Healthy Food & Healthy Living by Dr. Ayala

Our health report card for 2009: Are we making progress?

As 2009 winds down and the season for gratitude is upon us, this is a great time to reflect on our progress and contemplate the road ahead. This year especially, with the ongoing debate over public-policy directions for the U.S. health-care system, the collective state of our health deserves our attention.

America`s Health Rankings’ 2009 report came out just recently, and as a two-decade continuous assessment of our nation’s health, it’s a great tool for checking how we’re doing and—I hope—springing us into some action.

The longest-running annual assessment of the nation`s health on a state-by-state basis, the rankings urges all populations and communities to take action to improve health.

There are some bright spots in the report: Over the past 20 years, our nation has seen improvements in the reduction of infant mortality (a 33 percent drop), infectious disease (down 53 percent), prevalence of smoking (down 33 percent), cardiovascular deaths (29 percent fewer incidents), violent crime (a drop of 23 percent), air pollution and children in poverty (8 percent reduction), and there has been an increase in immunization rates of 42 percent.

We deserve a very light tap on the back for these advances since our progress has been slow. Even smoking cessation efforts, which have been the focus of a very large public health effort, has left nearly one in five Americans still smoking. Childhood poverty—which had been going down consistently—has gone up in the past year by a percentage point.

The past 20 years have also been very challenging in two important measures of public health: Obesity prevalence has increased by 129 percent since 1990, and the rate of uninsured Americans has increased by 14 percent, and now stands at about 15 percent. And yes, obesity rates are still climbing and have gone up since 2008.

Let’s take a closer look at obesity.

Obesity rates are climbing fast. The average American man has added about 17 pounds in the past 20 years and the average American woman has gained about 15 pounds. About a third of Americans are obese, and if obesity continues to grow at the same rate, the report predicts 43 percent of Americans will be obese by 2018, and since excess weight drives health-care costs, our collective weight gain will add $344 billion to our health bill bottom line.

There’s also great disparity among different ethnicities, with minority groups showing overall higher rates of both obesity and smoking compared to non-Hispanic whites.

National and international comparisons

The report ranks states’ healthfulness taking into account a multitude of measures from high school graduation, violent crime rates, health funding and prenatal care to obesity, smoking, binge drinking, and cancer and cardiovascular deaths.

The state-by-state assessments add a nice sense of competition, and I’m sure you’d like to see how your state ranks in health compared to others (after you finish reading my post!). Ranks go from 1 (healthiest) to 50 (least healthy). The winner is Vermont, up from 4th last year, with its low rates of kids in poverty, low obesity rates ('only' 23% of the Vermont’s population), a high rate of high school graduation, and low smoking rates (8th in the nation). Vermont’s downside: a high rate of binge drinking and low immunization rates.

At the very bottom of the list is Mississippi, which has won the dubious rank of least healthy state in the nation eight times in a row. Mississippi remains uninsured, poor, uneducated, the most obese of the states and one of the highest consumers of cigarettes (44th in the nation).

The thinnest state is Colorado.

My home state of Pennsylvania is ranked 28th—making us totally in the middle and unremarkable—with a 2 point improvement from last year. Pennsylvania’s main strengths are a high rate of high school graduation (7th in the nation) and a relatively low rate of uninsured (7th in the nation). The challenges are air pollution and a high rate of infectious diseases, and of course obesity (36th in the nation)—that goes without saying, as all American states suffer from high rates of obesity. Even Colorado.

Besides encouraging a healthy sense of rivalry, these comparisons are a great resource to draw upon, and see how we can learn from other states and implement best practices for good health.

But the comparison to other developed countries is what deserves our greatest attention.

When we measure ourselves against other countries, the conclusion is obvious—and there’s no softer way to put it—we simply aren’t the best.

Healthy life expectancy is the number of years a newborn can expect to live a healthy and productive life. The Japanese are at the top, and enjoy 76 healthy years on average. We in the US rank 30th, are on par with the Czech Republic and Chile, and our average healthy lifespan is 70 years. We rank #37 in infant mortality among 193 countries rated.

We spend more on health care than any other country in the world yet have a lower life expectancy, less access to care, less patient safety and definitely less equity than many other countries.

A short quote from the report:

“Based on two decades of consistent tracking, the 2009 Rankings calls for the nation to change unhealthy behaviors that are contributing to preventable, chronic diseases as the key to improving our nation`s health. Trends cite smoking as the greatest health challenge of the past 20 years and warn obesity is likely to be the next national health battle. When it comes to our national pursuit of health, Americans have benefited from disease treatment while preventable illnesses continue to decrease quality of life for many. With focused attention, change is possible.”

The way ahead

As the U.S. health care-reform debate continues, we’re becoming increasingly aware of the staggering cost of treating disease.

But prevention and improving public health are still very much missing in the general conversation.

I’m not referring to screenings (and I definitely don’t want to get into the mammograms schedule issue); screening is usually aimed at early detection and timely treatment of disease, which is a very important, but quite different from prevention.

What I’m talking about is modification of risk factors and prevention of disease through simple and proven changes in lifestyle. Smoking, poor eating habits and inactivity contribute to chronic diseases in a big way, and we’ll have to put some serious effort toward modifying these risk factors in order to slow the rise in chronic illness and truly reform our health-care system.

The incidence of diabetes has doubled in a decade, and we know that improved diet, obesity prevention and physical activity are the key to reversing this trend in type 2 diabetes, which is costing us both unnecessary suffering and lots of money.

The late Ted Kennedy said this in 1994 about health-care reform: "What we have in the United States is not so much a health-care system as a disease-care system."

Not much has changed in the past 15 years. Although disease treatment has progressively improved, preventable illnesses prevalence is still rising, causing a lot of suffering and impairing the quality of life for many.

Please check out the useful Take Action resource section in the report, which can help individuals, employers, community leaders and health care professionals take concrete steps toward the goal of changing unhealthy behaviors and preventing disease.

There’s much we can do, both individually and as a nation, to improve our health and prevent disease.

Dr. Ayala

Recipes for a healthy and happy Thanksgiving

Thanksgiving is a time to give thanks, celebrate fall, and enjoy the bounty of nature and the company of family and friends.

I love this holiday because it’s so important to take a break from focusing on all the problems in our world and in our lives, and spend time reflecting on the good in the world. There’s much to be grateful for, even in hard times.

As a vegetarian cook I follow the traditional Thanksgiving meal quite loosely. The palette of my presentation will definitely abide by the customary colors: the oranges, browns and reds of squashes, pumpkins, cranberries and chestnuts; the typical green of green beans or a fresh salad; and the lovely yellow of corn and corn meal. But otherwise, I let the quality seasonal produce I find show me the way, and I allow myself freedom in interpreting the Thanksgiving classics.

This week, I want to share a few of my healthy Thanksgiving recipes, most of which can be prepared well in advance and require minimal “finishing touches” right before the big meal.

Wishing you a happy and healthy holiday,

Dr Ayala

Roasted squash and chestnut soup with mulling spices

This is a terrific fall soup, perfect for the Thanksgiving holiday. It’s easy to make, and requires no pre-prepared soup stock. The aroma of the mulled spices is festive and somewhat surprising in a soup.

Ingredients:

• 2 butternut squash, peeled, halved lengthwise and cored
• 1 large onion
• 1 tablespoon canola oil
• 1 pound peeled roasted chestnuts (you can find peeled chestnuts sold in jars)
• 1-2 tablespoons honey
• Salt and freshly ground pepper to taste

For the mulling spices:

• 2 cinnamon sticks
• 1 teaspoon whole allspice
• 1/2 teaspoon whole cloves
• 5 cardamom pods, bruised
• Orange peel zest (the outer colorful skin of the orange peel)--about half an orange

Preparation:

Preheat the oven to 350 degrees F.

Place the squashes, cut-side down, on a baking pan and bake until tender, about 30-40 minutes. Cut into large chunks.

Gather the mulling spices into a muslin bag, tea ball or cheesecloth pouch. (The orange peel and cinnamon sticks can be allowed to roam free in the pot; they’ll be easy to fish out.)

In a large soup pot, over medium-high heat, sauté onions until translucent.

Add the chunks of roasted squash, honey, salt, pepper, and half the chestnuts.

Add water to cover by 1.5 inch and bring to a boil, then lower to a simmer.

Add the mulling spices, including the orange peel and cinnamon sticks.

Simmer over moderate heat for 20 minutes. Remove from heat. Remove the mulling spices, orange peel and cinnamon sticks.

Puree the soup with an immersion blender. (This is an inexpensive kitchen tool that saves a lot of cleanup. Immerse the blender into the pot in which the food has been cooked, and easily puree it with a switch of a button. If you don’t have an immersion blender you can use a blender or food processor.)

Crumble the remaining chestnuts into the pureed soup.

Taste and correct seasoning by adding ground cinnamon, more salt or some more freshly ground pepper.

To serve:

Garnish with freshly toasted pumpkin seeds (an excellent source of omega 3), and/or a cinnamon stick.

Serves 8-10.

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Roasted red and golden beets, with reduced balsamic vinegar

Beets are easy to find, especially between spring and fall. They make for a very simple, delicious, healthy dish that epitomizes fall color to me.
If you can find golden beets, they make for a delightful color contrast with the red beets. They also taste really great.

Ingredients:

• 3 medium red beets, rinsed, not peeled
• 3 medium golden beets, rinsed, not peeled
• 1/2 cup balsamic vinegar for reduced balsamic glaze
• Fresh herbs to garnish (chives, parsley or tarragon)
• Salt and freshly ground pepper to taste
• Optional - fresh goat cheese (chèvre)

Preparation:

Preheat the oven to 400 degrees F.

Wrap each beet in aluminum foil and place in pan in the oven.

Roast until tender and easily pierced with a fork, about 45 minutes to 1 hour.

Remove from the oven and let cool.

When beets are cool enough to handle, peel and slice them. (Red beets can be peeled and sliced in advance. Golden beets change color when exposed to air, so slice just before serving.)

To make reduced balsamic glaze: In a small pan over high heat, bring vinegar to a boil, then reduce heat to medium, and evaporate balsamic until quantity halves and turns to a light syrup.

Drizzle reduced balsamic over the beets.

Season with salt and freshly ground black pepper.

Garnish with fresh herbs, and add goat cheese if desired.

Serves 8-10 as a side dish.
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Wheat berry salad

Whole grains are important part for healthy nutrition. Wheat berries are the most wholesome and least processed wheat grain and include the entire wheat kernel—the bran, germ and endosperm. (For comparison, white flour is comprised only of ground endosperm.)
Look for wheat berries in the health food store or in the natural foods section of the supermarket. (Whole Foods usually sells them in bulk, which is great!) I like the hard red wheat berries, which are very high in protein, very nutritious, and have a sweet nutty flavor and a lovely chewy texture.

The trick with hard wheat berries is to plan ahead and soak them overnight. These grains are very hard indeed, and will require a very long cooking time if they’re not well-soaked.

This is a very simple recipe, and a dish everyone seems to love.
Ingredients:

• 1/2 cup wheat berries, soaked overnight
• 1 large ripe mango (can be replaced with oranges or persimmon), cut into cubes
• 3-4 celery stalks, with the fibery outer parts peeled and diced
• 10 dates, pitted and finely chopped (can be replaced by another dried fruit)
• A handful of dry cranberries
• A handful of nuts, such as roasted almonds, candied pecans or walnuts

Dressing:

• 1 tablespoon of a fine sweet and interesting marmalade. I use organic Adriatic fig spread (sold at Whole Foods)
• 2 tablespoons extra virgin olive oil
• 1 tablespoon balsamic vinegar
• 1 sprig of thyme, finely chopped

Preparation:

Cook the wheat berries by covering them with two inches of water, then bring them to a boil, lower the temperature to simmer, and cook until chewy—about 20-30 minutes. Drain and let cool.

Add all other salad ingredients besides the nuts.

Combine dressing ingredients.

Add the nuts and dressing right before serving.

Serves 6-8 as a side dish.
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Roasted French string beans with toasted sesame

Ingredients:

• 1 pound French string beans, both ends removed
• 2 tablespoons olive oil or toasted sesame oil
• 2 tablespoons sesame seeds
• Freshly ground black pepper and salt to taste
• A pinch or two of red pepper flakes (optional)

Preparation:

Preheat the oven to 400 degrees F with the oven pan in the oven.

Toss the string bean with the oil and spices.

Spread the beans in one layer on the pre-warmed oven pan.

Bake for 3-5 minutes, until beans become slightly brow and are sizzling, but are still very crunchy and vibrant.

Correct the seasoning by adding salt or pepper.

Serve hot, or at room temperature.

Serves 8-10 as a side dish.
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Pecan yeast “roses” cake

Pecan yeast “roses” cake is a perfect indulgence for the close of the Thanksgiving meal and a fresh take on pecan pie.
This isn’t a difficult recipe--yeast dough is actually easy to work with. The only real challenge is mastering the patience. You’ll have to factor in the rising time the dough needs to fully develop.
The “roses” part of this cake’s name comes from the delicate shapes formed on the individual cakes.

Ingredients:
For basic sweet yeast dough:

• 3 1/2 cups unbleached flour (I use King Arthur’s bread flour. All-purpose is fine too. Bread flour is a high-gluten flour called for in many bread and pizza crust recipes where you want the loftiness or chewiness that the extra gluten provides. All-purpose flour is made from a blend of high- and low-gluten wheats, and has a bit less protein than bread flour.)
• 1/2 cup sugar
• 1/2 cup milk
• 1/2 cup heavy cream
• 3 tablespoons melted unsalted butter
• 2 yolks
• 1 envelope rapid-rise yeast
• 1/2 teaspoon salt

For the pecan filling:

• 2 cups pecans, finely chopped (in the food processor or blender)
• 1 cup sugar
• 2 tablespoons butter
• 2/3 cup milk

Preparation:

To make the dough:

If you happen to own a bread machine, put all the ingredients in the mixing bowl and use the dough setting.

If kneading by hand: Put all the dough ingredients in a bowl, combine to make dough, and knead for about five minutes, until the dough is soft and elastic and not sticky at all. (Add a bit of extra flour or milk if you haven’t reached a really workable dough within five minutes, but that rarely happens with this recipe.)

Cover the bowl with a clean kitchen towel, and let sit for an hour and a half in a warm place, until the dough doubles its volume.

To make the filling:

Combine milk, sugar and butter in a small pot and bring to a boil, then lower to a simmer.
Add the nuts, and continue stirring on low heat for a minute or two.

Remove from heat and let chill completely. (The filling may seem too watery for handling when warm. Don’t worry. Its consistency will improve as it cools down.)

Putting it all together:

Roll the dough on a lightly floured surface to a rectangle, about 25 by 20 inches. Don’t be lazy! If you fail to roll it big enough the cake will have fewer leaves and too much dough between the nut layers. Rolling to a thin sheet is really important!

Spread the pecan filling on the dough and roll the dough.

Cut the roll crosswise into 2 inch pieces and place on a greased 10-inch spring pan, cut side up (will make 12-15 rolls).

Let rise again for about one hour.

Heat the oven to 350 degrees F.

Bake in the heated oven for 25 to 30 minutes, until golden brown.

Remove from oven and let chill on rack.

Serving suggestions:
The cake can be cut to slices (my preference) or separated into its rolls by hand.
This cake pairs very nicely with apple sauce, fresh berries or more simply, a steaming cup of herbal tea.

Serves 14-20
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How do low-carb diets affect mood?

The promise of many popular diets often includes not just weight loss, but a happier outlook. Yet, a new study shows that the expected mood improvement—the added perk usually seen when losing weight—seems to be short-lived in successful dieters on a low-carb diet.

The low-carb diet debate is one that doesn’t seem to want to fade away. The diet itself is an old one. The idea that eliminating most carbs as a weight-loss strategy is an idea that preceded Dr. Atkins by more than a century. There are many types of low-carb diets with varying restrictions on the types and amounts of carbohydrates permitted. Just like other diets, they work as long as you eat fewer calories.

Their relative popularity is at least partially because proponents find low-carb diets easier to follow: It may be that a low-carb diet produces more satiety and reduces appetite, and the initial weight loss might be greater than with other diets (although some of that initial weight loss advantage is probably explained by greater water loss).

Whether a low-carb diet is a sustainable plan is a whole different issue.

In order to lose weight on low-carb diet one needs to reduce total calories and do so over the long-term. Unfortunately, low-carb diets generally aren’t easier to stick to over the long run and the long-term weight outcomes of low-carb diets are no different than those of other diets. In fact, a large study published in the New England Journal of Medicine compared low-carb and low-fat diets and found that after a year, people dropped out of both diets at similar rates.

Many experts also worry that a low-carb diet, which replaces carbohydrates with foods containing a higher percentage of proteins and fats and especially saturated-fats, isn’t a healthy way to eat over a long period of time. Studies of low-carb diets continue to examine their effect on a multitude of end results, from heart health, atherosclerosis and kidney function, to Alzheimer’s, cognition and now—mood.

A recent study in the Archives of Internal Medicine compared participants’ long-term mood and cognition when undertaking low-carb and low-fat diets.

A total of 106 overweight and obese participants were randomly assigned to either a low-carb or low-fat diet for one year. Both diets were similar in calories and only moderately energy-restricted, with an average of about 1,400 calories for women and about 1,700 for men.

Mood was checked four times throughout the study year using validated questionnaires and looking at many aspects of mood, including tension, anxiety, depression, dejection, anger, hostility, vigor, fatigue and confusion. Cognitive function was also tested.

And the results:

• Eight weeks into the diet both groups reported similar marked improvement in mood.

• After the initial eight weeks, mood scores started to differ significantly and the low-fat group clearly outperformed the low-carb group in mood scores.

• In the low-fat diet group the majority of mood measures, including the measures for anger, depression and confusion improved long-term and mood was generally better than it was at the beginning of the diet.

• In the low-carb diet group, after an initial improvement in mood the majority of mood measures, including the measures for anger, depression and confusion returned to baseline level (before weight loss), and the positive mood lift was short lived.

• Both groups achieved similar weight-loss results.

• Cognitive functioning tested working memory and speed of processing, and both groups scored similar scores at one year.

Psychological well-being is one of the many health perks one gets from dieting, and at least in this long-term study, the low-carb diet didn’t achieve the sustained elevated mood that the regular low-fat one did.

The authors offer a few hypotheses to explain their finding:

Western diet eating patterns rely on carbs—bread, pasta, rice and fruit are quite central to our cuisine. Low-carb diets are far removed from our normal eating habits, and may create a sense of food preoccupation, social eating impairment and isolation, and may therefore result in a bad mood.

The other explanation is quite intriguing: low-carb diets may change the brain’s chemistry. Low serotonin levels in the brain are known to be linked to depression and anxiety (many antidepressant drugs work by making serotonin more available in the brain). A high-carb diet may increase serotonin production, and a fat- and protein- rich diet may reduce serotonin concentrations in the brain. Therefore, a low-carb (which is also high in protein and fat) diet may decrease serotonin levels and have a negative effect on moods. Serotonin may be only one of the brain chemicals affected by a low-carb diet.

Who is the fairest of them all?

The weight-loss industry is huge—we spend $40 billion a year on weight-loss and diet advice just in the U.S.; the diet business, unlike the American people, is always in great shape.

Each diet boasts its superior results, ease of use and testimonials from happy thin people, exemplifying the most positive outcome possible with no mention of the average results achieved by most dieters, so I think some reality checks are always welcome.

Whenever I see so many products on the market, it’s a clue that maybe none of them has a clear advantage. While all diets that prescribe an energy deficit—fewer calories consumed than calories expended—should work, the problem remains that only five percent of dieters manage to maintain their lower new weight for very long; most dieters typically slowly return to baseline weight in three to five years. In other words—all diets work but actually none of them really does. Our old eating habits are comfortable, and we are prone to fall back on them.

So which is the best diet? You’ll get many different answers and plenty of advice from experts. My point of view isn’t based on personal experience—I don’t diet—but rather on general health advice and common sense: I prefer diets that promote healthy eating habits, moderation, are balanced nutritionally, and resemble habits you can see yourself adopting long-term.

A better diet plan is one that’s both healthy in the long-term and sustainable. The more the weight-loss diet resembles the weight-maintenance diet habits you need to adopt in order to remain at your new weight, the better it is, as acquiring new eating habits is the ultimate challenge.

These general rules of course exclude fad and crash diets, such as the cookie, milkshake and cabbage soup diets, as well as extremely low-calorie diets. Any diet with “miracle” or “easy” label on it should be highly suspect—there are no miracles (sorry!) and losing weight and keeping it off is never easy.

And because losing weight and keeping it off is so difficult, we need to emphasize obesity prevention. Good eating habits, physical activity and a healthy food environment are the best tools to minimize the chances of ever needing to diet.

Dr. Ayala

Are we exercising less or eating more?

There are many compelling reasons to exercise. Regular physical activity has been shown to reduce the incidence of heart disease, diabetes and hypertension. It improves mental health, fosters strong muscles and strong bones. It also makes most participants happier and improves our looks.

Physical activity also burns calories. In the past few decades exercise has therefore become one arm of the two pronged approach to combat overweight and obesity. Exercise is the calories expended in the equation; food intake is the calories we take in. Any change in the balance of calories in and calories out that leaves us calorie depleted would, assumingly, lead to weight loss. The best approaches to overall health and weight maintenance employ both increased exercise and calorie restriction.

Inactivity has also been blamed for our weight gain. Our life has indeed become much more sedentary, as the car replaced walking, as convenience and mechanization crept into every aspect of our lives and as we started spending hours without end watching TV.

But blaming inactivity has also become a way for the fast food and processed food industry to escape any responsibility for the highly palatable and calorie-dense foods they produce and promote. It’s of course inconvenient for food manufacturers and for us individually to admit that we’re eating too much; it seems we’d all like to believe that we can just burn a lot more calories through physical activity and allow the party to go on.

Blame games are generally useless, but if we are to address the obesity crisis rationally perhaps it's worthwhile to look at the relative contribution of inactivity and overeating to our weight gain.

Surprisingly enough, there are now serious questions emerging about whether inactivity has contributed to the expanding American waistline in any significant way.

A new study in Obesity Reviews looked at adolescents’ activity levels and asked two questions:

Are American adolescents getting enough physical activity?

And

Have adolescents become less active over the past fifteen years or so?

The reviewers examined nationally representative Youth Risk Behavior Surveillance Surveys taken since 1991, which provide information on adolescents’ physical activity (such as swimming, soccer, running, etc.), physical education at school and sedentary behaviors, such as watching TV and playing video games. Sample sizes were large, ranging from about 11,000 to 16,000 participants each year.

Let’s start with the not-so-great news:

• Only a minority—about a third—of our adolescents met the recommended daily levels for physical activity. (Optimal physical activity is any activity that makes a person increase their heart rate and breathe hard for at least 60 minutes, at least five days a week.) More boys met these criteria than girls, as did more Caucasians compared to minority youths.

• Most participants—about two-thirds of the study population—reported what this study defines as “sufficient vigorous physical activity”—activity that makes a person increase their heart rate and breathe hard for at least 20 minutes, at least three days a week.

On the other hand, the data shows that American adolescents have not decreased their level of physical activity; physical activity levels have been quite stable over the past 17 years. During the same period of time studies show that obesity rates in kids had more or less doubled.

There were also a few encouraging trends:

• Physical education class attendance and engagement have improved.

• TV viewing time had decreased significantly in the past few years (although that doesn’t mean TV hasn’t been replaced by other media, such as the Internet and computers).

The authors, led by Youfa Wang, summarize by saying: “Reduced PE (physical activity) is not likely the major explanation of the recent increase in obesity among U.S. adolescents.”

Another recent study in the American Journal of Clinical Nutrition looked at the relative contributions of food and exercise habits to the development of the obesity epidemic, and concluded that the rise in obesity in the United States in the last three decades was virtually all due to increased energy intake.

These studies, and several others, suggest that the main driver of the obesity epidemic is increased food intake. Increasing physical activity has to be part of the solution because exercise is so very good for health and helps us lose weight, but in order to address the obesity crisis head-on, we have to face the fact that the main target of our efforts needs to be reducing our caloric intake.

We probably can’t—as a society—increase our energy expenditure to compensate for our levels of food consumption. We’d better be realistic about this.

The American Journal of Clinical Nutrition study cited above suggests that to get U.S. kids back to the mean weights we saw in the 1970s, kids would need to decrease their average daily intake by 350 calories/day, or walk an extra two and a half hours daily (while eating the same amount, which is no easy task since exercise drives hunger). Both options seem difficult, but the latter appears totally implausible.

Please don’t misunderstand me; I know the importance of physical activity and truly believe in its critical value. Exercise does help in weight loss and improves health, even if no weight is lost.

But I don’t think physical activity without a serious look at what and how we eat will likely get us and our kids out of the obesity crisis.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Walnut yeast “roses” cake: a delicious indulgent dessert

If the photo of this golden, brown delicacy wasn’t enough to whet your appetite, let me describe the smell: It’s the essence of childhood dreams, the aroma of pleasure itself. At least for me.

Clearly I’m digressing this week from veggie and whole grain recipes and the science of healthy living to the aroma of baked cakes. Well, I do make desserts, and am very much into indulgent ones. I don’t serve dessert every day but I’ll conclude every festive weekend meal with one, and I’ll always leave room for dessert when we eat out.

So for those of you who’ve asked what’s in my pantry besides the obvious healthy foods—I always have butter, heavy cream and the best baking chocolate I can find. I don’t replace the classic ingredients with anything else and never have. I believe that a reasonably small portion of a heavenly dessert will satisfy without breaking your calorie budget and is well worth its saturated fat.

Walnut yeast “roses” cake is just that type of creation.

This isn’t a difficult recipe, but I want to start with a note on yeast dough.
Yeast dough actually is easy to work with; the only real challenge is mastering the patience.

In fact, yeast dough teaches an important life lesson: Sometimes, all you need to do is let a little time pass.

You don’t need to wait passively; the dough won’t rise when you’re watching it. The patience of yeast dough is of the “let go, and things will happen” type. Leave your dough alone and go about your day. You’ll later find the yeast were hard at work for you and doubled your dough. Waiting for the yeast has been a good lesson for me—I tend to be a whirlwind of activity, and learning to wait has served me well as a parent, friend and doctor.

Working with yeast has also deepened my understanding that real food is part of the natural world around us. As such, there’s lots of variability, and each kitchen adventure won’t be exactly the same. I always manage to make reasonably good yeast dough, but even with the apparently same ingredients I find there are good dough days, and days when the dough is more of a challenge. Humidity, temperature, the physical action of kneading the dough and the yeast’s liveliness all affect the final outcome.

So here goes.

Ingredients:

For basic sweet yeast dough:

• 3 1/2 cups unbleached flour (I use King Arthur’s bread flour. All-purpose is fine too. Bread flour is a high-gluten flour called for in many bread and pizza crust recipes where you want the loftiness or chewiness that the extra gluten provides. All-purpose flour is made from a blend of high- and low-gluten wheats, and has a bit less protein than bread flour.)
• 1/2 cup sugar
• 1/2 cup milk
• 1/2 cup heavy cream
• 3 tablespoons melted unsalted butter
• 2 yolks
• 1 envelope rapid-rise yeast
• 1/2 teaspoon salt

For the walnut filling:

• 2 cups walnuts, finely chopped (in the food processor or blender)
• 1 cup sugar
• 2 tablespoons butter
• 2/3 cup milk

preparation:

To make the dough:

If you happen to own a bread machine, put all the ingredients in the mixing bowl and use the dough setting.

If kneading by hand: Put all the dough ingredients in a bowl, combine to make dough, and knead for about five minutes, until the dough is soft and elastic and not sticky at all. (Add a bit of extra flour or milk if you haven’t reached a really workable dough within five minutes, but that rarely happens with this recipe.)

Cover the bowl with a clean kitchen towel, and let sit for an hour and a half in a warm place, until the dough doubles its volume.

To make the filling:

Combine milk, sugar and butter in a small pot and bring to a boil, then lower to a simmer.

Add the nuts, and continue stirring on low heat for a minute or two.

Remove from heat and let chill completely. (The filling may seem too watery for handling when warm. Don’t worry. Its consistency will improve as it cools down.)

Putting it all together:

Roll the dough on a lightly floured surface to a rectangle, about 25 by 20 inches. Don’t be lazy! If you fail to roll it big enough the cake will have fewer leaves and too much dough between the nut layers. Rolling to a thin sheet is really important!

Spread the walnut filling on the dough and roll the dough.

Cut the roll crosswise into 2 inch pieces and place on a greased 10-inch spring pan, cut side up (will make 12-15 rolls).

Let rise again for about one hour.

Heat the oven to 350 F.

Bake in the heated oven for 25 to 30 minutes, until golden brown.

Remove from oven and let chill on rack.

The cake can be cut to slices (my preference) or separated into its rolls by hand.

Serving suggestions:

This cake pairs very nicely with apple sauce, fresh berries or more simply, a steaming cup of herbal tea.

By the way, the “roses” part of this cake’s name comes from the delicate shapes formed on the individual cakes.

Enjoy,
Dr. Ayala

Other dessert posts:
Healthy summer frozen treats and the dreaded brain freeze
Whole wheat banana bread with mint sauce

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Healthy neighborhoods can reduce the risk of diabetes

Do you live in a healthy neighborhood?

Is there such a thing as an unhealthy neighborhood?

Personal choice has a big impact on many aspects of our health, but do we really have the wherewithal to choose our lifestyle, or do most of us fall into a pattern determined by what’s easy to do and what everyone else is doing? Sure, there are a few motivated individuals who swim against the stream and set their own trend. Most of us don’t. Whether we realize it or not, we follow the lead of our parents and friends and do what’s easy along a path of least resistance.

There’s no doubt that our collective lifestyles have changed dramatically in the past decades. Convenience is everywhere—we do less physical work around the house, we drive a lot, and cheap highly processed calorie dense foods are everywhere.

But as I’m sure anyone driving through urban and suburban neighborhoods observes, there are great differences between regions. Some neighborhoods have green spaces, joggers, bikers, kids playing outside and farmer's markets and supermarkets with colorful inviting fresh produce. Not far away there are neighborhoods where all life is within four walls, fresh food sources are limited and corner and convenience stores are the sole resource for food.

Can a neighborhood influence health?

That’s a question researchers headed by Amy Auchincloss set out to answer in a recent paper in the Archives of Internal Medicine. They wanted to see if neighborhood’s physical attributes and the availability of healthy food affected the incidence of type 2 diabetes.

The researchers followed 2,285 people, aged 45-84 years at baseline, from three different regions in the US for five years for the development of diabetes. Among the data collected was income, assets, educational level, family history, smoking status, body mass index (BMI), exercise level and dietary measurements.

The data on neighborhood resources was obtained from an independent sample of the participants’ locales (not from the study population). The residents were asked if their neighborhood was easy or pleasurable to walk in, has ample opportunity for physical activity, or if they see other people jog or play sports. The food environment was determined by asking whether there’s a large selection of fresh fruits and vegetables available, whether produce is high quality, and whether there’s a large selection of low-fat products available.

During follow-up, 233 of the study participants (about 10 percent) developed type 2 diabetes.

And the result: Better neighborhood resources for food and exercise were associated with lower incidence of type 2 diabetes

• Participants living in great neighborhoods for activity and healthy food had 36% less chance of developing type 2 diabetes than their counterparts living in neighborhoods with poor resources for activity and healthy food.

• After adjusting for individual variables—such as age, family history of diabetes, socioeconomic status, smoking, physical activity and dietary factors—the environmental association persisted.

• The association was slightly reduced after also adjusting also for BMI.

The authors conclude:

“The prevalence of type 2 diabetes has increased substantially in the past 30 years. This makes it all the more urgent to identify environmental features that may mitigate risk of type 2 diabetes. Our results are consistent with the hypotheses that improving environmental features—such as having nearby, pleasant, safe destinations within walking distance and improving the availability of healthy foods—may halt increases in type 2 diabetes incidence. Many urban environments have developed with insufficient consideration for the ways that environments can promote or discourage healthy behaviors.
Current efforts to foster health-promoting environments include designing and modifying physical environments, such as zoning residential neighborhoods to require safe sidewalks, creating parks and attractive public green spaces, and improving public transportation so that residents rely less on their cars; supporting fresh-food farmers' markets in low-income, urban neighborhoods; and assisting stores in those neighborhoods in improving their selection of healthy foods.
There is unlikely to be a panacea for the obesity epidemic and rising epidemic of type 2 diabetes. However, altering our environments so that healthier behaviors and lifestyles can be easily chosen may be one of the key steps in arresting and reversing these epidemics.”

An accompanying editorial by Mitchell Katz discusses how hard it is to tease apart environmental and individual behavior influences on health. This study is by no means the last word on this complicated issue. But Katz sees us all as participants in a huge multinational study of the impact of the structural environment on diabetes.

In the past 50 years we in the developing world have stopped walking, our household chores are now reduced to pushing a button, fast food and super-sized meals replaced our food, and processed foods are easier to find than fresh fruits, vegetables and whole grains. And while a cause and effect is hard to prove, Katz sees this grand experiment going really badly—these environmental changes coincide with skyrocketing rates of obesity and diabetes all around the developed world.

Katz calls for a change in our environment, one that would make exercise and eating right much easier and more routine.

A closer look at an unhealthy neighborhood

From my home town, Philadelphia, comes a new study in Pediatrics led by Kelley Borradaile which investigates one aspect of an unhealthy neighborhood—the corner store and its impact on kids’ snacking habits.

The study looked at kids’ purchase patterns in urban corner stores, the small stores readily found in Philadelphia’s low-income neighborhoods. These stores carry high-profit less perishable items, which tend to be packaged foods low in nutrients and high in calories. These stores are very close to schools, and in some neighborhoods are the only convenient store, as supermarkets are absent.

As it looked at what kids in the fourth to sixth grade bought at the corner store next to their school on the way to or back from school, the study found that:

• Kids stop at the corner store frequently: More than half of the shoppers stop by daily; almost 30 percent reported stopping by twice a day.

• The average purchase supplies kids with about 360 calories.

• The most frequently bought items were (no surprise) chips, sugary drinks and candy.

• These calories are real cheap—360 calories cost a little over a dollar! For 25 cents, you get a bag of chips or a sugary drink at the corner store.

As the authors discuss, having a corner store next to school qualifies as an environmental and behavioral risk factor for obesity.

These inequity issues are deeply troubling to me. While we have to accept that there are inborn inequities we cannot change—such as the genetic risk for disease—can’t we work toward more of an equal opportunity for a healthy lifestyle for all of us?

A community with walkable, safe streets, safe and pleasant playgrounds and green spaces, and fresh produce for a reasonable price should be accessible to everyone. It should be a basic human right. It’s also likely to save a lot of healthcare dollars and make us happier.
Dr. Ayala

Related posts: When Healthy Food is Hard to Find

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Coke did make America fat

Coca-Cola’s CEO Muhtar Kent recently wrote a much viewed op-ed in the Wall Street Journal titled “Coke Didn't Make America Fat,” in which he claims Americans need more exercise, not another tax, and should “enjoy the simple pleasures of a Coca-Cola.”

While it’s perfectly understandable that Mr. Kent would fight the soda tax idea—not because it threatens American’s freedom to choose, but because it will undermine soda companies’ profits and image—the article includes so many untruths and misleading statements that it begs a fact check and a response.

First off, I’ve read many of the proposals for a soda tax, and nowhere have I seen them selling it as “the solution” to our obesity issues. But it is one tool in what needs to be a very large tool box.

(Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.)

Now, let's look at a few of Mr. Kent's points:

Kent: “Sugar-sweetened beverages have been singled out in spite of the fact that soft drinks, energy drinks, sports drinks and sweetened bottled water combined contribute 5.5% of the calories in the average American diet, according to the National Cancer Institute."

Not true! Sugary drinks are a major contributor of calories in American’s diet. The caloric contribution of added sugar from soft drinks in the average American's diet is much greater than what Mr. Kent cites. We can only wish the average American consumed 5.5% of their calories from sugary drinks. Studies show that they take in 2-3 times that!

A recent study published in the American Journal of Clinical Nutrition shows that the number of adults consuming sugar-sweetened beverages has increased dramatically in the past two decades. Two-thirds of adults now consume sugar-sweetened beverages, with an average daily intake from sugary drinks of almost 300 calories, or 15% of the 2,000 calories/day recommended for the typical diet.

Another recent study in Obesity paints an even grimmer picture: The average American gets twice as many calories from beverages as they did in the 1960's. The study quantified trends and patterns in beverage consumption among 46,576 American adults using nationally representative surveys of food intake, and over the past four decades total daily intake of calories from beverages increased by 94 percent.

I’m not sure where Mr. Kent found the 5.5% figure. What’s easier to find and ever present in the National Cancer Institute’s materials is a recommendation to stick to unsweetened beverages—such as water—in order to control weight and prevent obesity, which is an important risk factor for many types of cancer.

Perhaps an even better cancer-prevention resource is the World Cancer Research Fund and the American Institute for Cancer Research report, which looked at huge amounts of research and advises clearly: “Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.” Sugary drinks were targeted specifically in one of their recent reports where they wrote, “Such beverages appear to exert little influence on total daily self-selected energy intakes and their habitual consumption can lead to rapid and sustained weight gain even in the face of restricted solid food intake”.

Sugary drinks are different from other caloric dense foods

Kent: “It's difficult to understand why the beverages we and others provide are being targeted as the primary cause of weight gain when 94.5% of caloric intake comes from other foods and beverages.”

This is not difficult to understand at all! Some eating patterns are more conducive to overeating and overconsumption. Paramount among the foods that lead to an overconsumption pattern are sugary drinks.

There’s mounting evidence showing that when we drink beverages with calories we don’t compensate by eating less food (we might even eat more food), and that calories in liquid form produce less satiety than solid calories.

There are many studies to prove this point: In the cute Jelly bean study, researchers gave men and women 450 calories a day of either soda or jelly beans for a month, then switched them for the next month and kept track of total consumption. Candy eaters ate less food to compensate for the extra calories. Soda drinkers didn’t; they ate more calories than usual. Nutritionist Barbara Rolls from Penn State gave women water, diet soda, regular soda, orange juice, milk or no drink before lunch. Those given caloric beverages consumed about 100 calories more than those given diet soda, water or no beverage at the meal, without significantly affecting satiety ratings.

There’s also little question that sugary drinks are not just randomly associated with obesity, but actually contribute to it in a big way. Dozens of studies prove a connection between sugary drink consumption and obesity, and the only so-called “research” that tries to introduce doubt about this sad conclusion is industry-sponsored.

Taxing soda may very well change behavior

Kent: “Will a soft drink tax change behavior? Two states currently have a tax on sodas—West Virginia and Arkansas—and they are among the states with the highest rates of obesity in the nation.”

Actually, dozens of states impose some type of sales tax on sodas or snack products exceeding the standard state sales tax for food. The additional tax on soda is usually rather small.

Looking at The Kaiser Family foundation’s map of states with additional sales tax on soft drinks paints a clearer picture of which states have higher taxes on soda; neither West Virginia (2 percent tax) nor Arkansas (0 percent tax) are one of them.

The states with the highest soft drink tax are Rhode Island (7 percent), New Jersey (7 percent), Washington (6.5 percent) and Minnesota (6.5 percent). I’m not suggesting correlating soda taxation and obesity makes any sense—there are many other confounding variables—but since Mr. Kent suggested the method, lets humor ourselves and see how the high soda tax states rank in obesity rates (a scope of “1” would be the most obese state; “50” the thinnest) Rhode Island scores 46, New Jersey-42, Washington-32 and Minnesota-30. Eerie, isn’t it? The higher the soda tax the thinner the people!

Here’s a more scientific way to look for a correlation: A study in the American Journal of Preventive Medicine looked at the association between the presence of a soft drink/snack tax in the years 1991-1998 and the increase in obesity rates for those years at the state level. Adjusting for age, income, race on other variables, they found that states without a soft drink tax were more than four times as likely to have a high increase in obesity prevalence, and that states that repealed a soda/snack tax between 1991-1998 were more than 13 times more likely to see a high increase in obesity.

This data doesn’t prove that a tax reduces consumption—there can be other explanations: Maybe states in which a tax policy could be passed are those in which social norms act against obesogenic behaviors anyway. But it is encouraging data.

I’m sure that Mr. Kent predicts the tax will reduce consumption; that’s why the beverage industry opposes this idea so vehemently.

Lack of exercise didn’t make us fat; more exercise without cutting calories won’t make us thin

Kent: “If we're genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it's not just about calories in. It's also about calories out.”

Kent is right in his encouragement to be more active and spend less time in front of the TV. Exercise is very important to health, but won’t get us anywhere near an energy balance.

New research in the American Journal of Clinical Nutrition looked at the relative contributions of food and exercise habits to the development of the obesity epidemic and concluded that the rise in obesity in the United States in the last three decades was virtually all due to increased energy intake.

We need to be more active—no doubt about that—but that won’t exempt us from having to change our dietary habits. Even if we all met the recommendation of thirty minutes of vigorous exercise every day, we’d still need to cut our intake of sugary drinks and make them an infrequent special treat. Exercise just isn’t enough of an answer to our caloric imbalance. In order to reverse the obesity epidemic we’d need to add more than two hours of exercise every day; it’s much more realistic and logical to just cut out the soda and French fries.

The American Heart Association, American Academy of Pediatrics and many other medical authorities call for a severe reduction in the amounts of added sugar in our diet regardless of activity levels; high amounts of sugars have been linked not only to obesity and overconsumption, but also to high blood pressure, high triglycerides, diabetes and shortfalls of essential nutrients.

Many solutions are needed to address the obesity crisis--curbing the soda habit is an excellent way to start

Kent: “But a number of public-health advocates have already come up with what they think is the solution: heavy taxes on some routine foods and beverages that they have decided are high in calories.”

As noted earlier, I’ve not seen a soda tax being sold as “the solution” anywhere.

Wendell Berry said “Great problems call for many small solutions.” Obesity’s a big problem, and taxing sugary drinks can be one of the solutions.

Tax or no tax, drinking less soda has to be part of the solution—soda and sugary drinks are the number one source of added sugar in the American diet. Perhaps just talking about the soda tax informs more people about the adverse effects sugary drinks have on our waistlines and health. The conversation alone might be enough to motivate a change in habits.

But drinking fewer sugary drinks won’t be enough. Increasing physical activity also needs to be one of the solutions. On that point, Mr. Kent and I agree 100%.

Who wouldn’t?

Dr. Ayala

Related posts:
Health experts favor taxing sugary drinks in new report

Could a tax on junk food drive healthier choices?

Food, nutrients and relief from the common cold

Medical science has no cure for the common cold; symptomatic relief is the best we can offer as we wait for our body to overcome the viral illness.

Although the common cold is generally a mild disease and poses no real threat to overall healthy people it can be quite unpleasant. As a mom and a physician I really like having some helpful, natural, inexpensive common sense therapies to prescribe.

A good number of the methods used today haven’t changed much since my grandma’s time: Her advice was drink lots of liquids, get plenty of rest and eat chicken soup, but every grandma’s different and home remedies change from culture to culture.

Most of these home remedies pose no harm, and are well worth a try, even if there’s only an anecdotal notion of benefit. But I wanted to see if any of the remedies have attained enough scientific support through rigorous research so that we can now firmly say these kitchen-based medicines work better than a placebo, and there’s more than suggestion in their mechanism of action.

So, I headed to the online Cochrane library looking for reports on some of these natural remedies.

Before I get into the details of what I found, I’m sure you’ve been wondering how we make sense of study results when one study shows one finding while another study refutes those results. The experience can leave everyone quite confused, not knowing what to believe. But this is how the scientific method works. It’s only through refining and repeating studies that we can arrive at a tentative conclusion. The Cochrane reviews aim to do just that—take into account only the best of studies, and see if there’s enough evidence to prove efficacy.

The global Cochrane Collaboration is an independent network of volunteers that doesn't accept conflicted funding, and whose mission is to gather the best available evidence, summarize and interpret the results and make them readily available as a resource for evidence-based medicine on which to base scientifically grounded health-care decisions. (The full reports require a subscription, but the abstracts and summaries are free.)

Now, here are some interesting findings from the library:

Garlic

Garlic’s is a common-cold remedy handed down for generations in my husband’s family, and while I love garlic in cooking and use plenty of it, the result of a spouse consuming half a head of raw garlic is offensive to my nose. I just hate it! I admit I’m biased here; I really wanted this one to be proven ineffective.

The Cochrane report authors looked for randomized controlled trials of common-cold prevention and treatment comparing garlic with placebo, no treatment or standard treatment, and found five such studies with only one fulfilling their criteria. The study included 146 people and found that people who took garlic (in supplement form) every day for three months had fewer colds and fewer days of illness with a cold than people who took a placebo. They found no information from randomized, controlled trials about whether taking garlic at the time of a cold reduces either symptom severity or the number of days of illness.

They conclude:

“While this one study was positive, there is a need for large, high-quality randomised controlled trials to support these findings. Possible side effects in this small trial included odour and a skin rash. More information is needed about the possible side effects of garlic.”

Honey

Honey has been used from ancient times for many medical purposes, from wound healing to respiratory relief. Mixing honey into warm milk, tea or juice is a time-honored sore throat soother and cough suppressant.

The Cochrane reviewers looked for randomized, controlled studies comparing honey to placebos for the treatment of chronic cough, and found none that were applicable for review. In other words, there are no good studies out there, therefore no proof for or against honey for a four- week-old cough.

Honey for acute cough has shown promise in some studies, in which it outperformed both no treatment and cough syrup, and this treatment modality is currently evaluated by the Cochrane group.

A word of caution: Honey should not be given to kids younger than one year due to the risk of infant botulism.

Plenty of fluids

Drinking plenty of liquids makes sense: the water replaces losses due to rapid breathing, reduces the viscosity of mucus (therefore reducing congestion) and prevents dehydration. Alas, the reviewers found no evidence for or against increasing fluid intake during the illness—no randomized controlled studies have been conducted.

Vitamin C

Vitamin C was popularized by Nobel Laureate Linus Pauling in the 1960s and has been used widely as both a preventive and therapeutic agent for the common cold for decades. It’s still very controversial.

The Cochrane review was restricted to placebo-controlled trials testing at least 0.2 grams per day of vitamin C. Thirty studies involving more than 11,000 participants were analyzed and they showed:

• Regular ingestion of vitamin C has no effect on preventing the common cold in the ordinary population.

• Vitamin C reduced the duration and severity of common cold symptoms very slightly, and the magnitude of the effect was so small its clinical usefulness was doubtful.

• Six trials included participants exposed to short periods of extreme physical or cold stress or both (including marathon runners and skiers). In these people vitamin C reduced the common cold risk by half.

• Trials of high doses of vitamin C administered to treat the common cold showed no consistent effect on either duration or severity of symptoms. The authors call for more therapeutic trials (especially ones including kids who weren’t studied in trials) to settle the question.

Echinacea

Echinacea is a plant widely used for the common cold, but preparations vary greatly (there are many Echinacea species, and different parts of the plant are utilized in different ways). The Cochrane review found 16 clinical trials investigating the effectiveness of several Echinacea preparations for common-cold prevention or treatment.

Two trials using Echinacea for 8 to 10 weeks for common-cold prevention showed no clear effect.

Most of the trials investigated Echinacea for treatment of common-cold symptoms, and it seems that some preparations may be effective in adults, but the results were inconsistent. There’s no evidence of efficacy in kids. Side effects were rare, and included rashes in one trial in kids.

Zinc

Seven trials of variable quality were included in the review, and no strong evidence was found to show that zinc lozenges reduce the duration of the common cold. Side effects included mouth irritation, unpleasant taste and diarrhea.

As for chicken soup, I couldn’t find it in the Cochrane reviews. A study in CHEST (the cardiopulmonary and critical-care journal) looked at mucus velocity and airflow through the nose of 15 healthy people after they drank cold water, hot water or chicken soup. The results showed that both hot fluids increased the flow of mucus for about 30 minutes, with the chicken soup outperforming the hot water significantly. Another study in CHEST showed that chicken soup inhibited the movement of neutrophils (a subset of white blood cells) in the lab. So there is some evidence supporting my grandma’s regimen.

Writing this post and going through these studies reinforces my respect for the wisdom of traditional methods for symptom relief. Many of these old-fashioned remedies show some benefits, are worth a try, and won’t hurt. I think the current evidence on Echinacea, vitamin C and Zinc tend to show little or no efficacy, and zinc can have some nasty side effects, so I’d personally stay with the food remedies, and not the supplement ones—their safety profile’s better.

As to the garlic: I’m hoping my husband won’t read this post and decide on garlic as a preventive regimen, taken continuously. Personally, I think the secret to garlic’s success is that no one ventures near you when you eat that much raw garlic. Isolation is perhaps the best way to prevent the spread of communicable diseases, including the common cold. Washing hands frequently and well is probably the best preventive measure of them all.

Have a healthy fall,

Dr. Ayala

Whole wheat banana bread with mint sauce

I’ve always wondered why banana bread is called banana bread and not banana cake.

Is it because it’s baked in a bread pan, and not in a round pan? Is the name designed to make us feel better about eating it—bread’s a necessity and cake’s an indulgence?

To be honest, this recipe, although a more nutritious version than your ordinary banana bread, still should be filed in the dessert section due to the sugar and fat content. (To me, bread is flour, yeast, salt and water, with maybe trace amounts of added fat and sugar.)

Having said that, I do love banana bread. Like most banana-loving families, I find over-ripe bananas in my fruit bowl quite often. Bananas are a tricky fruit: They’re at their best when just ripe, and if you happen to look away for a few hours and neglect to consume them in time, you’re in banana bread territory with over-ripe bananas—still delicious, but not lunchbox material.

I write and speak often about the poor eating habits most of us have, especially related to fruit and vegetable consumption. The Centers for Disease Control and Prevention reported this week that fewer than ten percent of U.S. high-school students eat the combined minimum five-a-day daily recommended servings of fruits and vegetables, with some states such as Arkansas and North Carolina faring significantly below those averages and some New England states, particularly Vermont, doing notably better.

Combining bananas and mint into a bread or cake isn’t the answer to our kids’ low intake of fruits and veggies—not at all. But it is another fine use for these plant-based foods we should have in plenty at home and in our kids’ lunchboxes, available for snacking and ready to eat. And, just to be clear, I recommend eating most fruit raw.

However, this bread/cake is a delightful exception-—moist, scented, full of fruit and really delicious! Try it.

INGREDIENTS

For the mint sauce:

1 cup packed fresh mint leaves
1/4 cup almonds
1/4 cup honey
1/2 tablespoon vanilla extract

For the banana bread:

3 or 4 very ripe mashed bananas
1½ cups of whole wheat flour
2 tablespoons melted butter
½ cup sugar
½ cup dark raisins
2 eggs
1 teaspoon ground coriander
1 teaspoon vanilla extract
1 teaspoon baking powder
Pinch of salt

PREPARATION

• Make the mint sauce: puree all ingredients to a thick paste using a food processor (or blender) fitted with the steel blade.

• Preheat the oven to 350°F.

• In a large bowl, combine all of the banana bread ingredients. You don’t need a mixer, but feel free to use one.

• Pour the banana bread mixture into the buttered 4x8 inch loaf pan.

• Swirl the mint sauce into the banana bread (Transfer the mint sauce into a small plastic bag with a corner snipped off. Drizzle it on in parallel lines and then run a knife through the lines from the other direction to swirl.)

• Bake for 30-40 minutes until a toothpick inserted into center of the loaf comes out clean and the bread is golden brown.

• Cool on a rack. Remove from pan and slice to serve.

Tip: The mint pesto will keep in a tight container for a week or so, and will pair up nicely with any chocolate dessert. Double the quantity and you’ll look like a pro when you serve chocolate ice cream or cake with a few dollops of this home-made mint sauce on the side.

For more of my whole wheat recipes go here and here.
Enjoy,
Dr. Ayala

Can super-sizing fruits help you shed weight?

I’m very skeptical of promises that sound too good to be true.

No field is as rife with these as the diet industry, where new dream diets are invented daily and claim to have found a magic trick allowing us to eat as much as we want yet lose weight.

But here’s one worth checking out: Can eating more fruit help you shed weight?

This diet is worth a second look because we have many other good reasons to increase our fruit consumption—fruit and vegetables are an important component of a healthy diet and have a protective effect against many chronic diseases, such as heart disease, cancer and diabetes.

There’s also a plausible explanation for why eating fruit may protect against weight gain: Fruits have a relatively low-energy density, they have a lot of water and dietary fiber, and add lots of bulk. Studies show that food intake may be regulated by the weight of the food, and how long it takes to consume, therefore filling your plate with fruits would lead to greater satiety and less consumption of other foods.

A recent paper in Obesity Reviews analyzes the published studies on the association of fruits and weight loss. The authors specifically sought studies which look at fruit only, and not fruit and vegetables as one category (there are many studies showing that fruit and vegetable intake has an inverse relationship with overweight and obesity).

Of the sixteen human studies that met the inclusion criteria, eleven showed that increased fruit intake facilitated a significant reduction in body weight, decreased the risk of overweight or obesity or was associated with less overweight. The remaining five studies found no significant association, and no studies showed increased weight related to increased fruit consumption.

The studies included in this review were of three different types: Intervention studies, in which a study group is randomly assigned to receive an intervention—in this case increased fruit—and compared to a control group which receives a placebo or no intervention, prospective observational studies, in which a cohort with known exposures (in this case fruit intake) is followed for a health outcome over time (in this case weight), and cross-sectional studies, in which a population is observed at a certain point in time, looking for possible connections between, in this case, fruit consumption and weight. Each kind of study has its strengths and weaknesses.

Results from all three types of studies pointed towards an association between high fruit intake and lower weight. The authors call for large behavioral, randomized, controlled intervention studies to further clarify this issue.

Can supersizing the fruit serving increase fruit intake?

I think we’re all sold on the idea of including more fruit in our daily diet for a multitude of reasons, but many parents struggle with just how to do it—less than ten percent of kids consume their daily recommended number of fruit and veggie servings.

This brings me to another recent fruitful study, this one from the scientific journal Obesity.

Many studies show that increasing the size of the serving of food—entrees, snacks or soda—leads to increased intake, and supersizing the portion leads to supersized eating and supersized people. The authors asked the interesting question: Will supersizing the fruit and vegetables portion lead to higher intake of those in kids?

Forty-three Philadelphia-area kids aged five and six years were included in the study. They were twice fed dinner consisting of pasta with tomato sauce, broccoli, carrots, unsweetened applesauce and milk, with the portions of broccoli, carrots and unsweetened applesauce doubled in one of the meals randomly, while the pasta and milk portions stayed the same.
The results are pretty interesting:

Doubling the portion of fruit and vegetables side dishes resulted in a significant increase of 43 percent in the intake of the fruit—applesauce—but not the vegetables.

Doubling the portion of fruit and vegetables side dishes resulted in a significant decrease in the intake of the pasta dish, with the extra fruit displacing the more energy-dense pasta.

Overweight kids showed a bigger response to over-sizing the fruit and vegetables portion than normal weight kids; they ate more of the fruit and vegetables offered.

The study shows doubling the size of fruit and vegetables portions as a valid method for increasing fruit intake, but also maybe of controlling weight gain, as the fruit displaced a higher calorie food (pasta).

What about the vegetables?

A more careful look at how the vegetables were presented might offer an explanation: the broccoli and carrots were thawed from a frozen pack and served plain, with no seasoning or fat. I think even the most ardent vegetable lovers wouldn’t get too excited by those. Perhaps a more appealing preparation (broccoli sautéed with some olive oil, garlic, fresh ground pepper and salt anyone?) would have gotten a different result.

I think that if you’re plating a meal for yourself or for others increasing the size of the vegetable and fruit component is worth trying. It may very well be that the most obvious way to increase fruit and vegetables consumption is by making them show up in plenty! If they’re on the table, prepared in an appealing way, ready to eat and constantly available they’ll be what we eat when we’re hungry. That’s part of the way manufacturers of sugary drinks and junk foods make sure we consume more—they’re just everywhere and in plenty.

Food for thought!

Dr. Ayala

Health experts favor taxing sugary drinks in new report

A recent New York Times article says the debate over a tax on sugary soft drinks is starting to fizz over.

The story quotes President Obama as saying taxing sugary drinks is an idea worth exploring, and that “every study that’s been done about obesity shows that there is as high a correlation between increased soda consumption and obesity.”

A health policy report from the prestigious New England Journal of Medicine (NEJM) came out last week, and its well-respected expert panel of authors—including Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale University, Walter Willett of the Harvard School of Public Health and Thomas Farley, the New York City health commissioner—conclude that the reasons to proceed with this tax are compelling.

I’d like to take the time to go through the NEJM’s main points:

(Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.)

Sugary drink consumption is rising, as is obesity

The intake of sugary drinks has risen worldwide, practically doubling over the last several decades. At the same time, the evidence showing that sugary drinks and increased body weight are positively correlated is convincing and continues to accumulate. Different study designs, and especially more rigorous studies, show this positive association, and the results casting doubt over this link are for the most part beverage-industry sponsored.

Why would sugary drinks lead to poor health?

The most obvious mechanism is weight gain—obesity is a risk factor for heart disease, diabetes, hypertension, some cancers and many other diseases. Sugar in liquid form has poor satiating properties and several studies cited in the report show how sugary drinks’ calories don’t seem to be registered by our body.

High intake of added refined sugars have known adverse physiological and metabolic effects, including elevation of triglyceride levels, elevation of blood pressure and lowering of high-density lipoprotein (HDL) cholesterol levels—all of which are risk factors for heart disease.

The high glycemic load of sugary drinks would be expected to increase the risk of diabetes by causing insulin resistance and also through direct effects on pancreatic islet cells. (Glycemic load is a measure of the effect of carbohydrates in the food on blood sugar levels. Simple carbohydrates—such as table sugar and high fructose corn syrup—break down quickly during digestion, releasing glucose rapidly into the bloodstream.)

Economic rationale to taxing sugary drinks

The report authors write, “Economists agree that government intervention in a market is warranted when there are ‘market failures’ that result in less-than-optimal production and consumption,” and say that there are several “market failures” when it comes to sugary drinks:

• Lack of information and misinformation: The public doesn’t always know the health consequences of sugary drinks, especially given extensive marketing campaigns that advertise the benefits of drinking these calorie-laden drinks.

• “Time-inconsistent” preferences: The short-term reward of the sugary drink (instant gratification) trumps the long-term harm, especially in the eyes of kids.

• “Financial externalities": Consumers do not bear the true cost of sugary drinks. The drink itself is cheap, but its true cost is very expensive in medical costs. For example, medical costs associated with overweight conditions and obesity are estimated at $147 billion a year, half of which are tax-payer dollars.

The proposed tax and its projected effects:

The authors propose an excise tax of one cent per ounce for beverages that have any added caloric sweetener, and suggest levying the tax on producers and wholesalers, who will pass it on to consumers. Such a tax would increase the price of a 20 oz. bottle of sugary drinks by 15-20 percent, and studies suggest the price hike will result in about a 10-percent reduction in consumption of these drinks. Higher taxes would result in even more reductions in intake.

The authors do not propose taxing non-caloric sweeteners (diet) drinks at this point.

The revenue is projected to be considerable— one cent per ounce would raise $14.9 billion in the first year—and could help fund childhood nutrition programs, obesity-prevention programs and health-care for the uninsured.

Objections, industry reactions and growing public support

A tax on sugary drinks would be regressive. To this valid argument the authors reply that “The poor are most affected by illnesses that are related to unhealthful diets, and brand loyalties for beverages tend to be set by the teenage years. In addition, sugar-sweetened beverages are not necessary for survival, and an alternative (i.e., water) is available at little or no cost; hence, a tax that shifted intake from sugar-sweetened beverages to water would benefit the poor both by improving health and by lowering expenditures on beverages. Designating revenues for programs promoting childhood nutrition, obesity prevention, or health care for the uninsured would preferentially help those most in need.”

Another objection often made is that the tax would not solve the obesity crisis. The authors argue that taxing sugary drinks has to be only part of the plan to combat obesity, but that even a 1-2 percent reduction in caloric intake will have an effect on our health.

The industry reaction to the proposed taxes has been—as expected—strong and clever. The article states that: “PepsiCo threatened to move its corporate headquarters out of New York when the state considered implementing an 18 percent sales tax on sugar-sweetened beverages.” It also alerts us to the devious ways in which the beverage industry is fighting the proposed bills: for example, the beverage industry has created front groups, whose name suggests community involvement, such as Americans Against Food Taxes. Be aware!

But according to this paper, public support is not behind the beverage industry, and the trends are in the opposite direction—public support for a tax on high calorie low-nutrition foods and beverages to address obesity is on the rise.

The authors conclude:

The federal government, a number of states and cities, and some countries (e.g., Mexico) are considering levying taxes on sugar-sweetened beverages. The reasons to proceed are compelling. The science base linking the consumption of sugar-sweetened beverages to the risk of chronic diseases is clear. Escalating health care costs and the rising burden of diseases related to poor diet create an urgent need for solutions, thus justifying government's right to recoup costs.

As with any public health intervention, the precise effect of a tax cannot be known until it is implemented and studied, but research to date suggests that a tax on sugar-sweetened beverages would have strong positive effects on reducing consumption. In addition, the tax has the potential to generate substantial revenue to prevent obesity and address other external costs resulting from the consumption of sugar-sweetened beverages, as well as to fund other health-related programs. Much as taxes on tobacco products are routine at both state and federal levels because they generate revenue and they confer a public health benefit with respect to smoking rates, we believe that taxes on beverages that help drive the obesity epidemic should and will become routine.

I wrote about this volatile subject a few months ago, and made my arguments for considering such a tax. I’m glad to see the discussion heating up. Whether the tax is implemented or not, the discussion will, at the very minimum, make more people aware of the body of evidence linking sugary drinks to obesity and adverse health outcomes. The consumption of these drinks will continue to drop because consumers are smart enough to give up the liquid candy habit regardless of price once they know the facts.

Your thoughts, as always, are very welcome.
Dr. Ayala

How can “cutting added sugar” drive better health?

The American Heart Association’s (AHA) new guidelines published in late August were a refreshing point of clarity contrasting with the vagueness typical of nutrition advice designed not to offend any major food lobby.

The new statement, published in Circulation, replaces AHA’s hazier 2006 one to “minimize the intake of beverages and foods with added sugars,” and provides detailed guidance by recommending an upper limit on added-sugars intake.

Let’s start with the AHA guidelines and look at the numbers:

• The upper limit for added sugars should be no more than half our discretionary calories. (Discretionary calories are at the very tip of the food pyramid, an area that’s small but fun; this is what we can allow ourselves to eat once we’ve eaten a nutritious diet; luxuries such as solid (saturated) fats, added sugars, and alcohol fall into this category, all of which should be consumed sparingly.)

• Most American women should consume no more than 100 calories of added sugars per day (6 teaspoons of added sugars); most men, no more than 150 calories (9 teaspoons of added sugars).

For an average adult woman, who needs about 1,800 calories to maintain her weight, there are about 200 calories in the discretionary budget, and the AHA advises her to spend no more than 100 of these on added sugar. Alas, it’s not that easy to know how much added sugar there is in prepared foods, as the food label lists all sugars—both innate carbs and added sugar —in the sugar component of the label. The sugar content on the nutrition label of fresh fruit looks quite similar to that of a cookie, even though only the cookie has added sugar, and fruits have naturally occurring sugars that act quite differently in our body.

Many prepared foods have lots of added sugar in them—sugar increases palatability, appetite and really “sells” the product. To get an idea of how much sugar is added to common foods you can glimpse into the USDA database, where you’ll see that significant amounts of sugar are added not only to drinks and desserts, but also to many breads, salad dressings, condiments and even baby food. Added sugar even comprises about half of the carbohydrates of many breakfast cereals! Your meager six allotted teaspoons of sugar may very well be already spent with sugar added to cereal, ketchup and yogurt well before you’re thinking about a dessert.

Primary source

Now on to the number one source of added sugar.

(Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.)

The article states quite clearly that “Soft drinks and other sugar-sweetened beverages are the primary source of added sugars in Americans’ diets,” and provides a chart showing that soft drinks and fruit drinks combined make up over 42 percent of an average American’s added sugar. Just one 12-ounce can of Coke contains 130 calories in added sugars, which will put you over the AHA recommendation. The new guidelines, therefore, really spell out a recommendation that practically takes these sugary drinks out of the equation—unless one eliminates all other sweets and desserts altogether (and what’s life without an occasional dessert?)

I don’t want to leave the Circulation paper without providing some of the reasoning behind its cautious advice. To summarize, it states that:

“Excessive consumption of sugars has been linked with several metabolic abnormalities and adverse health conditions, as well as shortfalls of essential nutrients. Although trial data are limited, evidence from observational studies indicates that a higher intake of soft drinks is associated with greater energy intake, higher body weight, and lower intake of essential nutrients. National survey data also indicate that excessive consumption of added sugars is contributing to overconsumption of discretionary calories by Americans.”

The article reviews evidence showing that added dietary sugar:

• May raise blood pressure,
• Can elevate blood triglycerides levels (a risk factor for heart disease),
• Contributes to obesity and its many consequences, and
• Can undermine normal satiety levels, motivating us to eat more than we need and create food cravings.

Agreement from other authorities

The AHA statement joins that of many other influential medical authorities.

The American Academy of Pediatrics’ dietary recommendations for kids follow the same guidelines as those of the AHA and say that, “For young sedentary children, the amount of total energy intake that can come from foods used purely as a source of energy, 100 to 150 calories, is less than that provided by a usual portion size of most low-nutrient-dense snacks and beverages.” It has been calling to eliminate all sweetened drinks in schools for years.
The World Cancer Research Fund and the American Institute for Cancer Research report calls to “limit the consumption of energy-dense foods and avoid sugary drinks.”

Yet, the average American still takes in about 300 calories from added sugar a day from sugary drinks alone. We clearly have a long way to go to come close to meeting the recommendations.

To build awareness, the New York City Health Department’s new ad campaign confronts New Yorkers with a bold question posted on subway billboards and print media: Are you pouring on the pounds? “Sugary drinks shouldn’t be a part of our everyday diet,” says New York City Health Commissioner Thomas A. Farley. “Drinking beverages loaded with sugars increases the risk of obesity and associated problems, particularly diabetes but also heart disease, stroke, arthritis and cancer.”

What do you think of this image?

It’s encouraging to see that more and more independent bodies recommend moving away from all sugary drinks and minimizing highly processed foods. Whether it’s the sugar or the calories, the message is becoming clearer all the time. I hope more and more people are listening.

My concern is that the upper limit for sugar intake suggested by the AHA is shockingly low to most; I don’t know many people that can easily adhere to it. We all wish we could have more discretionary calories, just as it would be great if we could have more discretionary spending money and discretionary leisure time. (There is, however, a way to get more discretionary calories: by increasing our energy expenditure significantly through a greater level of physical activity.)

But for many of us, moderation in eating has to be spelt out, and moderation in sugar intake is one of the important messages we can act on to combat obesity.
Dr. Ayala

This entry has been posted as part of The Kathleen Show's Prevention not Prescriptions

Back to school -- five easy tips to improve your kids’ health this school year

I can’t believe the summer vacation is over and kids will be going back to school this week. This summer went by way too fast!

I was happy to get a letter from my daughter’s elementary school announcing new snack policies—the school will not be giving out any more snacks, will not give food as incentives, prizes or rewards, and birthday celebrations at school will become "food free." Parents are being encouraged to send healthy snacks from home, including fresh fruit, cut-up vegetables, dry fruit and trail mix (with no candy).

The reasons cited for this change of policy are dual—better nutrition to prevent childhood obesity and a precaution taken because many kids suffer food allergies.

I’m greatly encouraged to see that change in the way we feed our kids is indeed coming!
And to this hopeful note I’d like to add a few suggestions for simple steps that can add up to better health this coming school year. These steps are indeed small, certainly doable, and can have real impact, especially if they lead to the next small step towards wellness:

• Eat breakfast - Many know that breakfast may be the most important meal in the day. Studies show that eating breakfast is not only associated with better nutrition, better concentration and performance in school but also with less obesity. Yet up to a third of teenagers skip breakfast regularly. Make sure your kids leave home after they’ve had a nutritious breakfast! I’ve written more about the importance of eating breakfast in my post here.

• Teach your kids how to cook - Preparing simple healthy meals is a life skill that is a gift that keeps on giving. Give your kids age-appropriate healthy shopping and healthy cooking lessons, and if you feel you’re in need of a few lessons yourself, you can learn together from books, websites and cooking shows.

• Take the junk-food out - While a little junk every once in a while will probably do no harm, having it available at home on a regular basis enables bad habits and teaches the wrong lesson. Make home a safe haven of healthy, nutritious food. Take the soda, sweet drinks, fatty sweet and salty highly processed snacks out, and replace them with readily accessible fruits, vegetables, nuts and other healthy snacks.

• Find out what’s served in the school cafeteria - Unfortunately, the school lunch in many schools is not a healthy one. What’s more, competing with the school lunch are junk foods sold through vending machines and other sources. Find out what is served in your kids’ school, and if it doesn’t meet your standards, do something about it: Send your kids to school with a lunchbox and healthy snacks from home; speak up and try to effect change in the school lunch program in a practical and positive way.

• Get them moving! - A third of our kids are overweight or obese, childhood obesity has tripled in the past thirty years, and although these skyrocketing rates are mostly a result of the food environment we live in, kids’ inactivity also plays a role. If your kids aren’t getting their daily dose of vigorous exercise, encourage them to join a sports team, pick a new hobby that will get them moving, and incorporate more movement in daily life. If school and other activities are close to home, consider walking rather than driving when weather and time permits. Choose family activities that are active, and get the whole family exercising and out in the fresh air! Many neighborhoods are quite safe, yet kids don’t play outdoors often enough; find a way to get the kids on your block back in the playground or on the open field playing unorganized sports the old fashioned way, with supervision if you see the need, or without.

A happy, healthy start to the new school year to all of us!
Dr. Ayala

Poor nutrition driving rise in kidney stones—in adults and kids

A recent study in the Journal of the American Society of Nephrology, found that a high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of sodium, sweetened beverages, and red and processed meats was associated with reduced risk of kidney stones. This study, which analyzed data from more than a quarter million participants, led me to repost a piece I wrote last year. It's just one more argument to make for healthy nutrition. Enjoy the rest of your summer, Dr. Ayala

Kidney stones are becoming more common at an alarming rate, and this is one trend you should absolutely try to avoid.

If you’ve ever had one, you know they’re no fun. In fact, women who’ve experienced both kidney stones and child labor describe the pain associated with the passage of a stone as comparable in intensity to that of labor (without an epidural), with much less satisfying rewards.

Diet plays an important role in the development of kidney stones, especially in people who are predisposed to the condition. The incidence of stone disease tends to rise during periods of affluence, and many experts have concluded that kidney stone is—at least in part—a nutritional disease.

A recent article by Laurie Tarkan in the New York Times reports on the alarming rise in the incidence of kidney stones not just in adults, but also in children. Tarkan says that kidney stones in kids—once considered rare—are now becoming a fairly common condition and are seen in ever-younger ages. As with other diseases related to poor diet—such as type 2 diabetes and obesity—there’s a disturbing shift underway in the age of presentation of the condition.

The article interviews several leading urologists, and explores reasons for the rising incidence (emphasis is mine):

"Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.

Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.

Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.
“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.

Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty—but that may be too little, too late, especially for children who play sports or are just active.

“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said."

Other contributing factors examined in this article are obesity, which experts tie to the formation of kidney stones in children as well as adults, and sugary drinks:

“There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.”

I’d like to add one more to the list of suspects responsible for the rise in stones: Vitamin C.

High doses of Vitamin C can result in high levels of oxalate (a type of salt) in the urine and therefore increase the risk for kidney stones. Since high doses of Vitamin C are not proven to prevent or treat the common cold, or aid your health in any way, there’s no good reason to take them.

By no means am I suggesting that parents should worry about kidney stones and devise special diets to decrease their kids’ risk of stones. The experts’ dietary advice for avoiding kidney stones consists of guidelines one should already be following for a multitude of health reasons, and is quite simple:

• Drink adequate amounts of water. Sugar and high-fructose corn syrup-laden juices and sodas don’t count as healthy hydration.


• Avoid excess salt and highly processed foods. The diet that promotes kidney stone disease is high in sodium, animal protein and sugar, and low in fiber, vegetable protein and unrefined carbohydrates. Another way to describe this diet is a processed-food diet.

The sport drink industry has tricked us into thinking that we need electrolyte infusions on a regular basis, for recreational sports as well as everyday life. The fact is that as long as people are consuming food, which contains ample amounts of electrolytes (really just salts) there’s no need to worry about electrolytes.

And wherever electrolytes are added, sweetener is added too, to mask the taste of the electrolytes. That’s a good recipe for stones for those who already are susceptible to stone formation. I’ve written more about sports drinks here.

Dr. Ayala

This entry has been posted as part of The Kathleen Show's Prevention not Prescriptions

Are “functional” foods healthy foods?

I was disturbed by a short exchange I had with my ten-year-old daughter today. I told her we would be cooking a cholesterol-free dinner tonight, because one of our guests is trying to lower her cholesterol without medication, to which my dear daughter replied, “She should eat Cheerios.”

Apparently General Mills’ health claims—prominently displayed on every box—have reached my daughter, and she accepts them as fact.

Skimming through the New York Times later in the day, I read an Associated Press article, reporting on a Pricewaterhouse Coopers research paper just released, showing that even in a struggling economy America’s appetite for “functional foods” has not diminished. In fact, this category—accounting for more than $27 billion in sales a year of vitamin-, fiber-, calcium- and omega 3 fatty acids-fortified foods—is growing, and the report estimates a future growth range of from 8.5 to 20 percent per year—far more than the 1 to 4 percent forecast for the food industry as a whole.

The AP article cites nutrition experts who openly criticizing this trend, such as New York University nutrition professor Marion Nestle who says: "Functional foods are about marketing, not health. They delude people into thinking that these things are healthy,” while David Schardt, nutritionist for the consumer group Center for Science in the Public Interest, says: ''It's really a junk food dressed up to look prettier than it is. People are going to be deceived into thinking a lot of these products are especially healthy for them when there's little evidence they are. There's more hype to these products than there is reality.''

The article also warns against simplistic thinking, such as if a nutrient is good for you, then more is better, and that eating the nutrient in isolation, and not contained in the whole food it typically is part of, is just as beneficial. All too often the opposite is true. Indeed, studies have shown that several vitamins—such as vitamin A and E in excess—are actually harmful, and the benefits of eating fruits, vegetables and whole grains are not observed if vitamins and fiber come only from supplements.

Back to Cheerios—is it indeed a wonder drug? The package, website and ads claim that Cheerios can reduce "bad" cholesterol levels by four percent in just six weeks and ward off heart disease and cancers of the colon and stomach. The FDA authorized health claim, which General Mills (producer of Cheerios) is allowed to post (because the cereal is a food that contains whole grain), is: “Eating diets low in saturated fat and cholesterol, and high in fiber-containing fruit, vegetable, and grain products may reduce the risk of heart disease.” Big difference!

The FDA in fact issued a letter of warning to General Mills in May this year, informing the company the claims on the box make Cheerios 'an Unapproved Drug.'
I think that if a study performed on the stairs of a building proved that climbing up and down for thirty minutes a day lowered cholesterol and improved heart health, the take home message—provided the study was well preformed and backed by other evidence—would be that exercise is beneficial to heart health and lowering cholesterol, and perhaps that we should take the stairs at work. I can hardly see crowds forming at the research building queuing–up to climb the stairs used in the specific study—as if there’s anything unique about them.

But many people are humbled and confused by nutrition science, and it’s easy to leap to erroneous conclusions. The reality is that if a study on a certain berry shows benefits, that doesn’t mean that only this berry has the alleged benefit—perhaps all fruit do—and it certainly doesn’t mean that the micronutrients in that berry in isolation will be beneficial as well. Also, if a certain nutrient shows promise in rodents or a cell culture, it’s certainly exciting for the scientific community, which will further study the issue, but it’s hardly actionable news for consumers.

Many studies show that whole grain is indeed an important component of a healthy diet. Replacing refined grains with whole grains is a very good idea. There are many ways to add whole grains to your diet, and the best way is to add them through whole foods—using whole wheat or whole wheat flour, brown rice, whole oats and quinoa for instance.

If you’re shopping for breakfast cereal, look for the ones that are made with whole grain (and less sugar)—morning cereals are a practical way for many kids to eat a good breakfast. But don’t for a second be confused about which food is better for you: the fruit is better than the fruit drink with a health claim on it, and the corn on the cob you cooked is better that the corn flakes, despite the health claims.

So while moving from sausage, egg and cheese biscuits and triple chocolate muffins to Cheerios is a move in the right direction (and I’ll admit I have Cheerios at home), the health claims and “functionality” of these cereals is very misleading. Indeed, it’s all about marketing, and not about health.

So what’s on my no-cholesterol menu for tonight? Very simple—I’ll be cooking a vegan meal. No animal products—no cholesterol. I’ll be making some baked tofu, with wild mushroom and garlic whole-wheat pasta (with grated parmesan cheese on the side), an herbed fennel and zucchini gratin, a big green salad and a fruit sorbet for dessert. No cholesterol, lots of fruits veggies, whole grains and fiber.

But I won’t put a health claim on it; that could be confusing.

In case you’re interested in my recipes for whole grain foods here a few links (1, 2)

What do you think about health claims and functional foods?
Dr. Ayala

This entry has been posted as part of The Kathleen Show's Prevention not Prescriptions