SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 1

Fall 2018, Vol. 37, No 4

n CONTENTS

1Relationship of Olfactory and Taste Dysfunction to Dyslipidemiaand Hypertension

3From the Editor

4Energy Deficiency in the Male Athleteand the Role of the Sports Dietitian

8Food Addiction and Its Implicationsfor Weight Stigma and Treatment

11From the Chair

12Conference Highlights

15Research Digest

17SCAN Notables

17Of Further Interest

20Upcoming Events

Chemosensory function, generallyknown as olfactory and taste func-tions, plays an essential role in humanhealth and social behavior includingthe regulation of various aspects ofnourishment and a link to memoryand emotions.1 Disturbance of thesefunctions compromises quality of life,poses potential safety issues, and becomes a threat to public health.

The 2013-2014 National Health andNutrition Examination Survey(NHANES) data revealed a 13.5% self-reported prevalence of smell alter-ation and a 17.3% self-reportedprevalence of taste alteration2 amongadults aged 40 years or older in theUnited States. In the 1994 NationalHealth Interview Survey (NHIS), whichincluded 42,000 adults aged 18 yearsor older, the prevalence of perceivedchronic (lasting ≥3 mo) chemosen-sory problem was 1.65%.3 Interest-ingly, previous studies reportedrelationships between olfactory ortaste dysfunction and a variety of dis-eases, including diabetes, stroke, andother cardiovascular disorders.4

Underlying mechanisms such as thelink between the endocrine systemand olfactory system, the role of in-sulin, and the role of leptin inchemosensory function modulation

S C A N ’ SPu lseRelationship of Olfactory andTaste Dysfunction to Dyslipidemiaand Hypertensionby Shue Huang, MS, Yi-Hsuan Liu, MS, RD, and Xiang Gao, MD, PhD

have been proposed to explain suchrelationships.5

This article reviews the hypothesizedmechanisms and discusses our recentepidemiologic studies on the associa-tion between chemosensory impair-ment and two important metabolicdisorders, dyslipidemia and hyperten-sion, which are either risk factors orcomorbidities of the aforementioneddiseases.

Olfactory/Taste Dysfunctionand Blood Cholesterol

Several hormones that mediate foodperception and appreciation activityby signaling in the olfactory and gus-tatory systems are also crucial to en-ergy balance, glucose regulation, andlipid metabolism. These hormones in-clude glucagon-like peptide-1, leptin,cholecystokinin, and neuropeptide.6

Leptin, a hormone produced in adipose tissue, is known to participatein the regulation of low-densitylipoprotein (LDL) cholesterol concen-tration, decrease triglyceride (TG) andvery low-density lipoprotein (VLDL)in various ways, and relate to high-density lipoprotein (HDL) concentra-tion. Leptin also has been reported to

using cholesterol-lowering agents,which has been reported inperturbation of taste and smellfunction and thus could confoundlipid profiles, were excluded; potentialconfounders including socioe-conomic status, lifestyle behavior, and comorbidity were considered.

This study confirmed that chemo-sensory function is related to choles-terol metabolism in a populationlevel. However, whether it is the dys-lipidemia that causes the impairmentor it is the impairment that occurs before dyslipidemia remains to beelucidated.9

Olfactory/Taste Dysfunctionand Blood Pressure

Blood pressure indexes generally include systolic blood pressure, diastolic blood pressure, mean arterialpressure, and pulse blood pressure.Maintaining optimal range of bloodpressure indexes has been known tobe associated with improved healthstatus and better disease prognosis.In particular, several studies have indi-cated that systolic blood pressure isone of the key predictors for risk ofmajor cardiovascular events and mor-tality.10,11 Therefore, understandingpotential risk factors that could leadto dysregulated blood pressure mayprovide strategies for early preven-tion and therapeutic procedures.

Chemosensory functions, which serveas one of the main mechanisms formammals to sense and further reactto environmental stimulants, have potential roles in disease onsetthrough participating in signalingprocesses.12 It is noteworthy that olfactory receptors located in the kidneys have been found to be involved in renin secretion in micemodels, and this in turn plays a role inblood pressure regulation.13 In addi-tion, individuals with malfunctionedtaste and smell perception may havealtered food preferences with highercondiment intake that may furtherlead to compromised blood pressurecontrol.14,15 However, the evidencefrom human studies regarding the relationship between chemosensory

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modulate sweet taste perception, andit is positively related to higher olfac-tory capacities. Another importanthormone, glucagon-like peptide-1(GLP-1), known to decrease TG andVLDL, has also been found to impactsensitivity to sweet and umami. It isspeculated that altered chemosen-sory dysfunction might occur accom-panied with disturbance of thesehormones and lipid profiles, althoughthe mechanism for the associationbetween chemosensory dysfunctionand higher blood cholesterol concen-tration remains unclear. Animal mod-els or human studies on how taste orsmell function relate to these hor-mones would help to elucidate theunderlying mechanism.

We conducted a cross-sectional studyto investigate the association between perceived chronicchemosensory dysfunctions andblood lipid profiles among 12, 627Chinese participants (aged ≥25 y)from the Kailuan study.9

Chemosensory dysfunctions wereassessed using the questionnairederived from the NHIS.3 The preva-lence of perceived olfactory and tastedysfunction was 2.4% and 1.2%,respectively. We found no significantdifferences in LDL cholesterol, HDLcholesterol, and TG concentrationsacross dsysfunction and controlgroups, whereas we found that highertotal cholesterol concentration wasrelated to presence of chemosensorydysfunction. For example, participantswith olfactory and taste dysfunctionhad higher total cholesterol relativeto those with normal function(adjusted mean was 5.22 vs 4.84mmol/L; P<.05), after adjusting forage, sex, body mass index, alcoholdrinking, perceived salt consumption,smoking, presence of major chronicdiseases, and other potentialconfounders. Excluding participantswith cardiovascular disease, diabetes,or obesity, respectively, did notmaterially change the results,suggesting that the relationship wasindependent of other metabolicdisorders. Furthermore, theassociation was more pronounced inparticipants at least 60 years old orsmokers. For the analysis, individuals

Academy of Nutrition and DieteticsDietetic Practice Group of Sports,Cardiovascular, and Wellness

Nutrition (SCAN)SCAN Website: www.scandpg.org

SCAN Office120 S. Riverside Plaza, Suite 2190Chicago, IL 60606Phone: 800/249-2875info@scandpg.orgInterim Executive Director: Adriana Legreid

SCAN Executive CommitteeChairLindzi Torres, MS, MPH, RDN, CSSD

Chair-ElectJennifer Ketterly, MS, RD, CSSD

Past ChairCheryl Toner, MS, RDN

TreasurerLynn Cialdella Kam, PhD, MA, MBA, RDN

SecretarySherri Stastny, PhD, RD, CSSD

Director, Sports Dietetics—USA SubunitElizabeth Abbey, PhD, RDN, CDN

Co-Directors, Wellness/CardiovascularRDs SubunitMark Hoesten, RDCarol Kirkpatrick, PhD, MPH, RDN

Director of EventsEnette Larson-Meyer, PhD, RD, CSSD, FACSM

Director of CommunicationsCara Harbstreet, MS, RD

Director of Member ServicesKaren Reznik Dolins, EdD, RD, CSSD, CDN

SCAN Delegate to House of DelegatesJean Storlie, MS, RD

____________________________

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

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

SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 3

function and blood pressure remainslimited.

The lack of evidence in this area ledus to conduct the first longitudinalstudy to examine the potential associ-ation between chemosensory func-tion and changes in blood pressure.16

The study included 5,190 normoten-sive Chinese adults (4,058 men and1,132 women; mean age: 50.1 y) fromthe Kailuan study. Approximately2.1% of participants reported either a perceived taste or smell problem,while about 0.6% of participants reported perceived malfunction inboth taste and smell. It was observedthat individuals with both alteredtaste and smell perceptions hadlarger increases in systolic blood pres-sure (adjusted mean difference=5.1mmHg, 95% CI: 0.1-10.0, P=.04) andmean arterial pressure (adjustedmean difference=3.8 mmHg, 95% CI:0.4-7.1, P=.03) compared with thosewithout altered perception after 2years of follow up. In particular, therewas no significant association between altered taste or smell per-ception and change in blood pressurewhen altered taste or smell functionwas examined separately, suggestingthat potential common mechanismsare shared by taste and smell percep-tion. In addition, excluding individualswith some chronic conditions did not

change the observed association between chemosensory function andblood pressure, indicating that this association is independent of partici-pants’ existing medical history.

While these recently-published results provide preliminary insightsinto the role of chemosensory func-tion on blood pressure regulation inhuman, as well as directions for futurestudies identifying risk factors for hypertension, more studies areneeded to replicate these findings in different cohorts and to determinethe exact mechanisms to strengthenthese associations.16

Conclusion

In addition to traditional roles of sens-ing and responding to external chem-ical compounds and stimulants suchas flavor and odor, taste and smellfunction could also play a key role inbiological and metabolic processes inliving organisms, especially humans.Through its involvement in the endocrine system, specifically lipidmetabolism and renin secretion,chemosensory function is observedto be associated with total cholesterolconcentration and change in bloodpressure level in epidemiologic stud-ies. In clinical settings, taste and smellproblems are frequently reported by

patients using certain medications orhaving medical conditions. It is there-fore important for health care profes-sionals to better understand thepotential impact of chemosensorydysfunction, whether it be perceivedor clinically diagnosed, in order toprovide further assessments or neces-sary medical treatments as early prevention steps to reduce risk of developing metabolic disorders orchronic diseases.

In summary, as discussed in this briefreview, evidence exists on the associ-ation between chemosensory func-tion and two important risk factorsfor several chronic disorders: hyperc-holesterolemia and high blood pres-sure. Future studies are warranted toexamine these relationships as well asthe association between chemosen-sory function and other disease con-ditions to deepen our understandingof disease risk factors._____________________________Shue Huang, MS and Yi-Hsuan Liu, MS,RD are doctoral candidates in Nutritional Sciences at The Pennsylva-nia State University (Penn State), Uni-versity Park, PA; Xiang Gao, MD, PhD isdirector of the Nutritional EpidemiologyLaboratory and associate professor inthe Department of Nutritional Sciencesat Penn State University, UniversityPark, PA.

FromThe EditorBetcha Didn’t Know

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

The feature articles in this issue of PULSE have a common thread that really stuck out to me. They’re all on topics that few peo-ple know much about. But here at PULSE, our aim is to rectify that as best we can. While each of the topics requires more re-search to improve our knowledge base and impart a more complete understanding, the authors have all done excellent jobsof providing us with details that will keep us all in the know.

On the cover you’ll find an article from Shue Huang, MS, Yi-Hsuan Liu, MS, RD, and Xiang Gao, MD, PhD describing the latest re-search on the link between chemosensory dysfunction and key risk factors for heart disease. Our next article in this issue ad-dresses a topic that many of us are relatively unfamiliar with. In it Francis Dizon, MS, RDN discusses the state of knowledge ofthe male counterpart of the female athlete triad. Lastly, I’m sure you’ll enjoy the article by Jessica Reid, Kerry O’Brien, Tracy Bur-rows, Charlotte Hardman, and Adrian Carter about the very controversial issue of the potential for the existence of food addiction and how it could theoretically relate to the stigma and treatment of obesity.

As always, there’s much more for you to learn in this issue. I know I learned a lot from helping to assemble it, and I hope youwill too.

Daily energy demands are derivedfrom an individual’s basal metabolicrate (BMR), purposeful exercise, non-exercise activity thermogenesis(NEAT), and the thermic effect of food.1

An individual’s energy avail-ability (EA;measured in kcal/kgFFM/day) is a con-cept that describes the energy re-maining for one’s energy demandsafter accounting for physical activity(see Figure 1).2

For athletes, maintaining adequateenergy availability may present achallenge because of the high-energydemands of frequent, intense trainingsessions paired with a lack of the nutrition knowledge needed to fuelappropriately before, during, and afterexercise. Other athletes may inten-tionally restrict their intake to meet a

perceived internal or external pres-sure to maintain a lean build or frame.Chronic low EA underlies the condi-tion historically defined in female athletes as the female athlete triad.3

Another recent framework, the rela-tive energy deficiency in sport (RED-S) concept, attempts to modellow EA and its consequences to addi-tional body systems.4

Thresholds of Low EnergyAvailability

Previous laboratory controlled studiesinvolving sedentary women investi-gated the effects of varying levels oflow energy availability (10, 20, and 30kcal/kgFFM/day) on hypothalamichormones and markers of bone for-mation and resorption.5,6 From these

studies, abnormalities in the levels ofthese biomarkers were apparent atEAs below 30 kcal/kgFFM/day. For example, EAs of 10, 20, and 30kcal/kgFFM/day elicited decreases ofthe bone formation markers, osteo-calcin (OC), and procollagen type 1carboxy-terminal peptide (P1CP),while an EA of 10 kcal/kgFFM/dayalso increased the rate of a bone resorption marker, N-telopeptide

TDEI = total daily energy intake EEE = exercise energy FFM = fat-free mass in kilograms

EA = TDEI – EEE FFM

References

1. Welge-Lussen A. Ageing, neurode-generation, and olfactory and gusta-tory loss. B-ENT. 2009;5(Suppl13):129-132.2. Liu G, Zong G, Doty RL, et al. Preva-lence and risk factors of taste andsmell impairment in a nationwiderepresentative sample of the US pop-ulation: a cross-sectional study. BMJOpen. 2016;6:e013246.3. Hoffman HJ, Ishii EK, MacTurk RH.Age-related changes in the preva-lence of smell/taste problems amongthe United States adult population.Results of the 1994 disability supple-ment to the National Health InterviewSurvey (NHIS). Ann N Y Acad Sci.1998;855:716-722.4. Gouveri E, Katotomichelakis M,Gouveris H, et al. Olfactory dysfunc-tion in type 2 diabetes mellitus: an ad-ditional manifestation ofmicrovascular disease? Angiology.2014;65:869-876.5. Brady S, Lalli P, Midha N, et al. Pres-ence of neuropathic pain may explainpoor performances on olfactory test-

ing in diabetes mellitus patients.Chem Senses. 2013;38:497-507.6. Martin B, Maudsley S, White CM, etal. Hormones in the naso-oropharynx:endocrine modulation of taste andsmell. Trends Endocrinol Metab.2009;20:163-170.7. Kim WY, Hur M, Cho MI, et al. Effectof olfactory function on nutritionalstatus of Korean elderly women. NutrRes. 2003;23:723-734.8. Lee WH, Wee JH, Kim DK, et al. Prevalence of subjective olfactorydysfunction and its risk factors: Korean national health and nutritionexamination survey. PLoS One. 2013;8:e62725.9. Huang Z, Huang S, Cong H, et al.Smell and taste dysfunction is associ-ated with higher serum total choles-terol concentrations in Chineseadults. J Nutr. 2017;147:1546-1551.10. Ettehad D, Emdin CA, Kiran A, et al.Blood pressure lowering for preven-tion of cardiovascular disease anddeath: a systematic review and meta-analysis. Lancet. 2016;387:957-967.11. Verdecchia P, Reboldi G, Angeli F, etal. Systolic and diastolic blood pres-

sure changes in relation with myocar-dial infarction and stroke in patientswith coronary artery disease. Hyper-tension. 2015;65:108-114.12. Kovacs T. Mechanisms of olfactorydysfunction in aging and neurode-generative disorders. Ageing Res Rev.2004;3:215-232.13. Pluznick JL, Protzko RJ, GevorgyanH, et al. Olfactory receptor respondingto gut microbiota-derived signalsplays a role in renin secretion andblood pressure regulation. Proc NatlAcad Sci USA. 2013;110:4410-4415.14. Schiffman SS, Graham BG. Tasteand smell perception affect appetiteand immunity in the elderly. Eur J ClinNutr. 2000;54(Suppl 3):S54-63.15. Rust P, Ekmekcioglu C. Impact ofsalt intake on the pathogenesis andtreatment of hypertension. Adv ExpMed Biol. 2017;956:61-84.16. Liu Y-H, Huang Z, Vaidya A, et al. Alongitudinal study of altered tasteand smell perception and change inblood pressure. Nutr Metab CardiovascDis..May 30, 2018. DOI: 10.1016/j.nu-mecd.2018.05.002 [Epub ahead ofprint].

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Energy Deficiency in the Male Athlete and theRole of the Sports Dietitian by Francis Dizon, MS, RDN

Figure 1. Calculation of EnergyAvailability (EA)

(NTX).5 Similarly, triiodothyronine (T3)and leptin were found to be sup-pressed at an EA of 30 kcal/kgFFM/day,while detriments to estradiol requireda more severe EA condition (10kcal/kgFFM/day).6 As such, low EA hasbeen defined in female athletes as EA<30 kcal/kgFFM/ day.2 In male ath-letes, initial research suggests that themale-specific threshold of low EA maybe lower (~20-25 kcal/kgFFM/day), potentially requiring a more severeenergy deficit to elicit health consequences.7-9

Compared with studies involving females, there is a lack of carefullycontrolled studies evaluating the effect of various levels of low EA inmale athletes. However, observationson males with apparent energy defi-ciency (i.e., case studies and cross-sectional studies on endurance run-ners, bodybuilders, and other athletesstriving for leanness) have linked hormone disturbances and poorbone health to energy deficiency.10-13

These reports suggest that male athletes may experience a syndromeparallel to the female athlete triad, asoutlined by Tenforde et al.14

While not exclusively focusing on ath-letic populations, the “Minnesota Star-vation Experiment” performed byKeys and colleagues during WorldWar II induced a state of chronic lowEA among 32 young, active men. Themen underwent 3 months of a con-trol diet (3,200 kcal/day), followed bya 6-month energy deficient diet of~1,800 kcal/day, paired with an aver-age total daily energy expenditure of3,000 kcal/day and a subsequent 3-month refeeding period.15 The energy deficient phase of the proto-col elicited an estimated EA of ~22kcal/kgFFM/day among the men, whoexhibited a mean 16.8kg decrease inbody mass, a 38% decrease in restingenergy expenditure (REE), and psychological changes (including depression, irritability, social with-drawal, lack of focus, etc.).16,17 A morerecent but similar investigation byMüller and colleagues identified simi-lar results, with an average decreaseof 6 kg body mass, a 266 kcal/day reduction in REE following a 3-week

energy deficient period in which 32healthy, male participants consumeda total daily energy intake of ~1,350kcal/day.18 EA for this study was calcu-lated at ~21 kcal/kgFFM/day. Müllerand colleagues also observed a de-crease in T3 and testosterone (39%and 11%, respectively, from baseline)during this study.

Together these studies also supportthe body mass, metabolic, and en-docrine changes occurring at a levelof low EA at or below ~20 to 25kcal/kgFFM/day. Further controlledlaboratory studies among male ath-letes are needed to substantiate thisproposed threshold in male athletes.

Studying Low EnergyAvailability in Male Athletes

Recent research has focused on thedocumentation of low EA in male athletes.19,20 However, studies report-ing the prevalence of low EA in maleathletes are still scarce in the litera-ture. One recent investigation foundthat 6 of 24 (25%) male world-class,distance athletes presented with lowEA when using a cutoff of 30kcal/kgFFM/day.19 The relatively lowsample size and reliance on self-reported data, however, confound the results of this study.

The evaluation of EA continues to be challenging because of inherent errors with data collection methodsinvolving measurements of energy intake, exercise energy expenditure,and fat-free mass. Measuring theseconstructs in the field often relyheavily on self-reported data (via 24-hour dietary recalls, food logs,exercise logs, etc.), which may under-or overestimate EA calculations.Indeed, an investigation from 2014evaluating 59 nonathlete adultsdescribed self-reported levels ofenergy intake 5% to 21% lower thantheir actual intake when observing adlibitum feeding behaviors in alaboratory setting.21

As such, caution is warranted whenanalyzing self-reported intake to determine energy availability in prac-tical settings. Symptoms associated

with low EA (i.e., fatigue, moodchanges, bone stress injuries, etc.)may serve as supplemental indicatorsfor suspected low EA in athletes. As suggested by Heikura et al, qualita-tive screening methods (i.e., the TriadCumulative Risk Assessment Tool andRED-S assessment tool), measure-ments of REE, and assessments of lon-gitudinal blood hormones (namelyT3, testosterone, estradiol) may bemore sensitive indicators of long-term low EA rather than direct EA as-sessments through food and trainingrecalls.19

Consequences of Low EnergyAvailability

Prior research supports various healthconsequences of chronic low EA, de-fined as EA <30 kcal/kgFFM/day, inwomen. The female athlete triad out-lines two such conditions, includingamenorrhea and low bone mass. Priorresearch links factors associated withlow EA to increased risk of bone stressinjury.3 In male athletes, research sup-ports effects of low EA to hypothala-mic hormones, gonadal function,bone health, and bone stress injurysupporting a case for a parallel triadthat also includes hypogonadotropichypogonadism and low bone mineraldensity (BMD).20,22

Previous studies have reported lowerlevels of testosterone in male athletesparticipating in sports that emphasizeleanness, including endurance, aes-thetic, or weight-sensitive sports.11,13,23-28

Low EA may affect the hypothalamic-pituitary-gonadal (HPG) axis, withdecreases in gonadotropin-releasinghormone (GnRH), followed by reduc-tion in the pulsatile release of luteiniz-ing hormone and follicle-stimulatinghormone, which subsequently lowersthe synthesis of estrogen and testos-terone.29 Loucks and Thuma have pre-viously documented these alterationsin the HPG axis in healthy, youngwomen at various EAs <30 kcal/kgFFM/day.6 In a recent study investigating active males subject toEA levels of 15 kcal/kgFFM/day (lowEA) and 40 kcal/kgFFM/day (control)with and without exercise, the low EAand low EA + exercise conditions re-

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sulted in a nonsignificant decrease in testosterone of 7% and 15%, respectively.9 While the reductions intestosterone did not reduce levels tobelow a normal clinical range, thisstudy preliminarily supports an effectof low EA on male reproductive hormones.23,26,30

Studies involving male athletes alsoreport links between factors related tolow EA and low bone mass.Inadequate dietary intake, due toeither purposeful restriction orinadvertent undereating, may also beassociated with below-recommendedintake levels of bone-buildingmicronutrients, such as calcium andvitamin D. This is demonstrated in astudy by Misra and colleaguesinvolving adolescent males withanorexia nervosa (AN).31 Their sample,who by definition exhibited severelyrestricted dietary intakes, had lowerwhole body, lumbar spine, and hipBMD compared with healthy controlsmatched for chronological and boneage.31 Furthermore, the authorsreported significantly lower levels ofprocollagen type 1 N-terminalpropeptide (P1NP; a bone formationmarker) and NTX in the AN subjects,indicating a decreased rate of boneturnover. Aside from dietary intake,other risk factors that may predict lowBMD include body mass <85%expected weight, weekly mileage >30miles/week, stress fracture history, and<1 serving of a calcium-rich food perday, as reported by Barrack et al.32

These risk factors were found to havean additive effect, with increasingnumber of risk factors tied to a higherlikelihood of low BMD.

Energy balance also has been shownto play an important role regardingbone turnover in athletic populations.In an investigation by Zanker andSwaine in 2000 involving eight maledistance runners, intakes of 50% of arunner’s energy needs resulted in decreased serum levels of P1NP aswell as insulin-like growth factor-1(IGF-1).33 Similar to the effect of low EAand estrogen deficiency on bone den-sity in female athletes, previous stud-ies have also reported that loweredtestosterone may contribute to re-

duced BMD in male athletes.34,35 How-ever, a study by Maïmoun et al indicated there is no significant corre-lation between testosterone and BMDwhen comparing male endurance ath-letes and sedentary controls.26 Thus,more evidence is needed to elucidate whether testosterone’s rela-tionship with bone health is parallel tothat of estrogen and bone in femaleathletes. A possible confounder is thefact that male athletes often presentwith subclinical hypogonadism ratherthan clinical deficiencies, possiblyleading to the less pronounced effectson bone seen in the literature. Ultimately, poor bone health may pre-dispose an athlete to increased riskfor bone stress injuries (BSIs). Whenan athlete develops inadequate boneturnover (i.e., bone resorptioneclipses bone formation), micro-damage from exercise may accumu-late and progress into a stress injury.36

In particular, male athletes participat-ing in leanness sports such as en-durance runners are known todevelop BSIs at elevated rates.37-39

Role of the Sports Dietitian

A registered dietitian (RD) specializ-ing in sports is pivotal in the preven-tion and care of energy deficiency.Sports RDs work closely with athletesto optimize health, athletic perform-ance, and overall wellbeing. As such, a sports RD must be able to accu-rately assess an athlete’s nutritionalattitudes and behaviors. If concernsarise regarding the adequacy of anathlete’s diet, a sports RD may befirst to notice and identify anyissues.

Prevention of low EA requires a sportsRD to educate the athlete on appro-priate fueling needs as well as facili-tate the adoption of healthy eatingbehaviors (e.g., offer easy-accessmeals and snacks through fueling stations and training tables). In concert with the multidisciplinarycare team, a sports RD may assist inthe treatment of low EA by providingindividualized nutrition counseling,education, and referral to a sportspsychologist to support the processof recovery from disordered eating or

eating disorders. To maintain profi-ciency in these tasks, a sports RDwould benefit from critiquing and incorporating emerging research regarding energy deficiency to precisely identify and treat low EA in male and female athletes. With tact,a sports RD may serve as a resourcefor both athletes and performancestaff in managing a complicated anddebilitating condition such as energydeficiency.

___________________________Francis Dizon, MS, RDN is a sports dietitian fellow working at the SportsNutrition Department at Duke Univer-sity, in Durham, NC.

References

1. Poehlman ET. A review: exercise and its influence on resting energymetabolism in man. Med Sci SportsExerc. 1989;21:515-525. 2. Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J SportsSci. 2011;29(Suppl 1):S7-S15. 3. Nattiv A, Loucks AB, Manore MM, et al. American College of SportsMedicine position stand: the femaleathlete triad. Med Sci Sports Exerc.2007;39:1867-1882. 4. Mountjoy M, Sundgot-Borgen J,Burke L, et al. The IOC consensusstatement: Beyond the Female Athlete Triad—Relative Energy Defi-ciency in Sport (RED-S). Br J SportsMed. 2014;48:491-7. 5. Ihle R, Loucks AB. Dose-response relationships between energy avail-ability and bone turnover in youngexercising women. J Bone Miner Res.2004;19:1231-1240. 6. Loucks AB, Thuma JR. Luteinizinghormone pulsatility is disrupted at a threshold of energy availability inregularly menstruating women. J ClinEndocrinol Metab. 2003;88:297-311. 7. Fagerberg P. Negative consequencesof low energy availability in naturalmale bodybuilding: a review. Int J SportNutr Exerc Metab. 2018;3:1-18. 8. Papageorgiou M, Elliot-Sale KJ,Greeves JP, Fraser WD, Sale C. Impairedbone turnover in women, but not inmen, in response to low energy avail-ability: 796 board #112 June 1, 3:30PM – 5:00 PM. Med Sci Sports Exerc.

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2016;48(5 Suppl):219. 9. Koehler K, Hoerner NR, Gibbs JC, et al. Low energy availability in exercis-ing men is associated with reducedleptin and insulin but not withchanges in other metabolic hormones.J Sports Sci. 2016;34;1921-1929. 10. Burge MR, Lanzi RA, Skarda ST,Eaton RP. Idiopathic hypogo-nadotropic hypogonadism in a malerunner is reversed by clomiphene citrate. Fert Steril. 1997;67:783–785.11. Dolan E, McGoldrick A, DavenportC, et al. An altered hormonal profileand elevated rate of bone loss are associated with low bone mass inprofessional horse-racing jockeys. JBone Miner Metab. 2012;30:534-542. 12. Hagmar M, Berglund B, Brismar K,et al. Body composition and en-docrine profile of male Olympic ath-letes striving for leanness. Clin J SportMed. 2013;23:197-201. 13. Woodhill I, Cooper C, Zacharin M,et al. Low testosterone in a male ado-lescent bodybuilder: which diagnosisholds more weight? J Paediatr ChildHealth. 2014;50:739-741. 14. Tenforde AS, Barrack MT, Nattiv A,et al. Parallels with the female athletetriad in male athletes. Sports Med.2016;46:171-182. 15. Keys A, Brozek J, Henschel A, et al.The biology of human starvation (2vols). Oxford, England; Univ. of Min-nesota Press; 1950. 16. Schiele BC, Brozek J. Experimentalneurosis resulting from semistarva-tion in man. Psychosom Med. 1948;10:31-50. 17. Taylor HL, Keys A. Adaptation tocaloric restriction. Science. 1950;112:215-218. 18. Müller MJ, Enderle J, Pourhassan M,et al. Metabolic adaptation to caloricrestriction and subsequent refeeding:the Minnesota Starvation Experimentrevisited. Am J Clin Nutr. 2015;102:807-819. 19. Heikura IA, Uusitalo ALT,Stellingwerff T, et al. Low energyavailability is difficult to assess butoutcomes have large impact on boneinjury rates in elite distance athletes.

Int J Sport Nutr Exerc Metab. 2017;Dec18:1-30. 20. De Souza MJ, Williams NI, Nattiv A,et al. Misunderstanding the femaleathlete triad: refuting the IOC consen-sus statement on Relative Energy Deficiency in Sport (RED-S). Br J SportsMed. 2014;48:1461-1465. 21. Stubbs RJ, O’Reilly LM, Whybrow S,et al. Measuring the difference between actual and reported food intakes in the context of energy bal-ance under laboratory conditions. Br J Nutr. 2014;111:2032-2043. 22. Thienpont E, Bellemans J, SamsonI, et al. Stress fracture of the inferiorand superior pubic ramus in a manwith anorexia nervosa and hypogo-nadism. Acta Orthop Belg.2000;66:297-301. 23. Arce JC, De Souza MJ, PescatelloLS, Luciano AA. Subclinical alterationsin hormone and semen profile in ath-letes. Fertil Steril. 1993;59:398-404. 24. Gomez-Merino D, Chennaoui M,Drogou C, et al. Decrease in serumleptin after prolonged physical activity in men. Med Sci Sports Exerc.2002;34:1594-1599. 25. Hackney AC, Sinning WE, Bruot BC.Reproductive hormonal profiles ofendurance-trained and untrainedmales. Med Sci Sports Exerc. 1988;20:60–65.26. Maïmoun L, Lumbroso S, ManettaJ, et al. Testosterone is significantly reduced in endurance athletes with-out impact on bone mineral density.Horm Res. 2003;59:285-292. 27. Wheeler GD, Singh N, Pierce WD, et al. Endurance training decreasesserum testosterone levels in menwithout change in luteinizing hormone pulsatile release. J Clin Endocrinol Metab. 1991;72:422-425. 28. Rossow LM, Fukuda DH, Fahs CA, et al. Natural bodybuilding competi-tion preparation and recovery: a 12-month case study. Int J Sports Physiol Perform. 2013;8:582-592. 29. Chan JL, Mantzoros CS. Role ofleptin in energy-deprived states:normal human physiology andclinical implications for hypothalamic

amenorrhea and anorexia nervosa.Lancet. 2005;366:74-85. 30. De Souza MJ, Arce JC, Pescatello LS,et al. Gonadal hormones and semenquality in male runners: a volumethreshold effect of endurance training.Int J Sports Med. 1994;15:383-391. 31. Misra M, Katzman DK, Cord J, et al.Bone metabolism in adolescent boyswith anorexia nervosa. J Clin En-docrinol Metab. 2008;93:3029-3036. 32. Barrack MT, Fredericson F, TenfordeAS, et al. Evidence of a cumulative ef-fect for risk factors predicting lowbone mass among male adolescentathletes. Br J Sports Med. 2017;51:200-205. 33. Zanker CL, Swaine IL. Responses of bone turnover markers to repeatedendurance running in humans underconditions of energy balance or energy restriction. Eur J Appl Physiol.2000;83:434-440. 34. Bennell KL, Brukner PD, MalcolmSA. Effect of altered reproductivefunction and lowered testosteronelevels on bone density in male endurance athletes. Br J Sports Med.1996;30:205-8.35. Ackerman KE, Skrinar GS,Medvedova E, et al. Estradiol levelspredict bone mineral density in malecollegiate athletes: a pilot study. Clin Endocrinol. 2012;76:339-345. 36. Warden SJ, Davis IS, Fredericson M.Management and prevention of bonestress injuries in long-distance run-ners. J Orthop Sports Phys Ther.2014;44:749-765. 37. Changstrom BG, Brou L, Khodaee,M, et al. Epidemiology of stress frac-ture injuries among US high schoolathletes, 2005-2006 through 2012-2013. Am J Sports Med. 2015;43:26-33. 38. Tenforde A, Sayres LC, Mccurdy ML,et al. Identifying sex-specific risk fac-tors for stress fractures in adolescentrunners. Med Sci Sports Exerc.2013;45:1843-1851. 39. Nattiv A, Kennedy G, Barrack MT, etal. Correlation of MRI grading of bonestress injuries with clinical risk factorsand return to play. Am J Sports Med.2013;41:1930-1941.

8 | SCAN’S PULSE Fall 2018, Vol. 37, No. 4

Food Addiction and Its Implications for WeightStigma and Treatmentby Jessica Reid, Kerry O’Brien, Tracy Burrows, Charlotte A. Hardman, and Adrian Carter

In most Western countries such as theUnited States, more than 60% of thepopulation is categorized asoverweight or obese.1 The majority ofpeople in these countries alsounderstand the significant healthconsequences of excess weight, suchas diabetes, cardiovascular disease,and cancer.2 The proportion of peopleseeking to lose weight via methodssuch as dietary modification hasincreased substantially from 18.6%(1970-1979) to 48.2% (2000-2009),with dieting attempts more frequentamong overweight populations.3

Unfortunately, behavior change isdifficult: dieting and caloric restrictionhave been shown to be largelyineffective for long-term (2+ y) weightloss and weight loss maintenance.4

This is frustrating for most individualsas they encounter failure that causes arange of negative psychosocialconsequences, and also frustrating forthe health community seeking toaddress the problem of overweightand obesity. New research involvingdietitians, psychologists, andneuroscientists suggests that a largeproportion of the population mayhave a “food addiction,” which maymake long-term dieting and caloricrestriction extremely difficult and mayrequire different forms of treatment.

What is Food Addiction?

Foods high in refined sugars and fatare termed “hyperpalatable” becauseof their artificially high rewardpotency. Hyperpalatable foods triggerthe release of dopamine, a keyneurotransmitter associated with therewarding effects of a drug hit or atasty cheeseburger.5 For some people,the continual consumption ofhyperpalatable foods produces long-lasting neurobiological changes thatcould explain difficulties inmaintaining a healthy diet. The sameneurobiological changes are

observed in drug addiction,suggesting that hyperpalatable foodsand drugs may act on similar neuralcircuity in the brain and elicitcomparable long-term changes thatheighten the experience of cravingsand mean more food or drug isneeded to satisfy these cravings.5

The behavioral evidence is consistentwith the neuroscience. Self-identified“food addicts” report requiringgreater amounts of the foodprogressively over time to be satiated;using food to resolve anxiety ordepressive symptoms; eating morethan intended; having failed attemptsto cut back or stop eating refinedfoods; missing social, occupational, orrecreational activities because of theireating; and continuing to eat refinedfoods despite knowledge of negativeconsequences such as weight gainand fatigue.6

Not everyone supports the conceptof “food addiction.” Many academicsand clinicians have strongly critiquedthe animal and human neuroimagingevidence for food addiction.5,7

Despite this, our screens are floodedwith food- and diet-relatedinformation referring to “foodaddiction,” and while the academiccommunity may be in doubt, thegeneral public appears to be less so. A recent study found that 86% ofAustralians and Americans believethat foods, particularly sugars andfats, may be addictive;8 80% thoughtthat they were as addictive as cocaineand alcohol, and nearly 75% thoughtthat obesity is caused by a foodaddiction.

Exposure to a food addiction messagemay be enough for many of us toattribute our own patterns of eating toan addiction. Researchers found a two-fold increase in self-diagnoses amongthose who had read an article statingthat “food addiction is real” compared

with those who had read an articleproposing that “food addiction is amyth.”9While only 11% to 14% of thepopulation meet criteria for foodaddiction as measured using the YaleFood Addiction Scale,10 28% to 52% ofthe population self-identify as a “foodaddict,” with these rates highestamong overweight and obesepersons.9-11 This raises a number ofquestions, such as: Does a foodaddiction explanation for eating andoverweight reduce blame and stigmatowards people who are overweight?Might people who are overweight orobese view dieting as pointless andbeyond their personal control,lowering self-efficacy around weight-control?

Effects of Food AddictionMessages on Stigma

Being overweight and obese is one ofthe most stigmatised conditions insociety.12 Overweight people areoften seen as lazy, incompetent, andlacking in will power, and theseperceptions can significantly limitopportunities in employment, healthcare, and educational settings.12

Perhaps more concerning, however, isthe tendency for people to internalizethese hurtful comments and evenbegin to believe them, contributingto body dissatisfaction, depression,and lowered self-esteem.12

Despite the severity and prevalenceof weight-based stigma and itsadverse consequences, research intostrategies to reduce weight-basedstigma is scarce. Perhaps turning tofood addiction explanations ofobesity is one such strategy thatdeserves further attention. Whenprovided with an external cause foran undesirable characteristic (such asbeing overweight or overeating), wetend to view ourselves and othersmore positively—as a victim ofuncontrollable forces as opposed to

SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 9

someone with negative personalattributes. Consistent with this is thefinding that those who believeweight is personally controllablereport higher levels of stigma towardsoverweight and obese people.13 Thesuggestion, then, is that by attributingeating and weight to factors outsideof one’s control, we can reduce thenegative attitudes that surroundoverweight and obesity.13

Research has shown that describingobesity as a genetic disorder ratherthan caused by poor diet and lack ofexercise reduces the personal blameassociated with being overweightand improves attitudes towardsoverweight and obese persons.14

From a personal perspective, geneticattributes also help to mitigatenegative views of oneself whileincreasing body satisfaction.15

It is not yet clear whether describingobesity as the result of otherbiological causes such as a foodaddiction would have similar effects,especially as the “addiction” label alsocarries its own stigmatization. Somestudies have found that brain-basedexplanations of addiction mayactually increase stigma directedtowards people who use drugs.16 Onestudy found that “obese” and “foodaddict” labels elicited similar amountsof stigma, but that when combined,an “obese-food addict” label elicitedgreater stigma than either labelalone.17 Notably, “food addicts” werestill viewed as more likeable thanalcoholics and smokers.17 Althoughthis did not appear to be due toexternal attributions, alcoholism wasviewed as more “disease-based” andless likely to be due to individualchoices than food addiction.18 Foodaddiction was more highly attributedto free will and a general unhappinesswith one’s life.18 These findingssuggest that although “foodaddiction” may not cause the samelevel of stigma associated with “drugaddiction,” the term may have anadditive effect on an alreadystigmatized population of overweightor obese persons.

In contrast, Latner et al13 comparedattitudes towards individuals who

were described as either an “obesefood-addict,” “non-obese food-addict,” “obese non-food-addict,” or“non-obese non-food-addict.” Theyfound that an addiction-based modelof obesity reduced weight-basedstigma and blame towards the “foodaddicted” individual and obesepersons in general. Exposure to foodaddiction explanations was alsoassociated with a decreased concernabout gaining weight or fear ofbecoming fat.13 These findings suggestthat a food addiction explanation ofobesity could help to reduce thewidespread stigma and personaldistress that surrounds excess weight.

However, the limited evidence that isavailable at present is inconsistent.With the term “food addiction”gaining popularity in the media, thereis a pressing need for research toclarify the effects of food addictionexplanations of obesity on weightstigma and discrimination.

Clinical Implications of FoodAddiction Messages

Current treatments of obesity arecentered on calorie restrictionthrough diet and exercise. Therecognition of food addiction as avalid concept would likely promotethe introduction of new treatments,such as cognitive behaviour therapy(CBT), which have been useful in drugaddiction. While only a relatively smallsubset of people will meet criteria forfood addiction on the Yale FoodAddiction Scale, a research tool oftenused by researchers to identify foodaddiction, the tool could still be usedto assess other aspects of theirthoughts and behaviours that may beimpacting on weight loss results. The concern, however, is that use of afood addiction approach, particularlyin clinical settings, could have anegative impact on clients’ belief intheir ability to control their weight(referred to as self-efficacy) or theirwillingness to seek treatment. Self-efficacy is an important predictor ofsuccess in both weight managementand abstinence from addictivebehaviors.19 It is therefore critical tounderstand what effect food

addiction messages will have on self-efficacy for eating and weight. Arecent study has shown that peoplewho believe their weight is due tobiological causes such as genetics aremore likely to perceive their weightas unchangeable.20 This may explainwhy providing biologicalexplanations of obesity has also beenshown to predict unhealthy foodchoices15 and difficulty achievingweight loss.15

Other research suggests thatreceiving a mental health diagnosiscan be beneficial, with patientsreporting the experience as affirmingand optimistic.21 A recent study foundthat educating smokers about thechanges in the brain that causedtobacco addiction made quittingseem “easier” and increased theirmotivation to quit.22

There is little research on the impactof a food addiction explanation ofobesity on self-efficacy, treatmentintentions, and eating behaviors.While overweight and obese personshave indicated that a diagnosis of“food addiction” would notundermine their sense of personalresponsibility for their weight ortreatment seeking, this did notnecessarily correlate with perceptionsof control over eating.23

Exposing individuals to a foodaddiction explanation has had mixedresults.24 One study found thatparticipants had increased dietaryconcern and ate fewer calories afterbeing given a food addictiondiagnosis.24 However, in anotherstudy, participants who read a newsarticle supporting the concept offood addiction showed a trend forincreased consumption of indulgentfood (corn chips and chocolatecookies) compared with those whoread an article dismissing the conceptof food addiction.9

Where To From Here?

As scientific research continues todelve into the validity of foodaddiction as a psychiatric diagnosis,the adoption of this concept as a

10 | SCAN’S PULSE Fall 2018, Vol. 37, No. 4

“real” condition runs deeps in manydeveloped societies experiencing anobesity epidemic. It is important thatwe look at how this is impactingpeople’s relationship to food andweight loss, to their bodies, and toeach other. How a client will respondto a belief that he or she is addictedto food is unpredictable and needs to be considered on an individualbasis. There is a possibility, based on current literature, that a client will feel comfort in recognizing failedweight loss attempts as somethingother than a personal failing, and thiswould likely alleviate self-blame andincrease self-esteem. However,dietitians and other healthpractitioners need to help clientsunderstand that they still have a roleto play in their treatment outcomesand that addiction is not a permanentstate they must surrender to.

_____________________Jessica Reid is an honours graduate atthe Monash Institute of Cognitive andClinical Neurosciences, School ofPsychological Sciences, MonashUniversity, Australia. Kerry O’Brien isassociate professor at the School ofSocial Sciences, Monash University,Australia. Tracy Burrows is associateprofessor at the School of HealthSciences, Newcastle University,Australia. Charlotte A. Hardman is asenior lecturer at the Department ofPsychological Sciences, University ofLiverpool, UK. Adrian Carter is associateprofessor at Monash Institute ofCognitive and Clinical Neurosciences,School of Psychological Sciences,Monash University, Australia and theUniversity of Queensland Centre forClinical Research, The University ofQueensland, Australia.

References

1. Ogden CL, Carroll MD, Fryar CD, etal. Prevalence of obesity amongadults and youth: United States, 2011-2014: US Department of Health andHuman Services, Centers for DiseaseControl and Prevention, NationalCenter for Health Statistics; 2015.

2. Tompson T, Benz J, Agiesta J, et al.Obesity in the United States: publicperceptions; 2012. The AssociatedPress--NORC Center for Public AffairsResearch. www.apnorc.org/PDFs/Obesity/AP-NORC-Obesity-Research-Highlights.pdf. Accessed June 22,2018.3. Santos I, Sniehotta FF, Marques MM,et al. Prevalence of personal weightcontrol attempts in adults: asystematic review and meta-analysis.Obes Rev. 2017;18:32-50.4. Mann T, Tomiyama AJ, Westling E, et al. Medicare's search for effectiveobesity treatments: diets are not theanswer. Am Psychol. 2007;62:220-223.5. Carter A, Hendrikse J, Lee N, et al.The neurobiology of "food addiction"and its implications for obesitytreatment and policy. Annu Rev Nutr.2016;37.6. Ifland JR, Preuss HG, Marcus MT, et al. Refined food addiction: a classicsubstance use disorder. MedHypotheses. 2009;72:518-526.7. Ziauddeen H, Farooqi IS, FletcherPC. Obesity and the brain: howconvincing is the addiction model?Nat Rev Neurosci. 2012;13:279-286.8. Lee NM, Lucke J, Hall WD, et al.Public views on food addiction andobesity: implications for policy andtreatment. PLoS ONE. 2013;8:e74836.9. Hardman, Rogers PJ, Dallas R, et al.“Food addiction is real”. The effects ofexposure to this message on self-diagnosed food addiction and eatingbehaviour. Appetite. 2015;91:179-184.10. Meadows A, Nolan LJ, Higgs S. Self-perceived food addiction: prevalence,predictors, and prognosis. Appetite.2017;114:282-298.11. Ruddock HK, Dickson JM, Field M,et al. Eating to live or living to eat?Exploring the causal attributions ofself-perceived food addiction.Appetite. 2015;95:262-268.12. Puhl RM, Heuer CA. The stigma ofobesity: a review and update. Obesity.2009;17:941-964.13. Latner JD, Puhl RM, Murakami JM,et al. Food addiction as a causalmodel of obesity. Effects on stigma,blame, and perceived psycho-pathology. Appetite. 2014;77:79-84.

14. O'Brien KS, Puhl RM, Latner JD, et al. Reducing anti-fat prejudice inpreservice health students: arandomized trial. Obesity.2010;18:2138-2144.15. Hoyt CL, Burnette JL, Auster-Gussman L. “Obesity is a Disease”:examining the self-regulatory impactof this public-health message. PsychSci. 2014;25:997-1002.16. Kvaale EP, Haslam N, GottdienerWH. The "side effects" ofmedicalization: a meta-analyticreview of how biogeneticexplanations affect stigma. ClinPsychol Rev. 2013;33:782-94.17. DePierre JA, Puhl RM, Luedicke J. A new stigmatized identity?Comparisons of a “food addict” labelwith other stigmatized healthconditions. Basic Applied Soc Psychol.2013;35:10-21.18. DePierre JA, Puhl RM, Luedicke J.Public perceptions of food addiction:a comparison with alcohol andtobacco. J Substance Use. 2014;19:1-6.19. DiClemente CC. Self-efficacy andthe addictive behaviors. J Soc ClinPsychol. 1986;4:302-315.20. Pearl R, Lebowitz M. Beyondpersonal responsibility: effects ofcausal attributions for overweightand obesity on weight-related beliefs,stigma, and policy support. PsycholHealth. 2014;1-16.21. Holm–Denoma JM, Gordon KH,Donohue KF, et al. Patients' affectivereactions to receiving diagnosticfeedback. J Soc Clin Psychol.2008;27:555-575.22. Morphett K, Carter A, Hall W, et al.A qualitative study of smoker's viewson brain-based explanations oftobacco dependence. Int J Drug Policy.2016.29:41-48.23. Cullen AJ, Barnett A, Komesaroff P,et al. A qualitative study ofoverweight and obese Australians’views of food addiction. Appetite.2017;115:62-70.24. Ruddock HK, Christiansen P, JonesA, et al. Believing in food addiction:helpful or counterproductive foreating behavior? Obesity.2016;24:1238-1243.

SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 11

FromThe Chair

SCAN’s Leadership Harvestby Lindzi S. Torres, MPH, MS, RDN, CSSD

“It is only the farmer who faithfullyplants seeds in the Spring, who reaps aharvest in the Autumn.” — B.C. Forbes

One thing that is near and dear to meis the thoughtful and deliberate development of leaders and, morespecifically, leadership in dietetics. The quote above reminds me ofplanting the seeds of leadership earlyin one’s career so that it continues toreap a harvest of benefits for years tocome.

Why Volunteer?

One of the best ways to become engaged in an organization isthrough volunteering. In addition todeveloping leadership skills and increasing your network, did youknow that volunteering with SCAN isgood for your health? The Corpora-tion for National and CommunityService found a strong relationshipbetween volunteering and health:“Those who volunteer have lowermortality rates, greater functionalability, and lower rates of depressionlater in life than those who do not vol-unteer.” If you’d like information onhow volunteering can benefit yourhealth, go to www.nationalservice.gov/pdf/07_0506_hbr.pdf. I encourage you to get involved vol-unteering at any level and hope youwill look to SCAN as a place to investin your volunteer and leadershiphealth!

“My charge to you is

to plant seeds

sometime in the

near future, whether

you chose a small

volunteer job or

jump into a larger

role. Want to start

even smaller?”

SCAN’s Volunteer Opportunities

Here’s an overview of the variousareas of SCAN where you can find volunteer opportunities: Education – Webinars, podcasts,continuing education for SCAN pro-grams Website – SCAN resources andwebsite updating, Student Corner,writing, editing Membership - Mentoring program,volunteer coordination, communica-tions Partnerships - Assisting withSCAN’s partnership efforts Communications - Marketing, pub-lic relations, editing, writing

Publications - Writing, editing,SCAN’S PULSE, subunit newsletters,fact sheets Symposium - Planning and organ-izing committee, on-site assistance

For more information about volun-teer opportunities with SCAN, visitwww.scandpg.org/volunteer-oppor-tunites/.

Plant Your Volunteer Seedswith SCAN

My charge to you is to plant seedssometime in the near future, whetheryou chose a small volunteer job orjump into a larger role. Want to starteven smaller? Use the Find a SCANRD online program to find a localSCAN dietitian or leader in your area,respond to conversations on theSCAN electronic mailing lists (EMLs),join us at the SCAN events plannedfor the upcoming Food & NutritionConference & Exposition™ (FNCE®), orask other SCAN volunteers how theygot involved! We all started some-where with someone encouraging usto get involved and invest in our fu-ture and the future of dietetics.

I hope you will attend FNCE® 2018 onOctober 20-23, in Washington, DC.You’ll find some details about SCAN’sevents there on page 19 of this issue.See you there!

12 | SCAN’S PULSE Fall 2018, Vol. 37, No. 4

Conference Highlights

As always, the Annual SCANSymposium was filled with greatspeakers, high energy, and excellentnetworking opportunities. Here are justa few of the highlights.

Emerging Research onOmega-3s and Brain Health

Presented by Michael Lewis, MD, MPH,MBA, www.brainhealtheducation.org

Omega-3 fats are related to brainhealth. Animal research (rats, mice)suggests that giving intravenousdocosahexaenoic acid (DHA)within an hour after brain or spinalcord injury contributes to betteroutcomes regarding recovery.Would the same help athletes?Could DHA help with reducing thedamage done by brain injuries?According to Michael Lewis, MD,MPH, MBA, athletes, war fighters,and others at high risk forconcussion should consider taking3,000 mg EPA + DHA per day as aprotective strategy.

Omega-3s can also help treatdepression, and that might helpreduce suicides. The suicide ratewas 62% lower for soldiers withadequate levels of omega-3,versus soldiers with low bloodlevels of DHA.

Exercise and Bone Health

Presented by Wendy Kohrt, PhD,University of Colorado AnschutzMedical Campus

We've all heard thatweightbearing exercise isimportant for maintaining bonemass. Case in point: Runners havehigher bone density thanswimmers and cyclists. However,sometimes exercise breaks downbone. Both basketball players and

cyclists lose bone during theseason—and then regain some ofthat loss during the off-season. Isthis due to stress hormones, or lowenergy availability, or disruption ofcalcium homeostasis?

“Preliminary

research is seeking

to determine if

consuming pre-

exercise calcium

would help increase

bone mineral

density or if it would

disrupt normal

regulatory function.”

� We know that calcium is lost viasweat, and about 20% to 25% ofserum calcium leaves the bloodduring exercise. Where it goes isunknown. Preliminary research isseeking to determine if consum-ing pre-exercise calcium wouldhelp increase bone mineral den-sity or if it would disrupt normalregulatory function.

Should Athletes Supplementwith Antioxidants?

Presented by Scott Powers, EdD, PhD,University of Florida in Gainesville.

Should athletes take antioxidantsupplements? Probably not. Thebody has a natural balance ofprooxidants and antioxidants. Animbalance can lead to muscular

fatigue and molecular damage.Antioxidant supplements candownregulate the body's naturalproduction of antioxidants, andthat can blunt the trainingresponse.

Athletes can ingest aperformance-enhancing balanceof antioxidants (including vitaminsC and E, zinc, carotenoids, andpolyphenols) via all sorts ofcolorful fruits and vegetables:blueberries, strawberries, tartcherry juice, grape juice, broccoli,spinach, carrots, and so on.

Research Update onNutrition, Exercise and Aging

Presented by Bob Murray, PhD,www.sportsscienceinsights.com and Christine Rosenbloom, PhD, RD,professor emerita, Georgia StateUniversity

An estimated 35 millionAmericans are older than 65. By 2030, 70 million Americans willexceed the age of 85.Unfortunately, as we age, we losemuscle strength. That loss isassociated with frailty and falls.Because the daily diet of anestimated 25% to 40% of olderpeople lacks adequate protein,muscle loss is exacerbated.

Research suggests that olderpeople, including athletes, shouldincrease their protein intake to 1.4 gto 1.6 g/kg per day, and up to 40 gafter hard exercise. This helps boostthe muscle-building response toexercise. For an older athlete whoweighs 150 pounds (68 kg), thismeans 95 to 110 g protein per day.That's about 25 g four times a day—much more than what is providedin a bowl of oatmeal or a handful ofnuts!

34th Annual SCAN SymposiumKeystone, CO • May 5-7, 2018

SCAN’S PULSE Fall 2018, Vol. 37, No. 3 | 13

Possible Linkages BetweenCannabis and ExerciseParticipation andPerformance

Presented by Angela Bryan, PhD,University of Colorado Boulder

As we age, exercise becomesincreasingly important, but aches,pains, and disability can limit thedesire to exercise. Preliminaryresearch suggests that cannabiscan enhance the desire toexercise. Cannabis has anti-inflammatory properties that canreduce pain and enhancerecovery. While cannabis isunlikely to enhance performance,it might help motivate a person toexercise. A survey of 429 cannabisusers (average age: 40) indicatesthat 73% endorse cannabis useconcurrent with activity for betterenjoyment and recovery.

In addition, in a study of olderadults participating in asupervised exercise study, thosewho used cannabis reportedexercising more than those whodid not use cannabis. Stay tunedfor more results from thisemerging research topic.

The Evidence for Health atEvery Size Approaches inNutrition Therapy

Presented by Julie Duffy Dillon, MS, RD,CEDRD, Love Food podcast

Clients who live in a larger bodycommonly harbor shame, guilt,and body hatred. While theirsolution might be to eat less andexercise more to change theirbody size, we lack evidence thatpeople can lose weight and keepit off. We do have solid evidence,however, that going on a dietleads to going off the diet andregaining the weight, plus more—and then going back on aweight-loss diet again.

The health risks of yoyo dieting aremore harmful than the (short-lived) benefits of weight loss.

Weight cycling (yoyo dieting)contributes to malnutrition,muscle loss, reduced metabolicrate, and feelings of deprivation.The binge-eating that occurs upon"blowing the diet" is linked to fatgain, inflammation, elevated bloodpressure, and insulin resistance—to say nothing about disorderedeating. Dieting is the number onepredictor of who will develop aneating disorder. As a society, weneed to accept that humans comein diverse sizes and shapes, andthat dieting is harmful.

Binge Eating Disorder and Bariatrics

Presented by Megan Kniskern, MS, RD,CEDRD-S, Arizona State University

Larger bodies have been inexistence since the oldest knownhuman art forms. We need toembrace the fact that peoplecome in—and can be happy in—diverse bodies, shapes, and sizes,and that the messages and actionsof dieting can be very harmful.RDNs would do well to ensure afocus on food relationships andfood behaviors that support anoverall sense of happiness.

Supporting the struggles andstigmas associated with a largerbody requires evaluating thebigger picture. Can RDNs providesupport for their clients, yet stepaway from the “weight loss curesall” mentality we have been seeingin the past few decades? Researchdoes not suggest that largerbodies or bodies that might beconsidered “obese” by medicalstandards live shorter lives; theymay even have an advantage overother weight categories as itrelates to overall mortality.

Binge eating disorder can be acontributor to obesity. Anestimated 35% of those who seekbariatric surgery present withbinge eating disorder. Many of thepossible food struggles in bariatriccandidates are often missed. Thisincreases their risk for serious

emotional and medicalcomplications down the road. Ifyou suspect your clients mightsuffer from binge eating disorder,be sure to ask these questions:

What percentage of your timedo you spend thinking aboutfood? (There is a larger per-centage among binge eaters.)

What defines a binge for you?(This opens up the conversa-tion, reduces shame, takesaway the isolation, and givesthe client the opportunity totalk about this unspokentopic.)

What do you really want—health or happiness?

“A survey of

adolescent athletes

indicates that 97%

believed they would

benefit from greater

nutrition education.”

Developing a High SchoolNutrition Program

Presented by Brett Singer, MS, RD, CSSD,Memorial Hermann IRONMAN SportsMedicine Institute, and Christina Curry,MS, RD, Memorial Hermann IRONMANSports Medicine

A survey of adolescent athletesindicates that 97% believed theywould benefit from greaternutrition education. That meansthe time is ripe for sports dietitiansto teach them how to eat to win.

How we help the students? Some options include teampresentations, small group talks,one-on-one counseling, talks withparents, social media, and creatinghandouts and nutrition posters.What a good use of money frombooster clubs and PTOs!

Improving Trail NutritionThrough Education and MealPlanning Preparation

Presented by Aaron Owens Mayhew,MS, RDN, www.BackCountryFoodie.com

Long distance hikers can be on thetrail from 10 days to more than 6months. They carry with themtheir own food, water, andanything required to survive in thewilderness. They need food that ishigh in calories, light in weight,low in cost, and easy to prepare.This often results in a diet thatincludes highly processedconvenience foods with limitednutrient-density (followed bybinge-eating fast foods when intowns along the trails).

The question arises: Are thru-hikers’ diets nutritionallyadequate? The answer is probablynot, given that male hikerscommonly report losing 30 to 40lb on extended hikes. Aaronshared how she has developedultralight foods for a 5,000-calorienutrient-rich meal plan. Her goal isto help hikers go the distance withgood health and energy to spare.

Applying Science toPerformance

Presented by Leslie Bonci, MS, RD, CSSD, www.ActiveEatingAdvice.com#ScienceNotOpinion and#FactsOverFallacy.

Evidence shows that exercising ina fasted stated leads to musclebreakdown. Athletes should thinktwice before having nothing to eatbefore a morning workout.

Swishing and spitting a sport drinkcan offer an energy boost at theend of a tiring exercise bout, butthis can lead to inadequate fluidintake.

The keto diet does not enhanceperformance; rather, it leads to adownregulation of the enzymesthat carbohydrate needs to fuel asprint at the end of an event.

Whole30 and Intermittent Fastingare just two more fads to add tothe list of unsuccessful diets.

“Carb-phobia” refuses to go away,despite the plethora of researchsupporting the performancebenefits of a carbohydrate-basedsports diet. #Don'tDreadTheBread.

Filling the Gap in SportsNutrition Guidance for ActivePeople

Presented by Asker Jeukendrup, PhD,www.MySportsScience.com and Nanna Meyer, PhD, RD, CSSD, Universityof Colorado in Colorado Springs.

The Position Statement of theAcademy of Nutrition andDietetics, the American College ofSports Medicine and Dietitians ofCanada offers guidelines onnutrition for athletes—but whatabout nutrition for fitnessexercisers and weekend warriors?Exercise physiologist AskerJeukendrup, PhD, suggests thatRDNs help match clients'nutritional guidelines to theirathletic goals. In other words,determine why the client isexercising: Is it to lose weight, tobuild muscle, to finish an IronmanTriathlon, or simply to invest inbetter health?

When it comes to fueling duringextended exercise, Jeukendrupstated that the recommendationsare similar for both athletes andless fit people: Both elite athletesand weekend warriors whoexercise hard for more than 2hours want to train the gut to beable to tolerate the recommended60 to 90 g carbohydrate (240 to360 kcal) per hour. They mighthave to start at the low end of thecalorie range and build up to therecommended amount. The goal isto be able to enjoy high energyduring exercise.

Nanna Meyer, PhD, RD, CSSD,proclaimed that climate change ishere and it's a critical time forathletes and RDNs alike to thinkmore about how we can be goodcitizens and take better care of theearth that we enjoy. This couldinvolve eating locally grown foods,choosing more plant foods,buying sustainably farmed fish,using fewer plastic water bottles,eating less food in wrappers, andbuying from local farmers. Wewant to eat with integrity and withrespect for the planet.

Conference Highlights editor NancyClark, MS, RD, CSSD has a privatepractice in the Boston area and offersonline workshops for healthprofessionals. For more information,visit www.NancyClarkRD.com andwww.NutritionSportsExerciseCEUs.com.

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SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 15

Research DigestWeight Management andAtrial Fibrillation

Fioravanti F, Brisinda AR, Sorbo G, et al.Compliance in weight control reducesatrial fibrillation worsening: a retrospective cohort study. NutrMetab Cardiovasc Dis. 2017;27:711-716.

Of late, researchers have focused onthe link between atrial fibrillation (AF)and obesity. Recent findings haveshown a strong correlation betweenobesity and the etiology of AF.Research suggests that a normalbody mass index (BMI) no higher than25 kg/m2 may prevent and evenreduce repeated arrhythmia episodes.This retrospective cohort studyselected 270 eligible patients whowere analyzed for their symptomaticAF relapse over a 2.5-year time frame.Patients were divided into fourgroups according to their BMI duringthe follow-up period. Group 1participants had normal BMI (<25);group 2 participants were overweight(BMI 25-29.9) but lost weight overtime (at least two BMI units); group 3participants were overweight but hadno weight change over time; andgroup 4 participants (initial BMI >25)gained weight over time by two BMIunits. Results showed that one AFepisode occurred every 1.7 monthsin group 4, every 4.6 months in group3, every 9.7 months in group 2, andevery 10 months in group 1. Thefindings suggest that a BMI <25reduces the risk of AF recurrence two-fold. AF risk increased innoncompliant overweight patients.This study supports the LEGACY Trialfindings showing that obesity isdirectly implicated in the genesis ofAF. It is important to stress achievinga normal BMI to lower the risk factorsof AF and protect against occurrenceor recurrence.

Summarized by Dori Cinque, MS, RD,CDE, CDN, clinical nutritionist at IslandCardiac Specialists, a NYU WinthropMedical Affiliate, Garden City, NY.

“Educating teens to

identify higher-

quality foods and

improve overall

eating habits may

support not only

physical health but

also cognitive

development.”

Diet Quality and AdolescentAttention Capacity

Henriksson P, Cuenca-García M,Labayen I, et al. Diet quality andattention capacity in Europeanadolescents: the Healthy Lifestyle inEurope by Nutrition in Adolescence(HELENA) study. Br J Nutr. 2017;117:1587-1595.

Adolescence is a crucial period ofcognitive development. Tounderstand potential modifiablefactors, this study examined dietarypatterns and their effect onadolescents’ attention capacity. Using data from the Healthy Lifestylein Europe by Nutrition in Adolescence(HELENA) study, this cross-sectionalstudy involving 384 adolescentsexamined their dietary patterns, asmeasured by two nonconsecutive 24-hour recalls, and their attentioncapacity, as measured by the d2 Testof Attention. Macronutrient and fiberintake in addition to indices of threedietary patterns (the Diet QualityIndex for adolescents [DQI-A], theideal diet, and the Mediterranean

diet) were calculated using two-sidedT-tests. The DQI-A measures overalldiet quality and diversity, the idealdiet is based on the DietaryApproaches to Stop Hypertension(DASH) diet, and the Mediterraneandiet measures consumption ofspecific foods. After adjusting for age,sex, body mass index (BMI), maternaleducation, and family affluence,scores for the DQI-A and ideal dietwere positively associated withattention capacity (P=.002 andP=.005, respectively). After adjustingfor physical activity, the ideal diet didnot reach significance, because 44%of participants had missing physicalactivity data. A Mediterranean dietwas not associated with improvedattention capacity. While sodium andsoft drink consumption wasnegatively correlated with attention(P=.006 and P=.037, respectively),these were the only significant food-specific findings. These resultssuggest that an overall pattern ofhigh-quality food choices is mosthighly associated with improvedattention capacity in adolescents.

Educating teens to identify higher-quality foods and improve overalleating habits may support not onlyphysical health but also cognitivedevelopment. This study was fundedby the Spanish Ministry of Economyand Competitiveness and supportedby the SAMID III network, RETICS,funded by the PN I + D + I 2017-2021(Spain), ISCIII-Sub-Directorate Generalfor Research Assessment andPromotion and the EuropeanRegional Development Fund and bythe University of Granada, Plan Propiode Investigación 2016, Excellenceactions: Units of Excellence, Unit ofExcellence on Exercise and Health.

Summarized by Andrea Walsh,graduate student, Department ofNutrition and Integrative Physiology,Coordinated Master’s Program,Nutrition, Education and ResearchConcentration, University of Utah, SaltLake City, UT.

Exhaustive Training andOxidative Stress

Withee ED, Kimberly MT Dehen R, etal. Effects of methylsulfonylmethane(MSM) on exercise-induced oxidativestress, muscle damage, and painfollowing a half-marathon: a double-blind, randomized, placebo-controlledtrial. J Int Soc Sports Nutr. 2017;14:1-11.

Exercise results in the production offree radicals necessary for trainingadaptations, including musclegrowth. However, excessive levelsduring exhaustive exercise contributeto cellular damage, includingincreased muscle damage.Methylsulfonylmethane (MSM) is asulfur-based nutritional supplementthat appears to have pain andinflammation-reducing effects. Thepurpose of this study was to test theeffects of MSM in reducing oxidativestress associated with muscledamage, soreness, and joint pain. Inthis randomized, double-blind,placebo-controlled trial, 22 male andfemale participants from theregistrant pool of the Portland HalfMarathon were randomized toreceive either 3 g/day of rice flourplacebo or 3 g/day of MSM for 3weeks prior to the race andcontinuing until 2 days after the race.Blood serum measurements ofoxidative stress (8-hydroxy-2’-deoxyguanosine [8-OHdG] andmalondialdehyde [MDA]) and muscledamage (creatine kinase [CK] andlactate dehydrogenase [LDH]) werecollected 4 weeks prior to the raceday (baseline), and again 15 minutes(T1), 90 minutes (T2), 1 day (T3), and 2 days (T4) postrace. To measuremuscle and joint pain, a 100 mmVisual Analog Scale (VAS) was used ateach time point. Running in a half-marathon resulted in a significantincrease in oxidative stress, muscledamage, and pain outcome measures(P< .001). There were no significanttime-by-treatment effects for any

outcome measures. However, therewas a clinically significant (change>10 mm) reduction of muscle andjoint pain with MSM supplemen-tation. The results of this studysuggest that MSM supplementationdoes not decrease pretraining levelsof oxidative stress but may beassociated with a reduction in pain.Athletes considering supplemen-tation to combat joint pain shouldconsult a registered dietitianregarding individual efficacy. Thisstudy was funded by Bergstrom,supplier of the supplements andplacebos in this study.

Summarized by Lindsey Kotecki,graduate student, Department ofNutrition and Integrative Physiology,Coordinated Master’s Program, SportsNutrition Concentration, University ofUtah, Salt Lake City, UT.

“The results suggest

that athletes may

benefit from vitamin

C and gelatin

supplementation,

but further research

is needed.”

Vitamin C and GelatinSupplementation to PromoteCollagen Synthesis

Shaw G, Lee-Barthel A, LR Ross M, etal. Vitamin C-enriched gelatinsupplementation before intermittentactivity augments collagen synthesis.Am J Clin Nutr. 2017;105:136-143. The collagen-rich extracellular matrixsupports the body’s connective tissues.However, intense training strains the

musculoskeletal system, resulting inmore frequent injuries. Nutritionstrategies, such as use of vitamin C andgelatin, may promote collagensynthesis and improve mechanics inthese tissues. The purpose of this studywas to evaluate the effects of gelatinsupplementation on collagensynthesis. In this randomized, double-blinded, crossover study, eight activemales consumed either 5 or 15 g ofgelatin dissolved in a vitamin C-enriched isocaloric beverage or avitamin C placebo. Blood samples weretaken at baseline and at 30 minutesand 1 hour after beverage ingestion.Engineered ligaments that wereformed using ligament cells from amale donor were treated with bloodfrom before or 1 hour after initial drinkingestion. One hour after the initialdrink, participants performed rope-skipping continuously for 6 minutes,and blood samples were taken 30minutes, 1 hour, 2 hours, and 4 hourspostexercise. The supplementation andexercise regimen continued for 3 days,three times daily, with ≥6 hoursbetween bouts. Blood samples frombaseline, 4 hours, 24 hours, 48 hours,and 72 hours after the first exercisebout were used to examine N-terminalpeptide of pro-collagen I (PINP). Serumglycine, proline, hydroxyproline, andhydroxylysine significantly increasedand peaked 1 hour after ingestion inthe 15 g group (P<.05). The engineeredligaments increased in collagencontent in the 15 g group and meantensile strength in all groups (P<.05).PINP increased in the 15 g group, andthis effect was maintained throughoutthe 3 days (P< .05). The results suggestthat athletes may benefit from vitaminC and gelatin supplementation, butfurther research is needed.

Summarized by Kala Riester, graduatestudent, Department of Nutrition andIntegrative Physiology, CoordinatedMaster’s Program, Sports NutritionConcentration, University of Utah, SaltLake City, UT

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SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 17

by Traci Roberts

Michele Macedonio, MS, RD,CSSD and Christine Rosenbloom,PhD, RD, CSSD teamed up withother notable experts to producethe Active Nutrition Guide for ClifBar & Company. The guide providesevidence-based recommendationsthat can be used as a resource fornutrition professionals workingwith active individuals.

A team of RDNs receivedacceptance of their manuscriptthat adds to the evidence formedical nutrition therapy (MNT)for dyslipidemia management.Geeta Sikand, MA, RDN, alongwith Renee E. Cole, PhD, RDN,Deepa Handu, PhD, RDN, andcolleagues wrote, "Clinical andCost Benefits of Medical NutritionTherapy by Registered DietitianNutritionists for Management ofDyslipidemia: A Systematic Reviewand Meta-Analysis," which will bepublished in the Journal of ClinicalLipidology.

Marie Spano, MS, RD, CSCS,CSSD, Laura Kruskall, PhD, RD,CSSD and D. Travis Thomas, PhD,

RDN, CSSD had their book,Nutrition for Sport, Exercise andHealth, published through HumanKinetics. The book is meant toserve as a textbook for studentsand as a resource for professionalsinvolved in sports nutrition anddietetics.

Cheryl Toner, MS, RDNwashonored to represent SCAN at theSpecial Olympics Inclusive HealthSummit in June in Seattle, WA. Shewas joined by SCAN member andAcademy President-Elect, TeriRaymond, MA, RD, CD, FAND inlearning how our professionalorganization can do more topromote health care that isinclusive of those with intellectualdisabilities (ID), as well as supportour members in providing servicesthat are appropriate for athletesand others with ID.

SCAN member Mary Pittaway,MA, RDN along with Alice Lenihan,MPH, RD led a team of dietitians(including SCAN member AbbyPattison, MS, RD), kinesiologists,nurses, physicians and healtheducators in providing healthyeating, hydration, and physical

activity guidance to athletes at the50th Special Olympics USA Gamesin Seattle in July. The interactivestations assessed height, weight,bone density, and blood pressure,and engaged athletes inconversation and interactiveeducation opportunities toreinforce health educationrecommendations. Athletes wereinvolved in health-related goalsetting and referred to health careproviders including dietitians forfollow-up care. Mary and Alicedeveloped the Health Promotioneducation, screening and referralsprogram now delivered in the U.S.and throughout the world. Theprogram, part of the biggerHealthy Athletes program, isdesigned to help reduce healthdisparities of people withintellectual disabilities. Together,they have been serving SpecialOlympics athletes and traininghealth care professionals to jointhem for more than 15 years.

If you have an accomplishment thatyou would like published in anupcoming issue of PULSE, pleasecontact Traci Roberts atfivespotjones@gmail.com.

SCAN Notables

Of Further Interest News from Wellness/CVRDNs SubunitHere is an update from the Well-ness/CV subunit:

New Webinar on Health Coaching.Health and wellness coaching is be-coming more and more popular anddietitians are uniquely suited to thisrole. Well-developed coaching skillscan positively affect patient out-comes by helping clients work towardpositive behavior changes. Our newwebinar, Health & Wellness Coachingfor the RDN, is almost ready and is agreat introduction to health and well-

ness coaching and how it can helpyou and your clients. Watch for its re-lease this fall at SCAN’s e-library atwww.scandpg.org/e-library.

CV Reimbursement Trends/Efforts.RoseAnna Holliday, PhD, RDN andGeeta Sikand, MA, RDN, CDE, CLS,FAND, FNLA are SCAN’s new reim-bursement co-representatives. If you’reinterested in becoming involved in ourefforts to increase awareness of reim-bursement issues/topics, please con-tact Wellness/CV co-director CarolKirkpatrick at fellcaro@isu.edu.

SCAN Symposium Recap. We en-joyed meeting new members and re-connecting with long-time membersat the 2018 SCAN Symposium at theKeystone Resort. If you couldn’t attendthis year, we hope you’ll plan to join usin Phoenix, AZ, April 26-28, 2019, forthe 35th Annual SCAN Symposium,which has a wellness-focused theme(see “Upcoming Events” in this issue).

Seeking PULSE Liaison. The Well-ness/CV subunit is looking for a vol-unteer to serve as the PULSE liaison.This role entails writing brief newsitems and announcements (as shown

18 | SCAN’S PULSE Fall 2018, Vol. 37, No. 4

here) and submitting these as oursubunit’s contribution to “Of FurtherInterest” for each issue of PULSE. Ifyou’re interested in serving in thisrole, contact either of the Wellness/CVco-directors: Mark Hoesten atmshcg@yahoo.com or Carol Kirkpatrick at fellcaro@isu.edu.

News from SportsDietetics—USA (SD-USA)SubunitBelow are some highlights from theSD-USA subunit:

SCAN Speaking Opportunity. TheSCAN-NATA (National Athletic Train-ers’ Association) Committee has de-veloped a PowerPoint presentationthat highlights the collaborativeworking relationship of sports RDNsand certified athletic trainers (ATCs).Any SCAN member can apply to offerthis presentation at any NATA-approved provider program. SCANbenefits from increased exposure,NATA members benefit by connectingwith a local nutrition expert, and youcan benefit from potential referralsand an honorarium. Visit www.scan-dpg.org/sports-nutrition/working-with-a-sports-nutritionist/promoting-a-sports-dietitian/ for more informa-tion.

Volunteer Opportunities. SD-USAruns on volunteers, and we need you!Specifically, we are looking for mem-bers who: o Have experience with podcasts o Have a passion for working with

high school athletes o Are excellent editors and review-

ers (for fact sheets and webinars) o Want to strengthen partnerships

with our external relationships(with NATA, National Strengthand Conditioning Association[NSCA], Professionals in Nutritionand Exercise Science [PINES], Ath-letes in the Arts)

o Want to become leaders in sportnutrition

Visit the SCAN volunteer page atwww.scandpg.org/volunteer-opportunities/ today!

Athletes in the Arts Partnership.SCAN now has an official partnership

with Athletes in the Arts (an initiativeof the American College of SportsMedicine). This ties in with our Ex-panding the Arena Initiative by pro-moting opportunities for sportsdietitians to work with performingartists. We are looking for volunteerswho are interested in developing thispartnership. Please contact the SCANoffice at info@scandpg.org.

CSSD Exam Window. The 2019exam dates and fee schedule for theBoard Certified Specialist in Sports Di-etetics (CSSD) credential are nowavailable. Visit the Commission on Di-etetic Registration (CDR) website atwww.cdrnet.org/certifications/board-certification-as-a-specialist-in-sports-dietetics for more information.

Manuscripts for PULSEWelcomeSCAN’S PULSEwelcomes the submis-sion of manuscript to be consideredfor publication. In particular, PULSE isinterested in receiving original re-search reports and review articles.Manuscripts presenting practicalguidelines, case studies, and other in-formation relative to SCAN will alsobe considered.

Manuscripts must be prepared andsubmitted in accordance with PULSE’sGuidelines for Authors; only manu-scripts that follow these guidelineswill be considered. The Guidelines forAuthors can be accessed atwww.scandpg.org/nutrition-info/pulse/.

Call for Abstractors for“Research Digest”The “Research Digest,” which appearsin each issue of SCAN’S PULSE, pro-vides summaries of published papersrelating to all of SCAN’s practice areas:nutrition for sports and physical activ-ity, cardiovascular health, wellness,and disordered eating and eating dis-orders.

You can contribute to the “ResearchDigest” by volunteering to abstract arecently published study on any ofthe above practice areas. For detailson this opportunity, contact KaryWoodruff, MS, RD, CSSD, co-editor of

“Research Digest,” at kary.woodruff@health.utah.edu. Become a contribu-tor to PULSE!

Sports Nutrition Manual:The Authoritative TextSport dietitians who haven’t yet pur-chased their copy of Sports Nutrition:A Handbook for Professionals, sixthedition, can purchase the latest ver-sion of this long-revered sports man-ual today at www.eatrightstore.org.This full-color edition—edited by twoSCAN members and written and re-viewed by esteemed sports RDNs andother exercise experts—presentstimely research and evidence-basedadvice for health professionals work-ing with athletes at all levels. Compre-hensive in scope, the manualincorporates theoretical and practicalinformation with key takeaways de-signed for easy implementation indaily practice.

The latest Sports Nutrition explores allareas of sports and fitness nutritionfor both the seasoned and novice die-titian. Included in this edition is a newchapter discussing emerging oppor-tunities in sports nutrition, a com-pletely revised overview of exercisephysiology, strategies for sports nutri-tion assessment, updated population-and sport-specific recommendations,and more. The sixth edition alsoserves as an excellent study aid forthe CSSD specialty exam. The price is$65 for Academy members atwww.eatrightstore.org.

Learn More About Providing Telehealth Telehealth is an emerging area of prac-tice for many health care professionals.Until a consensus “gold standard” is inplace, the health care landscape re-mains in flux in terms of regulations,policies, and standards. Despite this,technology is entering into main-stream practice, and many RDNs areasking themselves how their patientscan benefit from telehealth and te-lenutrition. The Academy provides re-sources on this growing deliverystrategy. To obtain more informationon providing telehealth care to yourpatients, go to www.eatrightpro.org/practice/practice-resources/telehealth.

SCAN’S PULSE Fall 2018, Vol. 37, No. 4 | 19

Mark Your CalendarsFNCE® 2018October 20-23Washington, DC

Join us at the 2018 Food &Nutrition Conference & Expo™(FNCE®) for outstanding sessionsand events.

A few of the highlights include:

SCAN Networking ReceptionEnjoy this opportunity to meetand network with your SCANcolleagues

SCAN Booth at the DPG/MIGShowcaseTake a look at what SCAN offersmembers and chat with yourSCAN leaders

SCAN Spotlight Session“Heart of an Athlete: ManagingHypertension in AthleticPopulations”Presenters: Alan Hinderliter, MDand Jackie Buell, PhD, RD, CSSD,ATC

For more information andupdates, watch for eblasts andvisit www.scandpg.org/fnce-2018/

Academy Webinars CoverNumerous Topics The Center for Lifelong Learning’s Webinar Series is the perfect way toexpand your practice skills and learnabout late-breaking developments indietetics while earning continuingprofessional education units (CPEUs),all at your convenience. Live webinarsoffer opportunities to interact withleading food and nutrition practition-ers, while recorded webinars makeonline education available anytime.The Academy’s suite of recorded edu-cation webinars covers a range ofsubjections, from emerging clinicaltopics to reimbursement issues, prac-tice methods, and more. For informa-tion on the Academy’s webinars,including a list of upcoming live webi-nars, go to www.eatrightpro.org/prac-tice/professional-development/distance-learning/webinar-series.

Interactive HandoutTeaches Plate Method forHealthy EatingIdeal for RDNs working with clientson weight control, healthy eating, anddiabetes, Dish Up a Healthy Meal is anew handout that helps you explainthe popular plate method for portioncontrol and healthy eating in an en-gaging and interactive manner. Thistearpad of 50 colorful, placemat-sizedhandouts includes tips for choosinghealthful options from each MyPlatefood group and offers a place to cre-ate a customized meal plan. To order,go to www.eatrightstore.org.

Certificate of Training Program in Informatics in Nutrition—and Much MoreToday’s RDN can keep up with therapidly changing world of health carethrough a training program that ex-amines informatics in nutrition. TheAcademy's Center for Lifelong Learn-ing, planned with the Nutrition Infor-

matics Committee, the NIC ConsumerHealth Informatics Workgroup, andthe Interoperability and StandardsCommittee, offers this program to en-sure that nutrition professionals stayup-to-date with the latest methods ofprocessing and using data in all areasof the profession. The program coversevery facet of informatics, includingelectronic health records, security andethics, utilizing data, and more. The in-formation presented in this programcan be successfully used on a dailybasis.

Several other certificate of trainingprograms are also available from theAcademy’s Center for Lifelong Learn-ing. A sampling of the areas coveredinclude vegetarian nutrition, obesityinterventions in adults, childhood andadolescent weight management, andpublic health nutrition. For more in-formation on all of the Academy’s cer-tificate of training programs, go towww.eatrightstore.org/cpe-opportu-nities/certificates-of-training.

Take a Look at the Academy’s Online MarketingCenterThe Academy’s Online MarketingCenter provides members with the re-sources needed to improve theirbrand. The more RDNs do to cultivatetheir career brand, the more success-ful they will likely be in their career.Self-branding is essential to career ad-vancement because branding helpsdefine who you are, how you aregreat, and what value you bring tothe workplace. For resources on howto build a name for yourself andshowcase what sets you apart fromthe competition, visit www.eatright-pro.org/practice/career-develop-ment/marketing-center.

20 | SCAN’S PULSE Fall 2018, Vol. 37, No. 4

UpcomingEvents

SCAN’S PULSEOctober 20-23, 2018Food & Nutrition Conference &Expo™ (FNCE®), American Academyof Nutrition and Dietetics, Washington, DC. SCAN Spotlight Session: Heart of an Athlete: Managing Hypertension in AthleticPopulations, presented by Alan Hinderliter, MD and Jackie Buell, PhD,RD, CSSD, ATC.For information:www.scandpg.org/fnce-2018 andhttps://eatrightfnce.org/. Also, seepage 19 in this issue for some highlights.

November 10-12, 2018American Heart Association ScientificSessions, Chicago, IL. For information:https://professional.heart.org/profes-sional/EducationMeetings/Meet-ingsLiveCME/ScientificSessions/UCM_316900_Scientific-Sessions.jsp

November 9-11, 2018Annual Renfrew Center FoundationConference, Philadelphia, PA. For in-formation: www.renfrew.com

November 11-15, 2018Obesity Week, Nashville, TN. For infor-mation: American Society for Meta-bolic & Bariatric Surgery and TheObesity Society,https://obesityweek.com/

April 26-28, 2019Join your colleagues at the 35th An-nual SCAN Symposium, Navigatingthe Path of Wellness, Phoenix, AZ. Formore information: www.scandpg.org/symposium-2019/

Publication of theSports,Cardiovascular, and Wellness Nutrition (SCAN) dietetic practice group of the Academy of Nutrition and Dietetics.ISSN: 1528-5707.

Editor-in-ChiefMark Kern, PhD, RDExercise and Nutrition SciencesSan Diego State University5500 Campanile Dr.San Diego, CA 92182-7251619/594-1834619/594-6553 - faxkern@mail.sdsu.edu

Sports EditorsKristine Spence, MS, RD, CSSDMichelle Barrack, PhD, RDN, CSSD

Cardiovascular EditorTo be appointed

Wellness EditorsZachary Clayton, MSLiz Fusco, MS, RD

Conference Highlights EditorNancy Clark, MS, RD

Reviews EditorKristina Morales, RD

Research Digest EditorsStacie Wing-Gaia, PhD, RD, CSSDKary Woodruff, MS, RD, CSSD

SCAN Notables EditorTraci Roberts

Managing EditorAnnette Lenzi Martin708/445-0155annettemartin100@outlook.com

The viewpoints and statements hereindo not necessarily reflect policiesand/or official positions of the Academyof Nutrition and Dietetics. Opinionsexpressed are those of the individualauthors. Publication of an advertise-ment in SCAN’S PULSE should not beconstrued as an endorsement of theadvertiser or the product by theAcademy of Nutrition and Dieteicsand/or Sports, Cardiovascular, andWellness Nutrition.

Appropriate announcements arewelcome. Deadline for the Spring 2019issue: Jan. 1, 2019. Deadline for theSummer 2019 issue: April 1, 2019.Manuscripts (original research, reviewarticles, etc.) willl be considered forpublication. Guidelines for authors areavailable at www.scandpg.org. Email manuscript to the Editor-in-Chief; allow up to 6 weeks for a response.

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

Copyright © 2018 by the Academy of Nutriton and Dietetics. All rightsreserved. No part of this publicationmay be reproduced, stored in a retrievalsystem, or transmitted in any form byany means, electronic, mechanical,photocopying, recording, or otherwise,without prior written permission of thepublisher.

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