Healthy Food & Healthy Living by Dr. Ayala

Can we blame our habits for making us fat?

We’d like to think we’re free to make choices about our everyday life.

But studies show that almost half of the actions people take each day aren’t actually a result of decisions – they’re driven by habit alone.

Habits are so strong and so ingrained that they override many other thought processes. It seems like our human brain, trying to save on energy, goes into autopilot for every process it can use old routines for, and will fight any proposed change. The positive side of habit is that once you’ve mastered dressing up in the morning and backing out of your garage, your mind can wander free while you’re performing a rather complicated task. The negatives are quite clear to anyone trying to lose weight or stop smoking.

Charles Duhigg’s "The Power of Habit" is a fascinating exploration of the research of habits, and is packed with absorbing stories about how habits influence every aspect of our lives – the way we shop, listen to music, drive, and of course eat is driven mostly by habit. Understanding habits is the key to creating change.

The habit loop

A habit is a three-step loop, written in our brain’s pathways. First comes a cue: a trigger that tells our brain to go into the automatic mode of the habit. Then comes the routine, which is the physical, emotional or mental action we take. What follows is the reward: the prize at the end of the routine is what reminds our brain why this habit is worth keeping. When a habit is fully formed the reward’s rush of excitement appears well before it actually happens – brain scans show that we expect the reward and get excited as soon as the cue appears, and this anticipation creates cravings.

Food habits start innocently: Feeling tired or bored an hour after lunch can become a cue to walk to the vending machine and select a high calorie snack that hits all the right spots and gives you the instant reward of yumminess and energy. After repeating this routine several times it becomes habit, and your brain craves to finish the loop whenever the faintest prompt shows up. 

Watching TV acts as a cue for many people to munch: the cue is the TV or the couch, the routine is going through a bowl of chips, and the reward is that physical sensation of this delightful combo experience. The loop becomes so automatic, that watching TV without a bowl of munchies makes you feel robbed (and in case you forget it there’s always an ad to remind you that watching is better with eating).

Advertisers are well aware of the psychology of habit, and if you examine carefully, many ads and marketing campaigns build a habit loop in which they tie a certain cue – be it a place, an emotion, a time of day, a thought or a situation – to the action of consuming their product and feeling its reward. Duhigg uses McDonald’s as an example of habit building strategy:

“Every McDonald’s looks the same – the company deliberately tries to standardize stores’ architecture and what employees say to customers, so everything is a consistent cue to trigger eating routines. The foods at some chains are specifically engineered to deliver immediate rewards – the fries, for instance, are designed to begin disintegrating the moment they hit your tongue, in order to deliver a hit of salt and grease as fast as possible, causing your pleasure centers to light up and your brain to lock in the pattern. All the better for tightening the habit loop.”

Keystone habits

Some habits are more important than others, because they spill over to other parts of life, causing a ripple effect. These habits are called keystone habits and identifying them can often trigger widespread change.

Take exercise: Studies show that introducing exercise – even infrequently – changes other daily routines. Unknowingly, people who start to exercise start eating better, are less stressed, and become more productive at work. Duhigg lists eating dinner as a family as a keystone habit, which seems to go with better homework skills, higher grades, better self-control and more confidence.

I’d argue that sugary drinks are a keystone habit that initiates an array of associated poor nutrition habits. That’s one of the reasons most serious diet programs target the sugary drink habit first – winning the soda habit change leads to several other wins that follow.

Is habit destiny?

Once a fresh sheet of paper has been folded it will tend to fold into the same crease, and once water carved a path in the soft soil water will naturally flow in the same route, but our habits are malleable, and as Duhigg concludes:

"Once you know a habit exists, you have the responsibility to change it...others have done so...That, in some ways, is the point of this book...how we eat and sleep and talk to our kids, how we unthinkingly spend our time, attention and money — those are habits that we know exist. And once you understand that habits can change, you have the freedom and the responsibility to remake them. Once you understand that habits can be rebuilt, the power of habit becomes easier to grasp and the only option left is to get to work."

Changing habits is very hard work, and thinking about the power of established habit should remind us to be aware of habit acquisition, especially as parents.

We can do our kids a favor by helping them acquire good habits – habits that ensure that their automatic, default routines are healthy and beneficial. If kids brush their teeth every night before bedtime, get used to healthy eating habits, learn how to cook and are active when young they’re likely to continue doing these things throughout life.

We should also do our best to help them avoid habits that will be difficult to fight later on. Highly processed, densely caloric salty sweet and fatty foods are addictive and habit forming – ads make them even more so. Eating while multitasking, constant snacking and eating in the back seat of a car are learned routines that will not serve them well.

Dr. Ayala

“It is easier to prevent bad habits than to break them” ~Benjamin Franklin 

Reposted as part of Food Renegade's Fight back Fridays. 

The Family Dinner: A healthy ritual to look forward to every day

I have been making dinner pretty much every day for the past 16 years. I’d be lying if I said cooking, serving, participating and cleaning-up have been the highlight of each of my days. After a hectic day at work, the question “what’s for dinner” often felt like an accusation, reminding me that despite my efforts I’m still much behind. And not every meal has been peaceful. When my kids were very little (my kids are so close in age that at some point all three were toddlers — an age group you can expect very little table manners from) dinner was so hectic I could hardly taste the food. I often thought that perhaps we adults should eat our meal after we put the little ones to bed, so that we can feel half civilized. But we persisted, and I’m proud to say that I think we all, as a family, look forward to dinner together, and see it as an institution that renews our “familyness” every day.

This brings me to a Laurie David’s book. If you’re still in search of a realistic resolution for this new year this book may lead you to it. Laurie David is an environmental activist. I’ve been reading her newsletter for years. Food is an environmental issue, so it probably isn’t a huge surprise to see David publish a food book. The focus of David’s book – The Family Dinner — is, I believe, one of the most important, effective and fun lifestyle changes we should all enhance, in order to achieve a long list of good outcomes, and since kids imitate us more readily than they listen to us, family dinner is an opportunity to model to kids what we believe to be the right way to eat, share and interact. Dinner together is time to nourish our bodies, but it’s so much more than that. Dinner is time to reconnect, a time to slow down and share, a time to talk and listen — it’s, as David writes, “an island of calm in a sea of change”.

The book starts with an introduction that will motivate you, providing all the rationale to invest in dinner-time (many studies associate family dinner with lots of desired outcomes: less abuse of drugs and alcohol, lower obesity rates, better grades, better language skills etc.) The rest of the book is a lovely resource for everything you need to make dinner time easy, educational, fun and memorable.

David invited a diverse group of thought leaders — including Jamie Oliver, Alice Waters, Michael Pollan, Billy Collins, Jonathan Safran Foer and Mark Bittman — to share their family dinner wisdom and memories. But my favorite parts of the book were those around table talk and the creation of good conversation. David suggests various ways to get the family interacting, from word games to discussion topics to resources such as commencement speeches (these are published in newspapers yearly, and provide well written, valuable life lessons).

The recipes, by Kirsten Uhrenholdt, are practical without being dumbed down. They offer good, healthy food, and a wide range of flavor, texture and experience, and a plan that gets the whole family together, working in the kitchen and sharing the pleasure and responsibility of making food. Many of the recipes are meatless, and David devotes a whole chapter to her reasons for eating more vegetarian meals. Many of the dishes offer opportunities for personalizing the dish—from ‘choose your toppings’ to different final touches — which kids, I’m sure, will adore.

To give you a taste for the books’ approach to cooking together, I asked the authors for permission to share one of the recipes from the “kids in the kitchen” chapter. In this recipe the kid is boss, and is empowered to pick and choose garnishes, adjust and fine tune the sauce to his liking, and even boss the parents, and sent them off to clean their room, set the table and wash their hands. I tried this recipe with my 11 year-old a few days ago. It was enormous fun. The pictures above reflect my daughter’s creation and choices (the pictures in The Family Dinner, by Maryellen Baker, are much lovelier.)

Pea Nutty Noodles
Adapted from “The Family Dinner”

You Need

For the peanut sauce

• 1 pound of your favorite shaped pasta


• 1 cup peanut butter


• 1/2 cup soy sauce


• 2/3 cup warm water


• 3 tablespoons chopped fresh ginger


• 2 cloves garlic, chopped


• 1 tablespoon toasted sesame oil


• 1 tablespoon honey


• 3 tablespoons white (rice or wine) vinegar

Garnishes: Pick and choose any you please and as much as you want

• Chopped peanuts
• Diced cucumbers
• Diced apples
• Sliced scallions
• Limes cut into quarters
• Sliced cabbage
• Asian chili sauce, if you are brave
• Chopped fresh cilantro or mint
• Shredded carrots

To Make 6 Servings

• Pick out the garnishes you want to serve with the noodles and chop, dice, and slice them. Put them in little bowls.
• Ask your parents, nicely, to boil the pasta until it is al dente (not too mushy). Remind them gently that the pasta water should have enough salt to taste like the sea.
• When it’s done, have them quickly rinse the pasta in cold water. Thank them for helping you.
• Now mix all the ingredients for the peanut sauce together in a big bowl with a big spoon. You will have to stir, stir, stir, until it is all mixed together and smooth (or you could get a parent to mix it all in a blender).
• Taste the sauce…is it perfect? When it is, toss in the pasta and pour into a pile on a big platter or bowl. Put the little bowls of garnishes around the platter, and yell diiiinner!

Enjoy, and do fill me in on your best family dinner moments.

Dr. Ayala

Further resources: http://thefamilydinnerproject.org/

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

How we can end overeating and eat healthier

This week I’d like to reflect on one of my recent food related reads—David Kessler’s excellent “The End of Overeating.”

No, it doesn’t offer five easy ways to achieve a perfect beach body this summer, nor does it have a new magic trick to overcome food craving and obsessions. Rather, it‘s a lucid, well-researched and gentle book that takes a shot at explaining why we overeat. Knowing and understanding this could be a valuable first step toward eating better and with less torment, and maybe to losing weight or avoiding weight gain too. I think that Kessler’s book is a good read for anyone who eats food and for every parent raising kids in our food-crazed culture, and that includes those of us who have never struggled with overweight.

David Kessler M.D., a pediatrician, former dean of the Yale and University of California medical schools and former Food and Drug Administration commissioner has led the battle against the tobacco industry and dramatically reinvented the food label, and in this book goes deep into how the food industry, assisted by very clever marketing, designs and promotes products perfected to hijack our appetite and our brain and get us to consume more of their food.

Kessler admits to being one to obsess over food and struggle with uncontrolled eating and weight. His book combines personal stories with many scientific studies that delve into the science of obsessive, or what he dubs “conditioned overeating,” the kind in which food has power over you, draws you in, leaves you always wanting more and rarely satisfies your hunger.

The formula for irresistible food

According to Kessler, American industrial food has perfected a formula for food that’s highly palatable. The main driver of food desire is sugar, and when you layer that with fat and salt, food becomes irresistible (despite that these formulaic products are terrible for your body). Kessler cites food consultants and designers who describe processed food as “adult baby food” —free of the elements of whole healthy food, it goes down very smoothly and quickly, and delivers lots of calories without much chewing.

Processed foods manufacturers make what they know consumers want-- sugar, fat and salt in perfect balance, with the right texture, mouth feel and flavor. Flavor of course can be completely designed by food chemists and can make the blandest of raw material into a highly palatable food. Chemists can imitate a multitude of traditional, expensive or exotic ingredients, and create processed food in which the only real thing is cheap readily available ingredients with not much taste, yet the end product is optimized to give it great sensory appeal. Technology enables the food industry to make anything they want from a few simple cheap building blocks and plenty of sophisticated chemical inventions. It looks like food, it captures your attention (and your taste buds), but it isn’t nutritious and doesn’t satisfy.

Add to that the ingenious selling machine that pushes these foods and makes them available everywhere and you start to understand why it’s so easy to overeat.

How to regain control

The first step to improving your diet is to look at these foods critically--see them as addictive, not nutritious, and designed only to sell. Kessler calls for a perceptual shift of the kind that occurred with tobacco. The next step is to fight back. Kessler devotes several chapters to a strategy that starts to enable people to free themselves of overeating and obsessing. The treatment plan includes planned eating (rather than eating in an unstructured impulsive way), controlling portion size, choosing the right foods, finding joy in eating and overcoming the old unrestrained eating behaviors.

He also believes several public policies can make food manufacturers change their products for the better. Among these are calorie posting in restaurants, prominent display of added sugar, refined carbohydrates and fats on the food label, monitoring and exposure of food marketing ploys that promote harmful behavior, and education campaigns informing the public of the dangers of eating unhealthy foods loaded with sugar fat and salt.

But Kessler thinks the main power we have as consumers is our ability to change what’s acceptable as food—when we change social norms, and better food in moderate amounts is what’s expected by us the food landscape will change too.

Can we prevent junk-food craving?

I think that very few people are completely free of worries about eating and weight, and most people who care about their health and weight exercise control over eating on a regular basis—I certainly do. But one of the nagging thoughts I had while reading this book was that I personally couldn’t really identify with the attraction to the processed hyper-palatable foods that are rich in sugar, fat and salt that Kessler sees as conditioning us to overeat.

I don’t think I was ever attracted to these sweet, fat and salty processed foods. Did I reason with myself and turn against them because they’re unhealthy and fattening? Maybe, but honestly, I think I rejected them based on taste. When Kessler describes the milkshakes, chocolate chip cookies, fried foods and the offerings at Chilli’s and Cinnabon’s, my mouth didn’t water at all. I know I wouldn’t eat these foods even if I was hungry.

I tried to think about my kids, who are unconcerned with weight issues. While they do have a notion that eating well is important to their health, they don’t worry about it much. I do believe they, too, would reject these foods (even a triple-thick chocolate milkshake) on the basis of taste and appeal.

And in that thought lies a hopeful message to us parents: I believe that if you feed your kids real, unfussy food made from fresh, quality ingredients, they’ll develop a taste for it. They’ll also develop an expectation for how one feels after eating a good balanced meal, and contrast it with how one feels after consuming the super-sized fatty fast food meals. Real food has a sophistication and complexity that is very appealing if you’re sensitive to it. When you’re used to healthy real food, fast food feels like a heavy bombardment of sweet, fat and salt that’s really quite crude and indeed unsatisfying.

I do think that it’s just like art appreciation: once you’ve immersed yourself in the real thing, the reproductions pale.

I was thinking of Kessler’s book again when we were at a party last weekend. I was selecting dinner from the extensive buffet that included foods with “kid appeal”, such as French fries and onion rings. My ten year-old and her friend were right next to me, and her friend called with delight: “Asparagus! I love asparagus!” and filled his plate with the grilled stems topping them with hot sauce. My daughter selected nothing but cucumber sushi rolls. I don’t think the fried food had a chance with these kids—they simply didn’t think of it as food.

Part of the strategy to end our overeating, I think, lies with developing good competition to the sweet, fat and salty in the form of simple, healthy, tasty food.

Did you ever feel like food has power over you? Do you have ways to free yourself? Please share!

Dr Ayala