Healthy Food & Healthy Living by Dr. Ayala

Eat, drink, and be merry (before, during and after)

I think that eating well should provide joy before, during and after the meal.

My first December working at Children’s Hospital of Philadelphia taught me a lesson I won’t forget. I was very pregnant with my daughter, my third child, and December was very festive at the hospital. There were holiday parties and catered lunches in every department (my department consulted most hospital departments, so we were invited to many events); patients were very generous with treats throughout the month. Outside of work, the food-oriented gatherings of the holidays were extensive. (We are indeed lucky to have so much good food—maybe too much—around us, and let’s not forget to be grateful for that.)

On my next monthly Obstetric check-up, I realized I gained double what I normally would have added that month.

That December was the last December I allowed the abundance of tempting food to overcome my better judgment. Now, I go for the chocolate only if it’s my favorite, otherwise I (mostly) ignore the cookies and candy that are everywhere. If I attend several parties a week, I will resolve to eat only my regular foods—in reasonable amounts—and enjoy the social component of the party, which is the best part after all.

Most people cannot afford to feast several times a week without suffering consequences, and neither can I

But, can one big feast ruin your health?

There are some studies that suggest that there are measurable changes—such as blood fats and sugars—that go up after even one big fatty meal. On the other hand, a stressful emotional argument will have measurable effects too. For most people who don’t have metabolic disorders or very fragile health, one big feast won’t change all that much, won't make you gain any significant weight, and any lab tests would normalize quite quickly.

Yet, December has become, for some, a month of non-stop overindulgence, and I think that can make a difference. Here’s where my “joy before, during and after” rule comes in.

When you’re presented with food that’s indulgent, or circumstances in which you’d be tempted to eat much more than usual, it’s worthwhile to pause and consider. If this food is like the really expensive vacation that still brings a smile on your face, go ahead. It’s worth it. But if this food is just there and it doesn’t pose much more of a benefit than filling you up, do yourself a favor and skip it; choose a healthier alternative instead.

That explains the “during and after.”

The joy before the meal is a little harder to explain. Whether it’s a meal I make, or a meal made by others, I like to think of and enjoy the food well before the first taste. Considering where the food came from, who made it, its cultural connections, and (ideally) knowing that it was ethically produced, can give joy before it's consumed. I love relishing the smell, the colors, the presentation, and even the atmosphere in the room well in advance of that first bite.

I hope you enjoy the bounty of this season, the parties and the feasts. But bear in mind that the net effect of all celebrations should be joy. There’s no happiness in a week (or more) of binge eating and drinking when you’ll have to pay for it later, with heartburn, hangovers, extra pounds, diets and guilt.

Wishing you all happy holidays, and the best of health,

Ayala

Sugary drink consumption still on the rise

With the holiday season—and all of the celebrations that go with it—in full swing, it seems fitting to take a look at a new study about the consumption of sugar-sweetened beverages. The news is not good.

The 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 of almost 300 calories, or 15% of the 2,000 calories/day recommended for the typical diet.

Sugar-sweetened beverage consumption was highest among young adults, and particularly among young African Americans followed by young Mexican Americans, and was highest in populations at highest risk of obesity and diabetes.

The study analyzed the 24-hour dietary recall data of more than 15,000 people collected in the National Health and Nutrition Examination Survey (NHANES) for the period 1988 to 1994 and compared it to the survey data of more than 13,000 participants for NHANES for the period 1999 to 2004.

Sugar-sweetened beverages in this study included soda, sports drinks, fruit drinks and punches with added sugar, sweetened teas and other sweetened beverages. It does not include other caloric drinks such as 100% fruit juice, milk and alcohol. (Another study looking at the total calories consumed in beverages showed that the typical American consumed a staggering average of about 480 calories a day in 2002.)

The Clinical Nutrition study is a cross-sectional study (a study that looks at a population at a single point in time), whose purpose was to describe the national consumption trends, demographics, quantities and consumption behaviors of participants. While the study does not attempt to estimate sugary-drinks’ influence on the obesity epidemic, as cross- sectional studies aren’t useful to determine cause, other studies provide strong evidence for a cause-and-effect relationship between sugary drinks and obesity, the authors say.

Here are the main findings comparing the 1999-2004 population to the 1988-1994 group:

• Overall sugary-drinks consumption rose from 58% to 63% (a 5% increase).

• Average daily consumption increased from 22 ounces to 28 ounces.

• Average daily consumption increased from 239 calories/day to 294 calories/day.

• Average serving size rose from 11 ounces to 17 ounces.

There are a few interesting findings looking at consumption patterns that give me some hope:

• The largest share of sugary drinks was consumed at home. This should be useful information for anyone doing the shopping for the household—if you don’t bring these drinks home, they won’t be in your pantry.

• Overweight and obese people trying to lose weight consumed less than people without weight loss intention. It seems like weight watchers are starting to get the message, and are trying to reduce this most obvious source of empty calories.

The researchers, led by Sara N. Bleich, conclude:

“SSB (sugar-sweetened beverage) consumption has increased dramatically in the past decade in the United States, in parallel with the rising prevalence of obesity and type 2 diabetes. Large epidemiologic studies provide strong evidence for the independent effect of SSBs on weight gain and type 2 diabetes. Efforts to encourage replacing SSBs with low-caloric or noncaloric alternatives may be an important strategy to reduce consumption of empty calories. Physicians and public health professionals are well positioned to identify and promote concrete behavioral targets aimed at decreasing adult SSB consumption, making awareness of these changes critical among that group. The workplace and home offer key areas of intervention for reducing the energy imbalance in young adults.”

Although practically all guidelines for healthy eating include a recommendation to limit the amounts of added sugars, we still have a long way to go to decrease the most obvious and, in my opinion, least satisfying source of added sugar in the diet—sugary drinks.

New York governor David Paterson recently boldly proposed an 18% sales tax on soft drinks (fruit drinks with less than 70% fruit juice, non-diet soft drinks, sodas and other full-calorie sweetened beverages). The thought is that a price increase will discourage people, especially young ones, from excessive consumption of these beverages. It will also create much needed revenue. Some argue that the most effective measure in the fight against smoking was high taxation, and a tax on sugary drinks can help in this battle for public health, too.

So, as you celebrate this holiday season, encourage those around you to try an alternative to a sugary drink, and share a toast to a New Year of healthy living.

What do you think?

Ayala

Nuts for health

Do you eat nuts?

Although nuts are calorically dense and contain a high amount of fat, I eat some nuts every day, and we include them in our kids’ lunchbox.

Last week a new study in the Archives of Internal Medicine gave further evidence to support this tasty habit.

In this study, part of the large PREDIMED (Prevención con Dieta Mediterránea) Spanish study, the researchers compared the one-year effect of two types of Mediterranean diets—one enriched with virgin olive oil (one liter per week of virgin olive oil) and the other enriched with nuts (30 grams, or about an ounce per day, of mixed nuts—walnuts, hazelnuts and almonds) with a low fat diet on symptoms of metabolic syndrome.

The metabolic syndrome is a constellation of unhealthy attributes--abdominal obesity, high blood fats, elevated blood pressure, and high blood glucose—which are well-documented risk factors for cardiovascular disease. It is well known that dietary pattern has a great influence on the incidence of the metabolic syndrome, and that the Western diet in particular promotes this syndrome, while traditional diets rich in fruits, vegetables and grains lower the risk.

It’s also well known that, for overweight people, losing extra weight has a good chance of reversing the metabolic syndrome.

But can just improving the diet, without losing weight achieve the same result?

I find this study so interesting because the participants in the intervention groups actually increased the (unsaturated) fat content of their diet, were not instructed to limit caloric intake or increase exercise, showed a strong commitment to the intervention (as it was quite easy and tasty), but nevertheless achieved significant health benefits.

Here’s what this study of 1,224 men (aged 55-80) and women (aged 60-80) showed:

• At the start of the study 751 (more than 60 percent) of the participants had symptoms of metabolic syndrome. This was a high-risk group.

• The researchers randomized the participants to one of three groups: Mediterranean diet plus virgin olive oil group, Mediterranean diet plus nuts group, and a low-fat diet group, which acted as the control.

• The Mediterranean diet groups received quarterly education about the Mediterranean diet which encouraged increased consumption of fruits, vegetables, fish, olive oil, white meat vs. red meat, aromatic herbs, and moderate consumption of wine. The low-fat diet group was given advice on low-fat diets.

• At the end of one year, the metabolic syndrome rate went down by 13.7 percent in the Mediterranean diet plus nuts group, 6.7 percent in the Mediterranean diet plus olive oil group, and 2 percent in the low fat diet (control) group.

• Statistical analysis shows that the metabolic syndrome, present at the beginning of the study, reverted in Mediterranean diet plus nuts group.

• Although there was no significant change in body weight (patients did not lose weight), and overall the two groups assigned the Mediterranean diet increased their intake of total fat and total energy (calories), the metabolic status of these group members improved.

The researchers conclude:

“Traditionally, dietary patterns recommended for health have been low-fat, high-carbohydrate diets, which generally are not palatable. The results of the present study show that a non–energy-restricted traditional MedDiet (Mediterranean diet) enriched with nuts, which is high in fat, high in unsaturated fat, and palatable, is a useful tool in managing the MetS (metabolic syndrome). Dietary intervention may reduce cardiovascular risk among persons with the MetS”

One can only guess what the accumulated effect of improving diet components (eating a more Mediterranean diet) combined with exercise and weight loss could achieve. As we all know, losing weight and keeping a commitment to exercise are not easy tasks, whereas eating more of something tasty is quite doable for most people.

So, what’s so good about nuts?

Nuts are a whole food, rich in protein, fiber, arginine, vitamin E, magnesium, copper, phosphorus, potassium, calcium, selenium and folate.

The fats in nuts are mostly unsaturated fats, especially monounsaturated fat, which lower low-density lipoproteins (LDL or “bad” cholesterol) and increase high-density lipoproteins (HDL, the “good” cholesterol). Nuts contain the essential fatty acids. One ounce of walnuts meets the daily recommendation for omega-3 fatty acids. Nut consumption has been associated with lower risk of cardiovascular disease in several good studies.

An average handful equals about one ounce of nuts. One should remember that an ounce of nuts contains 160-200 calories (depending on nut type), so don’t overdo it if you’re watching your weight. But, nuts are quite filling and several studies show that weight gain was not a problem when subjects were fed nuts within the context of a balanced diet.

It’s very easy to add nuts to your life. You can eat them as a snack; sprinkle them on salad, yogurt, pasta and cereal; add them to batters, stews and stir fried dishes—the options are endless.

You can read more about the connection between food and the metabolic syndrome in my post here.

Enjoy your nuts. In moderation though.
Ayala

Is Organic Food Healthier?

I am taking a short break until mid-December to spend time with my family and travel. Meantime, I'm reposting some of the more popular posts I’ve written over the past year so that new readers have a chance to catch up. Enjoy this post! - Ayala

I support the organic movement and started buying organic food as soon as organic alternatives were available to me. I will gladly pay more for an organically produced food item.

As I studied the subject more carefully, I became more and more convinced that eating and buying organic isn’t just about maintaining your own health; it’s about political change and doing something for the greater good.

I think that the first, selfish motivation is quite clear. Conventional food is grown using a multitude of chemical fertilizers, pesticides and herbicides. We now know that these remain in the food, and are absorbed by and present in our body. Although conventional growers and food producers make every effort to convince us that these chemicals are safe and harmless in these amounts, common sense says that they definitely add nothing good to our health, and we’re probably better off without them.

Personally, I don’t want to be part of this experiment. We live in an environment that has hundreds of new, man-made chemicals. It will be very hard to prove that any single one of them is a direct cause of disease, as they probably do not have very high toxicity, but overall, this experiment is not going well so far. Despite major advancements in medical care, the rates of many chronic diseases are on the rise, and there is some concern that chronic, repeated chemical exposure contributes to that. While it’s impossible to avoid exposure altogether, I think that directly ingesting contaminants on a regular basis isn’t a good idea.

Organic farming practices

In order to look at the bigger picture of what “choosing organic” means, we have to understand organic practices. The certified organic label on a food means that the producers of the food followed several rules:

o They do not use synthetic pesticides, herbicides, or fertilizers to grow crops.

o They do not fertilize with sewage sludge.

o Food is not irradiated or genetically modified.

o Organic farmers are required by the National Organic Standards to minimize soil erosion.

o Soil fertility is maintained through practices such as crop rotation, cover crops, and use of composted material (which is basically recycling farm waste into soil nutrients).

o Animals cannot be fed the byproducts of other animals.

o Animals are given access to the outdoors and treated humanely (I read several reports that make me believe that the humane treatment of animals is an aspect that needs more attention).

We can easily see how important these practices are to the environment:

o An organic farm doesn’t contribute to the growing problem of chemical fertilizers’ run-off contaminating our rivers, lakes, oceans and drinking water. This contamination is persistent, and affects us -- as well as wildlife.

o An organic farm doesn’t contribute to our worrying dependence on foreign dwindling oil supplies (fertilizers are fossil fuel products).

o Farm workers on organic farms aren’t subjected to a work environment heavily contaminated by pesticides.

o Soil fertility is maintained for future generations.

o An organic farm recycles its waste, and doesn’t fill landfills with hazardous waste.

o An organic farm promotes biodiversity.

o Organic practices lead to crops that are more resistant to drought and pests, and probably are more complex in phytochemical composition. (Phytochemicals are chemical compounds derived from plants and fruits; there is evidence from epidemiological studies that phytochemicals in fruits and vegetables can significantly reduce the risk of disease.)

And as defined by the USDA National Organic Standards Board (NOSB):

"Organic agriculture is an ecological production management system that promotes and enhances biodiversity, biological cycles and soil biological activity. It is based on minimal use of off-farm inputs and on management practices that restore, maintain and enhance ecological harmony.”

What does the organic seal mean?

The organic seal was introduced in 2002, and assures that products labeled as organic meet stringent standards established by the U.S. Department of Agriculture (USDA). Under the USDA regulations, In order for a product to be labeled as “organic” and gain the organic seal it must contain a minimum of 95% organic ingredients.

The certification is a very arduous process.

Growers seeking certification have to study the organic standards. Farm facilities and production methods must comply with the standards. Extensive paperwork must document farm history and current practices, and usually must include results of soil and water tests. A written annual production plan must be submitted, detailing every aspect of farming: Seed sources, field and crop locations, fertilization and pest control activities, harvest methods, storage locations, etc.

Annual on-farm inspections are part of the certification process, with a physical tour, examination of records, and an oral interview. Also, short-notice or surprise inspections can be made, and specific tests (e.g., soil, water, plant tissue) may be requested. For first-time farm certification, the soil must meet basic requirements of being free from use of prohibited substances (synthetic chemicals, etc.) for three years.

Certification for food producers is similar. Every aspect of the production, including ingredients, transport, processing and packaging are examined and need to adhere to strict standards.

The organic seal is earned with a lot of effort. The certifiers take their job very seriously, and for that, they have gained the public’s trust. Our product, Herbal Water, recently earned the organic seal. The long process made me even more respectful of the certifying agencies and the seal.


Do our choices matter?

By choosing organic food, consumers send the message to food growers and manufacturers that organic practices are important. The growth of the organic segment has been so dramatic because more and more people are demanding these products. And whether producers sign on to organic practices for ideological or financial and marketing reasons, the result is the same -- less degradation to our environment and a healthier planet.

So, yes, our choices matter a great deal.

If organic produce seems expensive, bear in mind that conventional foods have many hidden costs; the expenses associated with personal health and environmental degradation, for example, just weren't factored in when you bought them. We (and our children) will pay those costs later. With the prices of fossil fuels rising, we’ll also see conventional crops costing more (remember, conventional foods use fertilizers that are made from fossil fuels).

When you consider all the issues from a broad perspective, non-organic food is really just too expensive to even consider.

Ayala

Body mass and cancer

I am taking a short break for a few weeks to spend time with my family and travel. Meantime, I'm reposting some of the more popular posts I’ve written over the past year so that new readers have a chance to catch up. Enjoy this post! - Ayala

Most people think changing their diet would make them healthier, and they are right. Nutrition affects health in a profound way, and unhealthy eating habits are a big risk factor in many diseases.

Excess bodyweight (overweight or obesity) is increasingly recognized as an important risk factor for some cancers. Since two thirds of Americans are overweight or obese, overeating is a major contributor to cancer occurrence in the US, even more so than cigarette smoking.

Last week, a new study in the prestigious Lancet, showed further evidence that increased Body Mass Index (or BMI, a measure of body fat based on height and weight that applies to both adult men and women) is associated with increased risk of common and less common malignancies (The Lancet, Volume 371, Issue 9612, 16 February 2008-22 February 2008, Pages 569-578). The researchers found that in men, a 5kg/m2 increase in BMI raised the risk of esophageal adenocarcinoma by 52%, thyroid cancer by 33%, and colon and kidney cancers each by 24%.

In women, a BMI increase of 5kg/m2 increased the risk of endometrial (59%), gallbladder (59%), esophageal adenocarcinoma (51%) and kidney (34%) cancers.

They also noted weaker but significant positive associations between increased BMI and rectal cancer and malignant melanoma in men; postmenopausal breast, pancreatic, thyroid, and colon cancers in women; and leukemia, multiple myeloma, and non-Hodgkin's lymphoma in both sexes.

This study is a meta-analysis combining findings of 141 carefully selected previous studies, and looking at over 282,137 cases of cancer.

It offers further support to the link between obesity and cancer, but does not supply a clear mechanism for how extra weight causes the disease.

Evidence has been accumulating about the relationship between lifestyle, nutrition and cancer prevention, and that led to collaboration between the World Cancer Research Fund and the American Institute for Cancer Research. Their second expert report was published recently, and was a huge undertaking, involving over 100 scientists from 30 different countries. WCRF/AICR commissioned and funded the report, but the content has been driven by an independent panel of 21 world renowned scientists. Over 5 years the group systematically collected and reviewed all the relevant global scientific literature on the subject. They then evaluated the evidence and produced consensus recommendations for reducing the risk of developing cancer and promotion of general good health and well-being. This report is the largest study of its kind, and its conclusions are as definitive as the available evidence allows.

The full report is very long and can be downloaded (free) at http://www.dietandcancerreport.org. Chapter 12 of the report features eight general recommendations for cancer prevention:

“1: Body Fatness: Be as Lean as Possible Within the Normal Range of Body Weight.” As discussed in the Lancet article, maintaining a healthy weight throughout life may be one of the most important ways to protect against cancer, and being overweight or obese increases the risk of some cancers.

“2: Physical Activity: Be Physically Active as Part of Everyday Life.”

“3: Foods and Drinks That Promote Weight Gain: Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.” Sugary drinks were targeted specifically in the report: “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”. Another recommendation under this heading is “Consume 'fast foods' sparingly, if at all.”

“4: Plant Foods: Eat Mostly Foods of Plant Origin.” Diets that are protective against cancer are characterized by large intakes of foods of plant origin and, indeed, several cancers are responsive to increased intakes of plant-based foods.

“5: Animal Foods: Limit the Intake of Red Meat and Avoid Processed Meat.”

“6: Alcoholic Drinks: Limit Alcoholic Drinks.” (Men-to 2/day, women to 1/day).

“7: Preservation, Processing, Preparation: Limit Consumption of Salt and Avoid Moldy Cereal Grains and Pulses (Legumes).” Salt and salt-preserved foods are probably a cause of stomach cancer, and foods contaminated with aflatoxins are a cause of liver cancer. Although salt is necessary for human health, typical levels of consumption are vastly excessive.

“8: Dietary Supplements: Aim to Meet Nutritional Needs Through Diet Alone.” Dietary supplements are not recommended for cancer prevention. According to the report the greatest danger associated with the use of dietary supplements is the possibility that consumption of supplements is serving as an alternate to good nutrition, and supplements are taken as “magic bullets” to compensate for cancer-friendly dietary and lifestyle practices.

Changing dietary habits may not be easy, but the gathered evidence makes me hopeful. By taking steps to improve our diet a lot of diseases can be prevented.

Ayala