Healthy Food & Healthy Living by Dr. Ayala

Study proves school nutrition standards work

School meals are far from perfectly nutritious, even after the long awaited and very welcome changes put in place earlier this year.

The good news is that under the new guidelines kids will hopefully double their fruit and veggie intake, will be served more whole grains, all milk will be low fat, and there’ll be upper limits to salt, trans-fat and calories in the school meal. The not so great reality is that kids will continue to eat lots of highly processed foods – very few schools actually cook food from scratch – and tomato paste on pizza counts as a vegetable.

But school food isn’t just the subsidized school lunch; competing with it are the foods sold in schools -- in vending machines, school stores, and a-la-carte in the cafeteria -- which make a big part of what kids actually eat while they’re in school.

The USDA administers and regulates the school lunch program, and is developing nutrition guidelines for the foods and drinks sold at schools. (The Healthy, Hunger-Free Kids Act, passed in 2010, gives the Agriculture Department authority to set health standards for all foods sold on school property — including those in vending machines). Right now, the only existing federal restriction is that foods of “minimal nutritional values”, such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors.

In the meantime some states have developed their own regulations. Studying the effects of different sets of regulations and their enforcement can teach us what’s been successful – and what doesn’t work.

Vending machines with fewer calories

California was one of the first states to implement rules for vending and selling foods in schools; these rules limit the caloric content, fat and sugar in snacks, and ban soda and sweetened beverages.

A new study in the Archives of Pediatric & Adolescent Medicine compared California high school students’ daily intake to the intake of students from 14 states without any school nutrition standards. 

California kids ate fewer calories per day at school -- 170 fewer – compared to high school students in other states. California kids also consumed less fat and sugar.

Did the kids load up the ‘lost’ calories on their way home or once they got there? It doesn’t seem so. Although California students ate more of their daily calories out of school when compared to the kids from the “no rules” states, the Golden State’s students took in 158 fewer calories a day, overall.

And a reduction of 158 calories is a big deal. We gain weight very gradually, and reducing even 100 calories a day can prevent weight gain and put a dent in the obesity crisis.

Fewer calories, perhaps no better nutrition 

California students ate fewer calories from fat and sugar, but the study found that their intake of nutrients such as vitamins and minerals was unchanged compared to the students from the other states. 

The authors suggest that the reason lies if the food laws themselves: the laws limit sugar fat and salt, they don’t require whole grains, fruits or vegetables. Replacing full fat chips with baked low-salt ones can only do so much.

Providing truly healthy substitutes is obviously the next step, but since obesity – too many calories -- and the abundance of sugar, fat and salt in kids’ diets are the main nutrition problem facing us, I’d conclude that California kids seem to enjoy better nutrition according this study.

Does public policy impact kids’ health?

While there are plenty of studies that show policies have a positive impact on kids’ eating habits, there are definitely studies that show that they don’t. I shared a recent study that showed that in schools that banned only soda, kids bought the other vended sugary beverages instead.  In schools that banned all sugary drinks kids indeed consumed fewer sugary drinks at school, but their consumption did not decrease overall; kids were able to find sugary drinks out of school, and filled the sugar gap before and after school. In other words, school vending policies only changed the school environment, and didn’t seem to be enough to change kids’ access and behavior overall.

I’d argue that even if the regulations don’t have the immediate nutrition-improving outcome we’d hoped for, it’s still imperative to apply nutrition rules for educational reasons. It’s impossible to advocate for safe driving while holding a cellphone with one hand and the wheel with the other.

School should have a central role in nutrition education, and you can’t teach healthy nutrition while benefiting from the sale of junk food within school walls.

Kids spend half their waking hours in school and consume much of their daily calories while on campus. Changing school food should be a critical part of the effort to combat obesity.

Dr. Ayala

 

Diet Soda and Metabolic Syndrome Linked in New Study

We’ve developed a national sweet tooth problem. Enjoying sweet foods is the most natural, inborn tendency – it used to get us excited about mother’s milk and ripe fruit -- but our level of added sugar consumption has reached such absurd heights that it’s clear that these mountains sugar are fueling the obesity epidemic.

To our alleged rescue came non-caloric sweeteners, offering the same intense sweetness without the caloric price tag.

Alas, diet drinks may not assist with weight loss. A few long-term studies surprisingly showed a dose-response correlation between consuming diet drinks and the development of obesity.

What was even more alarming was the emergence of studies showing a connection between the consumption of diet drinks and chronic disease: diet drinks were linked with the metabolic syndrome* and type 2 diabetes, and a recent study published in the Journal of General Internal Medicine showed that people who drink diet soft drinks on a daily basis may be at increased risk of stroke, heart attack, and vascular death.

The study of nutrition is a very tricky thing, as people don’t eat at researchers’ will, and the effects of many lifestyle choices – not limited to food – over a lifetime affect the measured health outcome. That’s why a good study looking at nutrition and heart health, for instance, controls for obvious confounders such as obesity, smoking, exercise and lipid profile.

The question always remains: Is it possible that the metabolic and heart problems experienced by diet soda drinkers come from some other behavior they share, one that has nothing to do with diet soda? Specifically, could diet soda drinkers have a tendency for a less healthy diet, which is the real (and already known) cause for the increased risk of disease observed?

Do those eating a less healthy diet prefer diet soda?

A new study, published online ahead of press in the American Journal of Clinical Nutrition tries to tease out the specific role that diet beverages play on metabolic health when the general healthfulness of the diet is considered at the same time.

The researchers, led by Kiyah Duffey, looked at the data of more than 4000 young adults, who were followed for 20 years for signs of heart disease, and analysis showed that their dietary practice can be broadly defined as fitting a “Prudent Diet” – emphasizing more fish, fruit, nuts and whole grains -- and “Western Diet” – highlighting meat, poultry, fast foods, refined grains, snacks and sugar sweetened drinks. Diet beverages consumption was considered separately, and the study population was classified as  “Consumers” vs. “Nonconsumers”. The study looked for development of the components of the metabolic syndrome: abdominal obesity (measured by weight circumference), elevated blood glucose, high blood pressure and high cholesterol.

Here are the main findings:

• People who ate a Prudent diet had a lower incidence of the metabolic syndrome and each of its components, compared with those who eat a Western diet.
• People who didn’t drink diet beverages (Non-consumers) had 19% lower risk of the metabolic syndrome compared with those who drank diet beverages, although the effect was not on all components of the metabolic syndrome: being a non-consumer lowered the risk of abdominal obesity the most.
• People on a Prudent diet were more likely to consume diet beverages than people on a Western diet; in other words, drinking diet soda is mainly a habit of those eating healthier diets.
• Eating a Prudent diet and not consuming diet drinks put people at the lowest risk.
• The combination of a Western diet and diet drinks put people at the highest risk for cardiometabolic outcomes.

So at least by the findings of this study, diet beverages aren’t the typical drink paired with a Western diet -- quite the opposite -- and they're associated with greater risk independently of diet quality.

Why would diet drinks lead to obesity?

The authors conclude that both dietary pattern and diet beverage intake are independently associated with the development of the metabolic syndrome and the development of abdominal obesity.

On the other hand, the study suggests that being a consumer of diet beverages in the context of a Western diet increases the risk of a metabolic outcome even more, so it very well may be that there’s an interaction between these two things.

This study didn’t go into proposed mechanisms that may explain how diet beverages might affect obesity or metabolic outcomes. Artificially sweetened beverages may habituate our taste receptors to prefer intense sweetness, leading us to reject less-sweet foods (such as veggies and fruit) and seek intensely sweetened foods. Diet drinks may also trick our hormonal and neurobehavioral pathways –- sweetness signifies to our body that energy and nutritious food are on the way, enacting a cascade of reactions, yet with diet drinks no calories are actually consumed. The outcome of this disconnect isn’t yet clear.

I’d still pick a diet drink over a full calorie one, but is seems like the more we study diet drinks the more we realize that they’re not an effective way to improve heart and metabolic health, or even lose weight.

Dr. Ayala

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 metabolic syndrome is a group of risk factors including abdominal obesity, high blood pressure, elevated triglycerides, low levels of high-density lipoprotein (HDL or “good”) cholesterol and high fasting glucose levels. The presence of three or more of the factors increases a person’s risk of developing diabetes and cardiovascular disease. The metabolic syndrome has become increasingly common in the United States. It is estimated that over 50 million Americans have it. 

 

 

Cities Fighting Soda

Several city health departments are stepping up their anti-soda efforts in an attempt to curtail obesity and diabetes. Philly is now airing its own TV spot, which my kids had noticed and brought to my attention over the dinner table.

There's quite a wide range in the messaging tactics each city takes.  NYC's campaign certainly caused a stir, especially the "Are You Pouring On The Pounds" video, which was deemed too disgusting by some. Take a look at these different approaces.  Which works best in your opinion?

Philly:

 

New York: 

 

 

Boston:

 

See LA's media campaign here and Santa Clara's here.

Dr. Ayala

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.

Halftime in the school cafeteria

Last month Michelle Obama and Agriculture Secretary Tom Vilsack announced some very welcome and long awaited changes to the government subsidized school meals. These are the first changes made in the program -- which feeds 32 million kids each day – in 15 years. Under the new guidelines kids will be doubling their fruit and veggie intake, will be eating more whole grains, all milk will be low fat, and there’ll be upper limits to salt, trans-fat and calories in the school meal.

Yes, the program is far from perfect, kids will continue to eat lots of highly processed foods – very few schools actually cook food from scratch – and tomato paste on pizza counts as a vegetable. But it’s a laudable change in the right direction, and considering the mighty fight the food industry wages against any proposed change, and the fact that the new rules will add 3.2 billion to the yearly cost of the program it’s reason for a mini celebration.

The next critical change is yet to come 

Competing with the subsidized school lunch are the foods sold in schools, which make a big part of what kids actually eat while they’re in school. These are foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events. The lunch money parents give their kids may very well be spent on these offerings rather than on the school lunch.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict of interest.

The USDA administers and regulates the school lunch program, and is developing nutrition guidelines for the foods and drinks available at schools. (The Healthy, Hunger-Free Kids Act, passed in 2010, gives the Agriculture Department authority to set health standards for all foods sold on school property — including those in vending machines). Right now, the only existing federal restriction is that foods of “minimal nutritional values”, such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors.

Vending junk 

A new study published in the Archives of Pediatrics & Adolescent Medicine showed that even in elementary school half of the students could buy potato chips, ice cream or similar snacks from vending machines and at snack bars during school.

Other studies show that a la carte foods sold in the cafeteria are common in all school levels. Vending machines are available in 87 percent of middle schools and virtually all high schools. Forty percent of kids consume competitive foods on any given day, eating 280 calories daily in mostly junk food (the most commonly consumed competitive foods are desserts, snacks and sweetened beverages.

The new age of vending

Getting rid of the vending machines is perhaps a fancy aspiration and a non-starter, especially during tight budget times.

Instead, states and schools have put in place policies guiding the nutritional content in schools’ vending machines, and now offer healthier vending options.  Several vending companies specialize in healthy vending. 

But the neatest idea I’ve seen yet is the LiVe vending machine Intermountain Healthcare installed at Rose Park Elementary School in Salt Lake City. The talking machine will make its rounds in Utah schools spending a few weeks at each. 

 

I want one of these in my kids’ school!

Let’s hope the upcoming USDA regulations for competitive foods in schools will be sensible and have teeth. 

Dr. Ayala

 

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

Study shows liquid calories trick body and mind to overeat

A calorie’s a calorie, isn't it?  Well, accumulating evidence shows that our body has a hard time registering calories from beverages in the tally towards satiety; unfortunately, these beverage's calories still count in our energy balance.  That’s why the extra calories in beverages are just extra—much like items that didn’t go into the budget, but will nevertheless have to be paid for.

There are numerous studies to prove this point; here are just a few:

Nutritionist Barbara Rolls from Penn State served 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.

In the cute jellybean study, researchers gave men and women 450 calories a day of either soda or jellybeans for a month, then switched them for the next month and kept track of total consumption. Candy eaters ate less food -- compensating for the extra calories. Soda drinkers did not, so they ate more calories than usual.

A study by Richard Mattes and Wayne Campbell of Perdue University looked at the effects of food form (solid, semi-solid or liquid) on appetite.  Participants consumed either a whole apple, applesauce or apple juice of equivalent caloric value. The apple juice reduced hunger the least, the whole apple reduced hunger the most and the applesauce response was intermediate.  The participants that had the beverage apple where ready for their next meal almost an hour earlier than those that had a bitable apple.

Is satiety in our senses or in our heads?

Previous research suggests that a fluid consistency leads to less satiety.  Beverages require less chewing, and travel faster through the stomach and the intestine, explaining the lower satiety effect.

But we also eat and get full in our mind.  Could it be that it’s our mind that doesn’t see fluids as food, and therefore fails to register beverage’s calories?

To try and tease apart the physiological from the psychological a new study led by Bridget Cassady and published ahead of print in the American Journal of Clinical Nutrition devised an interesting experiment.  Fifty-two healthy adults were treated to a pre-lunch “appetizer”, consisting of 10 percent of their daily caloric needs.  Each participant experienced 4 different pre-lunch settings, all containing exactly the same amount of calories:

• Liquid to liquid: participants consumed a clear, cherry flavored drink.  Study administrators demonstrated what happens in the body by mixing the drink with what they called “gastric acid”, but was really ordinary tap water.  The mix didn’t change the liquidity of the pre-meal, therefore participants drank a liquid, and believed it remained liquid in their stomach.

• Liquid to solid: participants consumed the same clear, cherry flavored drink.  Study administrators demonstrated what happens in the body by mixing the drink with what they called “gastric acid”, but this time it was calcium chloride, which formed a solid mass upon mixing, therefore participants drank a liquid, but believed it turned solid in their stomach.

• Solid to liquid: Participants consumed cherry flavored gelatin cubes.  The study administrator imitated what happens in the stomach by mixing the gelatin cubes with “gastric acid” which in this setting was warm water, which melted the cubes, leading participants to believe that although they swallowed a solid, their stomach experienced a liquid.

• Solid to solid: Participants consumed cherry flavored gelatin cubes.  The study administrator imitated what happens in the stomach by mixing the gelatin cubes with “gastric acid” which in this setting was cold water, which didn’t affect the cubes’ solidity, leading participants to believe that they swallowed a solid, and their stomach is digesting a solid.

Hunger, fullness and appetite were assessed after each pre-meal, as well as objective measures such as blood glucose, insulin and ghrelin, stomach emptying and intestinal transit time and caloric intake in the meal following the test pre-meals.

And the results:

Liquid meals and perceived liquid meals were followed by greater hunger and less fullness.  Participants’ responses to liquid to liquid and solid to liquid pre-meals included: ”this didn’t fill me up at all” and “it hardly feels I ate anything”.  On the other hand, the solid meal (solid to solid) and perceived solid meal (liquid to solid) elicited responses such as “ I can’t remember ever being so full” and “it feels like I swallowed a rock”.

Participants ate more (in the post-test meal) when they thought they’re eating liquids – 22 percent more, which amounted to about 160 additional calories.

Stomach emptying and transit time in the colon were faster when taking in liquid or when believing the solid turned into liquid.

Insulin and other hormones signaling satiety had an attenuated rise when consuming liquids. Ghrelin, a hormone, which is suppressed after meals, was less suppressed by the liquid pre-meals.

Thinking about liquids is enough to diminish satiety

This study confirms that liquid calories cause less satiety, and also shows that just thinking about food in liquid form increases not only hunger levels but also measurable physiologic responses such as the rate in which the stomach empties and the levels of hormones that affect appetite.

Why does our body seem oblivious to the calories in drinks? Perhaps it can be explained by looking at human history: Throughout most of human times people ate food when they were hungry, and drank water when they were thirsty. Beverages with calories were rare.

Nowadays, sugary beverages constitute about a fifth of the daily caloric intake and are probably the most ubiquitous food item, available for purchase practically everywhere. These liquids calories don't seem to satisfy hunger and are therefore a source for calories that just sneak up on us.

Dr. Ayala

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.

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

Banning soda in school isn’t enough

It took the whole village a few decades to create the obesity epidemic.  We slowly allowed the development of a food environment in which junk, fast and highly processed foods became available everywhere and anytime. Marketing and advertising of these food products permeated every real and virtual space making every moment and every deed a consumption occasion.

When we noticed that obesity rates among kids tripled and looked at what kids consumed, it was shocking to see that sugar sweetened beverages contribute about 300 (empty) calories a day to a teen’s diet, making them the single largest source of added sugar.  Indeed, sugary drinks have become a way of life, and their makers make sure fueling stations are densely spread so a kid would never have to go without.

And since so much time is spent at school, where kids are a captive and impressionable audience, school became another sugary drink fueling station.  Vended sugary drinks offered schools a source for much needed funds, and so developed the unholy union between the companies that want to imprint their brand’s image in kids’ minds and the institution that’s trusted to teach kids critical thinking and prepare them for a healthy and productive life.

Does changing the vending machine’s content change kids’ habits?

When the Institute of Medicine called for the removal of all sweetened beverages from schools and the American Academy of Pediatrics advised their elimination, some school districts and states did nothing, some opted to replace soda with lower-sugar options, such as sports drinks and vitamin water, and other cities and states went further and placed all-out bans on sweetened drinks.

A new study published in the Archives of Pediatrics and Adolescent Medicine examines the effect of different policies using data gathered from almost 7000 middle school students from 40 states; 22 of these school districts had no policy governing sales of sugary drinks in middle schools, 11 banned sales of soda only allowing all other sugary drinks, and 7 banned all sugary drinks, including sports drinks and fruit drinks (but not 100% fruit juice).

So how would you expect the kids to respond to the different vending policies?

I think no one would be surprised to hear that in schools that banned only soda, kids bought the other vended sugary beverages instead.  Banning soda did nothing to reduce sugary drink consumption in schools with a partial policy. 

But here’s an even more discouraging result: In schools that banned all sugary drinks kids indeed consumed fewer sugary drinks at school, but their consumption did not decrease overall; kids were able to find sugary drinks out of school, and filled the sugar gap before and after school.

In other words, school vending policies only changed the school environment, and didn’t seem to be enough to change kids’ access and behavior overall.

So are school policies useless?

It will take a village

The study authors, led by Daniel Taber, suggest it would take a comprehensive alteration of kids’ environment to change their sugary drink habits

“Experts have recommended broader policies, such as SSB (sugar-sweetened beverage) taxes or regulations of food marketing aimed at children. Future research should explore the effect that school-based policies have on youth diet and weight gain when implemented in conjunction with policies in other sectors.”

It would be naive to expect that changes at school can result in instant improvement when other sectors aren’t cooperating.

But there’s enormous value in creating a healthy school environment.

Giving a yellow card to kids shouting obscenities on the athletic field doesn’t guarantee the same words won’t be used when refs are out of earshot, but it still does teach kids sportsmanship – this is as much as we should expect from our schools.  Teaching kids good nutrition doesn’t guarantee they’ll eat well given the many unhealthy options all around them, but demonstrating through a school policy that chips and a sports drink aren’t food sends an educational message.   Schools should be parents’ partners in teaching healthy eating habits.  But schools can’t to do it all on their own.

At this point it will take a village to change our habits.

Dr. Ayala

 

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.

Reposted in Fight Back Fridays.

Childhood obesity: Prepare for the flood

In contrast to adults, chest pain in kids is rarely of cardiac origin. A new article in the journal Pediatrics reassures us that an aching chest in kids, although a common complaint, was only rarely due to abnormalities of the heart.

But is the growing epidemic of childhood obesity threatening to change that? Could obesity in childhood result in heart attacks and other cardiovascular events when those children hit their 20s and 30s and even when they’re still teens?

Dr. David Katz’s piece in Childhood Obesity last year starts with a scary prediction, a prediction he hopes will never come true. 

Katz, an internist and leading authority on nutrition, weight management and the prevention of chronic disease, director and founder of Yale University's Prevention Research Center, warns that heart disease might become a routine pediatric condition.  Heart disease can follow the path of type 2 diabetes, – previously called “adult onset” diabetes, because it was an affliction of adults – which is spreading among kids like an epidemic and is diagnosed in obese kids under the age of 10 years.

Dr. Katz tells us that in adults, guidelines for healthcare providers suggest that any patient with diabetes should be treated as if they have some degree of heart disease, because diabetes is such a strong risk factor for coronary artery disease. 

Can we assume the same for kids?  Kids who’ve had diabetes for 10 years have been exposed to the damages this disease causes to blood vessels, and Katz suspects we’re going to see more and more kids in their late teens with chest pain and heart attacks.  He’s personally encountered a 25-year-old who’s had coronary angioplasty and a 17-year-old who’s had a triple bypass.

Stack a sandbag today

Katz is announcing this grim prediction so that action will be taken to prevent it from materializing.

We know what causes childhood obesity.  Overconsumption of all the wrong foods and lack of physical activity are now the default way of life for so many of our kids.  We live in an obesogenic environment, which is going to deluge us with disease.  To prepare for the rising tide and to block its toxic water we need, Katz suggests, any sandbag we can find:

“Programs that provide routine physical activity throughout the school day are a sandbag. Nutrition education is a sandbag. Cafeteria makeovers are a sandbag. Adding sidewalks to a neighborhood is a sandbag. Nutrition information on menu boards is a sandbag. Worksite wellness programs are a sandbag. Reliable nutrition guidance systems in the supermarket are a sandbag. Recognizing that neither children nor adults will get healthy unless both do, together, is a sandbag.

The flood waters are both menacing and high. Stacking sandbags to raise a levee is hard work—but it’s not complicated. So seize the moment; embrace the opportunity in this crisis. Stack a sandbag today. The child you save from our new-age plague might be your own.”

Whenever a solution is proposed critics are quick to scrutinize and announce, quite correctly, that it will not solve the obesity crisis.  But if we can’t stop the flood and dam the mighty river should we dismiss sandbags? I completely agree with Katz: The sandbags needn’t be perfect, but we do need many of them and a joint effort to stack them up real high.

Dr. Ayala

More from David Katz here.

 

Study shows what kids eat at McDonald’s

Eating out, and especially eating at fast-food restaurants, is considered a risk factor for obesity, poor diet and chronic diseases.

Yet eating fast food is a major American habit: At least one quarter of adults eat fast food daily, as do 25 - 30 percent of kids.

Fast food meals typically serve big portions of calorically dense food, rich in fat and sugar and quite aptly labeled “fiberless food”.  The typical kids’ meal in fast food chains is no better – the main distinction of the young ones’ fare is the addition of the collectable toy.

Fast-food restaurants publicize (and are often applauded for) their move to healthier oils, and many have revamped their menu and now include a few healthier options, such as salads and apple slices (both accompanied by condiments that return guilt into the equation).  But do kids and their parents order the ‘better’ menu options?

What kids actually eat at McDonald’s

A new study in Childhood Obesity collected the receipts and interviewed 544 families with kids visiting the McDonald franchise inside the Children’s Hospital of San Diego for lunch.

Let me pause for a moment to comment on the presence of a McDonald franchise inside a children’s hospital, which feels like a great endorsement from a major medical institution.  I assure you that no reputable medical authority has ever given McDonald’s its blessing, yet San Diego’s Children’s Hospital is not alone in hosting a fast-food joint.  Children’s hospital of Philadelphia, considered by some the No 1 children’s hospital in the nation, had a McDonald’s for 34 years -- it closed a few weeks ago because the hospital needed the space -- Children’s Los Angeles has a McDonald’s on its first floor, as does Texas Children’s.

So what’s for lunch? The most frequent items bought for preschoolers (2-5 years) were French fries, soda, chicken nuggets, cheeseburgers and hamburgers.  The most frequent items for kids 6-11 years were French fries, chicken nuggets, cheeseburgers, soda and apple pie.  Adolescents’ choices centered on French fries, soda, cheeseburgers, chicken nuggets, and chocolate chip cookies.

Less than 1 percent of kids bought the yogurt parfait, and apple dippers were bought by less than 1 percent of preschoolers, 3.5 percent of 6-11 year-olds, and almost none of the teens (0.3 percent).

And now to the calorie count:  The average caloric content bought for kids’ lunch was 646-811 calories, which makes about half of the daily caloric need of a young kid.

The meals averaged 35-39 percent of calories from fat, with about 10 percent of that fat saturated. 

The sodium content of the meals averaged 866-1100 mg, which pretty much covers the daily sodium allowance of a preschooler.

The parents were asked what made them choose McDonald's for lunch, and the most common reasons for their pick were “the kids like the food” and its convenience. 

Better options at fast food restaurants – a remote option

This study confirms what we already know: Customers go to McDonalds for fries, hamburgers and soda, not for milk and salad.  A recent article by Christina Rexrode of the The Associated Press sums up the healthier options at fast food chains as just that – a remote option.  What really sells is the high calorie, high fat food, which the chains are famous for.   And the reasons are varied, but one of them is price: “Healthier foods also are usually among the most expensive menu items, which can be tough for recession-weary customers to stomach”.

Let’s face it, McDonalds isn’t renowned for its salads and apples, and as the kids in this study testify, they’re ‘lovin’ it’ for the taste they know -- it's the McDonald's fat-salt-sugar mixture they crave.

And it would have been fine, had it remained an infrequent indulgence.  Problem is, kids are eating fast food often.  Very often.

Dr. Ayala

 

Junk food is really cheaper!

In his recent New York Times article titled “Is Junk Food Really Cheaper”, Mark Bittman asserts:

 “In fact it isn’t cheaper to eat highly processed food: a typical order for a family of four — for example, two Big Macs, a cheeseburger, six chicken McNuggets, two medium and two small fries, and two medium and two small sodas — costs, at the McDonald’s a hundred steps from where I write, about $28… In general, despite extensive government subsidies, hyperprocessed food remains more expensive than food cooked at home. You can serve a roasted chicken with vegetables along with a simple salad and milk for about $14, and feed four or even six people. If that’s too much money, substitute a meal of rice and canned beans with bacon, green peppers and onions; it’s easily enough for four people and costs about $9.”

It’s the wrong comparison, though.  Jogging is a cheaper pastime than sitting on the couch and watching TV (cable packages don’t come cheap), yet our affinity for leisure and convenience comes into play when we choose how to use our free time.  The food cost question should more fairly be: Is a junk-food ready-to-eat meal cheaper than a healthier made-by-someone-else meal?  The answer to that is unquestionably yes!

Is healthier food more expensive?

A new study led by Colin Rehm in the American Journal of Clinical Nutrition addresses this question.  The study looked at the diet of almost 5000 participants, calculating the cost of their daily food and assessing its nutritional quality.  Diet healthfulness was scored taking into account foods and nutrients such as sodium, saturated fats, fruits and vegetables, total vs. whole grains and empty calories (SoFAS: solid fat and added sugar).

The study found a significant positive association between diet cost and diet healthfulness, and this was true for the entire study population, and especially strong for women.  But here’s an interesting finding: older adults, women and Hispanics had lower cost diets that were nutritionally higher quality when compared to other population groups.

Another recent study led by Adam Bernstein and including more than 78,000 women came to the same conclusion: It found that spending more money was clearly associated with a better diet.  Diet quality was assessed using the Alternative Healthy Eating Index (AHEI) -- a scoring method developed by Harvard researchers as an alternative to the US Food Pyramid -- that looks at the consumption of foods associated with lower risk of chronic diseases. Basically, the index gives points for eating fruits and veggies, whole grains, selecting white meats and fish over red meat and unsaturated fats over saturated ones.

But when the researchers divided the participants to quintiles according to their level of spending, they found that within each spending group there was quite a lot of variation in diet healthfulness. The diet healthfulness index for each spending group varied by as much as 29 index points, and just to put that number in perspective, a 20 percent increase in the AHEI score is associated with 25 percent lower risk of heart disease.

So this study, too, finds that there are ways to improve diet without adding cost: adding nuts, soy, beans, and whole grains, while reducing meat and dairy would improve the overall diet without increasing spending.

In another recent article Adam Drewnowski examined the cost of various foods compared to their nutritional content. He found that the cheapest foods per calorie or per serving are grains, sugars and fats, while fruit and vegetables are relatively expensive. Drewnowski argues that subsidies to wheat, corn and soy have led to increasingly cheap foods, rich in calories and poor in nutrition, and that “The fact that healthful foods cost more than less healthy options is a formidable real-world challenge for nutrition interventions”.

Unhealthy food’s lure

The raw ingredients that make a healthy diet are more expensive than those that make a less healthy one.

Experts overall agree that what’s most lacking in the average American diet is fruits and vegetables and foods with low caloric density.  By definition, and also just as a matter of fact, these kinds of foods have a higher cost per calorie than grains, fats and sugar, and since people living on tight budgets look also for foods that satiate (i.e. food with calories a-plenty), they’ll opt against fresh produce (full of water and fiber) in favor for calorically dense food.

But that’s not the main problem.  The bigger problem is that highly processed foods are weirdly inexpensive, and when affordable meets palatable, convenient, attractive, ready-to-eat ready-to-heat and highly advertised – the product becomes almost irresistible.

It’s possible to eat well on a budget.  Not all vegies and fruit are expensive and you can do quite well shopping for carrots, oranges, potatoes and beans.  Slow Food USA is proving through its $5 challenge that you can cook real food for $5 per person.   But doing so requires organization, cooking skills, time and determination. Before the age of highly processed foods people with low incomes would often grow their own food, eat very little meat and add very little sugar – sugar used to be expensive. Nowadays a low budget diet is more often a highly processed, fast-food diet, because nothing combines cheap with convenient and desirable as seamlessly.

Changing the culture

Bittman describes our relationship with fast-food as an addiction; we view home cooking, on the other hand, as “work”.  So how do we move from the quick fix offered in every corner to a culture that promotes simple, no-nonsense everyday cooking?  We need to convince people, especially kids, that fast-food isn’t food, isn’t cool, and we need to celebrate real food and have some fun cooking.  I’ll end with Bittman’s resounding words:

“To make changes like this more widespread we need action both cultural and political. The cultural lies in celebrating real food; raising our children in homes that don’t program them for fast-produced, eaten-on-the-run, high-calorie, low-nutrition junk; giving them the gift of appreciating the pleasures of nourishing one another and enjoying that nourishment together.

Political action would mean agitating to limit the marketing of junk; forcing its makers to pay the true costs of production; recognizing that advertising for fast food is not the exercise of free speech but behavior manipulation of addictive substances; and making certain that real food is affordable and available to everyone. The political challenge is the more difficult one, but it cannot be ignored.”

Dr. Ayala

 

Does soda cause belly fat? What about diet soda?

Mounting evidence links sugary drink intake with rising obesity rates, but it’s only recently that researchers started to sound the alarm: Sugary drinks not only cause obesity – which any food in excess will do – but may also act on our body in a uniquely harmful way.  Soda intake is associated with heart disease, type 2 diabetes and hypertension independent of obesity – now, how do we explain that?

Some blame the rapid and super-sized influx of refined sugar in sugary drinks, especially the fructose component of their sweeteners, and studies have shown a direct adverse effect of high fructose intake on fat metabolism and inflammation. 

Sugar’s not so sweet effects

A study from the University of California at Davis showed that drinking 25 percent of daily calories (which is quite a lot) in fructose for 10 weeks increased triglycerides and cholesterol, caused insulin resistance and belly fat accumulation. 

A recent study found that even moderate consumption of sugary drinks led to measurable undesirable effects after just three weeks: Belly fat accumulated, fasting glucose levels and inflammation markers rose, and the lipid profile changed when volunteers drank what amounted to just 1 can of soda a day.  Again fructose performed worse than glucose, but all sugary drinks had harmful effects, and it’s only in the lab that people can get pure glucose.  In our marketplace drinks are usually sweetened with sucrose (table sugar) or high fructose corn syrup (HFCS); both types of sweeteners are a combination of the simple sugars glucose and fructose, and all popular sugary drinks contain fructose. 

To add to this body of evidence, a new study in the journal Obesity examines the association between sugary drinks and diet beverages and the accumulation of fat, especially belly or visceral fat – the fat inside the abdomen that is active metabolically and associated with heart disease and diabetes.

The study, led by Andrew Odegaard, followed almost 800 healthy men and women, and looked at beverage consumption (assessed by questionnaires) and fat accumulation, measured by waist circumference, weight, BMI and the proportion of belly fat to under-the-skin fat, which was evaluated by MRI (Magnetic Resonance Imaging).

Here’s what the researchers found:

• Drinking more sugary drinks was associated with significantly more belly fat and wider waistlines
• Drinking more diet drinks (sweetened by non-caloric sweeteners) was associated with a larger waist circumference, higher BMI and more total fat, but not with increased visceral or belly fat.

The sugary drinks - belly fat connection

This study adds another small piece to the puzzle: sugary drinks are associated with obesity.  Sugary drinks are also associated with insulin resistance, type 2 diabetes and heart disease, which are all diseases associated with abdominal (visceral fat).  If drinking sugar leads to preferred accumulation of fat in the belly that may explain why sugary drinks stand apart as the most important link between a food and obesity and disease.

What about diet soda?

Diet beverages are calorie free, and were thought to be the perfect answer for those seeking sweetness without the caloric price tag.  However, the jury’s still out regarding artificial sweeteners' effect on weight: Short-term clinical trials show that artificially-sweetened beverages may produce short-term weight loss when they replace sugary drinks, however the few long-term studies available, which should be interpreted cautiously, show a surprising dose-response correlation between consuming diet drinks and the development of obesity, and a correlation between the consumption of diet drinks and the metabolic syndrome and type 2 diabetes.

This new study’s results join those that find that diet drinks are linked with weight gain.  Finding that the diet-soda-extra-fat is not in the worst place – larger waists and BMI related to diet-beverages were not because of fat deposited in the belly, but rather under the skin – is a small consolation.

Add to that the concern around synthetic chemicals in artificial sweeteners, the habituation to intense sweetness, and the false signals of sweetness without calories sends to our body and mind, you’ll see why many health professionals don’t see diet drinks as the solution to our sweet obsession.

Dr. Ayala

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.

 

Can healthy neighborhoods 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 led 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 developed 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.

What do you think of your neighborhood? Does it promote health or encourage unhealthy habits?

Dr. Ayala

Can super-sizing fruits help you shed weight?

I'll be taking a few weeks off to spend time with my family and travel and will be writing infrequenly during August. Meantime, I'll be reposting some of the most popular posts I’ve written over the past years so that new readers have a chance to catch up.  Happy summer!

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 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

 

Does electronic media make kids fat?

Why are today’s kids so much heavier than kids of previous generations?

The classic answer is that kids today are taking in more calories and spending less energy: They spend less time playing outdoors and have stopped working on the farm and doing chores – but hey, haven’t they stopped doing that a long time ago?

The energy expenditure side of the equation is the pet project of fast-food and junk-food makers.  Oh, if we could only give kids another hour of gym! If only kids could balance their ravenous appetite for snacks with a little more outdoor play we wouldn’t have to voice the unthinkable “eat less” advice.

But the numbers just don’t add up.  In order to eat like the TV ads suggest kids would have to increase physical activity to what amounts to no time left for homework or sleep.

I’d like to take an honest look at how sedentary activities really affect kids’ waistlines. 

An article in Obesity Reviews looked at the current trends of childhood pastimes, and how those affect not only energy expenditure, but also energy consumption.  Let’s take a look:

TV viewing

Kids watch many hours of TV and high rates of TV viewing are correlated with obesity.  While sitting on a comfy couch is super sedentary, watching TV has many other effects on energy balance. 

20-25 percent of daily calories are consumed in front of the TV.  This distracted eating increases intake of calorie-dense food (i.e. highly processed foods with lots of calories).

A study showed that 36 percent more pizza and 71 percent more mac&cheese were consumed when eaten in front of the TV, compared to meals eaten without the TV on.

For many people TV watching is associated with snacking.  They’ll munch while watching whether hungry or not, and if they ever forget to bring the munchies, an ad – so many of the TV ads are for junk-food -- will no doubt remind them that something is amiss.

Video games

Video and computer games fill many hours in the average kid’s day.   Video games are relatively new, and their effect on obesity has been studied less extensively than that of TV's, but observational studies show a connection, and a recent study showed obesity and overweight doubling for every extra hour spent playing electronic games.

Again we can argue that (non-active) video games are pretty sedentary, but the studies show that playing video games makes kids eat more.  Just like TV, video gaming leads to eating, the reflexive non-hunger kind of eating.

And don’t forget advertisers target video gamers on these platforms, too.

A single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.

Sleep

Who wants to sleep when there’s so much to do?  The presence of electronic devices such as a computer, TV or smart phone in the bedroom has been shown to delay sleep.

It seems counterintuitive, but shorter sleep duration is associated with increased risk of obesity.  It might be that being awake at night gives opportunity for late-night snacking; it might be that fatigue leads to inactivity the next day; and maybe lack of sleep messes up our hunger and appetite regulation.

We’re sleeping less – studies show that sleep has gone down by more than an hour over the past decades – and since sleep isn’t a waste of time, the barriers to sleep (many of them electronic) are hurting our health.

Media consumption begets food consumption

A recent Kaiser Family Foundation study showed that 8-18 year-olds devote an average of 7½ hours (!) to using entertainment media in a typical day.  Much of that time is spent media multitasking -- using more than one medium at a time. From what we learn from other studies we know that much of our kids’ multitasked media time also involves another added and almost automatic activity: snacking. 

Much more significant than the low energy expenditure toll of media consumption is its pairing with distracted eating.

Victorian ladies weren’t known for their workouts.  But they didn’t snack while embroidering.  Eating used to be prompted by hunger and traditional mealtimes.  Now, it’s prompted by an ad and constant availability of highly processed high-calorie food.

Uncoupling the TV, computer and video from it’s by now natural companion – sugary drinks, snacks and ready to eat meals – is a tall task.

Any ideas on where to start?

Dr. Ayala

 

2011’s hottest snack trend (and how to make it yourself in minutes)

 
I’m here to report that the hottest snack trend for 2011 is…flavored popcorn!  Walking the busy and delicious isles of the Fancy Food Show in Washington DC last week, I encountered popped corn in every imaginable combination, from bourbon to smoked almond, from chocolate caramel to bacon.

Popcorn is a great snack! It’s (potentially) nutritious, it’s inexpensive, and its neutral taste opens it to interpretation, so if you’re tired of eating popcorn the old-fashioned (butter and salt) way and feel like trying something new, popcorn innovation is here!

Popcorn nutrition tips

Popcorn is not only tasty and fun, but can also be healthful. Popcorn is a whole grain, high in fiber, relatively low in calories and fat, and it does fill you up.

But just like a banana -- a perfectly good snack -- can become calorie-laden when transformed to a banana split or banana chips, so it is with popcorn, so look out for what’s added to your popcorn.

Many microwavable popcorn brands contain either partially hydrogenated oil or have replaced those with palm oil, which is a highly saturated oil and not much better.

Many popcorn brands use butter flavor.  A few years ago we learned that microwavable popcorn contains diacetyl, a natural flavor that imparts butter aroma.  Heated diacetyl becomes a vapor and when inhaled over a long period of time inflames the small airways in the lungs and scars them. The severe form of the disease is called bronchiolitis obliterans or “popcorn workers’ lung”, which is untreatable and can be fatal.  Since the news of popcorn lung spread, many popcorn makers, lead by Orville, announced they’ve replaced diacetyl with new, safer, butter substitutes.  Recent studies have shown that these substitutes are similar to diacetyl and have produced similar health effects and are therefore just as toxic as what they've replaced.

So read the ingredient list and select a popcorn brand without unwanted additives, or better yet, make your own popcorn at home -- it’s really easy, I’m sure you don’t have diacetyl in your pantry, and since your popcorn will be devoured immediately you can use any healthy oil you’d like, and not worry about “shelf life”.

Spice up your popcorn: DIY popcorn ideas and tips

Feel like making gourmet popcorn at home? Here’s one of my favorites:

Sage popcorn

What you need:

• A large, preferably heavy pot with lid
• 1-2 tablespoons flavorless, high-temperature oil (I use canola)
• 2 tablespoons fresh sage, finely chopped
• ½ cup popcorn kernels
• Salt to taste

Preparation:

• Add the oil to the pot over medium heat.
• Throw a couple kernels of corn in the pot and cover it. When those kernels of corn have popped, your oil is hot enough to start.
• Add the rest of your popcorn, fine salt and the sage. Cover the pot and shake it to coat the popcorn with oil.
• Continue to cook, covered, and shake the pot occasionally (every 20-30 seconds is probably sufficient). Keep this up until the popping almost stops.
• Adjust salt to taste.

Substitutions and additions:

• Rosemary, oregano or thyme- replace the sage. 
• Truffle oil- add 1-2 tablespoons of good truffle oil to the popped corn.

For crispier popcorn: If the pot is very tightly covered, the steam released by the kernels can make the popcorn less crisp. If this happens, set the lid very slightly ajar, or lift the lid a few times to let the steam out.

Homemade microwave popcorn

Don’t feel like washing a pot? You can make your own popcorn in the microwave; all you need is a paper bag: 

• Put 1/4 cup popcorn kernels in a medium size paper lunch bag.
• Fold over the top 3-4 times.
• Put the bag in the microwave for a few minutes. It will pop fantastically and the bag will not burn. Turn microwave off when popping slows down significantly.
• Add butter and salt, or try one of the flavors below: 
  • Lime zest, olive oil and chili powder or go up in spiciness and add anything from cayenne to chipotle to habanero powder – see if you dare! Mix together, then add to popcorn.
  • Finely grated parmesan, paprika and olive oil -- mix together, then add to popcorn.
  • Cinnamon powder, orange zest and olive oil -- mix together, then add to popcorn.

Popcorn popping tip

Rejuvenating reluctant popcorn: If your popcorn doesn’t pop into fluffy, crunchy kernels, it may have lost some of its moisture.  Those unpoppable kernels are called "old maids”, a most politically incorrect term. Popability depends on water; as the kernel heats up, water inside it releases steam, putting more and more pressure on the kernel until it explodes. Revive “dry” popcorn by putting it in a closed jar and adding a little water. Cover and shake occasionally until all the water is absorbed. In two to four days popcorn should be perfect for popping.

Enjoy! And please do add your popcorn innovations below.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays

 

 

 

Study shows a daily can of soda has measurable harmful effects

There is very little doubt that drinking sugary drinks regularly is associated with obesity, type 2 diabetes, hypertension and heart disease. 

Since sugary drinks are the leading source of added sugar in the American diet, and it’s quite easy to take in lots of calories in beverages without much effect on satiety, a lot of the harm done by consuming sugary drinks can be explained by the weight gain associated with their consumption.

But there’s another school of thought, and growing supporting research, that believes that sugars -- and especially the fructose component of sweeteners -- are especially harmful to our health, and have direct adverse effects on fat metabolism and inflammation. 

Our metabolism on sugary drinks 

A previous study from the University of California at Davis showed that drinking 25 percent of daily calories in fructose for 10 weeks increased triglycerides and cholesterol and caused insulin resistance in people, while drinking the same amounts in glucose didn’t. And while both the fructose and the glucose groups gained weight during the study, the fructose group gained more belly fat.

Indeed, a concerning finding, but drinking 25 percent of calories in fructose is something very few of us do (although many teens do take in about 20 percent of their calories in added sugars, and do so daily for many years).

Now, a new study, led by Isabelle Aeberli, and published in the American Journal of Clinical Nutrition, looked at 29, young, healthy, non-overweight men, who drank more reasonable amounts of sugary drinks containing different levels of fructose, glucose or sucrose (which is a glucose/fructose mix). 

(Quick reminder: Our foods and drinks are usually sweetened with sucrose (table sugar) or high fructose corn syrup (HFCS); both types of sweeteners are a combination of the simple sugars glucose and fructose.) 

Each participant spent 3 weeks on each of the following 6 beverage regimens, with a 4-week washout between interventions: 

• Medium fructose: 40 g of fructose a day

• High fructose: 80 g of fructose a day

• Medium glucose: 40 g of glucose a day

• High glucose: 80 g of glucose a day

• High sucrose: 80 g of sucrose a day

• Control: No sugary drinks at all

Just to put the sugar content in perspective: The medium sugar interventions are equivalent to drinking 1 can (12 oz.) of coke/day; the high sugar interventions are equivalent to drinking 2 cans (24 oz.) of coke/day. 

The experiment lasted about 44 weeks; here are some of the main findings:

• Waist-to-hip ratio increased in the medium fructose, high fructose and high sucrose interventions (higher waist-to-hip ratios indicate abdominal obesity, which is associated with an increased risk of heart disease and type 2 diabetes)

• Fasting glucose levels increased in all five sugary drink interventions

• C-reactive protein, a marker of inflammation, increased in all 5 sugary drink interventions, with the highest values seen in the high fructose intervention.  Inflammation is a key factor in the development of both heart disease and type 2 diabetes

• There was a reduction in large, buoyant LDL particles when participants were consuming fructose drinks (high and medium fructose and high sucrose interventions).  A regular lipid profile measures only total LDL, which didn’t change between interventions; we now know that there are subclasses of LDL, and the smaller LDL molecules pose more risk and have a higher tendency to block arteries.  The large buoyant LDL is, as the name implies, flexible and bouncy, and causes less lumps and blocks.

• All sugary drink interventions lead to some increase in caloric intake

• Leptin (a hormone that regulates appetite and metabolism) increased in the medium and high glucose interventions, but not in the fructose and sucrose interventions

What can we learn from this study?

The first conclusion we can draw from this study is that fructose does seem to cause more damage than glucose – fructose leads to lipid abnormalities and more belly fat accumulation.  On the other hand all sugary drink regimens, including the moderate glucose exposure, had pretty unhealthy results: all 5 interventions increased markers of inflammation and increased caloric intake.

The practical, real-life understanding is that all sugary drinks, even in what many would consider “moderate” amounts, seem to have a measurable undesirable effect after as little as 3 weeks. 

As far as I know there are no popular drinks in the market sweetened by glucose; practically all forms of caloric sweeteners used in food processing are a glucose/fructose mixture.  Cane or beet sugar are sucrose (table sugar), which is a two-sugar molecule with exactly 50 percent glucose, 50 percent fructose. HFCS is about 45 percent glucose, 55 percent fructose. Fruit juice concentrate's sugar composition will depend on the fruit source: Apple juice concentrate is about 30 percent glucose, 70 percent fructose, while orange juice concentrate is about 50 percent glucose 50 percent fructose.  Agave syrup is about 70-75 percent fructose.

All sugary drinks contain fructose, and if this study’s findings are confirmed in larger and repeated studies, there’s reason for worry.

Dr. Ayala

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. 

Reposted as part of Food Renegate's Fight Back Fridays.