Healthy Food & Healthy Living by Dr. Ayala

Americans spend more time eating, mostly while distracted

How do you eat your meals? Do you have dinner with your family or dine in company? Do you eat while watching TV, or at your desk? Does how we eat really matter?

A study in Public Health Nutrition, looking at American’s food-related time use over 30 years reveals that besides the dramatic shift in how much and what Americans eat, there’s also been a big shift in the amount of time we spend eating, and in the quality of that time.

The study looked at four nationally representative time-diary surveys from 1975, 1985, 1998 and 2006. A time-diary assesses the use of time through a form that’s filled over 24 hours, in which participants list every minute activity. Sounds boring, but the results reveal some interesting trends:

• Eating as a primary activity declined in the past 30 years.

• On the other hand, eating as a secondary activity rose dramatically in the past 30 years.

• When we combine the primary and secondary eating time we see that overall we’re spending, on average, 25 more minutes daily eating than we did 30 years ago.

• Eating as a secondary activity comprised just 20 percent of overall eating-time 30 years ago. We now do almost 50 percent of our eating while concentrating on something else.

Eating is now done while driving, watching TV and working—as we all know, it’s now perfectly fashionable to eat while doing pretty much anything—and food’s available for nibbling and sipping to provide just that opportunity everywhere mouths are idle.

And the picture emerging from these dry statistics is pretty clear: We’re eating most of our calories while distracted. Could our eating habits explain our overconsumption and the upward trend in our collective weight? I think so, At least in part.

Mindful eating is one important technique used to help people modify their food intake, and it seems that we should all give some thought to how we eat, and perhaps try to multitask a little less during the time we have food in our mouths.

Much has been said about the French Paradox; there’s plenty of controversy about it (some even doubt its existence). Regardless, there’s a valuable lesson from French food culture that’s worth imitating: The French truly celebrate food. After all, food is one of life’s pleasures we can indulge in daily. Taking the time to truly enjoy and celebrate food, taking the time to savor the taste and beauty of good food makes overeating a bit less likely.

I’m as guilty as anyone of eating while doing something else—I’m writing this sentence while munching on a bell pepper—but I’ve set some ground rules that I’ve been able to stick to: We eat a family dinner every day, unrushed, no electronic distractions allowed, and I limit eating-while-distracted foods to low caloric density, highly nutritious ones, such as fruits and vegetables.

The absolute worst combination is munching while watching TV; huge amounts of calories can be consumed unregistered that way. That’s one habit I’d really like my kids to avoid.

Do you have tricks and rules for mindful eating?

Dr. Ayala
Related posts:
Eat slowly and help lower the risk of obesity

Do junk-eating friends ruin your diet?

Peer pressure is a pretty powerful force that can both help and impede kids’ choices. No kid is totally immune to peer pressure and that’s why I care a lot about who my kids hang out with—I’m sure most parents do.

Peer behavior influences a wide range of health related behaviors--from smoking to alcohol intake to bike-helmet wearing--and also influences kids' eating patterns. The need to belong and the effect of peers are most pronounced in adolescence.

A new study in the journal Appetite set out to see if friendship groups affect teens’ unhealthy snacking behavior. The study looked at the snacking habits of about 750 Dutch teens while mapping out who’s friends with who. It also collected data including the teens’ weight, education level and personal characteristics as well as the availability of high-caloric-density snacks (chips, candy, soda etc.) in those kids’ school canteens and vending machines.

Here are the study’s main findings:

• Teens with friends who ate snacks and drank soft drinks tended to do the same if snacks were available in schools canteens and vending machines. In fact most soft drinks were consumed by teens with friends that drank soft drinks.

• The tendency to conform to friends’ snack habits was stronger for boys and for teens with lower education levels.

• Girls ate more healthfully than boys, and seemed less susceptible to peer pressure to snack unhealthfully.

Chicken or egg?

So which came first? Do teens model their friends when it comes to snacking, or do they pick friends with similar snacking habits? This study can’t really answer that question. Other experimental studies though have shown that people model eating choices and quantities after friends’ patterns. Regardless, herd-like snacking behavior suggests new possibilities for intervention: Create a ripple of better eating within the group and it may grow into a wave that includes the entire cluster of friends.

The effect of vending machines

The presence of junk-for-sale in schools was a critical component of unhealthy snacking group-behavior in this study. In schools that had limited or no junk around, peer influence was less strong. It’s quite obvious that regardless of your friends’ habits, inability to perform the habit in school due to a missing key ingredient—the snack for purchase—gives less opportunity for the habit to spread.

Resisting unhealthy peer-pressure

Although friends affect teens quite a bit, and teens spend fewer hours with their family as they grow older, I’m quite sure that good family relationships, good role-modeling from parents and a high self-esteem are really important in enabling kids to stick to what they know is better for their health.

I don’t know how many parents-to-teen-boys (of which I am one) will appreciate this, but this study does hint that hanging out with the girls can promote better eating. I do love a study that compliments girls. Women tend to make healthier food choices at all stages of life, so having us around is usually a health promoting lifestyle.

Dr. Ayala

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

Marketing to kids: Candy ads decline as fast-food ads gain

Kids watch TV about three and a half hours a day. They’re exposed to it as background many hours more. Advertizing on TV therefore remains the central vehicle brands use to reach kids. Ads are clever and compelling, and their effect on kids—especially young ones—is very clear. The Institute of Medicine reviewed the scientific literature and concluded that ads influence food consumption and that the current food and beverage marketing practices put children's long-term health at risk.

In 2006, in response to criticism from many health organizations and children advocates, the Council of Better Business Bureaus launched the Children's Food and Beverage Advertising Initiative. There are a little more than a dozen major US food companies that joined the initiative, and these companies pledged to devote at least half of their child-targeted advertising to promote healthier or "better-for-you" products and encourage good nutrition and healthy lifestyles. "Better-for-you" is not clearly defined, and neither is “kids programming”, so it’s interesting to see how much has really changed since these voluntary limits on kids’ advertizing have been initiated.

A new study, led by Lisa Powel, and published in the Archives of Pediatrics and Adolescent Medicine, looked at TV ratings from Nielsen Media Research to assess total yearly exposure to food advertising for the years 2003, 2005, and 2007. Trends of TV exposure to food advertising were analyzed by age and race.

The data comparing food ads in 2003 and 2007 exposes a few interesting trends:

• Ad quantity: In 2003 kids saw, on average, a little more than 13 food ads a day. By 2007, the number of food ads seen daily by very young kids (2-5 year-olds) fell by 13 percent to about 11.5 ads per day, decreased a little bit for kids 6-11 years, and increased a tad for adolescents (it's still above 13 ads a day for these older age groups).

• Food product categories: ads for beverages and sweets (candy bars and cookies) declined the most while exposure to ads for fast food restaurants increased the most. By 2007, fast food ads were the most frequently food ad seen by kids. In fact fast-food ads surpassed cereal ads in the 2-5 year-old programming by almost 2.5 ads-per-day. McDonald's is the most dominant marketer to kids, with Burger King coming in second.

• Racial disparity: African American kids in all age groups saw more food ads per-day than their white counterparts, and got a double dose of fast-foods ads compared to white kids. There were more food ads on African American targeted after-school and prime-time TV programs compared to general public programs, and the racial gap in exposure grew between 2003 and 2007.

Is self regulation working?

The study finds that among the 13 companies who pledged more responsibility in advertizing to kids by 2007 there were a few promising changes—overall ads aimed for young kids declined somewhat. The largest reductions were seen from Hershey, Coca-Cola, and Mars, companies that promised not to engage in child (under 12 year-old) directed advertizing. However, because the interpretation of “better for you” was left to food-makers “better for you” was often far from good enough (for example: sugary cereals may be better than a donut, but both aren’t a healthy breakfast). The pledge also regulates only advertizing to very young kids under the age of 12 years—the most vulnerable age group—while leaving out pre-teens and teens, who are still quite impressionable, but considered by this initiative fair game. Most importantly, membership in this initiative is voluntary, and many food companies that advertize to kids haven’t signed on.

The authors conclude:

“The bar was set so low, with more than 9 of 10 ads seen by children for products high in fat, sugar, or sodium, that the move to “better for- you” advertising is likely to be inadequate. Rather, regulatory calls requiring “good-for-you” advertising for healthy products may lead companies to compete to reformulate products and to make the monetary investments and harness the effective persuasion techniques typically used to market unhealthy foods to children.”

Do you think self-regulation can result in a real change in the food-ad landscape, or is self-regulation just a delaying tactic and a way for industry to set lenient rules in order to get regulators and the public off their back without changing much?

Dr. Ayala

Related post: The TV diet and your health

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

Kombucha: Health elixir or risky experiment?

Kombucha tea is a popular complementary remedy, which after many decades of small-scale home brewing made a commercial debut in the marketplace and got off to a flying start. Kombucha drinks are a multimillion business, and these beverages are marketed as the elixir of health in both specialty and mainstream stores. Many people—including celebrities—swear by them.

But commercially brewed raw kombucha will be harder to find this summer. Last week Whole Foods Market pulled all raw (live) kombucha bottles off the shelf due to a concern that their alcohol levels may exceed the 0.5 percent ceiling allowed by law in non-alcoholic beverages. Other retailers are following suit. Products with alcohol levels exceeding 0.5 percents are subject to special regulations regarding permits, labeling, advertizing and taxation. Most importantly, alcoholic beverages must bear a health warning statement, as alcohol poses special risks for kids, pregnant women and people on certain medications. The Alcohol and Tobacco Tax Trade Bureau received several complaints about kombucha teas’ alcohol content, and is now looking into the matter.

What is kombucha? Where’s the alcohol from?

Kombucha tea is prepared by fermenting sweetened black or green tea with a symbiotic culture of yeast and bacteria. The resulting liquid contains acids, B vitamins and a number of other chemical compounds. Alcohol is another natural product of the fermentation process. In live kombucha drinks fermentation can continue in the bottle, and therefore the alcohol levels may rise with time, providing an extra kick.

Is kombucha truly magical?

Kombucha tea is promoted in some alternative therapy circles as a cure-all for a wide range of conditions, from memory loss, baldness, insomnia and intestinal disorders, all the way to cancer and AIDS.

Unfortunately, there is no scientific evidence that kombucha is an effective treatment for any condition. In fact, a systematic review of scientific literature found no clinical trials of kombucha in humans. The limited studies on rodents yielded conflicting results: kombucha had antioxidant activity in some studies, but caused liver and spleen enlargement in others.

Although there are no proven health claims that can be made regarding this drink, the well established commercial kombucha brands tell an artful story that suggests eternal health and freedom from disease without actually saying anything that can get them in trouble with current labeling laws—rules which leave plenty of room for confusing consumers into believing a product is a healing elixir.

Is alcohol the only concern? Should we be concerned?

Despite the dearth of scientific support for kombucha’s health benefits in humans, there are several case reports in the medical literature of adverse reactions associated with the consumption of home-grown kombucha tea, including abdominal complaints, allergic reactions, jaundice, toxic reactions, metabolic acidosis, and occasionally even death.

The fact that there are only a few case reports of bad outcomes after kombucha consumption is perhaps somewhat reassuring—it means that the described outcomes are an unusual occurrence. On the other hand these case reports suggest kombucha’s safety profile needs further study.

The Food and Drug Administration cautions that because of the method of preparation, home brewed Kombucha can easily become contaminated if brewed in unsanitary conditions. Medical experts warn that Kombucha may reduce the absorption of certain pH sensitive drugs and caution people with a compromised immune system against drinking it. Evidence-based practitioners advise prudence with this unproven drink, and even open-minded, holistic and alternative therapy embracing Andrew Weil M.D. counsels: “I don't recommend kombucha tea at all”.

What’s next?

Kombucha has a dedicated following—people say it gives them energy (perhaps easily explained by kombucha’s caffeine and sugar content) and makes them feel good, which is hard to argue with. It’s going to be interesting to see whether attention to kombucha’s alcohol levels will also raise interest in its other controversial features—there are no scientific studies to back the health claims made for it, there are concerns about its safety, and the health claims touted on these products are baseless and misleading.

Taste is a personal matter, but in a quick survey among my kombucha consuming friends and acquaintances I couldn’t find even one who drinks it because it’s a culinary delight. In the mind of most of its consumers kombucha is a healing elixir, and as such should be judged on its healing merits—proof of which is seriously lacking.

Will raw kumbucha makers shift to pasteurizing their brew? Pasteurization—a process that wipes out most bacteria and mold—stops fermentation, ensuring stable alcohol levels, and also prevents microbial contamination. On the other hand pasteurization takes away kombuchas biggest claim to fame—its live cultures.

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic culinary 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.
Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

What should Americans eat? The 2010 dietary guidelines

The advice on what to eat for optimal health is reevaluated and dispensed by the government every five years and we’ll be seeing new guidelines published later on this year.

The foundation for the guidelines is an independent, evidence-based report, prepared by the Dietary Guidelines Advisory Committee, which is comprised of independent experts—mostly academics in the fields of nutrition and health. The advisory committees have been giving, in essence, pretty much the same advice for the past thirty years: Eat less solid fats, salt, and added sugars and more fruits, vegetables, and whole grains. Move more. The devil’s in the details—wording, upper and lower limits for nutrients, emphasis on food groups—and this document is usually not received without debate by the food industry and other players.

Yet not much happens. Guidelines aside, obesity rates have continued to climb, and the fast- and processed-food diet is still the most prevalent food pattern observed by Americans.

The Dietary Guidelines Advisory Committee Report of 2010 issued its recommendation recently, the report is now open for comments, and following the public comment period the USDA and US Department of Health and Human Services will take in the comments—let’s hope politics won’t be thrown into the mix—and translate the Advisory Report into the 2010 Dietary Guidelines for Americans.
So what’s new in the 2010 Advisory Committee Report guidelines?

Cut Salt. By a lot.

The 2005 guidelines recommended a daily sodium upper limit of 2,300 mg sodium for the general adult population, and a 1,500 mg per day sodium limit for people with hypertension, African-Americans and older Americans. Since these latter groups comprise 70 percent of US adults, the new 2010 guidelines recommend 1,500 mg per sodium day upper-limit for the general population. It’s quite a challenge, given the vast amounts of salt processed foods contain, and the high levels of salt most people are accustomed to. Most Americans consume more than twice the 2,300 mg “old” upper-limit.

Food patterns: Plant centered patterns promote health, and vegetarian diets get the nod

The new report realizes that people eat food, not isolated nutrients, and counting grams of fats, servings of carbs and milligrams of salt isn’t a tempting lifestyle for most—who wants to walk around with reading glasses and a calculator? Many experts believe that total diet and food patterns are better guides to what we should be eating. The 2005 report mentioned two eating patterns recommended for their health benefits, the DASH (Dietary Approaches to Stop Hypertension) eating plan, and the USDA food guide eating plan—yet these two plans still resemble a diet recipe and not a dietary pattern—they’re still more about counting servings rather than providing food rules and a framework for a healthy diet.

The new proposed guidelines go further, and suggest two eating patterns proven to promote health: the Mediterranean-style and vegetarian-style diets. What these patterns have in common is emphasis on plant-foods. If the vegetarian style diet indeed gets an endorsement in the final guidelines this is going to be quite a shift—the guidelines and pyramids of past were big promoters of animal protein, and vegetarians and vegans seemed like poor step-kids living a life of compromise on inferior substitutions. (Full disclosure: I am a vegetarian, mainly for ethical reasons.)

Here’s the report’s recommended diet in a nutshell:

“Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.
Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium.”

I guess this is as close as we can get to spelling out how we should eat without offending any food industry. May I offer my interpretation in plain-speak?

There are many ways to eat healthy, all of which emphasize plenty of plant foods—fruits, vegetables, whole grains and such—and moderation in pretty much everything else. There’s one food pattern that clearly doesn’t work: the processed- junk- and fast-food diet tends to make people fat and unhealthy. Eat that stuff only on special occasions.

The food environment: We all need to work together to improve it

The guidelines acknowledge that although personal food choices play a central role in the obesity epidemic, our food environment is also a key-player that needs to be addressed urgently:

“In order to reduce the obesity epidemic, actions must be taken to improve the food environment. Policy (local, state, and national) and private-sector efforts must be made to increase the availability of nutrient-dense foods for all Americans, especially for low-income Americans, through greater access to grocery stores, produce trucks, and farmers’ markets, and greater financial incentives to purchase and prepare healthy foods. The restaurant and food industries are encouraged to offer foods in appropriate portion sizes that are low in calories, added sugars, and solid fat. Local zoning policies should be considered to reduce fast food restaurant placement near schools.”

Is there hope for change?

Absolutely. I think the guidelines provide an evidence-based framework on which policies, action and choices need to be made. Although the advice is basically the same over many decades, there are more people listening, a first lady dedicated to the cause, a strong and growing crowd of people who care about this issue, and are eager for change, a health-care system threatening to collapse under the rising costs of obesity-related disease and a food movement rising.

I’m hopeful (as a matter of principle and as a way of life). Are you?

Dr. Ayala

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