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

 

Put those fruits and veggies a little closer

Much of our eating is mindless and automatic. That’s why environmental changes can lead us to overeat. Many argue that what’s at the root of the obesity epidemic is the transformation in our environment, which gradually changed into an obesity-promoting one.

Proximity and convenience affect food choices. Food sellers know that the closest, easiest to grab, and most noticeable food items will sell more, that’s why they place the products that they want you to buy on an eye-level shelf, near the checkout and in an open case. Previous studies have shown that when candy is placed closer and is in a clear rather than an opaque bowl, people eat more of it.

Could proximity and visibility promote good-for-you foods just as well?

Gregory Privitera and Heather Creary tested how distance and visibility affect apple and carrot consumption. Their new study appears in the Environment and Behavior Journal.

The 96 healthy students in the study were not aware that eating behavior was the purpose of the experiment, and were assigned randomly to have a bowl of the fruit or the veggie in one of these four settings:

• Within arm’s reach and in a clear bowl
• Within arm’s reach and in an opaque closed bowl
• On a table about 2 yards away in a clear bowl
• On a table about 2 yards away in an opaque closed bowl

The students watched the researcher take the food out of a sealed bag (this was done to ensure the participants knew the food’s fresh and good to eat), and the researcher then excused himself for 10 minutes, with a cover story of “I’ll be right back with some questionnaires”, and an invitation to munch on the carrots or apples.

Within arm’s reach

Leaving the apples and the carrots close, within arm’s reach of where the student sat, increased intake significantly. The transparent bowl trick worked only with apples; carrot intake wasn’t significantly increased when the bowl showed though. The researchers suggest an explanation:

“apple slices may be more visually appealing than carrots in that seeing sweet-tasting apple slices (vs. bitter-tasting carrots) induces a stronger wanting to consume those foods.”

I’m here to defend the meager carrot: carrots are generally not bitter! I wonder where the researchers got their veggies, or when they last tasted a good carrot. Carrots actually have high sugar content, and are very tasty! They’re pretty, too.

Anyway, I suppose most moms knew this intuitively, but here’s some experimental proof showing that making fruits and veggies readily available can get us closer to the minimum recommended 5-a-day.

Another thing that caught my eye in this study is the background information on the study group. The students were about 19 years of age, and their average body mass index (BMI) was about 27. A BMI of above 25 puts a person in the overweight range. The study sample is a small one, and quite random, but what we see again and again is that even among young students, being overweight has become the norm. Every year of being overweight adds to the risk of chronic diseases such as type 2 diabetes and heart disease, and that’s why the overweight and obesity epidemic among kids and young people is especially worrisome.

Eating more fruits and veggies is important to health, as well as for healthy weight maintenance; so let’s think up some clever fruit and veggie placements!

Dr. Ayala

 

Flat Belly Tip: Eat More Fiber

Not all body fat is created equal.  Some people accumulate fat predominantly in the belly, while in others fat deposits are spread all around, and it does matter, because belly fat presents a higher risk for chronic diseases.  Think of belly fat as a big, active endocrine gland secreting risky substances — abdominal or visceral fat is especially active metabolically and plays a part in insulin resistance and diabetes, lipid abnormalities, hypertension and cardiovascular disease. 

And here’s another piece of worrying news: The majority of Americans are now overweight or obese, and the extra padding we’ve added as a population has accumulated preferentially in the worst location for our health — our belly — and even people with normal weight seem to be getting wider waistlines.

Why are bellies getting disproportionately bigger? Some ethnic groups — such as Asians, Indians and Hispanics — have a higher tendency to accumulate abdominal fat. Other factors suggested to affect belly fat buildup include lack of exercise.

But does our diet affect where we deposit our fat stores?  Does the kind of food we eat determine body shape?

Lifestyle and belly fat

Several studies suggest that sugary drinks and fructose increase fat accumulation in the worst possible locations of our anatomy.

A new study in the journal Obesity followed 1,114 people over 5 years, looking to see if lifestyle factors directed fat preferentially to the belly.

The study population included 339 African Americans (African Americans tend to have lower belly fat than whites or Hispanics) and 775 Hispanic Americans, aged 18-81 years.   Participants were asked about their dietary and exercise habits, weight and height were measured at baseline and follow-up visits, and belly fat was measured with an abdominal CT scan.  A CT scan is a rather invasive way to measure belly fat, but a very accurate one.

Of all the foods and nutrients considered in the study one single nutrient was most significantly associated with belly fat: Fiber.  For every 10 grams of soluble fiber eaten per day, belly fat was reduced by about 4 percent after 5 years -- irrespective of total weight or BMI. 

Other studies have shown that reduced fiber diets are associated with weight gain, but this study actually showed that soluble fiber makes fat “choose” a depot that’s healthier for us — if you overeat, but eat more soluble fiber, the fat will go under the skin, rather than into the belly.

Oh, and here’s one more important finding: Vigorous exercise was also associated with less belly fat. 

Fiber: soluble, insoluble, and where to find it

Dietary fiber is a part of plant food that we humans cannot digest, but it nevertheless has many health benefits.

Soluble fiber is fermented by bacteria in the gut and has physiologically active byproducts; insoluble fiber is metabolically inactive, and just absorbs water and creates bulk as it moves through the gut, thus speeding food’s passage in the gut and preventing constipation.

Both soluble and insoluble fiber may help in making us feel full on less food, because they add to food bulk while adding no calories.  Soluble fiber has shown promise in lowering LDL (bad) cholesterol, regulating blood sugar and prevention of heart disease.  Insoluble fiber aids regular bowel movement.

Good sources for soluble fiber include fruits such as apples, bananas, plums, and berries, vegetables such as broccoli and carrots, sweet potatoes and onions, legumes such as soy, peas and other beans, and grains such as oats and barley.

Good sources of insoluble fiber include whole grain foods, bran, nuts and seeds, vegetables such as celery and zucchini, and the skins of many fruits and veggies.

Most Americans get only about 15 grams of fiber per day in their diet, which is half the minimum 25-30 grams recommended.

What about fiber supplements and foods with fiber added to them? It’s unclear if added fiber provides the benefits of naturally occurring fiber and the benefits of supplements have not been studied as extensively as those of dietary fibers – the food plant as a whole is usually more than the sum of its known parts.

Fiber for a flat belly

All fruits, veggies whole grains and nuts contribute fiber to our diet.  I don’t participate in the fiber wars, and wouldn’t favor one fruit over another for its fiber quantity or quality.  If you eat your fruits and veggies you’ll get plenty of fiber – but do try to leave the peel on where appropriate.

Eating fruits and veggies reduces the risk of obesity, but this new study suggests that eating them also enables us to direct where were we deposit our fat even if we do gain weight — dietary fiber may funnel that fat to a more favorable storage area.

Dr. Ayala 

 

Can fruits and veggies make your skin glow?

I used to chuckle when I heard moms urge their daughters to eat tomatoes for rosy cheeks. Old wives' tale, so, I thought, and by that logic would I turn greener with kale? I was a little less sure of my dismissiveness when my own palms turned an orangey tint when I went heavy on my carrots, and was totally humbled when I met my first pink flamingoes.

Beauty from the garden’s bounty 

A new study in the scientific journal PLoS ONE followed 35 students for 6 weeks looking at how fruit and veggie intake affects skin tone, as measured by a spectrophotometer (an instrument that measures the spectrum and photometric intensity of each wavelength present, and in this case of visible light). 

The researchers, led by Ross Whitehead, found that measured skin tone correlated with reported changes in the diet: eating more fruits and veggies increased skin redness and yellowness, and these skin color changes where achieved with a relatively modest increase of fruit and veggie intake – adding about 4 servings did the trick.

In a second part of the study, the researchers asked 24 students to rank face’s health appearance and attractiveness when these faces were manipulated to take on the hue change seen under low fruit and veggie diet as opposed to a fruit and veggie rich one.  The experiments showed that the faces with the skin color associated with high fruits and veggie intake were perceived as more appealing and vibrant.

Carotenoids and blood perfusion

This study, and others before it, show that we prefer rosy, slightly flushed, lightly yellow-toned skin -- perhaps because it sends a signal of healthfulness -- and pigments from the fruit and vegetables in our diet seem to impart just the right tone to our complexion.

Fruit and veggie pigments, such as lycopene and carotenoids, make their way into the skin and change its hue. Fruits and veggies may also change skin’s blood perfusion. 

Skeptical of this small study’s results? We are what we eat, and food affects health in a profound way. There are many reasons to eat your veggies, but if you find the beauty-from-a-tomato argument effective, I’d consider this study support to use it as needed.

Dr. Ayala

Hot peppers, brown fat and weight loss

A new chili pepper was recently crowned the hottest of the hot. It’s called the Trinidad Moruga Scorpion and has a measured spiciness of 2,000,000 Scoville heat units, which brings it to the level of law enforcement grade pepper spray.  Care for a bite?

Hot peppers and weight loss 

Hot peppers have many culinary and nutritional benefits, and have also been used for topical pain relief. One of the interesting research areas of hot chili peppers is their alleged capacity to aid in weight loss.

A few studies showed that eating good amounts of hot peppers might increase energy production as heat temporarily in rats and in people. Increasing energy expenditure’s a good thing – we’d love to burn extra calories without hard work.

The active ingredient in hot peppers is capsaicin. Capsaicin also gives peppers their pungency, which limits the amounts people can comfortably eat without hitting the ceiling.

Brown fat and spicy peppers

Hot pepper’s capsaicin weight loss effect on rats and mice can be explained by the rodents’ elevated temperature after ingestion. Rodents’ brown fat, which usually burns energy and creates heat during cold exposure, showed elevated activity and temperature after eating capsaicin.

Scientists once thought that brown fat was only present in babies. We now know that brown fat can also be detected in about 50 percent of healthy adults, that the human body is capable of creating new brown fat cells throughout life, and that the amount of brown fat in the body may affect the likelihood of obesity.

Might brown fat activity explain hot peppers’ metabolic effect on humans too? 

A new study published in the American Journal of Clinical Nutrition started by measuring the brown fat activity of 18 healthy young men. The men underwent a special PET scan exposed to a temperature of 66 °F, while intermittently placing their feet on a block of ice. Ten of the 18 men had brown fat activity, and 8 had no such activity.

Next, the researchers exposed both the men with brown fat and the men without brown fat to capsinoids. Capsinoids are similar to capsaicin in formula, but aren’t that spicy. They come from a unique variety of non-spicy chili peppers, CH-19 Sweet, and have been shown to have effects similar to capsaicin. The energy expenditure of both groups was similar before ingesting the capsinoids. The brown fat positive group’s energy expenditure increased after capsinoids ingestion, but not after ingesting placebo. On the other hand, the men who had no detectable brown fat showed no increase in energy expenditure after capsinoids ingestion or after ingesting placebo.

How much increase in energy burning are we talking about? The brown fat endowed's extra energy burn in the hour after ingesting their hot pepper analog was an average of about 15 kilojoule an hour.

To put this number in more understandable terms, 15 kilojoules are about 4 of our familiar calories. All this hot pepper earned eaters an extra piece of chewing gum.

Spiciness is a nice add-on

Hot pepper weight-loss research, though exciting, brings one down to earth regarding the possibility of a magic remedy soon replacing the true but unpleasant advice of “eat fewer calories and exercise more”. Under the best of circumstances, adding palatable level of spiciness will result in very modest weight loss, and we’re not at all sure about the long-term effects of hot peppers, as people may adapt to the effects of capsaicin over time.

If you enjoy spicy food, look at hot pepper as a nice add-on. It has shown some activity, similar to that of green tea and caffeine. But by all means don’t see hot sauce as an excuse to eat more, or hope that it can help you lose weight without decreasing overall caloric intake.

I happen to love spicy food, and tiny amounts of hot pepper flakes make it into many of the dishes I cook, but I’ve come to realize that what I perceive as tingling pleasure, others feel as pain and embarrassment, so I serve the hot sauce on the side.

Dr. Ayala

reposted as Food Renegade's Fight Back Friday.

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. 

 

 

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 suggests kids prefer more color and variety in their plate

Brian Wansink is famous for his work on the psychology of eating and for popularizing terms such as "mindless eating" and "health halos." His research has unveiled some of the many occasions in which environmental cues such as packaging, label claims and plate size influence our eating.

There’s something particularly encouraging about Wansink’s findings. If so much of our eating, overeating and unhealthy eating is driven by nothing more than unconscious, mindless habits, a targeted environmental change can improve our eating without much sacrifice, indeed, almost without individuals having to do a thing.

Plate presentation affects eating

A new study from Wansink’s group, published in the January issue of Acta Paediatrica, and led by Francesca Zampollo looks at how the look of the plate affects kids and adults.

Twenty-three kids and 46 adults were shown full-size photos of 48 different combinations of food on plates that varied by number of items, placement of entrée and organization of the food.

Kids preferred plates with more items and more colors, they liked the entrees placed in the front of the plate, and they liked figurative designs.  In fact, kids liked it when their plate had 6 different colors and 7 different foods, while adults preferred a plate with no more than 3 colors and 3 foods.  Both kids and adults appreciate a non-crowded plate, with just enough empty space.

More color and more choice

Food marketers have known about kids’ attraction to rainbow design for years I suppose.  Take a look at the packaging of foods targeted to kids’ and the recurring pattern is lots of colors, shapes and figurative designs.  Minimalism and simplicity aren’t a winning style in kids’ products.  So I guess young focus groups have told marketers much the same as the study group told the researchers.

According to this study kids visually prefer a plate with many elements and many choices.  It is yet to be proven that they’ll actually eat more readily if such a multiple-choice plate were served, but if that is indeed the case I welcome this finding.  All we need in order to achieve 6 colors and 7 choices is to serve several kinds of vegetables and fruit to accompany the entrée – and we don’t even need to chop them into a salad.

Have you noticed how presentation affects you or your kids?

Dr. Ayala

 

Should we reward kids for eating their veggies?

Many parents struggle with getting their kids to eat veggies.  A new study in the American Journal of Clinical Nutrition tests a new tactic to getting those veggies in and shows that rewarding kids for tasting a disliked veggie increased both its intake and liking.

I was surprised when I read the title of the study – prizes for healthy eating run contrary to the advice generally dispensed to concerned parents – so let’s read through the study and see what we can learn from it.

Rewards and praise for trying veggies

The study, led by Anna Remington, was conducted in North London, UK, and recruited 3-4-year-olds.

The 149 kids who completed the study were randomly divided into 3 groups:

• Tangible rewards - parents offer their kid a small piece of the target veggie for 12 days, and if the kid tastes the piece of veggie he’s rewarded with a sticker.
• Social rewards - parents offer their kid a small piece of the target veggie for 12 days, and if the kid tastes the piece of veggie he’s rewarded with praise, such as “brilliant, you’re a great vegetable taster”.
• Control group - no daily tasting and no rewards.

The target veggie was picked according to the kid’s initial reaction.  The families were presented with 6 veggie options: carrot, cucumber, white cabbage, red pepper, celery and sugar snap peas.  After the kid had a taste he ranked the veggies from 1 (most liked) to 6 (least liked).  The target veggie for the experiment was each kid’s “4”, giving this veggie an opportunity to either rise or fall in fondness.

And the result: the kids who received the prize ate more of the target veggie and reported liking it better than the controls.  This increase in intake and liking persisted over the 3 months of follow-up.  The praise group also increased its intake and liking, but less so than the reward group.

Give veggies a chance

This study, and many others, capitalizes on the well-known fact that repeated tasting works.  We are creatures of habit, and people -- especially kids -- like what they know.  The way to know a veggie is to see it often, know its name, and give it a taste – many times.  Studies show that it might take 10 taste exposures to get kids to accept a new food.

Young faces will light up with pleasure when tasting a sweet food for the first time, but foods that are out of the realm of sweet, fatty and salty can be an acquired taste, if given the chance.

To know is to like; to like is to eat.  In that respect we parents can really make a huge difference in our kids’ food preferences and habits.

Anything to get a kid eating

So how far would you go to get your kids eating healthy? The issue of rewards for eating is a controversial one, with many experts arguing that rewards -- or any kind of pressure for that matter -- are counterproductive in the long run.

This study suggests that rewards do work, at least for 3 months, and the reward was small enough to perhaps make parents deem it a non-issue.

But whether large or small, is a reward worth considering?

I personally believe that eating behavior shouldn’t be punished or rewarded.  After all, eating isn’t a good deed or an achievement.  Eating, whether healthful or not, is something one does to fulfill a basic self-interested need.

Kids, I think, are not supposed to be eating for their parent’s satisfaction or praise.

How did we even get to accept that “like” is a requirement for eating good food when hungry? Have marketers convinced us that “lovin it” is a prerequisite? 

Family dinner should be simple: Serve a healthy meal, don't serve anything that you don't want your kids to eat, no fuss, no electronics, no need to clean the plate, but a taste is much appreciated. Except it isn't, and many families struggle with how to best feed their kids peacefully and healthfully.

Regardless, the person to be thanked and praised is the provider of the meal – praise the cook, not the eater!

What do you think? Would you try prizes to get your kids eating their veggies?

Dr. Ayala 

 

My Mom’s Super Comforting Vegetable Soup

This is the vegetarian version of the all-healing chicken soup.  Works just as well, I think, if not better.

Made of simple, inexpensive ingredients, and requiring very little chopping (thanks to my loyal helper, the food processor) this vegetable soup is one of the best ways to get a lot of the veggies you need all in one dish, and the whole grains in the soup add substance, richness and protein to the mix.  Nothing like a big pot of soup for the cold days ahead!

Ingredients:

• 2 tablespoons canola oil
• 2 large onions, chopped
• 1 leek, white and light green parts only, thinly sliced
• 1 teaspoon paprika
• 1 teaspoon salt
• Freshly ground pepper to taste
• 2-3 celery stalks, stringy tough outer parts peeled, diced
• 2-3 zucchini, peeled
• 4 potatoes, peeled
• 3 carrots, peeled
• 1 large sweet potato, peeled
• 1 parsnip, peeled (optional)
• 1/3 cup pearled barley, rinsed
• 1/3 cup old-fashioned rolled oats
• 8 cups good-tasting vegetable broth
• Finely chopped parsley or chives, to serve

Preparation:

In a large soup pot heat the canola oil over medium-high heat, add the onions and leeks and the seasoning: paprika, salt and pepper. Cook, stirring frequently, until onions are translucent, 5 to 8 minutes.

While the onions and leeks are sweating in the pot, using a food processor, grate all the other vegetables -- zucchini, potatoes, sweet potato, carrots and parsnip – using the course grating plate.

Add the diced celery and the all the grated vegetables. Sauté for about 5 minutes until the vegetables are a bit tender and start to brown.  You may need to add a touch of water if your pot looks too dry.

Add the pearled barley and the oatmeal and stir.

Add the broth and bring the pot to a simmer.

Cook until the barley is soft, about 20 minutes.

Taste, and add more salt and pepper if needed. Finish with chopped herbs and serve

Serves many, and is even better the next day.  Keeps well for 5 days in the fridge.

 

Enjoy in good health,

Dr. Ayala

Reposted in Fight Back Friday

Thanksgiving Healthy Side Dish Recipe Collection

I have much to be thankful for this Thanksgiving and I want to take this opportunity to thank you for your kind readership. 

In case you're still looking to add some color and health to your big meal, or looking for "cleansing" recipes for the coming weekend, I'd like to share a few of my healthy Thanksgiving/fall recipes, most of which can be prepared well in advance and require minimal finishing touches.

I'd also like to share a wonderful New York Times article by John Tierney, emphasizing the health benefits of gratitude.  Tierney writes:

"Cultivating an “attitude of gratitude” has been linked to better health, sounder sleep, less anxiety and depression, higher long-term satisfaction with life and kinder behavior toward others, including romantic partners."  

But how do you get to this heightened level of gratefulness?  Tierney consulted with some of the greatest experts in the field and provides tricks and practical advice -- really simple ideas that I liked a lot! On adopting the "it could be worse" attitude:

"Instead of focusing on the dry, tasteless turkey on your plate, be grateful the six-hour roasting process killed any toxic bacteria."

Wishing you a happy and healthy holiday,

Dr. Ayala

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Roasted squash and chestnut soup with mulling spices

 

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

Ingredients:

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

For the mulling spices:

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

Preparation:

Preheat the oven to 400 degrees F.

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

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

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

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

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

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

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

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

Crumble the remaining chestnuts into the pureed soup.

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

To serve:

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

Serves 8-10.

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Roasted red and golden beets, with reduced balsamic vinegar

 

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

Ingredients:

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

Preparation:

Preheat the oven to 400 degrees F.

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

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

Remove from the oven and let cool.

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

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

Drizzle reduced balsamic over the beets.

Season with salt and freshly ground black pepper.

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

Serves 8-10 as a side dish.
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Herbed brown rice  

Ingredients:

• 2 cups vegetable stock
• 1 cup parsley
• 1 cup cilantro
• ¼ cup mint leaves
• 1 ½ cup brown rice
• 2 tablespoons olive or canola oil
• 2 large onions, diced
• 1 teaspoon paprika
• 1 teaspoon salt
• Black pepper to taste

Preparation: 

Bring the vegetable stock to a boil

Wash the herbs, remove the large stems leaving mostly leaves (you can cheat a little, since it’s all going into the food processor)

Place herbs and ½ a cup of the warm vegetable stock in a blender or food processor and process until you have a smooth chunk-less puree.  Add the puree to the rest of the stock

Wash the rice in a sieve under cold water

In a medium pot heat the oil on medium high, and sauté the onions and the paprika and salt for a few minutes until translucent

Add the rice, and toss around until the rice is aromatic and coated with oil

Add the herbed broth, bring to a boil, and then reduce to a low simmer

Cook rice according to directions – mine cooks for about 1½ hours

Fluff the rice, check seasoning, and serve with a few leftover sprigs of herbs for garnish.

Serves 8-10 as a side dish.

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Wheat berry salad

 

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

Ingredients:

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

Dressing: 

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

Preparation:

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

Add all other salad ingredients besides the nuts.

Combine dressing ingredients.

Add the nuts and dressing right before serving.

Serves 6-8 as a side dish.

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Black rice with roasted butternut squash

Black rice

Ingredients:

• 2 cups black rice (I use “Forbidden Rice” from Lotus Foods, sold at Whole Foods in small packages) 
• 2 and 1/4 cups water (this does not conform to the package instructions.  I find that using less water results in better flavor and texture)
• 1-2  tablespoons canola oil
• 1 large onion, diced
• 1 teaspoon salt or to taste
• Optional: chopped fresh parsley or cilantro.

Preparation:

Rinse rice in a strainer under cold running water for 30 seconds

Heat the oil in a medium pot, over medium-high heat 

Stir in the onion and sauté until golden 

Stir in rice and toss around until coated with oil and fragrant

Add salt and water and bring to a boil

Reduce heat to low, cover, and simmer for 30 minutes. By the time the water is absorbed the rice should be done

Garnish with freshly chopped parsley or cilantro and serve hot.

Roasted butternut squash

Ingredients:

• 1 medium butternut squash, seeded and diced to 1/2’’ cubes
• 1 tablespoon maple syrup 
• 1 tablespoon olive oil
• Salt and pepper 
• Optional: chopped sage.

Preparation:

Preheat oven to 400 degrees F

Toss butternut squash cubes with the rest of the ingredients

Spread the cubes out on a baking sheet and roast in the oven until they are tender and slightly caramelized. This will take 25-35 minutes.

Finishing touches:

You can combine the rice and butternut squash, or (my preference) serve them in a large platter where the rice creates the outer circle, and the squash is placed in the center. I like this presentation visually, and it also allows each diner to choose how much of each of the platter components he wants to eat.

Serves 8-10 as a side dish.

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Roasted French string beans with toasted sesame

 

Ingredients: 

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

Preparation:

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

Toss the string bean with the oil and spices.

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

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

Correct the seasoning by adding salt or pepper.

Serve hot, or at room temperature.

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

 

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

Ingredients:
For basic sweet yeast dough:  

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

For the pecan filling: 

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

Preparation:

To make the dough:

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

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

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

To make the filling:

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

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

Putting it all together:

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

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

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

Let rise again for about one hour.

Heat the oven to 350 degrees F.

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

Remove from oven and let chill on rack.

Serving suggestions:

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

Serves 14-20

 

 

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

 

The 5-a-day of good parenting

It’s always hard to say goodbye to summer.  And what a glorious end-of-summer we’ve had -- days of lazing about together, good food, wonderful books (I have to mention Ann Patchett’s remarkable “State of Wonder”, which put me in a an utter state of wonder) and a few glorious hiking days in Yosemite and Sequoia National Parks. My kids are back in schooI and I, too, feel the beginning of a New Year – time to get focused and get a lot of work done, but also time to give some thought to reflect on education and child rearing.

The 5-a-day for raising healthy young kids

I recently came across a report from the British think tank CentreForum that pulled my attention.  Drawing directly on the science of early childhood experience, the author, Chris Paterson, suggests that 5 steps are proven to be vital to kids’ optimal development:

• Read to your child for 15 minutes- being read to regularly from a young age is extremely important to language skills, fosters bonding and develops the young brain.

• Play with your child on the floor for 10 minutes - the adult and the child need to be on the same physical level, and to have fun together.

• Talk with your child for 20 minutes with the television off - switching off external distractions, such as the TV, is crucial, and we all know what distracts us, don’t we? 

• Adopt positive attitudes towards your child and praise them frequently – this speaks to the quality of the parent-child interaction, where the previous guidelines were more about quantity.  Adopting a positive parenting approach doesn’t mean the child isn’t criticized, but rather that criticism is constructive.

• Give your child a nutritious diet to aid development – kids need good food to develop and grow, but as importantly, tastes and eating habits are formed early in life, therefore emphasis on healthy nutrition in early life can lead to healthy eating habits throughout life, and to prevention of obesity and disease.

The report calls government to support high quality parenting, and implement a 5-a-day parenting campaign – in much the same way governments established and supported the ‘5-a-day’ concept in relation to fruit and vegetables.

I’m sure much of the reaction to this proposal centered on “nanny-state” type of criticism. CentreForum is a liberal think tank, and for some, any suggestion of governmental influence in the home reeks of loss of liberty, and many believe that parenting is a private matter.  But politics aside, it’s hard to argue that adopting these 5-a-day wouldn’t be a positive step, and it is so fundamentally unfair that some kids don’t experience these 5 elemental needs daily.

In many ways these 5 pieces of simple guidance are so basic that I doubt they’re news to parents, but I do think that it’s helpful to have a memorable, automatic way to remember these guidelines.  There’s something about announcing a new ‘norm’ and breaking up the big job of being a good parent into a few small manageable actions that I do like.

A healthy diet

Parents have been in charge of feeding kids from the beginning of time, but parents’ role in nutrition in our times is shifting, and we need to learn and readjust.

Parents of previous generations had to think about getting enough food, enough calories, enough nutrients to support growth and development.  In the past few decades the food landscape has changed so much, that besides providing adequate food for growth it has become imperative for parents to teach kids how to edit their food environment: How to tell food from junk, how to say no to frequent, unrelenting opportunities to snack and overeat all the wrong foods, how to resist and dismiss the marketing and advertising messages kids are bombarded with from a very young age.

Because if you just go with the flow, and don’t actively create a sanctuary of healthy eating at home and in your kid’s mind, your kid is more likely than not to eventually end up struggling with weight, and suffer from overconsumption of sugar, fat and salt.

Not just for babies and toddlers

There’s ample evidence to support the investment in early childhood – early investment pays off big time.  But I find that my parents still pretty much extend the 5-a-day gift to me every time I interact with them.  I am no longer read to, but we’ll share a good read over the phone and exchange books.  My parents really listen – no distractions – I can count on that, and their positivity lifts me up.  We still play together – whether it’s a board game or a visit to a garden, we concentrate on having fun together.  And I credit my mom with teaching me the fundamentals of how to eat healthily in a world full of junk and highly processed foods, and to this day we learn something new about food whenever we share a meal.

The 5-a-day of fruits and veggies is a huge success in that most adults and kids know what the advice behind the 5 is.  It’s an utter failure in implementation – very few Americans (only about 11 percent!) actually eat the minimum daily-recommended fruits and veggies. 

But awareness is a good start, and suggesting to us moms and dads that what parents do, every day, matters so much to our kids’ wellbeing is both empowering and humbling.

I’d love to hear your thoughts.

Dr. Ayala

 

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

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