SCAN’S Pulsescandpg01-prd.s3.amazonaws.com/media/files/2a13851b... · SCAN’S Pulse Benefits of Mindfulness for Wellness and Sport by Erin G. Mistretta, MA and Carol R. Glass,

Summer 2018, Vol. 37, No. 3

■ CONTENTS

1Benefits of Mindfullness for Wellness and Sport

3From the Editor

5CPE article:Potassium Intake, Metabolism, andHypertension

10Evolving Role of Dietitians in Elite Sports

14From the Chair

15Conference Highlights

17Reviews

18Research Digest

20SCAN Notables

21Of Further Interest

24Upcoming Events

Mindfulness is having a zeitgeist mo-ment, with the “mindful revolution”1

spreading throughout society atlarge as well as within the fields ofmental and physical health. Wellnessadvocates and the media havetouted the benefits of mindfulness,and companies have seized the termto advertise products. Mindfulnessmight seem like a novel approachdesigned to help make us happier,calmer, and healthier overall, but itactually stems from concepts foundin ancient Eastern spiritual practices,such as Buddhism.

In Buddhism, mindfulness involvesactive and focused attention to sur-roundings and internal experiencesthrough simple practices, and is con-sidered a core concept inmeditation.2,3 One of the first Ameri-can meditation practitioners to re-search the effects of mindfulness in amore secularized way was Jon Kabat-Zinn. His groundbreaking develop-ment of mindfulness-based stressreduction (MBSR) for chronic pain pa-tients set the course for the studyand definition of mindfulness as it isknown today. According to Kabat-Zinn, mindfulness is the act of pur-posefully paying attention,moment-to-moment, and with non-

S C A N ’ SPu lseBenefits of Mindfulness for Wellness and Sportby Erin G. Mistretta, MA and Carol R. Glass, PhD

judgmental awareness.4 Since the de-velopment of MBSR, psychologists,neuroscientists, physicians, and otherhealth and mental health profession-als have continued to develop newinnovative interventions based onmindfulness and acceptance, andhave taken an evidence-based ap-proach to examine the benefits ofmindfulness practice.

Mindfulness and Wellness

Mindfulness has been adapted into avariety of treatment modalities andhas been shown to improve physi-cal5,6 as well as emotional well-being7-9 in clinical populations. For in-stance, mindfulness-based interven-tions have been shown to alleviatepain,5 assist with weight loss,10 treateating disorders,11 and reduce anxi-ety and depressive symptoms.8 Inter-ventions can vary greatly acrossstudies, but they often follow a pat-tern similar to that of MBSR training.MBSR involves eight weekly 1.5- to2.5-hour group classes teaching for-mal (e.g., sitting meditation, mindfulyoga) and informal (e.g., awareness ofbreath, eating, walking) mindfulnessmeditation, with group discussionalong with an all-day retreat. Thecourse also advises a daily meditation

Mindfulness and Sport

For an athlete, mindfulness may beespecially important for maintainingoptimum mental clarity in sport.Competition and training can resultin inflexible, repetitive patterns ofthought, emotion, and behavior.Mindfulness may help athletes de-tach from these often negative, judg-mental thoughts and establishenhanced forms of concentration, re-laxation, emotion regulation, andflow.21-23

Flow is a state in which a personmaintains a balance between theskills required to complete a chal-lenging task and one’s perceived abil-ity to complete the task.24 In thecontext of sport, this state can be de-scribed as moments when the mindand the body merge to create a mo-tion or performance that feels effort-less. Research has found thatmindfulness is highly correlated withflow,25,26 and increases in flow are ob-served after mindfulness training.23

One of the most widely known andstudied mindfulness-based interven-tions for athletes (with applicationsfor others interested in the benefit ofmindfulness for their own perform-ance or personal fitness) is mindfulsport performance enhancement.26,27

Mindful Sport PerformanceEnhancement (MSPE)

MSPE introduces athletes andcoaches to mindfulness skills de-signed to help them become moreaware and accepting of present-moment experiences, and, further-more, implement these skills in ath-letics as well as in their lives outsideof sport.23,26 MSPE is rooted in theMBSR tradition and follows a similarformat, but it has been uniquely de-signed for sport performers (i.e., ithas fewer sessions, no day-long re-treat, and instruction in how to bemindful during sport practice andcompetition). For many people, theinability to pay attention nonjudg-mentally is similar to a weak muscle,and MSPE can be viewed as a“strength training” for attention.27

2 | SCAN’S PULSE Summer 2018, Vol. 37, No. 3

practice of up to 45 minutes per dayto be done at home.12 Continuouspractice of mindfulness meditationteaches individuals to develop a dif-ferent relationship with their internalexperiences and external surround-ings.

From a theoretical perspective, mind-fulness results in increased wellnessthrough the act of paying attentionto thoughts, emotions, and physicalsensations, allowing for deeper re-flection and awareness of experience.Through awareness, the individualbecomes cognizant of the automaticthoughts and behaviors that result inless-than-optimal wellness. The prac-tice of nonjudgment and compassionhelps one to realize that this auto-maticity is a human experience thatcan be altered if given adequate at-tention. Together, awareness and ac-ceptance encourage individuals to be“present” in a nonreactive way withboth their negative and positive ex-periences, reducing avoidance andincreasing motivation to engage inlifestyle changes and even alter bio-logical functioning.13 Researchers arecontinuing to examine the mecha-nisms by which the practice of mind-fulness influences wellness.

Clinical populations experiencingpsychological or physical ailmentscan certainly benefit from mindful-ness practice, but what about healthypeople hoping to achieve optimalwellness? Wellness is not the absenceof illness, but rather a distinct dimen-sion that includes other elementsapart from physical health such asspirituality, identity, education, effec-tive coping, friendship, and love,along with nutrition and exercise.14

Healthy individuals have also shownimprovements in many of these areasthrough mindfulness interventions.For example, workplace mindfulnessinterventions increase indicators ofwellness such as job satisfaction,15

work engagement,16 self-compas-sion,17 and resiliency.16 Mindfulnesspractice can enhance other wellnessfactors including mindful eating,18

sleeping,19 exercise adherence,20 andathletic performance.

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

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

SCAN OfficePhone: 800/[email protected]

SCAN Executive CommitteeChairLindzi Torres, MPH, MS, 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, CLS

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, CSSD

DPG Relations ManagerRita Brummett

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

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

Participants typically attend 75- to90-minute MSPE sessions once aweek for 6 weeks, led by an experi-enced group facilitator. These ses-sions involve education in variousmindfulness skills (e.g., nonjudgment,concentration) and the experientialpractice of mindfulness exercises tobuild awareness and acceptance.Training progresses from sedentarymindfulness to mindfulness in mo-tion, and culminates with bringingmindfulness to key sport-specificmovements, thus building a bridgebetween mindfulness fundamentalsand direct sport applications. Eachsession also involves discussionsabout athletes’ experiences with thetraining and how mindfulness can beimplemented within and outside ofsport. Recommendations for homepractice include both formal mindful-ness exercises (e.g., body scan, medi-tation with a focus on the breath,mindful yoga) along with more infor-mal mindfulness practice that bringmindful awareness and acceptanceto what is happening in the moment.In addition, recordings of the formalexercises are available for guidanceoutside of the sessions.

MSPE has been implemented withathletes from a variety of sport back-

grounds (e.g., archery, golf, long-dis-tance running, lacrosse, field hockey,baseball). Following MSPE training,significant increases in mindfulness,flow, and self-rated performancehave been observed, along with de-creases in perfectionism, sport-related anxiety, and experientialavoidance26,28,29 (T. R. Pineau, unpub-lished data, 2017). Many mindfulnessinterventions and practices are de-signed to improve particular aspectsof well-being such as stress, pain, anddepression, but research tends tofocus less on improvements of inter-ventions beyond the purported ben-efits. MSPE may also improve aspectsof wellness beyond the realm ofsport, as collegiate athletes have ex-perienced benefits from MSPE inboth their sport and everyday lives.

A recent study30 found that athletesfrom a wide range of sports who at-tended MSPE training reported thatlearning mindfulness skills led tosport-related benefits such as lessstress, more relaxation and mentalfocus, better emotion regulation, andself-awareness, along with sport per-formance improvement. In addition,athletes mentioned benefits to theirlives outside of sport that includedbeing better able to let go of nega-

tive feelings, stay in the moment, andfeel less anxious and more focused,suggesting that MSPE may be a use-ful intervention for athletes hopingto achieve wellness both within andoutside of sport.

For those interested in learning moreabout mindfulness and sport and/orleading themselves through thetraining, see Kaufman, Glass, andPineau’s recent book entitled MindfulSport Performance Enhancement:Mental Training for Athletes andCoaches,27 published by the AmericanPsychological Association (APA) in2017. Handouts and mindfulness logsare available on the “companion web-site” for this APA book atwww.apa.org/pubs/books/4317476.aspx, and recordings of all MSPE mind-fulness exercises can be accessed asresources at www.mindfulsportper-formance.org/.

Erin G. Mistretta, MA is a doctoral stu-dent in clinical psychology at ArizonaState University in Tempe, AZ. Carol R.Glass, PhD is a professor in the Depart-ment of Psychology at The CatholicUniversity of America in Washington,DC.

This is Only a Test

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

Quick, think of the most important thing that you’ve learned about nutrition and dietetics today. If you came up blank, thenthis issue of PULSE is your chance to learn something new. But even if you had a great answer, it doesn’t mean that you can’tlearn a little more, so please keep reading.

Our cover article in this issue by Erin Mistretta, MA and Carol Glass, PhD reviews the latest research regarding the potentialbenefits of using mindfulness approaches to promote both wellness and enhancements to athletic performance. MichaelStone, MS and Connie Weaver, PhD have written a comprehensive and excellent article that you can use for a free CPE unit re-garding potassium with special attention toward its potential role in the prevention of hypertension. We also have an insight-ful article by Judith Haudum, MSc regarding practical issues that dietetics professionals who wish to work with elite athletesshould consider as they work in this growing area.

Don’t stop with our feature articles, though. There’s plenty of other valuable information throughout PULSE, so be sure to pe-ruse every section. Consider it a test!

FromThe Editor


ness in medicine. JAMA. 2008;300:1350-1352. 14. Myers JE, Sweeny TJ. The indivisi-ble self: an evidence-based model ofwellness. J Individ Psychol.2004;60:234-245. 15. Hülsheger UR, Alberts HJEM, Fein-holdt A, et al. Benefits of mindfulnessat work: the role of mindfulness inemotion regulation, emotional ex-haustion, and job satisfaction. J ApplPsychol. 2012;98:1-16. 16. Klatt MD, Steinberg B, DucheminAM. Mindfulness in motion (MM): anonsite mindfulness based interven-tion (MBI) for chronically high stresswork environments to increase re-siliency and work engagement. J Vis

Exp. 2015;101:1-11. 17. Shapiro SL, Astin JA, Bishop SR, etal. Mindfulness-based stress reduc-tion for health care professionals: re-sults from a randomized trial. Int JStress Manag. 2005;12:164-176.18. Hendrickson KL, Rasmussen EB. Effects of mindful eating training ondelay and probability discounting forfood and money in obese andhealthy-weight individuals. Behav ResTher. 2013;51:399-409.19. Winbush NY, Gross CR, Kreitzer MJ.The effects of mindfulness-basedstress reduction on sleep distur-bance: a systematic review. J Sci Heal-ing. 2007;3:585-591.20. Ulmer CS, Stetson BA, Salmon PG.

References1. Pickert, K. The mindful revolution:finding peace in a stressed-out, digi-tally dependent culture may just be amatter of thinking differently. TIMEMagazine. Feb. 3, 2014;40-46.2. Kabat-Zinn J. Mindfulness-based in-terventions in context: past, present,and future. Clin Psychol Sci Pract.2003;10:144-156.3. Ganarantana H. Mindfulness in PlainEnglish. Boston, MA: Wisdom Publica-tions; 1992.4. Kabat-Zinn J. Full Catastrophe Liv-ing: Using the Wisdom of Your Bodyand Mind to Face Stress, Pain, and Ill-ness. New York, NY: Delacorte; 1990.5. Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain:a systematic review of the evidence. J Alt Comliment Med. 2011;17:83-93.6. Creswell JD, Lindsay EK. How doesmindfulness training affect health? Amindfulness stress buffering account.Curr Dir Psychol Sci. 2014;23:401-407.7. Chiesa A, Serretti A. Mindfulness-based cognitive therapy for psychi-atric disorders: a systematic reviewand meta-analysis. Psychiatry Res.2011;187:441-453.8. Hofmann SG, Sawyer AT, Witt AA, etal. The effect of mindfulness-basedtherapy on anxiety and depression: ameta-analytic review. J Consult ClinPsychol. 2010;78:169-183.9. Keng SL, Smoski MJ, Robins CJ. Ef-fects of mindfulness on psychologicalhealth: a review of empirical studies.Clin Psychol Rev. 2011;31:1041-1056.10. Katterman SN, Kleinman BM,Hood MM, et al. Mindfulness medita-tion as an intervention for binge eat-ing, emotional eating, and weightloss: a systematic review. EatingBehav. 2014;15:197-204. 11. Wanden-Berghe RG, Sanz-Valero J,Wanden-Berghe C. The application ofmindfulness to eating disorders treat-ment: a systematic review. Eat Disord.2010;19:34-48.12. Kabat-Zinn J. Mindfulness medita-tion: What it is, what it isn’t, and itsrole in health care and medicine. In:Haruki Y, Ishii Y, Suzuki M, eds. Com-parative and Psychological Study onMeditation.Delft, the Netherlands;Eburon;1996:161-169. 13. Ludwig DS, Kabat-Zinn J. Mindful-

Mindfulness and acceptance are as-sociated with exercise maintenancein YMCA exercisers. Behav Res Ther.2010;28:805-809.21. Kabat-Zinn J, Beall B, Rippe J. Asystematic mental training programbased on mindfulness meditation tooptimize performance in collegiateand Olympic rowers. Poster pre-sented at: World Congress in SportPsychology; June, 1985; Copenhagen,Denmark. 22. Birrer D, Röthlin P, Morgan G.Mindfulness to enhance athletic per-formance: theoretical considerationsand possible impact mechanisms.Mindfulness. 2012;3:235–246. 23. Kaufman KA, Glass CR, Pineau TR.Mindful sport performance enhance-ment (MSPE): development and ap-plications. In: Baltzell A, ed.Mindfulness and Performance. Cam-bridge, MA: Cambridge UniversityPress; 2016:153-185.24. Jackson SA, Csikszentmihalyi M.Flow in Sports. Champaign, IL: HumanKinetics; 1999. 25. Cathcart S, McGregor M, Ground-water E. Mindfulness and flow in eliteathletes. J Clin Sport Psychol.2014;8:119-141. 26. Kaufman KA, Glass CR, Arnkoff DB.Evaluation of mindful sport perform-ance enhancement (MSPE): a new ap-proach to promote flow in athletes. J Clin Sport Psychol. 2009;3:334-356.27. Kaufman KA, Glass CR, Pineau TR.Mindful Sport Performance Enhance-ment: Mental Training for Athletes andCoaches.Washington, DC: AmericanPsychological Association; 2018. 28. De Petrillo LA, Kaufman KA, GlassCR, et al. Mindfulness for long-dis-tance runners: an open trial usingmindful sport performance enhance-ment (MSPE). J Clin Sport Psychol.2009;3:357-376.29. Glass CR, Spears CA, Perskaudas R,et al. Mindful sport performance en-hancement: randomized controlledtrial of a mental training programwith collegiate athletes. J Clin SportPsychol. In press.30. Mistretta EG, Glass CR, Spears CA,et al. Collegiate athletes’ expectationsand experiences with mindful sportperformance enhancement. J ClinSport Psychol. 2017;11:201-221.


CPE article

Potassium Intake, Metabolism, and Hypertensionby Michael S. Stone, MS and Connie M. Weaver, 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, go to www.scandpg.org/nutrition-info/pulse-newsletters/) andclick Take The Quiz Now.

Upon successful completion of thequiz, a Certificate of Completion willappear in your My Profile (under theheading, My History). The certificatemay be downloaded or printed for yourrecords.

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

■ Explain how dietary potassium isabsorbed and metabolized in thebody, and discuss its antihyperten-sive effects.

■ Summarize epidemiologic dataand clinical findings regarding theimpact of potassium intake and sup-plementation on blood pressure.

Potassium is an essential nutrient. It isthe most abundant cation in intracel-lular fluid, where it plays a key role inmaintaining cell function. Becausepotassium is a major intracellular ion,it is widely distributed in foods oncederived from living tissues. Potassiumconcentration is higher in fruits andvegetables than in cereals and meat.Western dietary practices that havehigher consumption of cereal andlow nutrient-dense processed foods,and lower consumption of fruits andvegetables have led to a dietary in-take lower in potassium and higherin sodium in recent decades.1

Potassium Intake Needs

Recommended adequate intakes forpotassium were set by the Food andNutrition Board of the Institute ofMedicine at 4,700 mg/day.2 This waslargely based on meta-analyses ofrandomized, controlled trials investi-gating the effect of potassium sup-plementation on reducing bloodpressure. Few Americans meet therecommended intakes; the averageintake is 2,591+/- 19 mg/day.3 Thislarge gap between potassium intakesand recommended intakes led topotassium being identified as ashortfall nutrient in the Dietary Guide-lines for Americans.4

Actual potassium requirements varywith an individual’s genetics, sodiumintake, and status of various health-related biomarkers. Blood pressure(BP) is currently the primary criterionfor determining potassium require-ments.

Potassium Intakes in the U.S.

It is estimated that only 3% of adultsand 10% of children under the age of5 in the United States meet the ade-quate intake (AI) level for potas-sium.5,6 However, it should be notedthat the AI for potassium in the U.S.,set at 4,700 mg/day for adults, is sub-stantially higher than the 3,150mg/day for adults recommended inthe World Health Organization(WHO) guidelines.7,8 National Healthand Nutrition Examination Survey(NHANES) data indicate that 99.2% ofpotassium in the U.S. diet is naturallyoccurring, with the remaining 0.8%coming from fortified foods.3 Thesenaturally-occurring sources includemilk and other nonalcoholic bever-ages, as well as potatoes and fruit,which rank highest as sources ofpotassium intake among adults inthe U.S.9

Potassium Tissue Movement

About 90% of dietary potassium (K+)is passively absorbed in the small in-testine. In the proximal small intes-tine, potassium absorption primarilyfollows water absorption, while dis-tally movement is influenced moreby changes in trans-epithelial electri-cal potential difference. In the colon,potassium is both excreted, in ex-change for sodium, as well as reab-sorbed via H+/K+ ATPases.10 Totalbody K+ is estimated to be approxi-mately 43 mEq/kg in adults, with only2% of this found in the extracellularfluid. Most of the body K+ content isfound in the intracellular space ofskeletal muscle. Potassium is the pri-mary intracellular cation and plays akey role in maintaining cell function,having marked influence on trans-membrane electro-chemical gradi-ents.11 The gradient of K+ across thecell membrane determines cellularmembrane potential, which, basedon the normal ratio of intracellular toextracellular K+, is −90 mV. This po-tential difference is maintained inlarge part by the ubiquitous ionchannel, the sodium-potassium(Na+/K+) ATPase pump. Transmem-brane electrochemical gradientscause the diffusion of sodium (Na+)out of the cell and influx of K+ intothe cell. This process is reversed andcellular potential difference is heldconstant via the Na+/K+ ATPasepumps. When activated, the Na+/K+ATPase pump exchanges two extra-cellular K+ ions for three intracellularsodium (Na+) ions, influencing mem-brane potential based on physiologi-cal excitation or inhibition. Thesechannels are partially responsible,along with the Na+/K+ chloride sym-porter and sodium-calcium ex-changer, for maintaining thepotential difference across the rest-

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ing cell membrane as well. Both rest-ing membrane potential and theelectrochemical difference across thecell membrane are crucial for normalcell biology, especially in muscle andnerve tissue.11,12

In healthy individuals, blood K+ con-centration ranges between 3.5 to 5.5mmol/L, with numerous homeostaticmechanisms in place for mainte-nance within this narrow margin.Changes in plasma concentrations ofK+ alter the electrochemical gradientand can lead to physiological dys-function (e.g., hyper- or hy-pokalemia). As mentioned previously,approximately 98% of systemicpotassium is found intracellularly,stored primarily in muscle (70%), andstored to lesser extent in bone, liver,skin, and red blood cells. Insulin, cate-cholamines, acidemia, and osmolarityall affect the transcellular distributionof K+ between plasma and cells.

In response to dietary consumptionof a high K+ meal that includes glu-cose, pancreatic beta cells are acti-vated to increase production andrelease of insulin. Insulin enhancesthe uptake of K+ via stimulation ofNa+/K+ ATPase activity, independentof effects on glucose uptake, in skele-tal and cardiac muscle, adipocytes,liver, bone, and red blood cells, atten-uating postprandial rise in plasmaK+.13 Na+/K+ ATPase pump activityand expression are also influenced bystimulation of both alpha and beta-2adrenergic receptors by the circulat-ing stress hormones catecholamines(epinephrine, norepinephrine).11,12

Subsequently, alterations in thesehormone levels can affect cellular ionmovement and serum potassium.Stimulation of both beta-2 adrener-gic and insulin receptors may lead toa synergistic cellular influx of potas-sium, in part because insulin releasefrom beta cells is increased via beta-2adrenergic stimulation as well as cat-echolamine-related increases in gly-colysis leading to increases in bloodglucose.

Renal Potassium Handling

Approximately 90% of absorbedpotassium (60-100 mEq) is lost in the

urine, with the other 10% excreted inthe stool and a very small amountlost in sweat.14 Potassium has ahigher ratio of dietary intake to extra-cellular pool size; only 2% of the totalbody K+ is distributed in extracellularfluid, while the remaining is distrib-uted in the intracellular fluid of vari-ous tissues. To meet the challenge ofa high K+ meal, the K+ homeostaticsystem is very efficient at clearingplasma K+ via an increase in renal K+excretion. When dietary K+ intake in-

creases or decreases, the kidneysmodulate excretion accordingly, en-suring the maintenance of plasma K+concentration. In addition, with theadministration of acute K+ loads, onlyabout half of the dose appears in theurine after 4 to 6 hours, suggestingthat extrarenal tissues (e.g., muscle,liver, adipose) play an important rolein K+ homeostasis as well via insulinand catecholamine uptake.15,16 Exces-sive extrarenal K+ losses are usuallysmall, but they can occur in individu-als with diarrhea, severe burns, or ex-cessive and prolonged sweating.

Potassium is freely filtered by theglomerulus of the kidney, with mostof it (70%–80%) reabsorbed in theproximal convoluted tubule (PCT)

and loop of Henle. Under physiologi-cal homeostasis, delivery of K+ to thenephron remains constant. Con-versely, secretion of K+ by the distalnephron is variable and depends onintracellular K+ concentration, lumi-nal K+ concentration, and cellularpermeability.11 Two major factors ofK+ secretion/loss involve the renalhandling of Na+ and mineralocorti-coid activity. Reabsorption in theproximal tubule is primarily passiveand proportional to reabsorption ofsolute and water, accounting for ap-proximately 60% of filtered K+.17,18

Within the descending limb ofHenle’s loop, a small amount of K+ issecreted into the luminal fluid, whilein the thick ascending limb (TAL), re-absorption occurs together with Na+and chloride (Cl-), both transcellularlyand paracellularly. This leads to theK+ concentration of the fluid enter-ing the distal convoluted tubule tobe lower than plasma levels (~2mEq/L), facilitating eventual secre-tion. Similar to reabsorption in theproximal tubule, paracellular diffu-sion in Henle’s loop is mediated viasolvent drag, while transcellularmovement occurs primarily throughthe apical sodium-potassium-chlo-ride (Na+/K+/2Cl-) cotransporter.18

The renal outer medullary K+ chan-nel (ROMK), also located on the apicalmembrane, mediates recycling of K+from the cell to the lumen, sustainingthe activation of the Na+/K-2Cl co-transporter and K+ reabsorption inthe ascending limb. The movement ofK+ through the ROMK induces a posi-tive lumen voltage potential, increas-ing the driving force of paracellularcation (e.g., Ca2+, Mg+, K+) reabsorp-tion as well. Na+/K+ ATPase pumpslocated basolaterally throughout theloop maintain low levels of intracellu-lar Na+ and further provide a favor-able gradient for K+ reabsorption.11,12

Major regulation of K+ excretion be-gins in the late distal convolutedtubule (DCT) and progressively in-creases through the connectingtubule and cortical collecting duct. Inthe early DCT luminal, Na+ influx ismediated by the apical sodium-chlo-ride cotransporter (NCC) and contin-ues into the late DCT via the


of vascular sympathetic neural trans-missions, and increase the release ofnitric oxide from endothelial cells.22,24

In addition to enhanced vasodilation,other possible mechanisms in whichK+ is proposed to lower BP and im-prove vascular outcomes includemodulation of baroreceptor sensitiv-ity, reduced sensitivity to cate-cholamine-related vasoconstriction,improved insulin sensitivity, de-creases in oxidative stress and inflam-mation, and increases in Na+excretion.

In relation to sodium, increases inpotassium can lead to increasedsodium excretion, or naturesis, and inturn decreased fluid volume andblood pressure. Active Na+ reabsorp-tion and K+ secretion take place inthe distal convoluted tubule and col-lecting duct of the kidneys. The pri-mary transporters involved in thisprocess and discussed earlier includethe epithelial Na+ channels (ENaC;sodium reabsorption) and the renalouter medullary K+ channel (ROMK;potassium excretion). In addition,Na+ is also actively reabsorbed in theDCT by the Na+/Cl- cotransporter(NCC), which is activated upon phos-phorylation. The activity of the NCCdetermines the delivery of Na+ to thedownstream ENaC and ROMK, andthe extent to which Na+ is reab-sorbed and K+ is excreted. Shown pri-marily in animal models, increased K+load (via feeding) causes a subse-quent increase in extracellular K+concentration, which may lead to sin-gling that results in the dephospho-rylation and a decrease of NCCactivity, reducing Na+ reabsorption inthe DCT and increasing Na+ urinaryexcretion.25 In humans, prospectivepopulation studies point to increaseddietary K+ via higher fruit and veg-etable intake, influencing Na+ excre-tion and possibly leading to a benefitfor overall fluid balance and arterialpressure.5 From the above findings itis clear that K+ and its relationshipwith Na+ influence arterial pressure,although the complete understand-ing of the mechanisms related to thisinteraction have yet to be fully eluci-dated.

ing as a preventable cause of deathin the United States.21

Potassium and Arterial Pressure

The antihypertensive effects of in-creased potassium intake may be re-lated to numerous mechanisms.Acutely, increased plasma K+ is asso-ciated with endothelial-dependentvasodilation. Endothelial cells are amonolayer of cells that control thetone of the underlying smooth mus-cle throughout the vasculature.Potassium can induce endothelial hy-perpolarization via a stimulation of

Na+/K+ ATPase pumps and the acti-vation of plasma membrane K+ chan-nels. The response is then transmittedto vascular smooth muscle cells bythe accumulation of K+ in the my-oendothelial space or direct electricalcoupling through myoendothelialgap junctions.22 Hyperpolarization ofendothelial cells may also lead to anefflux of Ca2+ from vascular smoothmuscle, resulting in smooth musclerelaxation and increased bloodflow.23 An increase in K+ intake mayalso improve overall endothelialfunction, promote vascular smoothmuscle relaxation through inhibition

epithelial Na+ channel (ENaC).10 Bothare expressed apically and are theprimary means of Na+ reabsorptionfrom the luminal fluid. Na+ reabsorp-tion leads to an electrochemical po-tential that is more negative thanperitubular capillary fluid. This chargeimbalance is matched by an increasein the aforementioned paracellularreabsorption of Cl- from the lumen,as well as increases in Na+/K+ ATPaseand ROMK activity. Increased distaldelivery of Na+ increases Na+ reab-sorption, leading to a more negativeluminal/plasma potential gradientand an increase in K+ secretion. MostK+ excretion is mediated by principalcells in the collecting duct. Principalcells possess basolateral Na+/K+ AT-Pases, which facilitate the movementof K+ from the blood and into thecell. The high cellular concentrationof K+ provides a favorable gradientnot only for the movement of K+ intothe tubular lumen, but for the reab-sorption of Na+ as well. Movementsof K+ and Na+ occur through theROMK and ENaC channels, respec-tively. In conditions of K+ depletion,reabsorption of K+ occurs throughH+/K+ ATPases, located on the apicalmembrane of alpha-intercalated cellsin the collecting duct, thus providinga mechanism in which K+ depletionincreases K+ reabsorption.10

Potassium and Hypertension

Hypertension (HTN), or high bloodpressure (BP), is the leading cause ofcardiovascular disease (CVD) and amajor contributing risk factor to de-velopment of stroke, coronary heartdisease (CHD), myocardial infarction,heart failure, and end-stage renal dis-ease, amounting to a U.S. publichealth financial burden of $50.6 bil-lion.19 Nearly one in three Americanadults (~72 million) are estimated tohave HTN, while nearly 70 million areat risk for developing prehyperten-sion (BP between 120/80 mmHg and140/90 mmHg). Approximately 90%of U.S. adults older than age 50 are atrisk for development of HTN, withsystolic rises being the most preva-lent.20 Hypertension is a leadingcause of morbidity and mortalityworldwide and second only to smok-


Epidemiologic Data

Numerous epidemiologic studiesshow that diet is a key component inblood pressure (BP) control, withsome studies showing lower BP inpopulations consuming higheramounts of fruits and vegetables.26-28

Dietary patterns known to lower BPinclude reduced sodium intake, in-creased potassium and magnesiumintake, and increases in fruit and veg-etable consumption as well as inother foods rich in antioxidants.29,30 A1982 population study conducted byKhaw et al in St. Lucia, West Indiessuggested that an increase in potas-sium by 20 to 30 mmol/day (~700-1,200 mg/d) resulted in a 2 to 3mmHg reduction in systolic bloodpressure (SBP).31 In adults, a 2-mmHgreduction in BP can reduce CHD andstroke mortality rates by 4% and 6%,respectively.32 The INTERSALT study, aworldwide epidemiologic study (n =10,079 men and women aged 20-59 yfrom 32 countries) that examined therelationship between 24-hour Na+excretion and blood pressure, pro-vided evidence of potassium intakeas an important factor affecting pop-ulation BP among diverse populationgroups.32 The American Heart Associ-ation has estimated that increasingpotassium intake may decrease HTNincidence among Americans by 17%and lengthen life span by 5.1 years.19

Clinical Findings from Supplementation Trials

Observational studies have evaluatedthe effects of potassium from foods,while clinical intervention trials haveprimarily used potassium supple-ments. Several meta-analyses show asignificant reduction in BP with in-creasing potassium supplementa-tion.33-36 In an early meta-analysis,Cappuccio and MacGregor reviewed19 clinical trials looking at the effectof potassium supplementation on BPin primarily hypertensive individuals(412 of 586 participants). With the av-erage amount of potassium given at86 mmol/day (~3,300mg/d; as prima-rily KCl) for an average duration of 39days, researchers found that potas-sium supplementation significantly

reduced SBP by 5.9 mmHg and dias-tolic blood pressure (DBP) by 3.4mmHg. Greater reductions werefound in individuals who were onsupplementation for longer periodsof time.35 As is evident, the effect ofpotassium supplementation on BPreduction is generally positive, butnot consistent. According to a morerecent meta-analysis conducted byDickinson et al in 2006, potassiumsupplementation did not significantlyreduce BP in those with hyperten-sion, although this analysis was basedon only five trials and the findings,while not statistically significant, didreveal reductions in both SBP andDBP.33,37 In general, these outcomes

show that the BP-lowering effects ofpotassium supplementation aregreater in those with HTN and morepronounced in blacks compared withwhites. Other noted factors that mayinfluence the effects of potassiumsupplementation on BP include pre-treatment BP, age, gender, intake ofsodium and other ions (magnesium,calcium), weight, physical activitylevel, and concomitant medications.

Dietary Interventions

Overall findings from clinical trials onthe effect of increased potassium in-take have been conflicting.20,29,38,39 Ev-idence from dietary interventions isextremely limited, with the majorityof findings extrapolated from The Di-etary Approaches to Stop Hyperten-sion (DASH) study.29 The DASHintervention revealed that a diet richin fruit and vegetables, fiber, and low-fat dairy products, together with re-ductions in saturated and total fatand sodium, could positively influ-ence BP compared with the averageAmerican diet.40 Although the DASHdiet does lead to a dramatic increasein potassium consumption (+1,447 to2,776 mg/d) and reduction in BP,these beneficial effects cannot be at-tributed to potassium alone becausethe diet involves other dietary modi-fications as well.30

In an earlier study reported byChalmers et al in 1986, the effects ofboth the reduction of dietary sodiumand increase of dietary potassium onBP were assessed.41 A total of 212 par-ticipants (age 52.3 ± 0.8 y; 181 malesand 31 females) with a DBP between90 and 100 mmHg were recruitedand placed in one of the four dietgroups: a normal-diet group (control),a high-potassium diet (>100 mmolK/d; >3,900 mg/d) group, a reduced-sodium diet (50-75 mmol Na+/d;1,150-1,725mg/d) group, or a high-potassium/low-sodium diet group.Participants completed the dietphase for 12 weeks, during whichthey were regularly counseled onhow to adequately modify their foodchoices based on their group (e.g.,avoiding salt and high-sodium foodsor increasing fruit and vegetable in-take). Significant reductions in bothSBP and DBP in each dietary inter-vention group compared with thecontrol group were observed, but nosignificant differences were observedbetween intervention groups. Reduc-tions in the high-potassium groupwere 7.7 ± 1.1 and 4.7 ± 0.7 mmHgfor SBP and DBP, respectively. Al-though high potassium intake didappear to reduce BP, the lack of differ-ences between intervention groups


points to the possibility of an overalldiet effect. In addition, for both thehigh-potassium and low-sodiumgroups, there was a significant reduc-tion in weight during the study,which may have further confoundedthe results.

In a more recent study, Berry and col-leagues assessed the effects of in-creased potassium intake from bothdietary sources and supplements onBP in untreated prehypertensive indi-viduals (DBP: 80-100 mmHg).42 In acrossover design, 48 participants (age22-65 y) completed four 6-week di-etary interventions including a con-trol diet, an additional 20 or 40 mmolK/day (780 or 1560mg/d) from fruitand vegetables, and 40 mmol/day ofpotassium citrate capsules. Similar tothe Chalmers study, nutrition coach-ing was used to regulate participantfood choice during each dietary in-tervention and was primarily focusedon increasing fruit and vegetable in-take. No significant changes in ambu-latory BP between the control groupand any of the dietary or supplementinterventions were observed. Thesample size was small and the cohortwas heterogeneous, but the lack ofcontrol used to conduct the potas-sium dietary intervention was the pri-mary limiting factor in the Berrystudy. Given these mixed results, itseems necessary to adequately as-sess the true effect of increased di-etary potassium intake on BP andother health outcomes of a con-trolled feeding study.

Conclusions

Increasing dietary potassium has thepotential benefit of lowering risk ofhypertension and may provide bene-fit to normal kidney function. Weneed to understand more about thebioavailability of potassium fromfoods. Are there yet-to-be-identifiedinhibitors of potassium absorption orfood matrix effects? Do some anionsthat accompany potassium in foodshave differential functional advan-tages? Research on potassium islikely to increase, not only because itis an identified shortfall nutrient butalso because increasing dietarypotassium is a well-established modi-

fiable factor for hypertension, thelargest risk factor for some of ourmost common chronic diseases.

Michael S. Stone, MS is a PhD candidatein the Department of Nutrition Scienceat Purdue University, West Lafayette, IN.Connie M. Weaver, PhD is a distin-guished professor in the Department ofNutrition Science, and director of TheWomen’s Global Health Institute at Pur-due University, West Lafayette, IN.

References1. Weaver CM. Potassium and health.Advances Nutr. 2013;4:368S-377S.2. Institute of Medicine. Dietary Refer-ence Intakes for Water, Potassium,Sodium, Chloride, and Sulfate. Wash-ington, DC: The National AcademiesPress; 2005.3. Fulgoni VL, 3rd, Keast DR, Bailey RL,Dwyer J. Foods, fortificants, and sup-plements: where do Americans gettheir nutrients? J Nutr. 2011;141:1847-1854.4. DeSalvo KB, Olson R, Casavale KO.Dietary Guidelines for Americans.JAMA. 2016;315:457-458.5. Cogswell ME, Mugavero K, BowmanBA, Frieden TR. Dietary sodium andcardiovascular disease risk—meas-urement matters. New Engl J Med.2016;375:580-586.6. National Center for Chronic DiseasePrevention and Health Promotion.Highlights: Sodium and Potassium In-takes Among US Infants and PreschoolChildren, 2003-2010; 2013.7. World Health Organization (WHO).Guideline: Potassium intake for adultsand children; 2012.8. US Department of Health andHuman Services Dietary Guidelines

Advisory Committee. Report of the Di-etary Guidelines Advisory Committeeon the Dietary Guidelines for Ameri-cans.Washington, DC; 2010.9. O’Neil CE, Keast DR, Fulgoni VL,Nicklas TA. Food sources of energyand nutrients among adults in theUS: NHANES 2003-2006. Nutrients.2012;4:2097-2120.10. Meneton P, Loffing J, Warnock DG.Sodium and potassium handling bythe aldosterone-sensitive distalnephron: the pivotal role of the distaland connecting tubule. Am J PhysiolRenal Physiol. 2004;287:F593-601.11. Palmer BF. Regulation of potas-sium homeostasis. Clin J Am SocNephr. 2015;10:1050-1060.12. Unwin RJ, Luft FC, Shirley DG.Pathophysiology and managementof hypokalemia: a clinical perspective.Nature reviews. Nephrology.2011;7:75-84.13. Greenlee M, Wingo CS, McDo-nough AA, Youn JH, Kone BC. Narra-tive review: evolving concepts inpotassium homeostasis and hy-pokalemia. Ann Int Med.2009;150:619-625.14. Shils ME, Shike M, eds. Modern Nu-trition in Health and Disease, 10th ed.Philadelphia, PA: Lippincott Williams& Wilkins; 2006:114-118.15. Youn JH. Gut sensing of potassiumintake and its role in potassiumhomeostasis. Sem Nephrol.2013;33:248-256.16. Bia MJ, DeFronzo RA. Extrarenalpotassium homeostasis. Am J Physiol.1981;240:F257-F268.17. Penton D, Czogalla J, Loffing J. Di-etary potassium and the renal controlof salt balance and blood pressure.Eur J Physiol. 2015;467:513-530.18. Ludlow M. Renal handling ofpotassium. ANNA J.1993;20:52-58.19. Roger VL, Go AS, Lloyd-Jones DM,et al. Executive summary: heart dis-ease and stroke statistics—2012 up-date: a report from the AmericanHeart Association. Circulation.J2012;125:188-197.20. Svetkey LP, Simons-Morton DG,Proschan MA, et al. Effect of the di-etary approaches to stop hyperten-sion diet and reduced sodium intakeon blood pressure control. J Clin Hy-perten. 2004;6:373-381.21. Lopez AD, Mathers CD. Measuring

Shaper AG. Migration and geographicvariations in blood pressure in Britain.BMJ. 1990;300:291-295.29. Appel LJ, Moore TJ, Obarzanek E,et al. A clinical trial of the effects of di-etary patterns on blood pressure.DASH Collaborative Research Group.N Engl J Med.1997;336:1117-1124.30. Svetkey LP, Simons-Morton D,Vollmer WM, et al. Effects of dietarypatterns on blood pressure: sub-group analysis of the Dietary Ap-proaches to Stop Hypertension(DASH) randomized clinical trial. ArchInt Med.1999;159:285-293.31. Khaw KT, Rose G. Population studyof blood pressure and associated fac-tors in St Lucia, West Indies. Inter J Epi-demiol.1982;11:372-377.32. Stamler R. Implications of the IN-TERSALT study. Hypertension.1991;17(1 Suppl):16-20.33. Beyer FR, Dickinson HO, NicolsonDJ, Ford GA, Mason J. Combined cal-cium, magnesium and potassiumsupplementation for the manage-ment of primary hypertension inadults. Cochrane Database SystematicRev. 2006(3):CD004805.34. Whelton PK, He J, Cutler JA, et al.Effects of oral potassium on bloodpressure. Meta-analysis of random-ized controlled clinical trials. JAMA.1997;277:1624-1632.35. Cappuccio FP, MacGregor GA.Does potassium supplementationlower blood pressure? A meta-analy-sis of published trials. J Hypertens.1991;9:465-473.


the global burden of disease and epi-demiological transitions: 2002-2030.Ann Trop Med Parasitol. 2006;100:481-499.22. Haddy FJ, Vanhoutte PM, FeletouM. Role of potassium in regulatingblood flow and blood pressure. Am JPhysiol. Regulatory, integrative andcomparative physiology.2006;290:R546-R552.23. Ekmekcioglu C, Elmadfa I, MeyerAL, Moeslinger T. The role of dietarypotassium in hypertension and dia-betes. J Physiol Biochem. 2016;72:93-106.24. He FJ, Marciniak M, Carney C, et al.Effects of potassium chloride andpotassium bicarbonate on endothe-lial function, cardiovascular risk fac-tors, and bone turnover in mildhypertensives. Hypertension.2010;55:681-688.25. Veiras LC, Han J, Ralph DL, McDo-nough AA. Potassium supplementa-tion prevents sodium chloridecotransporter stimulation during an-giotensin ii hypertension. Hyperten-sion. 2016;68:904-912.26. Young DB, Lin H, McCabe RD.Potassium’s cardiovascular protectivemechanisms. Am J Physiol. 1995;268(4Pt 2):R825-R837.27. Intersalt Cooperative ResearchGroup. INTERSALT: an internationalstudy of electrolyte excretion andblood pressure. Results for 24 hoururinary sodium and potassium excre-tion. BMJ. 1988;297:319-328.28. Elford J, Phillips A, Thomson AG,

36. Geleijnse JM, Kok FJ, Grobbee DE.Blood pressure response to changesin sodium and potassium intake: ametaregression analysis of ran-domised trials. J Human Hypertens.2003;17:471-480.37. Dickinson HO, Nicolson DJ, Camp-bell F, Beyer FR, Mason J. Potassiumsupplementation for the manage-ment of primary hypertension inadults. Cochrane Database SystematicRev. 2006(3):CD004641.38. Gu D, Rice T, Wang S, et al. Heri-tability of blood pressure responsesto dietary sodium and potassium in-take in a Chinese population. Hyper-tension. 2007;50:116-122.39. Kawano Y, Minami J, Takishita S,Omae T. Effects of potassium supple-mentation on office, home, and 24-hblood pressure in patients with es-sential hypertension. Am J Hypertens.1998;11:1141-1146.40. Sacks FM, Campos H. Dietary ther-apy in hypertension. N Engl J Med.2010;362:2102-2112.41. Chalmers J, Morgan T, Doyle A, etal. Australian National Health andMedical Research Council dietary saltstudy in mild hypertension. J Hyper-tens.1986;4(Suppl):S629-S637.42. Berry SE, Mulla UZ, ChowienczykPJ, Sanders TA. Increased potassiumintake from fruit and vegetables orsupplements does not lower bloodpressure or improve vascular func-tion in UK men and women withearly hypertension: a randomisedcontrolled trial. Br J Nutr. 2010;104:1839-1847.

Evolving Role of Dietitians in Elite Sportsby Judith Haudum, MSc

Athletes in many sports are sup-ported by a large team of experts in-cluding doctors, physiotherapists,and sport scientists. In recent years,the presence of sports dietitians/nu-tritionists in these settings hasgrown, and, where present, sportsRDNs have become vital componentsof multidisciplinary treatment teams.For example, professional soccerteams, cycling teams, and nationalfederations worldwide have begunadding nutrition experts to their core

staff to enhance the level of supportfor their top athletes. Several studieshave shown that a multidisciplinaryteam approach to provide support,including nutritional support, im-proves injury recovery, performance,health, and nutritional outcome.1-4

These apparent benefits affirm thedecision to add dietitians to the teamstaff. A dietitian’s contribution to ateam includes the following:5,6

■ Energy and nutrient requirementassessment and planning

■ Management of dietary supple-ment intake

■ Travel nutrition, including athletes’menu at team hotels (e.g., cookingprocedures, serving size),

■ Food safety protocols

■ Training and race nutrition

■ Hydration and recovery strategies


ing and race nutrition, there are in-creasing incidences of dietary limita-tions, the need to manageintolerances/food allergies or othernutrition-related problems, and theneed for additional support. Surveydata indicate that athletes appreciateand benefit from nutrition advice, es-pecially those reporting dietary con-straints.11

Interestingly, however, prior investi-gations suggest that athletes prima-rily seek out sports nutritioninformation from coaches, other ath-letes, physicians, or family.11 These ob-servations suggest that sportsdietitians are not widely recognizedas the nutrition experts or go-tosource for professional dietary ad-vice. They also highlight the likeli-hood that a lot of informationprovided to athletes is not based onevidence but, rather, based on popu-lar beliefs and subject to current fadsor trends. This fact is of particular im-portance when professional athleteslook for information on dietary sup-plements. Especially in elite sports,where athletes also compete underthe World Anti-Doping Agency(WADA) code, faulty guidance on thechoice and use of performance-en-hancing substances can lead to seri-ous consequences including adversetesting results in doping controland/or side effects that compromisethe health of an athlete.

Lack of Understanding theSports Dietitian’s Role

Because we all eat and drink, do gro-cery shopping, and possess a certainlevel of cooking skills, it may be diffi-cult to understand why nutrition sup-port is of value on an elite team.However, to assess, treat, and provideevidence-based nutrition support,the specialized skills and knowledgeof a sports dietitian is required. Agrowing body of evidence indicatesthat coaches and therapists lacksport nutrition knowledge, i.e., theydo not have the skills to provide ade-quate information.12-15 Furthermore, itis important to understand thatsports dietitians are not team cooks

■ Weight management and achieve-ment of optimal physique (bodycomposition)

■ Management of food allergies, in-tolerances, and other clinical condi-tions that require dietetic support

■ Recovery from injury/illness

However, despite the growing pres-ence and numerous roles and re-sponsibilities of dietitians on teams,there are cases in which other de-partments within a sports team (e.g.,skiing, cycling) cover basics of nutri-tion. This is especially noteworthywhen it is considered that many ath-letes suffer from gastrointestinal dis-tress or other symptoms related topoor nutrition management.7

Over the past 20 years the practiceand expertise of sports dietitians/nu-tritionists has evolved. The dietitian’straditional role regarding the knowl-edge of food and understanding howto manage dietary therapy has ex-panded. Professional sports nutritionsupport includes many aspects (seeaforementioned skills) that cannot becovered by other professions withoutdietetics education in these areas.Several associations and groups suchas the Academy of Nutrition and Di-etetics and Professionals in Nutrition,Exercise and Sports (PINES) havemade efforts to enhance the recogni-tion of the skills and expertise ofsports dietitians. Credentials such asthe Certified Specialist in Sports Di-etetics (CSSD) help to furtherstrengthen the sports dieteticsgroup. It also highlights the potentialand benefits of adding professionalnutrition support to sports teams.

Furthermore, nutrition experts cantrain other staff members from differ-ent disciplines (e.g., therapists) in theareas of food hygiene, race foodpreparation, and grocery shopping.Competitions take place in differentcountries and on several continents,yet dietitians do not always travelwith the team. Training other staffcan be valuable for maintaining con-sistent high standards and ensuringappropriate execution of established

nutrition protocols. While trainingother team members on nutritionprotocols is important, on-site assis-tance from the team dietitian, espe-cially at major tournaments orcompetitions, is probably the bestapproach for useful and effective nu-trition support,8 and the team dieti-tian should be considered a fullmember of the team staff.

A Growing Interest in Nutrition

Very recently, knowledge of the im-portance of nutrition and nutrienttiming in professional sports hasgrown.9,10 Because sports such as cy-cling and track and field have suf-fered headline-grabbing scandals ondoping, athletes and their supportpersonnel are placing greater em-phasis on nutrition and food intake.Athletes have become more inter-ested in how food and nutrients af-fect their performance andwell-being. While amateur and eliteathletes aim to optimize their train-

.


nor should they have the same role;this misconception that the two areinterchangeable is widespread.Familiarizing sports organizationsand professional teams with thescope of practice of registered dieti-tians16 and those specialized insports5 may aid in further highlight-ing the skills of the RDN and promot-ing the potential benefits of bringinga sports dietitian onto a team. Also,dietetics associations can potentiallywork with institutions that instructtrainers and team managers to pro-mote the unique and specialized roleof sports dietitians in elite sports anddistinguish the different roles ofsports team members.

Benefits for Athletes

While it remains a challenge to makethe case for sports dietitians becom-ing the mainstay on elite teams,headway has been made at the colle-giate level in the United States.Deregulation of National CollegiateAthletic Association (NCAA) feedingguidelines and the active member-ships of both the Sports, Cardiovascu-lar, and Wellness Nutrition (SCAN)dietetics practice group and the Col-legiate and Professional Sports Dieti-tian Association (CPSDA) indicate thevalue that a sports dietitian brings tothe table. The sports dietitian in boththe collegiate and elite settings canbenefit athletes in the followingways:

■ Improve overall standards of hy-giene/food safety, which includesevaluating the quality of food andplanning the menus for team hotels.

■ Establish team and individualstrategies for athletes to meet energyneeds on competition and trainingdays. Studies indicate that amongelite athletes, nutrient needs are notalways met.17-19 Carbohydrate intakesare often below the required intakerecommendations in many sports;furthermore, athletes do not meetrecommended micronutrient intakes(e.g., iron, vitamin D, zinc).17,18 Sportsdietitians can help prevent deficien-cies or identify and adjust nutrient-

deficient diets. This is of benefit forathletes, as there is strong evidencethat low intakes of vitamin D, iron,carbohydrate, and other nutrientscan negatively affect performanceand compromise health.17,20

■ Establish a working relationshipwith the team physician in order tosupport athletes by managing nutri-tion support after injury or surgery.This may include supporting goalsaround body weight and composi-tion and may help prevent athletes

from using unhealthy weight lossstrategies to achieve their desiredphysique.

■ Provide nutrition education re-garding overall healthy eating, gro-cery shopping, and cookingprocedures. General nutrition knowl-edge among athletes remains poor,13

and these interventions may not onlypositively affect performance butmay also improve well-being andeveryday life. More knowledge willalso make athletes more resistant topopular diet trends.

■ Assist in managing medical nutri-tion therapy for certain clinical condi-tions. Some athletes are on restricteddiets for medical reasons, and thesports dietitian can guide athletes onappropriate choices, especially whentraveling.

■ Provide informed recommenda-tions for nutritional supplements. Be-cause athletes are often exposed tonutritional supplements, the dietitiancan become a very important re-source for information on a variety ofproducts. Dietitians can play a role inevaluating the safety and effective-ness of certain supplements, developsafe administration guidelines,and/or provide guidance on the ac-tual need for such products. Dieti-tians can control the quality of theproducts and advice to athletes onthe use and dosage of supplementalnutrient intake.

Future Directions

The current situation highlights theneed to further communicate thescope of practice of dietitians andpromote them as a valuable part ofmultidisciplinary teams. In addition,more research studies that show ben-efits of nutrition support would behelpful to strengthen the role thatsports dietitians play in elite sports.Sports teams and federations wouldthen hopefully acknowledge the po-tential to add dietitians to theirteams.

Summary

Sports nutrition and the scope ofpractice of sports dietitians has madesubstantial progress over the past 20years. However, the number of sportsdietitians in elite sports is still low.Since multidisciplinary teamwork insport settings is becoming more im-portant, there would be many bene-fits of adding a sports dietitian to ateam’s core staff. Advising athletes onenergy and nutrient intakes and im-plementing evidence-based nutritionstrategies will help athletes maintainhealth, reach their goals, and performat their best.


Judith Haudum, MSc is the sport dieti-tian of the Olympic Training Center inSalzburg Austria. She was head of nu-trition of the American BMC RacingTeam, and currently works with cyclistsfrom several world tour teams. She isan adjunct faculty member of the De-partment of Exercise Science of the Uni-versity of Salzburg (Austria) andassistant lecturer at the Swiss FederalInstitute of Sport Magglingen (Switzer-land).

References1. Feigenbaum LA, Kaplan LD, MustoT, et al. A multidisciplinary approachto the rehabilitation of a collegiatefootball player following ankle frac-ture. A case report. Int J Sports PhysTher. 2016;11:436-449.2. Dijkstra HP, Pollock N, ChakravertyR, et al. Managing the health of theelite athletes: a new integrated per-formance health management andcoaching model. Br J Sports Med.2014;48: 523-531.3. Cong MH, Li SL, Cheng GW, et al. Aninterdisciplinary nutrition supportteam improves clinical and hospital-ized outcomes of esophageal cancerpatients with concurrent chemora-diotherapy. Chin Med J (Engl).2015;128:3003–3007.4. Beck A, Andersen UT, Leeds E, et al.Does adding a dietician to the liaisonteam after discharge of geriatric pa-tients improve nutritional outcome: arandomised controlled trial. ClinRehab.2015;29:1117-1128.5. Steinmuller PL, Meyer NL, KruskallLJ, et al. American Dietetic Associa-tion Standards of Practice and Stan-dards of Professional Performance forRegistered Dietitians (Generalist, Spe-cialty, Advanced) in Sports Dietetics.JAMA. 2009;109:544-552, 552.e1-30.6. Thomas DT, Erdman KA, Burke LM.Position of Dietitians of Canada, theAcademy of Nutrition and Dieteticsand the American College of SportsMedicine. J Acad Nutr Diet. 2016;116:501-528.

7. Murray R. Training the Gut for Com-petition. Curr Sport Sci Rep. 2006;5:161-164.8. Burkhart SJ, Pelly FE. Beyond sportsnutrition: the diverse role of dietitiansat the Delhi 2010 CommonwealthGames. J Hum Nuts Diet. 2013;27: 639-647.

9. Killer SC, Svendsen S, JeukendrupAE, et al. Evidence of disturbed sleepand mood state in well-trained ath-letes during short-term intensifiedtraining with and without a high car-bohydrate nutritional intervention. J Sport Sci. 2017;35:1402-1410.10. Hansen EA, Emanuelsen A, Gert-sen A, et al. Improved marathon per-formance by in-race nutritionalstrategy intervention. IJSNEM. 2014;24: 646-655.11. Pelly F, O’Connor H, Denyer G, etal. Catering for the Athletes Village atthe Sydney 2000 Olympic Games: TheRole of Sports Dietitians. Int J SportsNutr Exerc Metab. 2009;19:340-354.12. Kratzenstein SM, Carlsohn A, Hei-denreich J, et al. Dietary supplementuse in young elite athletes. Dtsch ZSportmed. 2016;67:13-17.

13. Torres-McGehee TM, Pritchett KL,Zippel D, et al. Sports nutrition knowl-edge among collegiate athletes,coaches, athletic trainers, andstrength and conditioning specialists.J Athl Training. 2012;47: 205-211.14. Long DL. Nutrition knowledge ofsport physical therapists. J OrthopSports Phys Ther.1989;10:257-263.15. Trakman GL, Forsyth F, Devlin BL,Belski R. A systematic review of ath-letes’ and coaches’ nutrition knowl-edge and reflections on the quality ofcurrent nutrition knowledge meas-ures. Nutrients. 2016;8(9). Pii:E570.16. Academy Quality ManagementCommittee and Scope of PracticeSubcommittee of Quality Manage-ment Committee, et al. Academy ofNutrition and Dietetics: Scope ofPractice for the Registered Dietitian. J Acad Nutr Diet. 2013;113:S17-28.17. Owens DJ, Fraser WD, Close GL. Vi-tamin D and the athlete: emerging in-sights. Eur J Sport Sci. 2015;15:73-84.18. Burkhart SJ, Pelly FE. Dietary in-take of athletes seeking nutrition ad-vice at a major internationalcompetition. Nutrients. 2016;8:638.19. Shriver LH, Betts NM, WollenbergG. Dietary intakes and eating habitsof college athletes: are female collegeathletes following the current sportsnutrition standards? J Am Coll Health.2013;61:10-17.20. Burke LM, Loucks AB, Broad N. En-ergy and carbohydrate for trainingand recovery. J Sport Sci. 2006; 24:675-685.


hope to see you at our next Symposium, Navigating the Pathof Wellness, April 26-28, 2019, at the Pointe Hilton Tapitio CliffsResort, in Phoenix, AZ.■ The Academy’s Sports Nutrition Care Manual (SNCM) hasentered a partnership with SCAN and we will now work to in-crease the breadth of this resource. The incoming editor-in-chief of the SNCM is SCAN member Kate Davis. We arelooking forward to this partnership and to enhancing this re-source’s capabilities.

Future: Where Are We Headed?

• Strategic planning. SCAN will embark on the third year ofour 3-year strategic plan this year to ensure that we consis-tently meet the needs of our members and judiciously moveour organization forward as such.• Enhanced programing.With the changes and our newstrategic plan, we will be enhancing the focus and level ofeducation for our programming. • Increasing digital capabilities. A new website and newSCAN podcasts are coming your way in the near future. Thiswill help make sure our resources are available on multipleplatforms for our members to access.•Developing new leaders. I encourage every member to getinvolved at any level! Leadership development both withinSCAN and within our dietetics community as a whole is veryimportant to our profession and this will be my key focusarea for this coming year. SCAN will move to creating moredeliberate opportunities for leadership development in thefuture.

Lastly, part of our future is standing on the shoulders of thosewho came before us. We build upon each other’s successand learn from our failures. It is a pleasure and honor toserve as your chair this year. I would like to thank the giantswho came before me—all the past chairs of SCAN, andspecifically Cheryl Toner and Karen Collins, for the amazingmentorship they extended to me and their excellent leader-ship of SCAN!

Our next face-to-face opportunity will be at the 2018 FNCE®

on October 20-23, in Washington, DC. I look forward to con-necting with you there at several events, including the SCAN Reception, which promises to be a memorable experi-ence, the DPG Showcase, and our SCAN DPG Spotlight ses-sion, Heart of an Athlete: Managing Hypertension in AthleticPopulations. Look for more details about FNCE® on page 23 ofthis issue and in future eblasts.

FromThe Chairby Lindzi S. Torres, MPH, MS, RDN, CSSD

SCAN: Past, Present, Future

“Progress is impossible without change, and those who cannot change their minds cannot change anything.”

— George Bernard Shaw

Change is an important part of leadership and programdevelopment, though at times it is uncomfortable and atother times resisted. My favorite saying is “The only con-stant is change” because change provides an opportunityfor learning and growth. As I begin the distinct pleasure ofserving as SCAN chair for this year, our practice group is inthe midst of some change. As with all change, it is impor-tant to see where we have been, where we are currently,and where we are going.

Past: What We Accomplished in the Past Year

■ The Executive Committee retreat last summer took placeat the Keystone Resort. Meeting at this venue helped uspre-plan and map out the excursions and events for ourmost recent Symposium.■ The Food & Nutrition Conference & Exhibition™ (FNCE®)Centennial was a great success and we look forward to thisyear’s event! Highlights included:

• Sports Nutrition: Advanced Practice Workshop • FNCE® Sessions (available on the Academy’s website for purchase): Fueling Teen Athletes: Unique Challenges and Winning Strategies and Putting Heart into Performance Nutrition for Collegiate Athletes• SCAN Reception: Celebrating 36 years of SCAN, we gathered at the beautiful Apogee rooftop lounge in downtown Chicago

■ Publication of Sports Nutrition: A Handbook for Profes-sionals, Sixth Edition (editors: Christine Karpinski and Chris-tine Rosenbloom)

Present: Where Are We Today?

■ As of June 1, SCAN will no longer maintain a separateDisordered Eating & Eating Disorders (DEED) subunit.However, DEED programming has been and will remain apart of what we do as SCAN. We will continue to ensurethat all members benefit from the opportunity to learnfrom and collaborate with each other across practice areas.Please visit our website (www.scandpg.org) for more infor-mation and our FAQ page about this transition. ■ We recently wrapped up the 34th Annual SCAN Sympo-sium in Keystone, CO. We had an amazing program and anamazing arsenal of internationally known speakers rang-ing from Asker Jeukendrup to Jon Ivy. If you missed it, we


Conference Highlights

Multi-Service Eating Disorder Association Annual ConferenceBoston, MAMarch 16-17, 2018

The Multi-Service Eating DisordersAssociation (www.MEDAinc.org) ad-dresses the needs of people with eat-ing disorders and their health careproviders in the Boston area and be-yond. The group’s annual conferencewas filled with excellent informationhelpful to RDs and therapists. Beloware some of the highlights that mightboost your counseling skills whenworking with clients who strugglewith food, weight, and body image.

Size Acceptance

In her keynote presentation, RaganChastain, advocate for the Health AtEvery Size (HAES) movement, ex-plained how losing weight did notwork for her. She got tired of hatingher large body and decided to learnto love her body. “This is my body; thisis what I’ve got.” The following keypoints from her talk offer food forthought.

■We live in a fat-phobic world wherehating your body and being terrifiedof gaining weight are “normal.“ Ourculture dictates that people either bethin or be on a diet.

■ People who live in large bodieshave the right to enjoy a life withoutshame, stigma, or bullying. Size ac-ceptance needs to become a civilrights movement.

■ Our society needs to embrace sizeacceptance if we really want to pre-vent eating disorders (EDs) and letpeople with EDs recover. Eating disor-ders generally start with a diet andfear of getting fat. Among fourth-grade girls, 81% are afraid of beingfat.

■ What is the proper language to usewhen describing a person with obe-

sity? “Obese” tends to be pathologiz-ing, so preferred terms include per-son of size, a larger body, heavierperson, and plus-size.

■ Tip for RDs: When a client says “I’mfat,” correct her or him by saying “Youare not fat, just as you are not finger-nails or hair. You have fat, just as youhave fingernails and hair.”

■ Is it ethical for RDs to offer weightloss counseling? The Academy’s codeof ethics says, “Do no harm.” Are wedoing harm when we offer interven-tions that are associated with peopleending up heavier than before theydieted? Perhaps we need to admit wehave no idea how to make anyonethin? Chastain reported we have noproof of efficacy for weight reductionprograms.

■ Every body is worthy of health carethat is blame-free, shame-free, andevidence-based. Chastain encourageshealth care professionals to focus onhealthy habits. The more healthyhabits a person has, the better his/herhealth—and that is not related toweight.

Body Dysmorphia Disorder

■ An estimated 1.7% to 2.4% of thegeneral population suffers from bodydysmorphic disorder (BDD); 85% ofthose are women. People with BDDhave a much higher rate of suicidethan the general population.

■ People with BDD can spend from 1to 8 hours a day being preoccupiedwith a perceived body flaw. This dif-fers from people with eating disor-ders who hate their whole body, notjust one or two body parts.

■ The most hated body parts areskin (73%), hair (56%), nose (37%),and stomach (27%). People with BDDuse harsh words to describe thesehated parts, including abnormal,flawed, deformed, andmonstrous.

■ If clients with BDD ask what youthink about their “flaw,” do not reas-sure them they look fine (this canperpetuate the problem). Instead ask,“What do you think I’ll say? What doyou want me to say? I need to hearyour story so I can understand you.“

■ Ask your client about the ritualsthat interfere with her or his life(body checking, looking in mirrors,avoiding being in a photo, wearinglots of makeup). Rank order the ritu-als and then, starting with the easiest,do exposure work. For example, askthe client “What do you see when youlook at yourself in a mirror?” If theclient sees an ugly person, let the per-son know what you see: a face withblond hair, blue eyes, and a few freck-les.

■ Encourage the client to find alter-native thoughts, such as “I don’t al-ways need to look perfect for people tolike me.”

Male Athletes with EatingDisorders

■ Exercising hard is a “male thing.”Male athletes with eating disordersare commonly resistant to receivingtreatment due to the perception thatthey will be seen as being weak. Thisgets further amplified by having a“woman’s disorder.” Male athletesmay be resistant to letting you knowthe seriousness of their ED. They fearlosing a scholarship, and fear disap-pointing their coaches and familymembers.

■ How do you help a man go againstsocialized norms to be vulnerable, ex-press and experience emotions, andreach out for help? We can encour-age them to be more compassionate


and respectful to their bodies, insteadof doing punishing workouts toreach an overachieving athletic goal.

Mothers and Eating Disorders

■ Studies of mothers with eating dis-orders are limited. We do know that40% to 60% of pregnant women donot disclose having (or having had)an eating disorder.

■ Miscarriages are 70% higheramong women with anorexia.

■ Postpartum depression is commonamong 60% of new mothers with bu-limia.

■ New mothers with EDs feel greatpressure to “snap back into shape.”Not surprisingly, relapse into ED be-haviors is common within the first 6months postpartum. The new moth-ers can easily return to restrictive eat-ing and diet pills. As RDs, we need toreduce the pursuit of unrealistic bod-ies.

■ Many mothers with EDs are perfec-tionists. They can easily feel like theyare a “bad mother” when a baby criesout of control and the ED rears itsugly head.

■ Babies of women with EDs tend tohave lower weight for height for thefirst 12 months. Do the mothers notproduce enough breast milk? Dothey restrict food?

■ When infants start eating solidfood, some new mothers focus on“clean eating.” They have fears about“tainted” food, and cut out gluten anddairy.

■ As children get older, mothersneed to be role models for positivebody image and say things like “I lovemy strong arms” or “I love my muscu-lar thighs”.

■ As professionals, we need to re-mind mothers that they want to helptheir kids in every way—and that in-cludes resolving their own eating is-sues.

Internal Family Systems

■ The Internal Family Systems (IFS)model of treating eating disorders iseffective. This model is based on thetheory that our persona is composedof many different parts. Ideally, all ofour parts are harmonious. However,due to inevitable life-challengesand/or trauma, some parts of us getwounded and take on extreme rolesor feelings.

■ Some parts, called protectors,strive to suppress feelings. They getyou to “go on a diet,” “get to the gym,”and “read diet books” as a means tokeep the pain away. Eating disordersprotect a person from painfulwounds.

■ IFS focuses on a person’s internalability to hear those wounded parts.Once the wounded parts can learn tofeel safe, a person can experience in-ternal harmony. IFS fosters healing bygetting to the root cause of thewounds, compassionately workingwith the wounded parts, and restor-ing positive connections.

Compassion

■ Compassion is the antidote toshame. People with eating disordershold a lot of shame, so it’s importantfor health care providers to minimizethat shame and be compassionate.

■ Compassion comes from the heartand is at the heart of our work withclients with eating disorders. We wantto notice when clients are suffering,see their worth and goodness, join

them where they are, and practiceloving kindness.

■ Clients don’t recover until they canhave self-compassion and are able toreceive compassion as well as havecompassion for others. Self-compas-sion is being able to be nice to our-selves when we don’t do as well aswe would like to do.

Palliative Care

■ In a long-term study, 36% of pa-tients with anorexia had not recov-ered after 22 years since firstreceiving treatment. Appropriatequestions to ask include, “What areyour goals for your quality of life?”and “Why have you hit the wall at thisparticular point?”

■ How do we know when to forcesomeone into treatment against hisor her own will? Forced treatmentmight contribute to weight restora-tion briefly, but immediately after in-patient treatment is over, the patientcan rapidly relapse. Do we offer thempalliative care?

■ As an RD, you can ask the client totell you about the benefits and bur-dens of going through residentialtreatment (again). You might need tomove away from the advice to “Justeat. Just try one more time. Just go totreatment again“ and recognize thatthe suffering of the mind might be asreal and painful as the suffering ofthe physical body care.

■ Death from malnutrition will even-tually occur, but it can take a substan-tial amount of time with a great dealof suffering. Palliative care does notmean “giving up” but rather easingthe physical and emotional symp-toms, and avoiding aggressive treat-ments.

“Conference Highlights” editor NancyClark, MS, RD, CSSD has a private prac-tice in the Boston area and is author ofthe bestselling Nancy Clark’s SportsNutrition Guidebook. For more infor-mation, go to www.NancyClarkRD.com.


Fertility Foods Cookbook:100+ Recipes to Nourish Your BodElizabeth Shaw, MS, RDN and ChefSara Haas, RDNHatherleigh Press, Hobart, NY800/733-3000http://www.hatherleighpress.com2017, paperback, 320 pp, $20.00ISBN 978-1-57826-703-3

With nearly 10% of our nation’swomen suffering from infertility, Fer-tility Foods Cookbook is a timely publi-cation and a valuable resource for allwomen in their childbearing years.This resource is filled with nutritioninformation and recipes developedto include fertility-boosting foods.The book emphasizes focusing oncooking with whole foods containingminimal processed ingredients tosupport a woman’s overall nutritionto improve fertility and prepare forthe nutrition demands of pregnancy.

Fertility Foods Cookbook opens with agenuine welcome from both authors,building immediate rapport with thereader. Each shares their own strug-gles with infertility and their hopesfor readers in the use of this cook-book. The authors also review alengthy discussion on key macro-and micronutrients that support andboost fertility nutrition. The authorsmake the discussion of each nutrientapproachable and engaging, andthey provide tips on good dietary

sources for these nutrients. This sec-tion includes charts that summarizekey text regarding portion size, reciperecommendations, and sources ofwhole foods as well as personal anec-dotes from each author.

The book includes recipes for allmeals including breakfast, salads,sandwiches, entrees, sweets, andmuch more. Each recipe presents

clearly written instructions and in-cludes nutrition information; mostare accompanied by mouthwatering

photographs as well. There are notesexplaining the fertility benefits ineach recipe. In addition, severalrecipe variations and storage tips areprovided throughout the text. Eachpage of this book feels like a friendproviding support and encourage-ment, while also providing nutritionexpertise advice. The underlying mes-sage of Fertility Foods Cookbook lies inthe uncontrollable situation of infer-tility. Focusing on fertility-fueling nu-trition can provide a sense ofconfidence in the ability to care forone’s body even when it is difficult tounderstand the struggles of fertility.

This cookbook is a valuable resourcefor those who are in the midst of fer-tility challenges or anyone whomight be concerned about achievingoptimal nutrition status for preg-nancy prior to conceiving. There arerecipes for all occasions that incorpo-rate many flavor profiles that anyonewould be excited to test out in thekitchen.

Elizabeth Shaw, MS, RDN is a nutritionexpert and product developmentspecialist. Sara Haas, RDN is a foodand nutrition expert and formally-trained chef. Both are freelance writ-ers who have been featured inseveral publications.

Reviewed by Jen Tate, MDA, RD, SNS,school nutrition dietitian in San Diego,CA.

Reviews

from the National Institute of MentalHealth and the National Institute onAging.

Summarized by Allison DePaolo, grad-uate student, Department of Nutritionand Integrative Physiology, Coordi-nated Master’s Program, Nutrition, Edu-cation and Research Concentration,University of Utah, Salt Lake City, UT.

BMI, Body Composition, andCVD MortalityOrtega FB, Sui X, Lavie CJ, et al. Bodymass index, the most widely used butalso widely criticized index: would acriterion standard measure of totalbody fat be a better predictor of car-diovascular disease mortality? MayoClin Proc. 2016;91:443-455.

While obesity is a worldwide epi-demic, there is controversy surround-ing how to best assess obesity statusand whether measurement of bodycomposition would be more accu-rate. This prospective, epidemiologicinvestigation of adult men andwomen examined whether a meas-urement of total body fat wouldmore accurately predict cardiovascu-lar disease (CVD) mortality comparedwith body mass index (BMI). The fol-lowing conditions were tested to seewhich of three parameters morestrongly predicts CVD mortality andall-cause mortality: an excess of bodyweight, an excess of body fat, or anexcess of fat-free mass (FFM). Most ofthe participants were white, well-ed-

ucated, and have worked in executiveor professional positions. All partici-pants completed a detailed question-naire; measurements included aphysical examination, fasting bloodchemistry analyses, personal andfamily health history, body composi-tion (assessed by hydrostatic weigh-ing or by the sum of seven skinfoldthicknesses using standardized pro-tocols), smoking and alcohol use, anda maximal exercise treadmill test.Compared with a medium BMI(15th–85th percentile), a very highBMI (>95th percentile) was associ-ated with a 2.7-fold higher risk ofCVD mortality. Compared with amedium FFMI (fat-free mass index)(15th-85th percentile), a very highFFMI (>95th percentile) was associ-

ated with a 2.2-fold higher risk ofCVD mortality. These estimates weremarkedly smaller for FFM. This studysuggests that the simple and inex-pensive measure of BMI can morestrongly predict CVD mortality thanaccurate measures of body composi-tion employing accurate, complex,and expensive methods. Further-more, FMI (fat mass index) is a moreinformative measure of future CVDprognosis than is %BF.

Summarized by Julia Erbacher Wylie,MS, RDN, CSSD, assistant professor, SaltLake Community College, Salt LakeCity, UT.


Research Digest

Menu Calorie Labeling andEating Disorders Haynos AF, Roberto CA. The effects ofrestaurant menu calorie labeling onhypothetical meal choices of femaleswith disordered eating. Int J Eat Dis-ord. 2017;50:275–283.

Menu calorie labeling policies havebeen recently pushed forward tocombat the obesity epidemic. Therehas been little understanding of howthese policies could influence themore than 30 million Americans suf-fering from clinically significant eat-ing disorders (EDs). This randomized,cross-sectional study was undertakento determine whether calorie label-ing affects food choices amongwomen with disordered eating (DE)or EDs. A total of 716 women (meanage 21; 62% white) completed the Ea-ting Disorder Examination Question-naire to identify DE/EDs; 10, 7, 23, and66 participant met diagnostic criteriafor DE, anorexia nervosa (AN), bulimianervosa (BN), and binge eating disor-der (BED), respectively. The AN andBN groups were combined for analy-sis. All women completed an onlinesurvey, where they were randomly as-signed menus with or without calorielabels and were instructed to choosefoods representative of a meal theywould order. Results showed thatmenu labeling did not have an effecton hypothetical food choices amongparticipants with DE behaviors(P=.45). However, ED groups showedan effect of menu labeling: theAN/BN group ordered fewer calorieswith menu labeling than without(P<.001), while the BED group or-dered more calories when menu la-beling was included (P<.001). Thissuggests menu labeling may exacer-bate ED behaviors in those with clini-cally significant EDs but not in thosewith DE behaviors. Further research isneeded to understand why calorie la-bels might encourage females withBED to consume more calories. Thisresearch was supported by grants


Macronutrient Intake Variance Between SportsWardenaar F, Brinkmans N, Ceelen I, etal. Macronutrient intakes in 553Dutch elite and sub-elite endurance,team, and strength athletes: does in-take differ between sport disciplines?Nutrients. 2017;9:119.

While macronutrient requirementsvary between sport disciplines, ath-letes in general have greatermacronutrient needs than sedentarypopulations. It is currently unclearwhether athletes are meeting theirmacronutrient requirements andwhether this intake differs betweensport disciplines. The purpose of thisstudy was to compare macronutrientintakes across sport disciplines anddetermine if needs were being met. Atotal of 553 Dutch elite and sub-elitecompetitive athletes (326 male, 227female) completed this observationalcohort study and were categorizedinto three sport disciplines: en-durance, team, and strength sports.Within a 4-week period, all but 28athletes completed three unan-nounced Web-based 24-hour dietaryrecalls using the validated “Compl-eat” program and a dietary supple-ment questionnaire; the recall datawere then converted into energy andmacronutrient intake using the 2010Dutch food composition database.The remaining 28 athletes (male soc-cer players) completed the 24-hourrecall and questionnaire face-to-facewith a trained RD using the sameprogram. The nutrient intakes werecompared with the total energy ex-penditures (TEEs) that were esti-mated for each sport discipline. Theaverage training load among all disci-plines was 100 minutes per day. Theresults indicated that both male andfemale endurance athletes con-sumed significantly more energy andmacronutrients than team sport ath-letes (P<.05). While most athletes(~70%) had a protein intake abovethe sports nutrition recommendationof 1.2 g/kg of bodyweight per day,more than half of all athletes did notreach the recommendation for carbo-hydrates of 5 g/kg of bodyweight per

day (P<.05). This under-consumptionof carbohydrates should be ad-dressed among all sport disciplinesto ensure adequate intake. This studywas funded by the Eat2Move project.

Summarized by Alyssa Gomez, gradu-ate student, Department of Nutritionand Integrative Physiology, Coordi-nated Master’s Program, Sports Nutri-tion Concentration, University of Utah,Salt Lake City, UT.

Effects of Betalain Supplementation on ExercisePerformance and Recovery Montenegro C, Kwong D, Minow Z, etal. Betalain-rich concentrate supple-mentation improves exercise per-formance and recovery incompetitive triathletes. Appl PhysiolNutr Metab. 2017;42:166-172.

Recent studies suggest that ingestionof beetroot juice may have bothhealth and exercise performancebenefits. These benefits have largelybeen attributed to the nitrate con-tent of beetroots. However, beets alsocontain high amounts of betalain,which has antioxidant and anti-in-flammatory properties. The purposeof this crossover, double-blinded,placebo-controlled study was to ex-amine the effects of a sugar-free andnitrate-free betalain-rich beetrootjuice concentrate (BRC) on runningperformance and muscle damage in26 competitive male and female

triathletes. Participants ingested 50mg of BRC or placebo twice per dayfor 6 days and then on day 7 ingested50 g BRC or placebo 120 minutesprior to completing 40 minutes ofsubmaximal cycling (75% VO2max)followed by a 5-minute active recov-ery and then a 10-km running timetrial (TT). Participants ingested an ad-ditional 50 mg BRC or placebo post-TT and then completed a 5-kmrunning TT performance 24 hoursafter the initial 10-km TT. Blood sam-ples to measure creatine kinase (amarker of muscle damage) and a 100mm visual analog scale (VAS) tomeasure subjective fatigue and mus-cle soreness were measured at base-line (pre-submaximal exercise andpre-BRC ingestion), post-10-km TT,and pre-5-km TT. Compared withplacebo, BRC supplementation signif-icantly decreased 10-km running TTduration (49.5 ± 8.9 vs. 50.8 ± 10.3min, P=.03) and 5-km running TT du-ration (23.2 ± 4.4 vs 23.9 ± 4.7 min,P=.003). The change in muscle dam-age markers and fatigue levels frombaseline to 24-hour after the 10-kmTT was significantly lower with BRCcompared with placebo (P≤.05).These results suggest that BRC sup-plementation in the absence of ni-trates can improve enduranceexercise performance and recovery inhealthy, competitive triathletes. Fi-nancial support for this study wasprovided by VDF FutureCeuticals, Inc.

Summarized by Corinna Coffin, gradu-ate student, Department of Nutritionand Integrative Physiology, Coordi-nated Master’s Program, Sports Nutri-tion Concentration, University of Utah,Salt Lake City, UT.


NotablesSCAN

by Traci Roberts

The following three award recipientswere honored at the recent 2018SCAN Symposium in Keystone, CO:

■ Christine Karpinski, PhD, RD,CSSDwas awarded the SCANAchievement Award, which recog-nizes exceptional members who haveplayed a significant role in the evolu-tion of SCAN through both outstand-ing service to the organization andprofessional accomplishments in thefield. Chris is an exercise physiologistand registered dietitian and is cur-rently associate professor and chairof the Department of Nutrition atWest Chester University (WCU). Chrisearned her BS degree at WCU in exer-cise science and played field hockeyand lacrosse. She received her MS de-gree from Immaculata University andher PhD from Rutgers University, withher doctoral research project involv-ing the athletes at WCU. In additionto her teaching and chair responsibil-ities, she provides nutrition educationand services to WCU athletes, men-tors undergraduate and graduatestudents interested in sports nutri-tion, and serves as a preceptor for di-etetics interns wishing to do a sportsnutrition rotation. Chris served on theSCAN Executive Committee as the di-rector of Sports Dietetics–USA (SD-USA) subunit from 2013 to 2016. Sheis a member of the American Collegeof Sports Medicine (ACSM), the Pro-fessionals in Nutrition for Exerciseand Sport (PINES), and the Collegiate& Professional Sports Dietitians Asso-ciation (CPSDA). She has presentedfrequently to many different groupsand advocates for the critical need ofsports dietitians in all college pro-grams. She is editor-in-chief of SportsNutrition: A Handbook for Profession-als, 6th edition, published in Septem-

ber 2017. Chris enjoys working out,hiking, playing golf, gardening, andwatching almost any sport.

■ Meridan Zerner, MS, RDN, CSSDwas honored with SCAN’s 2018 Excel-lence in Practice Award for outstand-ing service and professionalaccomplishments that have ad-vanced her practice area. Meridan isan award-winning RDN with 28 yearsof experience in the field of healthand wellness. She has spent the past17 years at Cooper Clinic, where sheworks with patients and shares herpassion for nutrition through mediasegments and lectures across thecountry. Meridan received her BS de-gree from Syracuse University andher MS degree in nutritional sciencewith an emphasis in health promo-tion from the University of Okla-homa. She is a Certified Specialist inSports Dietetics (CSSD) and special-izes in weight management and exer-cise and sports nutrition. She alsoshares her expertise in preventiveand cardiovascular health and nutri-tion throughout the life cycle. Meri-dan is a certified wellness coach anduses behavioral change skills to helpsupport long-term lifestyle changesin her patients. She contributes tomultiple entities across the Coopercampus in a variety of capacities. Sheserves as an adjunct instructor at TheCooper Institute, the lead facilitatorfor Cooper Wellness Strategies, and agroup exercise instructor and lecturerat Cooper Fitness Center. Her well-ness philosophy is to do the best youcan with what you have, where youare. When she isn’t partnering withpatients or leading classes, Meridanenjoys traveling with her husband,two children, and one quirky dog. Herfavorite destination is Maine, whereshe lived prior to making Dallas herhome.

■ Cortney Steele, MS, CSCS re-ceived SCAN’s 2018 Student Award.Cortney is a third year PhD and di-etetics student in the Department ofHuman Nutrition, Foods, and Exerciseat Virginia Tech. She has served onSCAN’s Student Board and The Beatnewsletter team for the past twoyears. Currently, she works in theHuman Integrative Physiology Labo-ratory at Virginia Tech. Cortney com-pleted her BS degree in Health andHuman Performance at Messiah Col-lege in 2013 and her MS degree in ex-ercise science at BloomsburgUniversity in 2015. Her master’s re-search involved applying differentstrategies of carbohydrate intakeamong athletes, including carbohy-drate mouth rinsing. Her current re-search interests focus on the effectsof dietary choline intake on vascularhealth in adults.

■ Kate Davis, MS, RD, CSSDwas re-cently named as the editor-in-chieffor the Academy of Nutrition and Di-etetics’ online Sports Nutrition CareManual (SNCM). The SNCM containsresearch-based information writtenby CSSDs. For more information,visit www.nutritioncaremanual.org/about-sncm.

If you have an accomplishment thatyou would like published in an upcom-ing issue of PULSE, please contact TraciRoberts at [email protected].


Of Further Interest

■ 2018 SCAN Election ResultsSCAN members cast their votes ear-lier this year and elected the follow-ing to SCAN’s leardership.Congratulations to our new leaders,and thank you for stepping up toserve SCAN:

Chair-Elect: Jennifer Ketterly, MS, RD, CSSDTreasurer: Lynn Cialdella Kam, PhD,MA, MBA, RDNNominating Committee: JosephineConnolly-Schoonen, PhD, RD and Car-oline Sullivan, MS, RD, CSSD

■ News from Wellness/CV RDs Subunit

Here’s an update from theWellness/CV subunit:

• Wellness Task Force Updates. TheWellness Task Force is developing a 3-year plan with the objective of creat-ing materials and programming tobest support SCAN members work-ing in the wellness arena. Stay tunedfor more details!

• SCAN Symposium Recap.We en-joyed meeting new members and re-connecting with long-time membersat the recent SCAN Symposium, heldin May at the Keystone Resort. If you couldn’t join this year, we hope youwill plan to join us in Arizona for the2019 SCAN Symposium, where thetheme will be wellness-focused.

• New Webinar: Health Coaching.With the rise in popularity of careersas “health coaches” and various certi-fication programs out there, it can bea difficult space for registered dieti-tian nutritionists to navigate. How-ever, it is also a space in which we arewell-suited to practice. Recognizing aneed for more information about thiscareer path, a webinar on healthcoaching has been recorded and willsoon be available on the SCAN web-site. Look for it in the e-library(www.scandpg.org/e-library/), and

remember, webinars are free to mem-bers for the first month!

■ News from Sports Dietetics—USA (SD-USA) Subunit

Below are some highlights from theSD-USA subunit:

• Volunteer Opportunities. If youwere able to attend the SCAN Sym-posium in May, you heard about all ofthe exciting projects and opportuni-ties on SD-USA’s plate this year. Forexample, we are entering year 2 ofour Expanding the Arena Initiative,launching a podcast, publishing sev-eral new fact sheets, and continuingto collaborate with our external part-ners such as the National AthleticTrainers’ Association (NATA), the Na-tional Strength and Conditioning As-sociation (NSCA), and Professionals inNutrition for Exercise and Sport(PINES). None of this can happen,however, without help from ouramazing volunteers. We need you!Visit the SCAN volunteer page atwww.scandpg.org/volunteer-opportunities/

• Athletes in the Arts Partnership.SCAN now has an official partnershipwith Athletes in the Arts (an ACSMinitiative). 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 visithttp://www.scandpg.org/volunteers.-opportunties/.

• SCAN Speaking Opportunity. TheSCAN-NATA Committee has devel-oped a PowerPoint presentation thathighlights the collaborative workingrelationship of sports RDNs and certi-fied athletic trainers (ATCs). Any SCANmember can apply to offer this pres-entation at any NATA-approvedprovider program. SCAN benefits

from increased exposure, NATA mem-bers benefit by connecting with alocal nutrition expert, and you canbenefit from potential referrals andan honorarium. Visit the www.scandpg.org/sports-nutrition/and-click on Promotive Sports Dietetics”for more information.

• CSSD Exam Window. The 2019exam dates and fee schedule for theBoard Certified Specialist in SportsDietetics (CSSD) credential will beavailable on August 1. Visit the Com-mission on Dietetic Registration(CDR) website atwww.cdrnet.org/certifications/board-certification-as-a-specialist-in-sports-dietetics for more information.

• NEW Fact Sheets. The fact sheetteam was busy this past year! Go towww.scandpg.org/sports-nutrition/sports-nutrition-fact-sheets/sn-fact-sheets/ to check outthe following new fact sheets: LowCarbohydrate, High Fat Diets for Ath-letes; Gut Health for Athletes; Hydrationand Cooling Needs for Athletes with aSpinal Cord Injury (SCI); Post-CollegiateNutrition; Nutrition for Adventure Rac-ing; Protein Supplements for Athletes;Nutrition for Athletes with GERD; andThe Top 10 Reasons CSSDs Deliver. Asalways, our fact sheets are free toSCAN members.

■ 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 practiceareas: nutrition for sports and physi-cal activity, cardiovascular health,wellness, and disordered eating andeating disorders. You can contributeto the “Research Digest” by volunteer-ing to abstract a recently publishedstudy on any of the above practiceareas. For details on this opportunity,contact Kary Woodruff, MS, RD, CSSD,co-editor of “Research Digest,” at

https://www.scandpg.org/sports-nutrition/sports-nutrition-fact-sheets/sn-fact-sheets/



https://www.cdrnet.org/certifications/board-certification-as-a-specialist-in-sports-dietetics



https://www.scandpg.org/sports-nutrition/

https://www.scandpg.org/sports-nutrition/

https://www.scandpg.org/volunteer-opportunities/




https://www.scandpg.org/e-library/


[email protected]. Become a contributor to PULSE!

■ Manuscripts for PULSEWelcomeSCAN’s PULSE welcomes the submis-sion of manuscripts to be consideredfor publication. In particular, PULSE isinterested in receiving original re-search reports and review articles.Manuscripts presenting practical gui-delines, case studies, and other infor-mation relative to SCAN will also beconsidered.

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/.

■ Easy Access to EAL Guideline RecommendationsDietetics practitioners can now getpractical quick-reference tools fortheir pocket or electronic devicesfrom the Academy’s Evidence Analy-ses Library. These guideline tools pro-vide graded recommendations forscreening, referral, assessment, inter-vention, and monitoring of the spe-cial nutritional needs of variouspatient populations, such as thosewith heart failure, diabetes types 1and 2, gestational diabetes mellitus,and more. For more information, goto www.guidelinescentral.com/shop/society/academy-of-nutrition-and-dietetics.

■ Take Advantage of theAcademy’s WebinarsThe Center for Lifelong Learning’sWebinar 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.

Just a few of the archived recordedwebinars include:

• Beyond the App Game: Integrating Mobile Apps into Dietetics Practice• Branding: Creating Your ProfessionalImage• Evidence-Based Nutrition: Using Scientific Evidence to Inform ClinicalPractice• Orthorexia Comes of Age: Perspec-tives on the Healthy Eating Disorder• Seafood Nutrition: Benefits from Seato Table• State of the Sweeteners Union: HowStrong is the Evidence on Low and No-Calorie Sweeteners?• Supermarket Victory: OptimizingSports Performance Through Step-by-Step Shopping Guides• The Mighty Microbiome: What WeKnow and What We Need to Learn• Vitamin E: Setting the Record Straight

For information on the Academy’swebinars, including a list of upcom-ing live webinars, go towww.eatrightpro.org/practice/professional-development/distance-learning/webinar-series.

■ Nutrition Care ManualProducts from the AcademyThe Nutrition Care Manual productsfrom the Academy are interest-baseddiet manuals and professional prac-tice resources for RDNs, NDTRs, andallied health professionals. ManySCAN members are already users ofthe sports-related product in this se-ries—the Sports Nutrition Care Manual(SNCM). This manual, focusing onsports and performance, will undergofuture enhancements as a new part-nership with SCAN and the Academymoves forward (see “From the Chair,”page 14).

The other two manuals in this seriesavailable from the Academy are theNutrition Care Manual (NCM), whichaddresses adult (18+ years) popula-tions, and the Pediatric Nutrition CareManual (PNCM), which focuses on pe-diatric populations and their care-givers.

All three products are purchased byannual subscription and give mem-bers online access to evidence- andknowledge-based nutrition informa-

tion that keeps practitioners currentand compliant. More information onthese manuals can be found atwww.nutritioncaremanual.org.

■ New Code of Ethics for the Nutrition and Dietetics ProfessionThe Academy and the Commissionon Dietetic Registration believe it is inthe best interest of the profession—and the public it serves—to have aCode of Ethics that guides profes-sional practice and conduct. Ashealth care becomes more complexand the areas in which nutrition anddietetics practitioners work becomemore challenging, it is important thatcodes of ethics governing the profes-sion evolve as well. With that in mind,the Academy/CDR’s Code of Ethicswas recently updated. The new Codeof Ethics went into effect on June 1,2018 for all Academy members andall practitioners credentialed by theCommission on Dietetic Registration.

The review and revision of the Acad-emy/CDR’s Code of Ethics recognizesthe changes in nutrition and dieteticspractice that exist today, and is re-sponsive to new trends such as digi-tal health care, social media, and theevolving use of other technologies.The Code of Ethics has been updatednumerous times since the 1930 pub-lication of “A Professional Code forthe Hospital Dietitian.” The most re-cent revision prior to this year’s waspublished in 2009.

The full text of the Academy’s Codeof Ethics is available at www.eatright-pro.org/practice/code-of-ethics/what-is-the-code-of-ethics.Also, the Academy provides addi-tional resources in ethics to furthereducate members on this topic. Forexample, an ethics reading list offerslinks to several articles that havebeen published in the Journal of theAcademy of Nutrition and Dieteticson ethical practice related to theCode of Ethics. This informative list isavailable atwww.eatrightpro.org/practice/ code-of-ethics/ethics-education-resources. Check it out!

https://www.eatrightpro.org/practice/code-of-ethics/ethics-education-resources




https://www.eatrightpro.org/practice/code-of-ethics/what-is-the-code-of-ethics



https://www.nutritioncaremanual.org/

https://www.eatrightpro.org/practice/professional-development/distance-learning/webinar-series



https://www.guidelinecentral.com/shop/society/academy-of-nutrition-and-dietetics



https://www.scandpg.org/nutrition-info/pulse/



■ RDN Exam PreparationMade Easy If you’re planning on taking the RDNexam, take advantage of the Acad-emy’s comprehensive and conven-ient eatrightPREP tool. This effectivelearning experience is a great way toprepare and gain an edge in passingthe exam. The course provides morethan 900 questions, unlimited accessto full-length practice exams, morethan 500 flashcards, performance sta-tistics to identify your strengths andtarget weaknesses before exam day,and much more. Learn more aboutthis opportunity by visitingwww.eatrightprep.org/rdn-exam

■ Academy President CallsOut Need�for�RDN�on�President’s�Council�onSports,�Fitness�and�NutritionIn a letter written on behalf of the

Academy and the nation’s RDNs,

Donna Martin, EdS, RDN, SNS,

FAND, 2017-2018 president of the

Academy, urged President Trump

to appoint an RDN to the Presi-

dent’s Council on Sports, Fitness

and Nutrition. The letter states that

the presence of an RDN on the

Council “would help give our fellow

citizens the tools they need to

make the best food choices for

health, while preventing food and

nutrition confusion that hurts our

citizens.” The letter noted the many

highly qualified candidates among

the ranks of the nation’s RDNs,

and said the Academy would be

happy to work with the White

House to identify potential Council

members.

■ Menu�Labeling�Takes�EffectAfter several years of delays, the

country’s menu labeling rule, cre-

ated under the Affordable Care Act,

took effect May 7. The new rule ap-

plies nationwide to standard menu

items in restaurants and similar re-

tail food establishments with 20 or

more locations. The final rule and

industry guidance from the Food

and Drug Administration were the

result of a deliberate process that

included input from stakeholders

across industry, government, and

public health. The Academy has

long supported Americans’ ability

to know what is in their food and

make healthy choices at the point

of purchase.

■ House�Launches�FoodWaste�CaucusU.S. Reps. David Young (Iowa)

and Chellie Pingree (Maine) have

created a Food Waste Caucus in

the House of Representatives. The

U.S. wastes 40% of the food avail-

able for consumption throughout

the supply chain; identifying where

waste occurs is necessary to in-

crease efficiencies. The Academy’s

farm bill recommendations em-

power consumers to choose

healthful foods and reduce waste,

while supporting producers and re-

tailers in meeting demand for a

healthful and safe system. To learn

more, visit www.eatrightpro.org/

advocacy/legislation/

all-legislation/farm-bill.

■ Food�and�Nutrition�Issues�in�NAFTA�NegotiationsThe Academy is monitoring the

North American Free Trade Agree-

ment (NAFTA) negotiations, espe-

cially their impact on food labeling

of products from abroad. Recog-

nizing that trade is a complex, mul-

tifaceted issue, the Academy is

withholding formal comment while

considering how negotiations may

implicate our food labeling princi-

ples. The Academy continues to

support policies that ensure all la-

bels are truthful and provide infor-

mation to help consumers make

healthful choices.

Mark Your Calendars:

FNCE® 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 SCAN colleagues

• SCAN Booth at the DPG/MIG ShowcaseTake a look at what SCAN offersmembers and chat with yourSCAN leaders

• SCAN Spotlight Session:Heart of an Athlete: Managing Hypertension in Athletic PopulationsPresenters: Aaron Baggish, MD, FACC, FACSMand Jackie Buell, PhD, RD, CSSD, ATC

For more information and up-dates, watch for eblasts and visitwww.scandpg.org/fnce-2018/

https://www.scandpg.org/fnce-2018/

https://www.eatrightpro.org/advocacy/legislation/all-legislation/farm-bill



https://www.eatrightprep.org/rdn-exam


Publication of the Sports,Cardiovascular, and Wellness Nutrition (SCAN) dietetic 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 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/[email protected]

The viewpoints and statements hereindo not necessarily reflect policiesand/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 Winter 2019issue: Oct. 1. Deadline for the Spring2019 issue: Jan. 1, 2019.Manuscripts(original research, review articles, etc.)willl be considered for publication.Guidelines for authors are available atwww.scandpg.org. E-mail manuscriptto the Editor-in-Chief; allow up to 6weeks 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 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.scandpg.org/nutrition-info/pulse

EventsUpcoming

July 9-27, 2018CDR Board Certified Specialist inSports Dietetics examination (at vari-ous U.S. sites). For information: Com-mission on Dietetic Registration,www.cdrnet.org/certifications/board-certification-as-a-specialist-in-sports-dietetics

August 17-20, 2018American Association of Diabetes Ed-ucators Annual Meeting, Baltimore,MD. For information: AADE, www.diabeteseducator.org

September 12-15, 2018AACVPR Annual Meeting, Charleston,SC. For information: American Associ-ation of Cardiovascular and Pul-monary Rehabilitation,www.aacvpr.org

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

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

April 26-28, 201935th Annual SCAN Symposium,Phoenix, AZ. For more information: www.scandpg.org

http://renfrewcenter.com/

http://renfrewcenter.com/

https://obesityweek.com/

https://obesityweek.com/

https://www.aacvpr.org/

https://www.diabeteseducator.org/

https://www.diabeteseducator.org/






Documents

SCAN’S Pulsescandpg01-prd.s3.amazonaws.com/media/files/2a13851b... · SCAN’S Pulse Benefits of Mindfulness for Wellness and Sport by Erin G. Mistretta, MA and Carol R. Glass,