EXERC ISE abnormalities seen by the UCLA Craniofacial Clinic include craniosynostosis (an abnormal head shape resulting from the premature fusion of two or more bones of the skull) and craniofacial microsomia (abnormalities of facial symmetry, including misshapen ears and jaws). Beyond congenital conditions, the clinic’s doctors treat pediatric patients with trauma-related injuries, such as those from car accidents, faces disfigured from cancer treatment, and vascular malformations. In most cases, Dr. Ozaki notes, these deformities are not merely cosmetic concerns. “There are functional issues as well,” he says. “Kids with clefts of the lip and palate can’t eat very well, and hearing and speech can be affected. For a child with craniosynostosis, the head can’t grow in a normal way, and there are increased pressures on the brain, along with the abnormal head shape.” Treatment often is a multistage process that includes surgeries at various developmental milestones, as well as rehabilitative services. For example, Dr. Ozaki explains, a newborn with a cleft lip and palate may have a surgical lip repair at 3 months, a palate repair at 10-to-12 months, nose-lip revision surgery at age 5, a bone graft at age 8 to use bone from his or her hip to repair the cleft in their gums, and then surgeries to fi x the misshapen nose and jaw as the child gets older. Because of the complexity of these and other cases seen at the clinic, patients typically are seen at least annually until age 21. “At different stages, these patients may need to see different experts,” Dr. Ozaki says. “By having everyone here and working together, we can better meet our goal of giving every child a chance to feel normal and good about themselves.” For more information about the UCLA Pediatric Craniofacial Program, go to: uclahealth.org/ pediatriccraniofacial A Cup of Joe for More Get Up and Go Everyone knows that the prescription for weight loss relies heavily on proper diet and exercise, but could an optimal and well-timed dose of caffeine confer an additional benefit? “There has been a great deal of interest in the effects of caffeine on exercise and weight loss, and for the most part it appears that in moderation, caffeine can contribute in a positive way,” says Daniel Vigil, MD, a UCLA sports-medicine physician. The latest evidence comes from a recent study finding that among athletes, exercising after consuming a moderate amount of coffee resulted in their burning 15 percent more calories for three hours post-workout than non-coffee drinkers. Dr. Vigil explains that the positive effect relates to faster and deeper breathing in the hours following the exercise, which results in more calories burned. He notes that other studies have found that caffeine can promote the preferential burning of fat over carbohydrates, which could also be beneficial to weight-loss efforts. Jason Hove, MD, a UCLA family medicine physician with an expertise in exercise physiology, points out that one well- known benefit of consuming caffeine prior to exercise is its ability to boost endurance. “What it comes down to is perceived exertion — how hard you think you’re working,” Dr. Hove says. “There is some evidence that caffeine makes it easier for people to exercise longer and harder, which is going to burn more calories.” Dr. Hove adds that if the caffeine makes the physical activity seem less grueling and thus more enjoyable, it might increase the frequency of workouts — another potential benefit. One of the concerns some people have about caffeine prior to exercise is that it will make them dehydrated. “We now know that caffeine doesn’t cause dehydration, especially if you start out well hydrated,” Dr. Hove says. Dr. Vigil warns against taking the evidence too far. The optimal intake of coffee for an average-weight person seeking to achieve the exercise-related benefit is about two-to-three cups roughly one-to-two hours before the workout. “Someone who is already drinking four or five cups a day isn’t likely to get a benefit from drinking more,” he notes. Similarly, people who aren’t coffee drinkers shouldn’t feel the need to start, since the benefits are only marginal. “We need to keep in mind that diet makes up about 80 percent of the weight-loss equation,” Dr. Hove says. “Of course, exercise is certainly important for fitness as well as for losing weight, and if caffeine can be used to enhance that effect, that is going to be beneficial.” To view a video about coffee and exercise, go to: uclahealth.org/ coffeeandexercise Vital Signs Summer 2015 Vol. 67 11