion classes that each participant at-tended were not recorded. Furtherresearch is needed in this area to de-termine which class topics may bemost beneficial for reducing total di-etary fat intake.

Conclusion

In conclusion, nutrition educationclasses taught by an RDN as part of acardiac rehabilitation program re-duced dietary fat intake among par-ticipants. Further studies are neededto determine the total number of nu-trition classes needed to achieve alower dietary fat intake; higher classattendance may be required to im-

pact dietary changes. As this studysuggests, nutrition education im-proved dietary changes previouslyshown to be beneficial among car-diac rehabilitation patients, and itshould be included as part of a car-diac rehabilitation program.

Heather A. Butscher, MS, RDN, works atUniversity Hospitals Case Medical Cen-ter in Cleveland, OH, and has imple-mented a nutrition program within thecardiac rehabilitation program atUHCMC. Keisha Angell, MS, RDN, is aclinical dietitian at St. Luke’s MedicalCenter in Twin Falls, ID, and is currentlyworking towards obtaining certifica-tion as a Pediatric and Nutrition Sup-port Specialist. Richard Josephson, MD,MS, is a professor of medicine at CaseWestern Reserve University, as well asdirector of Cardiac Intensive Care anddirector of Cardiovascular and Pul-monary Rehabilitation at UniversityHospitals of Cleveland.

References

1. Conner S, Gustafson J, Sexton G,Becker N, et al. The diet habit survey:a new method of dietary assessmentthat relates to plasma cholesterolchanges. J Am Diet Assoc. 1992;92:41-47.2.Watson S, Webster IV W, Feigen-baum M, et al. Assessing dietary fatintake in chronic disease rehabilita-tion programs. J Cardiopulm Rehab.2002;22:161-167.3. Esselstyn C, Ellis S, Medendorp S, etal. A strategy to arrest and reversecoronary artery disease: physician’spractice. J Fam Pract.1995;41:560-568.4. Esselstyn C. Updating a 12-year ex-perience with arrest and reversaltherapy for coronary heart disease.Am J Cardiol.1999;84:339-341.5. Haskell W, Alderman E, Fair J, et al.Effects of intensive multiple risk fac-tor reduction on coronary atheroscle-rosis and clinical cardiac events inmen and women with coronary ar-tery disease. The Stanford CoronaryRisk Intervention Project (SCRIP). Cir-culation.1994;89:975-990.6. Ornish D, Scherivits L, Billings J. In-tensive lifestyle changes for reversalof coronary heart disease. JAMA.1998;280:2001-2007.

7. Schuler G. Regular physical exerciseand low-fat diets: Effects on progres-sion of coronary artery disease. J AmHeart Assoc.1992;86:1-11.8. U. S. Department of Health andHuman Services. National Institute ofHealth. National Heart, Lung, andBlood Institute. Your Guide to Lower-ing Your Cholesterol with TLC, Thera-peutic Lifestyle Changes. Available at:http://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf.http://www.nutritioncaremanual.org/content.cfs?ncm_content_id=72900&highlight=TLC%20diet. AccessedNovember 22, 2013.9. Adult Treatment Panel III. NationalHeart, Lung, and Blood Institute. FinalReport: Detection, Evaluation andTreatment of High Blood Cholesterolin Adults. Related links: Full Text (Ac-cessed July 1, 2012).http://www.nhlbi.nih.gov/files/docs/guidelines/atp3xsum.pdf. 10. American Association of Cardio-vascular and Pulmonary Rehabilita-tion. Guidelines for CardiacRehabilitation and Secondary Preven-tion Programs, 5th ed.; 2013.11. Karvetti RL, Hamalainen H. Long-term effects of nutrition education onmyocardial infarction patients: a 10-year follow-up study. Nutr Metab Car-diovasc Dis.1993;3:185-192.12. Rustard C, Smith C. Nutritionknowledge and association behaviorchanges in a holistic, short-term nu-trition education intervention withlow-income women. J Nutr Ed Behav.2013;45:490-498.13. Pluss CE, Billing EB, Held C, et al.Long-term effects of an expandedcardiac rehabilitation program aftermyocardial infraction or coronary ar-tery bypass surgery: a five-year fol-low-up of a randomized controlledstudy. Clin Rehab. 2011;25:79-87.14. Fletcher B, Berra K, Ades P, et al.Managing abnormal blood lipids: acollaborative approach. Circulation.2005;112:3184-3209.


by Eve Pearson, MBA, RD, CSSD

FromThe Chair

scope of practice, looking into what areas of wellness ourmembers practice in order to provide you with more usefulresources, and identifying the areas of crossover among thesubunits to bring them even closer together.

Our next opportunity to gather together will be the 2016SCAN Symposium, on April 8-10—and it promises to be an-other superb event where members can greatly expand theirknowledge, improve their practices, and enjoy unrivalled net-working. Carrying the timely theme of Prescriptions for Sus-tainable Health, Performance and Practice, the final programfor the 2016 SCAN Symposium has been released and onlineregistration is now up and running. Be sure to register soon! Iknow I speak for everyone on the Executive Committeewhen I say we look forward to seeing you all in Portland!

Did you go to the 2015 Academy Food & Nutrition Confer-ence & Expo™ (FNCE®)? If not, just know that it was amaz-ing, especially for SCAN! Our events were top-notch andthere was so much positive chatter about the sports nutri-tion track. Among some of the many highlights of FNCE®,SCAN donated $7,216 ($1 per member) to the AcademyFoundation; we had the memorable experience of doingyoga together one morning and you might even see somephotos floating around of SCAN members (including me!)line dancing on Tennessee’s largest dance floor at the SCANreception! It made me proud, once again, to be part of thisamazing group.

Also know that your Executive Committee is diligentlyworking to solidify our strategic plan that will carry usthrough the 2016-2019 period. We are defining SCAN’s

Solidifying Our Strategic Plan and Looking Ahead to Symposium 2016

Conference Highlights

American College ofSports Medicine AnnualMeetingMay 26-39, 2015San Diego, CA

At the 2015 Annual Meeting of Amer-ican College of Sports Medicine(ACSM), more than 6,000 researchers,educators, sports medicine profes-sionals, and exercise scientists con-vened to share the latest information.Below are a few of the highlightsfrom the more than 3,500 cutting-edge research presentations. Abstractnumbers are shown in parentheses;you can access abstracts at http://acsmannualmeeting.org/educational-highlights/final-program-and-abstracts/. ACSM’s an-nual meeting is an excellent place forSCAN dietitians to update theirsports nutrition knowledge. ACSM’s2016 meeting will be in Boston, May31 to June 4. See you there?

■ Is there a relationship betweenbody mass index (BMI) and bodycomposition in collegiate athletes? Astudy of 172 athletes (92 males) froma variety of sports reports that 35%were classified as overweight and 4%as obese. According to BodPod as-sessments, only 3.5% were over-weight and 3% obese. BMIclassification and percent body fatagreed only about 60% of the time inathletes from a variety of sports. Thehigher the body fat, the more likelythe BMI classification would be ap-propriate. (Abstract 188)

■ An inadequate sports diet is com-mon among runners. Collegiatecross-country runners (30 males, 19females) who trained about 60 milesper week completed three phone-based, 24-hour food recalls. Based onthat information, 37% of the runnersmet the criteria for energy deficiency(defined as energy intake less than90% of total daily energy expenditure)and 35% had low carbohydrate in-

take (defined as less than 6 g carbohy-drate/kg/day). How much bettercould they perform with adequatenutrition? (Abstract 81)

■ Figure competitors go to extremesto lose body fat. A case study of adrug-free amateur female figurecompetitor indicates that during 20weeks of preparation she reducedher energy intake by about 500 calo-ries from her baseline intake. She wasable to maintain muscle mass whiledropping her body fat from 15% to8.5% (as measured by DEXA). Shestopped having menses in the earlystages of preparation. (Abstract 84)

■ Approximately 30% of female ath-letes suffer from iron deficiency (asdefined by serum ferritin <20 ug/L orhemoglobin <12g/dL). Iron defi-ciency commonly results from aniron-poor diet. Given that peoplewith eating disorders commonlyhave an iron-poor diet because theytend to avoid iron-rich red meats and


iron-enriched breakfast cereals, thequestion arises: Do eating disorderscontribute to the high prevalence ofanemia in female athletes? To testthis, 91 collegiate female athleteswere assessed by the Female AthleteScreening Tool (FAST), a question-naire that addresses disordered eat-ing attitudes and behaviors. Theresults suggest that eating disorderswere associated with iron deficiencyas well as suboptimal performance.Integrating FAST into the pre-seasonphysical assessment could be a wiseprotocol. (Abstract 87)

■ Although weight loss programsguided by health professionals canbe effective, they are also time-con-suming and expensive. Can programsthat use self-monitoring devices suchas the SenseWear Armband be just aseffective? When 78 obese adults (31males) were randomized to either aguided weight loss group, an arm-band group, or both for 8 weeks, allgroups lost weight. The most weightloss occurred in the group who re-ceived both personal guidance aswell as the armband. Self-monitoringplus professional help can be a win-ning combination. (Abstract 555)

■ Does yoga help with weight man-agement? A 12-month study with 37middle-age women compared a re-duced-calorie diet plus either 40 min-utes of aerobic exercise 5 days a weekor 40-minutes aerobic exercise plusan additional yoga session on 3 days.The subjects in the yoga group weremore likely to complete the program(95% retention rate vs 61% retentionwithout yoga at 12 mo). They lostmore weight and body fat, plus theytended to have greater gains in mus-cular endurance and flexibility. En-courage your clients to do thosedownward dogs! (Abstract 557)

■ While nutrition certainly enhancessports performance, so does sleep. Astudy with athletes who flew fromConnecticut to Georgia to performexercise tests suggests that flying 1day prior to the event impaired ath-letic performance. Hence, athletestraveling to an event that crossestime zones would be wise to invest in

more time spent recovering frompre-event jet-lag. While National Col-legiate Athletic Association rulesallow for travel 48 hours pre-event forcollege athletes, doing so steals fromclassroom-time. (Abstract 2987)

■ Are protein supplements (whey +colostrum + leucine) beneficial foruntrained men starting a weightlift-ing program? Results from a studywith 27 untrained men who did 4weeks of resistance training indicatethey all had significant improve-ments in muscle size and strength,but there were no significant differ-ences between those who took theprotein supplements versus placebo.This underscores the wisdom of urg-ing clients to spend their money onreal food instead of protein supple-ments. (Abstract 713)

■ Sodium bicarbonate, beetroot, andcaffeine are three supplements withpotential ergogenic benefits for row-ers. If a rower took these supple-ments all at once, would they causegastrointestinal (GI) distress? To an-swer that question, researchers cre-ated a supplement protocol, whereby10 heavyweight elite male rowerspracticed with each supplement indi-vidually, and then combined onewith a second, and then a third sup-plement. Each rower recorded his in-testinal response and any side effectsassociated with taking the supple-ment(s) during high-intensity train-ing, low- and high-level competition,and athlete testing. Of the 777 totalGI reports, 85% revealed no GI issues,while 8.5% revealed low, 4.5% re-vealed moderate, and 2.5% revealedsevere GI issues. The majority of theseproblems occurred in the lower intes-tinal tract and were related to sodiumbicarbonate in combination withbeetroot. Using this protocol, eachathlete was able to determine hisunique responses to the supple-ments, and was thus able to buildconfidence in creating an effectiverace-day protocol. (Abstract 717)

■ Bioelectrical impedance analysis(BIA) is commonly used to assess per-cent body fat. It actually measuresbody water to predict body fatness.

Given that women retain water pre-menstrually, is pre-menstrual water-weight gain enough to alter the BIAmeasurement of body fatness? In agroup of 13 female collegiate ath-letes who were tested with the In-Body 720 bioelectrical impedanceanalyzer before, during, and aftertheir menstrual periods, body fatmeasurements remained stable. TheInBody 720 provided reliable esti-mates of body fatness, regardless ofmenstrual cycle phase. (Abstract 846)

■ GI distress is a common perform-ance-limiting problem for ultrarun-ners, probably due to a combinationof physiological, mechanical(jostling), and dietary factors. Among30 participants who recorded their GIsymptoms four times throughout theWestern States 100-mile run (~161km), 77% of the runners reportedsome type of GI issue. The most com-mon symptoms were nausea (53%),belching (40%), flatulence (30%), andvomiting (30%). Race diet was similarin terms of consumption of energy,carbohydrates, and fluids for runnerswith and without nausea, suggestingthat factors other than nutritionmight have contributed to the GIsymptoms. Each athlete is an experi-ment of one! (Abstract 852)

■ A gluten-free diet has becometrendy among some athletes, evenwhen they do not have celiac disease(and seemingly have no health rea-sons for avoiding gluten). Are thereany advantages for athletes whochoose to eat a gluten-free diet? It’sdoubtful. Among 13 competitivemale cyclists with no history of celiacdisease or irritable bowel syndrome, a(short-term) gluten-free diet did notimprove performance, GI symptoms,well-being, or intestinal injury. (Ab-stract 856)

■ For the average fitness exerciser,do room-temperature water (22 C de-grees), cold water (4 C degrees), andan ice slurry (-1 C degrees) offer simi-lar cooling benefits when consumedduring exercise in the heat? In astudy with 15 males who did threeheat trials to exhaustion on cycle er-gometers, the slurry offered an ad-

Saccharide Composition andUltra-Endurance TriathlonWilson PB, Rhodes GS, Ingraham SJ.Saccharide composition of carbohy-drates consumed during an ultra-en-durance triathlon. J Am Coll Nutr.2015;5:1-10.

Carbohydrate intake between 30 to60 g�h-1 during events lasting longer

than 90 minutes has been shown toenhance performance. Evidence sug-gests that because glucose and fruc-tose use distinctive intestinaltransporters, a glucose-to-fructoserange of 1.2:1 to 1:1 may increase ex-ogenous carbohydrate oxidation andreduce gastrointestinal (GI) distress.The purpose of this study was to pro-vide saccharide profiles for commonfood and beverages consumed dur-

ing an ultra-endurance triathlon anddetermine whether the amount ofglucose and sucrose consumed wasassociated with GI distress. In this ob-servational study, 54 participants (43men, 11 women) competing in theChicago Lakes Triathlon (1.2-mileswim, 56-mile cycle, 13.1-mile run)self-reported food and beveragesconsumed during the race. Self-re-ports were verified through collec-

vantage over room temperaturewater (35 vs 31 minutes to exhaus-tion), but it gave no clear advantageover cold water (35 vs 34 minutes toexhaustion). Some of the subjects re-ported the designated volume of ice

slurry (about 200 mL. every 10 min-utes) was difficult to consume. Coldwater is likely good enough for theaverage exerciser. (Abstract 801)

Summarized by ACSM member and

sports dietitian Nancy Clark, MS, RD,CSSD, who has a private practice in theBoston-area and is author of NancyClark’s Sports Nutrition Guidebook (seewww.nancyclarkrd.com for more infor-mation).


Research Digest

Reviews

Eat Like a ChampionJill Castle, MS, RDN, CDNAMACOM, 1601 Broadway, New York,NY 10019www.amacombooks.org2016, softcover, 246 pp, $16.96ISBN-13:978-0-8144-3622-6

Eat Like a Champion is a sports nutri-tion book for children and adolescentathletes, as well as for parents andcoaches. Jill Castle, a registered dieti-tian and mother of four active chil-dren, understands that kids are notmini-adults and tailors her nutritionadvice to young athletes. Castleclearly introduces why nutrition playsan important role for active kids andillustrates her advice with case stud-ies that will also be useful to all dieti-tians. She has a knack for helpingathletes and their parents solve themost common nutrition problems.

The book is divided into three parts:nutrition rules and regulations, play-by-play eating, and clearing the hur-dles. Each part contains three

chapters that help a young athleteunderstand the basics of nutrition forpeak performance while also provid-ing simple strategies for fueling andhydration. The content helps youngathletes recognize the twin demandsof fueling for sport and obtainingneeded energy and nutrients for nor-mal growth and development. Thechapters are peppered with usefulcharts and tips to make the informa-tion meaningful and quickly accessi-ble.

The author provides easy recipes forsnacks and heathy drinks, all kid-tested and kid-approved. What makesthis book unique is that it boils downall of the evidence-based science onsports nutrition into an easy read forchildren. Sports participation at everylevel is growing; 69% of girls and 75%of boys participate in organizedsports each year. Yet, there remainslimited information on sports nutri-tion for this population.

This book is well organized with a

logical flow. SCAN members whowork with active children can use thisbook as a one-stop shop for good nu-trition practices. The author also ad-dresses controversial topics such asdietary supplements for kids and thechallenge of providing healthfulsnacks at sports venues. The authorprovides a sample note to parentswho provide snacks for their chil-dren’s games to encourage them toprovide fueling snacks in the rightportions.

Jill Castle is a registered dietitian nu-tritionist who is a regular contributorto Sports Kidmagazine and USASwimming’s Web site and Splashmagazine. She is the author of Fear-less Feeding and mom to four activechildren.

Reviewed by Chris Rosenbloom, PhD,RDN, CSSD, nutrition professor emeritaat Georgia State University in Atlantaand editor-in-chief of SCAN’s SportsNutrition: A Practice Manual for Pro-fessionals, 5th edition.


tion of food and beverage packagingand dietary interviews. Glucose andfructose content was determinedthrough manufacturer information,high-performance liquid chromatog-raphy, and the U.S. Department ofAgriculture database. Participantsself-reported GI distress on a 1-10scale (0 no discomfort, 10 unbearablediscomfort). Eighty food and bever-ages consumed during the race werefound to have unique saccharide pro-files. Only 8.8% of these foods hadthe optimal glucose-to fructose ratioof 1.2:1 to 1:1; 55% had ≥3:1 glucose-to-fructose ratio. The median glu-cose-to fructose ratio ingested byparticipants was 2.9:1 (range 2.4:1-5.3:1). Twenty participants consumed≥50 g�h-1 during the swim and cycleportion of the race. Approximately89% of participants reported GI dis-tress by mile 12 of the run. GI distressat mile 1 was positively correlatedwith glucose intake (r=0.480, P=.032)and negatively associated with fruc-tose intake (r=-0.454, P=.044). Thisstudy provided information on theglucose-to-fructose ratio of severalfoods, which can serve as a guide forathletes and practitioners. Athletesparticipating in ultra-enduranceevents requiring ingestion of carbo-hydrate in amounts greater than 50g�h-1 may benefit from consumingmore foods with lower ratios of glu-cose to fructose (<1:1 to 1.99:1).

Summarized by Megan Foley, BS, grad-uate student, Coordinated Master’sProgram, Sports Nutrition Concentra-tion in the Department of Nutritionand Integrative Physiology, Universityof Utah, Salt Lake City, UT.

Effects of Protein and Fat onBody Composition, Strength,and Stress in WeightliftersHelms ER, Zinn C, Rowlands DS,Naidoo R, Cronin J. High-protein, low-fat, short-term diet results in lessstress and fatigue than moderate-protein, moderate-fat diet duringweight loss in male weightlifters: apilot study. Int J Sport Nutr ExercMetab. 2015;25:163-170.

Studies suggest that calorie-re-stricted diets high in protein have the

potential to spare fat-free mass (FFM)in resistance-trained athletes duringweight loss. The purpose of this studywas to determine the effects of high-protein intake compared with mod-erate-protein intake on anthro-pometrics, strength, and psychologi-cal stress following a 2-week energy-restricted diet. In this double-blindcrossover study, 13 resistance-trainedmales consumed either a 40% calo-rie-restricted, carbohydrate-matchedhigh-protein (2.6 g/kg) low-fat(15.4%) (HPLF) diet or a moderate-protein (1.6 g/kg) moderate-fat(36.5%) (MPMF) diet for 2 weeks. Tri-als were separated by 25 to 49 days.Anthropometrics (height, weight, 8-site skinfold thickness, waist, hip, calf,arm girth, and femur and humerusbreadths) and an isometric mid-thighpull (IMTP) strength assessment weremeasured 1 day pre- and 1 day post-intervention. Study participants alsocompleted the Profile of Mood States(POMS) and the Daily Analysis of LifeDemands of Athletes (DALDA) ques-tionnaires to assess psychological re-sponses. In both treatments, bodyweight, calculated FFM, and skinfoldssum decreased significantly, but simi-larly using qualitative analysis. IMTPstrength losses were slightly less(1.1%) for the MPMF group and con-sidered “likely trivial.” During the in-tervention, DALDA, POMS fatigue,and TSMS were higher in the MPMFgroup compared with HPLF groupand classified as “likely harmful.” Inconclusion, the results suggest thatduring a short-term calorie-restrictivediet in weight-class restricted or aes-thetic sports (e.g., weightlifting, body-building, and combat athletics), ahigh-protein low-fat diet approachprovides less stress, fatigue, mooddisturbance and diet dissatisfactionthan a moderate-protein moderate-fat approach. There were no changesin strength performance or anthro-pometrics between diets, but furtherresearch is warranted to examine alonger calorie-restricted period forsignificant changes in body composi-tion and performance.

Summarized by Valerie Mey, BS, gradu-ate student, Coordinated Master’s Pro-gram, Sports Nutrition Concentration

in the Department of Nutrition and In-tegrative Physiology, University ofUtah, Salt Lake City, UT.

Effects of Social NetworkingSites and ConventionalMedia on Body Image DissatisfactionCohen R, Blaszczynski A. Comparativeeffects of Facebook and conventionalmedia on body image dissatisfac-tion. J Eat Disord. 2015;3:23.

Young women frequently experiencebody image dissatisfaction (BID),which is closely associated with eat-ing disorders (EDs). BID occurs, inpart, from appearance comparison(AC) of societal and personal stan-dards. Consequently, exposure toconventional media (e.g., magazinesand television) has been consistentlylinked to BID. Because social network-ing sites (SNS) such as Facebook arenow the preferred social resource foryoung adults, and SNS images areperceived as authentic unlike imagesin conventional media, this study wasundertaken to determine whethercollege-age women were more likelyto engage in AC with their SNS peers.In this study, 193 female first-yearuniversity students were randomlyassigned to view Facebook profiles(n=102) or commercial images ofmodels/celebrities (n=91) for 5 min-utes. Pre- and post-exposure vali-dated questionnaires compared BID,AC, and risk of EDs. Facebook usagehad a significantly positive correla-tion with a higher baseline BID(P≤.01) and risk for ED (P≤.05) as indi-cated by a score of ≥20 on the EatingAttitudes Test (EAT-26). Exposure toFacebook (P≤.01) images and expo-sure to conventional media (P≤.034)images both significantly impactedBID; however, there was no significantdifference in the amount of changein BID the two exposures elicited.These results suggest that whenworking with adolescents and col-lege-age patients, it is important toremember that all types of media ex-posure may increase the risk of BID.Use of SNS does not likely cause anED, but it may help perpetuate BIDthoughts and support ED behaviors.


NotablesSCAN

Supporting individuals in reducingSNS time and AC may assist in thetreatment of BID and EDs.

Summarized by Ali Spencer, RD,CD,Outpatient Dietitian at IntermountainMedical Center, Murray, UT.

Quality of Life, Weight, andEating Disorder Symptoms inSevere and EnduringAnorexia NervosaBamford B, Barras C, Sly R, et al. Eatingdisorder symptoms and quality oflife: where should clinicians placetheir focus in severe and enduringanorexia nervosa? Int J Eat Dis-ord. 2015;48:133-138.

Anorexia nervosa (AN) is a difficultcondition to treat and becomes in-creasingly more difficult the longer apatient has the condition. Those whohave suffered from AN for 7 or moreconsecutive years are classified ashaving severe and enduring anorexianervosa (SE-AN). Preliminary researchsuggests Quality of Life (QOL) im-provement may be a useful adjunctto successful therapy for this condi-tion. This study examined the rela-tionship between body mass index(BMI), eating disorder (ED) symptoms,and improved QOL to determine

whether BMI and ED symptoms arepredictors of current and future QOLin patients with SE-AN. This study is asecondary analysis of a randomizedcontrolled-trial conducted between2007 and 2010, in which participantswere randomized to receive eithercognitive behavioral therapy-ANtreatment or specialist supportiveclinical management. Sixty-three fe-male SE-AN patients of either restrict-ing subtype (n=47) or binge-purge

subtype (n=16) received 30 individ-ual outpatient treatment sessions (50minutes each) focused on QOL im-provement over the course of 8months. Physical assessment (height,weight), the Eating Disorder Examina-tion (EDE) questionnaire, the EatingDisorder Quality of Life (EDQOL), theshort form-12 (SF-12), and the Weis-man Social Adjustment Scale (WSAS)were administered at 15 weeks, endof treatment, and 6 and 12 monthsfollow-up. Improvement in BMI wasassociated with improvement acrossall three QOL questionnaires (EDQOL,SF-12, WSAS) upon treatment com-pletion and at follow-up. There wasalso an association between im-provements in ED symptoms andmeasures of QOL in all but SF-12. Theresults of this study suggest that QOLis associated with, and may be di-rectly dependent on, weight gain andbehavioral change. Consequently,treatment for SSE-AN may benefitfrom a combination of weightrestoration, improved eating behav-ior, and QOL improvement, but notsolely QOL improvement.

Summarized by Lori Cole, RD, CD, dieti-tian, The Orthopedic Specialty Hospital,Murray, UT.

■ Angela Grassi, MS, RDN, receivedthe 2015 Outstanding Nutrition En-trepreneur Award from the NutritionEntrepreneur Dietetic Practice Group(NEDPG) for providing evidence-based nutrition information andcounseling to thousands of womenwith polycystic ovary syndrome(PCOS) around the world. Her newestbook, The PCOS Nutrition Center Cook-book: 100 Easy and Delicious WholeFood Recipes to Beat PCOS is nowavailable at www.PCOSnutrition.com.

■ Ingrid Skoog MS, RD, has just fin-ished developing the first sports nu-trition mobile app, Your Sport

Nutrition Coach, which provides usersthe ability to calculate pre-physicalactivity, during activity, and recoverynutritional and hydration needsbased on individual profile informa-tion. It is also capable of generatingspecific food choices based on per-sonal profile information and prefer-ence. Further details can be found atwww.yoursportsnutritioncoach.com,or the Apple apps store.

■ Judy Simon MS, RDN, and CarrieDennett, MPH, RDN, have authoredan article on PCOS and its role in re-productive health entitled, “The Roleof Polycystic Ovary Syndrome in Re-

productive and Metabolic Health:Overview and Approaches for Treat-ment,” published in the May 2015Di-abetes Spectrum, pages 116-120. Judyalso recently spoke on nutritionalperspectives on eating disorders andhypothalamic amenorrhea at the2015 American Society of Reproduc-tive Medicine Annual Meeting.

If you have an accomplishment thatyou would like to be considered for anupcoming issue of PULSE, please con-tact Michael Stone, MS, [email protected] or [email protected]

■ Call for Abstractors

The “Research Digest” includessummaries of published papersrelating to all of SCAN’s practiceareas: nutrition for sports andphysical activity, cardiovascularhealth, wellness, and disorderedeating and eating disorders. Youcan contribute to the “ResearchDigest” by volunteering to ab-stract a recently published studyon any of the above practiceareas. For details on this opportu-nity, contact Kary Woodruff, MS,RD, CSSD, co-editor of “ResearchDigest,” at [email protected].

Of Further Interest


■Cast Your Vote for SCAN LeadersYour vote counts! Take an active rolein how SCAN is governed by partici-pating in the upcoming election forSCAN leaders. Once again, SCAN willuse an electronic ballot. To vote on-line, go to the home page of SCAN’sWeb site (www.scandpg.org) andclick on the link that says “2016 Elec-tion Ballot.” Online voting polls openFebruary 1, 2015; the final date tovote in February 22, 2015.

■ View SCAN’s Latest AnnualReport OnlineMembers can find the SCAN’s AnnualReport for fiscal year 2014-2015posted at www.scandpg.org, underthe “About SCAN” tab. The report pro-vides an inside look at SCAN’s pro-grams, services, initiatives, andmore—giving you important high-lights on what SCAN has to offer, andhow it is continually working for you.

■ News from Wellness/Cardiovascular RDs SubunitHere’s an update on developmentsfrom the Wellness/CV RDs:• Attend the 2016 Annual SCANSymposium. Building around thetheme of sustainability, the upcom-ing Symposium will feature Well-ness/CV-specific presentations fromexpert researchers and practitioners.See details on sessions related to oursubunit and register at www.scan-dpg.org/2016-symposium/. • Watch Webinars and Earn CPEs.There is always something to learnand webinars are a great way to stayup to date on the latest research andhot topics of interest. We think you’llbe particularly interested in checkingout these latest webinars: 1) RedRaspberries: What Makes This Fruit“Super”; 2) Food Pairings for HealthBenefits: How to Maximize Nutrient Ab-sorption; and 3) Heart-Health Benefitsof EPA and DHA Omega-3s.• Volunteer Opportunities. We arealways looking for members who arewilling to contribute their time andexpertise by writing for the newslet-

ter, reviewing webinars, or assistingwith wellness and CV-related socialmedia posts. Please reach out to vol-unteer coordinator Sara Vine([email protected]) if you wouldlike to get involved.

■ News from DEED SubunitFollowing are some announcementsfrom the Disordered Eating & EatingDisorders (DEED) subunit:• DEED e-Newsletter. By now youshould have received the third edi-tion of Bite by Bite, which featured anarticle on credentialing (the CEDRDcredential). Be sure to check out thisand past editions by logging into theSCAN Web site (www.scandpg.org).• Fact Sheets. You’ll find DEED factsheets on SCAN’s Web site. Checkback often for the latest offerings. Wehave two new ones for RDNs: 1)Recognition and Treatment of DeficientEnergy Intake Among Athletes; and 2)Navigating the Complexity of Weightand Health.• Let’s Hear Your Ideas. We welcomeyour input! Send your ideas for DEEDand upcoming publications to theDEED director, Sarah Gleason, RDN,CEDRD, at [email protected].

■ News from Sports Dietetics—USA (SD-USA)SubunitBelow are some highlights from theSD-USA subunit:• PINES: A Great Opportunity. Pro-fessionals in Nutrition for Exerciseand Sports (PINES) is a nonprofit or-ganization that links professionals innutrition, exercise, and sport aroundthe globe, enhancing excellence insports nutrition services provided toathletes and active individuals. PINESmembers reside in more than 30countries and constitute a varietyamong sports nutrition professionalsthat is unique to the field. Rather thanreplacing national sports nutrition or-ganizations, PINES emphasizes col-laboration among existingorganizations and mentorship forprofessionals trying to establish their

own national organization. PINES’saim is to expand the presence ofsports nutritionists and dietitiansworldwide. For more information goto www.pinesnutrition.org.• Fact Sheets. Check out the factsheets released during the past year:1) Making Weight, Sports Foods, Pro-tein Needs in Athletes; and 2) Nutritionfor the Injured Athlete. Stay tuned—we’re currently reviewing and updat-ing many of our fact sheets.• Don’t Miss this Webinar. SD-USA’slatest evidence-based webinar isTreating the Injured Athlete: NutritionStrategies to Promote Healing and Re-covery, offering 1 CPEU. For access, goto www.scandpg.org/ store/default.aspx?search=Webinars.

• Next CSSD Exam Windows. Thenext exam dates are February 8-29(excluding President’s Day); postmarkdeadlines are November 6, 2015 toJanuary 5, 2016. Application fee riseswith each postmark deadline closerto the exam; for details go towww.cdrnet.org. Check out the 20-minute webinar, CSSD: Prepare Your-self and Succeed! The webinar can beaccessed under “Sports Nutrition In-formation” at www.scandpg.org. Clickon “Become a CSSD.”

• NATA Partnership. If you work withathletic trainers, make sure theyknow about SCAN and all the re-sources we offer. Encourage them toask the National Athletic Trainers’ As-sociation (NATA) to continue collabo-rating with SCAN. Each of us plays animportant role in the health and per-formance of athletes. If you haveideas to share, contact Jen Doane,MS, RD, CSSD, at [email protected].

• Students, Take Note! Considerearning a graduate degree in a sportsnutrition-focused program. You’ll findinformation on this at www.scan-dpg.org/sports-nutrition-education-programs/. Also, be sure to view thelatest interviews from the SCAN Stu-dent Corner at www.scandpg.org.


Publication of the Sports,Cardiovascular, and Wellness Nutrion (SCAN) dieteic practice group of theAcademy of Nutrition and Dietetics.ISSN: 1528-5707.

Editor-in-ChiefMark Kern, PhD, RD, CSSDExercise and Nutrition SciencesSan Diego State University5500 Campanile Dr.San Diego, CA 92182-7251619/594-1834619/594-6553 - [email protected]

Sports EditorsKathie Beals, PhD, RD, CSSDKristine Spence, MS, RD, CSSD

Cardiovascular EditorSatya Jonnalagadda, MBA, PhD, RD

Wellness EditorsZachary Clayton, MSLiz Fusco, MS, RD

Disordered Eating EditorsKaren Wetherall, MS, RDGena Wollenberg, PhD, RD, CSSD

Conference Highlights EditorNancy Clark, MS, RD

Reviews EditorKristina MoralesStacie Wing-Gala, PhD, RD, CSSDKary Woodroff, MS, RD, CSSD

SCAN Notables EditorMichael Stone, MS

Managing EditorAnnette Lenzi Martin708/[email protected]

The viewpoints and statements hereindo not necessarily reflect policies

and/or official positions of theAcademy of Nutrition and Dietetics.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 theAcademy of Nutrition an Dieteicsand/or Sports, Cardiovascular, andWellness Nutrition.

Appropriate announcements arewelcome. Deadline for the Summer2016 issue March 1, 2015. Deadline forthe Fall 2016 issue: June 1, 2016.Manuscripts (original research, reviewarticles, etc.) willl 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: Academyof Nutrition and Dietetics, 120 S.Riverside Plaza, Suite 2000, Chicago, IL60606-6995.

Subscriptions: For individuals noteligible for Academy of Nutrition andDietetic membership: $50. Forinstitutions: $100, To subscribe: SCANOffice, 800/249-2875

Copyright © 2016 by the Academy ofNutriton and Dietetics. All rightsreserved. No part of this publicationmay be reproduced, stored in aretrieval system, or transmitted in anyform by any means, electronic,mechanical, photocopying, recording,or otherwise, without prior writtenpermission of the publisher.

SCAN’S PULSE

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

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PRESORT STANDARDU.S. POSTAGE

PAIDROCKFORD, ILPERMIT NO. 2495

February 5-6, 2016 “Nutrition for Sports, Exercise &Weight Management: What ReallyWorks and Why,” Arlington, VA. For in-formation: Nancy Clark, MS, RD, CSSD,www.NutritionSportsExerciseCEUs.com

February 26-27, 2016“Nutrition for Sports, Exercise &Weight Management: What ReallyWorks and Why,” Arlington, VA. For in-formation: Nancy Clark, MS, RD, CSSD,www.NutritionSportsExerciseCEUs.com

April 2-6, 2016Experimental Biology (EB) 2016, SanDiego, CA. For information: experi-mentalbiology.org/2015/Home.aspx

March 29-April 1, 2016ACSM’s Health & Fitness Summit &Exposition, Orlando, FL. For informa-tion: acsmsummit.org

April 8-10, 2016Don’t miss the exciting 32nd AnnualSCAN Symposium, Prescription forSustainable Health, Performance andPractice, at the Hilton Portland andExecutive Tower, Portland, OR. Regis-ter today! For information: www.scan-dpg.org/2016-symposium/

May 31-June 4, 2016ACSM Annual Meeting, World Con-gress on Exercise is Medicine®, andWorld Congress on the Basic Sciencesof Exercise Fatigue, Boston, MA. Forinformation: www.acsmman-nualmeeting.org

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