Healthy Food & Healthy Living by Dr. Ayala

Do nutrition labels confuse you?

 

Nutritional labels have been around for well over a decade, and the familiar panel — which provides some key nutrition information, an ingredient list and nutrition declarations — enables more informed food decisions.

Do people make good use of the information? The first step is for people to bother looking at it -- and they do. Women more than men, health conscious and exercise enthusiasts more than couch potatoes, but most people report they do consult with the label, at least when they’re buying a product for the first time. A recent review of 120 studies of nutrition label usage in Public Health Nutrition finds that 75% of Americans check the label.

Eyeing the label is a good start, but do consumers get what they need from it?

A recent paper in Nutrition Reviews found that of the 60 percent of consumers who said they use the Nutrition Facts Panel, only a quarter found it easy to use. The calorie information on the Nutritional Facts Panel gets a glance from 75 percent of consumers, but most consumers cannot put the calorie count in context since they have no idea how many calories they should consume, and about half of the people overestimate their suggested daily caloric intake. The percent daily values, typically located above the actual ingredients, were either ignored or poorly understood by most surveyed.

A ‘D’ in label comprehension

A new study in the journal Appetite studied 120 young Israeli adults’ understanding of the various parts of the nutrition label. The study was performed in a travellers’ immunization clinic, so it’s by no means a representative sample of the population, but rather a group of highly schooled, mid to upper socio-economic class individuals.

People were presented with several common food products, and were asked about their attention to and understanding of the nutrition facts on the label.

Most of the people (almost 80 percent) reported that they looked at nutrition labels when selecting foods.

But when given a label comprehension evaluation, the average score was a ‘D’ – 60 percent correct answers.

The nutritional table was understood much better than the ingredient list or the nutrition declaration information. For instance, when asked about red “Bamba”, most participants replied it did not contain food coloring, although the ingredient list says it does -- Bamba uses natural food color. (Bamba, a corn peanut snack, is perhaps the strongest food brand in Israel. It’s perceived almost as a weaning food, and is said to be the third word an Israeli baby attains – right after “mom” and “dad”.) The nutrition declaration piece, with its “without”, “contains no” and “less” assertions was least understood. When a bottle of canola oil declares it contains “no cholesterol” does it mean there’s naturally no cholesterol, or that this manufacturer kindly removed the cholesterol for added nutrition value?

Figuring out food labels

The nutritional label is an important tool for promoting healthy eating. Reading the label helps consumers decide if, and how much, of that packaged food they should eat.

Some of the nutrition confusion can be solved by nutrition education – of which there currently is very little. Not all people know that ingredient lists, by law, have to list ingredients by their relative amount in the product, from high to low, so fruit as the first ingredient is very different from fruit at no. 5, and that added sugar comes has so many different names. The people in the Israeli study thought they understood the label much better than they actually did – they didn’t know they didn’t know – and that overconfidence hinders further learning.

The nutrition label could also be more consumer friendly. Most studies suggest that readability (larger fonts please!) and clarity could be much improved. There are many suggested simple, visual symbols such as the traffic light symbol, that attempt to give a nutrition-in-a-nutshell view on the front of the panel. Each system has its supporters and detractors. Recently, the Institute of Medicine advocated that the front of the package panel display only four nutrition facts: calories, saturated and trans fat, sodium and sugars. It recommends that the FDA develop a point system -- much like the energy star® program used for assessing electronics’ energy efficiency – which takes into account just saturated and trans fats, sodium, and added sugars, since these nutrients pose the most pressing diet-related health concerns.

To increase the mix-up, manufacturers introduce some more confusion in an effort to better market their product. The declaration “no cholesterol” on a vegetable oil is redundant – no vegetable oil has any cholesterol, as cholesterol is present only in animal derived foods. Likewise, package health claims promising “immunity” “antioxidants” "heart-health" “strong bones” and “lower cholesterol” don’t mean the food is healthy.  They practically don’t mean a thing.

So how to read the label? For an FDA tutorial on how to read the Nutrition Facts label go here, and I’d love to hear your personal approach.

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.

Does soda add belly fat?

Do sweet drinks cause belly fat? Fat around abdominal organs is much more active metabolically than the fat under our skin, and poses additional risk for diabetes, heart disease and stroke above and beyond the risk seen with being overweight.

And while fat distribution is influenced by age and genetics a growing body of evidence suggests dietary choices, and especially sugary drinks increase fat accumulation in the worst possible locations of our anatomy.

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.

Another study in the journal Obesity, following 800 people, found that drinking sugary drinks was associated with significantly more belly fat and wider waistlines.

A new study in the American Journal of Clinical Nutrition adds to this body of evidence with a rather long-term study, in which a small group of overweight people were assigned to drink cola, skim milk, diet cola or water, while fat distribution and metabolic markers were monitored.

Drinking soda for 6 months 

The Danish study involved 47 healthy participants – it’s definitely a small study.  The participants drank 1 liter – about 33 ounces -- of regular cola, skim milk, diet soda or water daily, for 6 months.

The total caloric intake didn’t differ between the participants, and all the participants gained just about the same amount of weight (almost 3 pounds).

On the other hand, the amount of fat in the liver, abdominal organs and muscle increased significantly in the regular soda group, while it remained unchanged in the other study groups. (Fat was measured by an MRI technique.)

Blood pressure and triglycerides also rose among the soda drinkers. 

The soda belly-fat connection

Why would soda lead to preferential accumulation of belly fat? There’s some evidence that the fructose content of the drink is to blame.  The simple sugar fructose is metabolized in our body in a way that promotes fat production, raises triglycerides and affects cholesterol levels.  Soda is made with either table sugar, which is 50 percent fructose, or High Fructose Corn Syrup (HFCS), which is about 55 percent fructose.  Fructose is absent in milk, diet soda and of course water.

Diet soda was off the hook in this study, but other observational studies have shown that diet soda is linked with obesity, type 2 diabetes and the metabolic syndrome.

Is 33 ounces of soda a lot?

While 1 liter or 33 ounces of soda sound like a lot, the authors, led by Maria Maersk, present an embarrassing comparison to average American intakes.  The typical young American (12-29y) drinks 60 ounces of sugary drinks-a-day; the average American guzzles 16.  Fast food eateries offer 42-ounce and 64-ounce sodas.  Unfortunately, 33-ounces-a-day isn’t out of the realm of what people actually do.

Soda, not beer, might be inducing our belly expansion.

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.

 

Ever wondered how low-fat food versions are made?

When a home cook wants to cut fat and sugar from a meal he’ll bake the potatoes rather than deep fry them, choose tomato sauce over a creamy one and serve fresh fruit in place of Crème Brulee for dessert.

But when a food producer is designing a product that he wants to adorn with a “reduced fat”, “fat free” or “low carb” claim, he usually turns to the food chemist for a fix.  Food engineers replace the unwanted ingredient while recreating the same texture, mouth-feel and taste of the original.  Absolute magic.

The cover story titled “Call In The Food Fixers” in last week’s edition of Chemical & Engineering News, the American Chemical Society’s weekly magazine, gives us a glimpse into the science of tricking the tongue (the article was available in full text, but access is now restricted).

“To make sure consumers won’t miss what’s missing, food makers can choose from a long list of texture-improving additives and replacements—from agar to xanthan gum—and they normally choose several. The functional ingredients may come from specialty chemical companies or from firms devoted to food ingredients.”

And since long, complicated, chemical sounding lists of ingredients are falling out of favor:

“Ingredient suppliers are playing a big role in helping customers balance health claims, good taste, and consumers’ desire for “natural” foods.”

Balance is an interesting way to put it.  Does balance mean finding ingredients that are really better for you, or finding a way to stay within the letter of the law, and dress-up chemical processing as innocuous, wholesome goodness?

“Although adding texture to products with reduced fat and sugar is a trend that ingredient makers can count on, consumers who scan labels to ascertain whether a food is “natural” will continue to face an uphill battle. There are no government standards that regulate the use of the words “natural” or “all natural.” Food ingredient lists are not as informative on the subject as some consumers might wish. For example, carboxymethylcellulose normally appears as cellulose gum on food labels. Chemically altered starch is listed as modified, but modified pectin is just listed as pectin.”

I must say, I love the science and ingenuity behind these new inventions.  The article's accompanying images were fascinating, especially the mouth map trained testers use for designing low-fat food, which breaks down food texture to no less than 17 parameters, including ‘slipperiness’, ‘blends with saliva’ and ‘viscosity’.

But do these modifications lead to an improved diet?  Decades of “fat free” and “reduced fat” products, yet the population gains weight.  I don’t know if it’s our mind that sees “fat free” as permission to eat more, our tongue that refuses to be tricked, or our dissatisfaction with fakes that leaves us wanting.

I’d rather eat a really satisfying small piece of the real thing.  It tastes better, and I have no illusions about the source of indulgence.  Yes, I bake with butter. 

Traditionally fatty and full-of-sugar foods are now engineered to be blame-free or better-for-you through a process of replacing fat and sugar with something else.  The fix can often be wickeder than the original.

Dr. Ayala

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

Fat burning miracles?

A few years ago billboards announced the arrival of “negative calorie” food.  Drinking three 12-oz. cans a day of Enviga, the Coca Cola and Nestle carbonated tea drink, will burn an extra 60-100 calories daily, claimed the products’ packaging.

The Center for Science in the Public Interest (CSPI) filed a lawsuit against Coke for Enviga’s false weight-loss claims. Coke and Nestlé agreed to add language to the labels and marketing materials stating that the product will not promote weight loss without diet and exercise and Enviga is slowly vanishing from shelves.  But supplements and foods claiming to slim you down have not – they are alive and thriving.

A new paper in Obesity Reviews looks at the dynamic market of nutritional supplements claimed to increase fat metabolism, and explores how much evidence – or lack of it – is behind some of these popular supplements.

What is a ‘fat burner’?

A fat burner is a substance that is claimed to increase energy expenditure, make you lose weight, or somehow promote fat breakdown.  Many fat-burning supplements combine several ingredients, claimed to work in concert.  Is there such a thing as a fat burner?  The article examines some of the most popular such miracles, and I’ll discuss just a few of those.

Fat burners on the market

Caffeine

The ultimate functional ingredient, caffeine appears naturally in coffee, tea and cocoa and is also added to many foods and drinks.  Anyone who drinks coffee knows that coffee does have active ingredients that increase alertness – that’s why I love my morning cup.  It makes loose dreamy words stick into lucid sentences.  But does it increase energy expenditure and promote weight loss? 

A few studies showed that high doses of caffeine increased metabolic rate, however, longer-term studies tracking dieters taking caffeine or placebo showed caffeine performing no better than the dummy pill.  Overall, the authors conclude:

“Caffeine on its own has not been shown to be effective in reducing body weight and if caffeine increases fat metabolism, the effects are generally small”

Carnitine

Carnitine, which occurs naturally in meat, and is produced by our own liver and kidneys, is claimed to improve fat metabolism and increase muscle mass. 

Most of the carnitine in our body is in our muscles, and our muscle takes up carnitine from our blood against a huge concentration gradient (sorry for the flashback to high school chemistry, but it’s needed in order to understand how little sense this makes).  Studies have shown that the enzyme that is responsible for transferring carnitine into the muscle is at maximum capacity, and therefore ingesting extra carnitine doesn’t raise muscle carnitine at all.

The only way in which muscle carnitine could be elevated was by increasing blood levels of both carnitine and insulin at the same time – by insulin intravenous drip or very large amounts of ingested sugar.  This impractical scenario is quite counterproductive from the weight-loss point of view.

Carnitine supplementation for weight-loss just doesn’t make sense!

Tea

Tea contains catechins, which are thought to stimulate fat metabolism.  Green tea, which is non-oxidized and non-fermented tea leaves, has especially high levels of catechins, the most interesting of which is EGCG (epigallocatechin 3-gallate).  The authors review the green-tea weight burning studies and find them inconclusive:

“Green tea has the potential to increase fat metabolism at rest, also during exercise, and may help to lose body fat and body weight.  As with caffeine, the effects appear to be relatively small…”

Chromium

Chromium is added to many “functional” foods and drinks (Vitamin Water, Fuze) and is sold as part of many supplements as a fat burner and muscle builder.  Chromium occurs naturally in broccoli, red wine, mushrooms, brewer’s yeast, wheat germ and other foods, and was reported to increase lean body mass during exercise. 

The excitement was dampened by further, better studies that found chromium had no effect – overall, the majority of studies find it useless – and the authors also caution that a few studies on cell cultures found chromium can cause chromosomal damage.

Want to burn calories?

The authors, A. E. Jeukendrup and R. Randell, conclude with an overall impression that most of the supplements marketed as fat burners have little or no science to support their claims, and that among the group, caffeine and green tea have some effect, but it is small, and more consistent in habitual caffeine users.  They write:

“The ever increasing list of fat-burning supplements is industry driven, and is likely to grow at a rate that is not and cannot be matched by similar increase in scientific underpinning” 

In other words, marketers are quick to announce miracle solutions based of the flimsiest of evidence collected on a few lab mice or a cell culture; if and when the science manages to amass enough research that more often than not doubts the substance’s merit, sellers are already quick to market with the next new fat-burning sensation.

How can we end this? Silly and optimistic as I am, I’m hoping for an end to health claims on foods and supplements.  Health claims were introduced in 1994, have been so miserably abused and have become so utterly misleading that it’s just time to say goodbye. 

The other more realistic way is that consumers will start rejecting the hype and express their skepticism with their wallets.

Let’s end with the age-old solution to fat burning.  We know it works.  It’s healthy and inexpensive, too.  It’s called exercise.

Dr. Ayala

 

The American Academy of Pediatrics Advises Against Energy and Sports Drinks

Energy and sports drinks are aggressively marketed to kids and teens. Not only is engaging in a sports activity – however casually and briefly – a reason to “rehydrate” with a sports drink, kids are now encouraged to consume sports drinks before, during and after thinking of moving a muscle. Sports drinks are sold in many school’s vending machines, and judging by ads for energy drinks our young ones couldn’t stay alert or study were it not for shot after shot of energy in liquid form.

Are these drinks of any benefit?

The American Academy of Pediatrics' (AAP) committee on nutrition and council on sports medicine and fitness reviewed the scientific literature and consulted with many experts for its new clinical report on sports and energy drinks. In order to clear some of the confusion around these products the report starts with a few definitions and ingredient lists:

• Sports Drinks - these contain sugars (2-20 grams of sugar per 8 oz serving, or 30-200 calories per bottle), electrolytes (sodium, potassium), minerals (calcium, magnesium), flavoring and sometimes vitamins. They are supposed rehydrate and replace water and electrolytes lost during exercise.

• Energy Drinks - these contain sugars (0-31 grams of sugar per 8 oz serving, or 10-270 calories per container) stimulants, such as taurine, guarana and caffeine, vitamins and other supplements. Energy drinks deliver stimulants, which supposedly improve performance.

Sports drinks: For serious athletes playing prolonged, vigorous sports in a the heat

For all non-prolonged less exhausting occasions the AAP report warns that the extra calories in sports drinks may lead to extra body weight, and the combined sugar and acid in them causes dental erosion.

As for the heavily marketed beneficial and functional ingredients in sports drinks: electrolytes are plentiful in food, protein and amino acids as well as vitamins are plentiful in food, and the specific amino acids added to sports and energy drinks to enhance performance (glutamine, arginine, taurine) have not been proven beneficial by good clinical trials.

Energy drinks: Totally unsuitable for kids and teens

The report stresses that energy drinks “pose potential health risks primarily because of stimulant content; therefore, they are not appropriate for children and adolescents and should never be consumed.”

Eliminate sugary drinks: Drink water!

The expert panel concludes:

“Given the current epidemic of childhood overweight and obesity, we recommend the elimination of calorie containing beverages from a well balanced diet, with the exception of low-fat or fat-free milk, because it contains calcium and vitamin D, which are particularly important for young people.”

We're very far off from the AAP's target: A recent CDC survey found that one in four high school kids drink soda every day and two in three drink a sugary drink every day. This is actually an improvement -- in previous surveys three-quarters of kids reported drinking a sugary drink each day.

When celebrity athletes drink sugary drinks in ads they do it because they’re paid handsomely to do just that. In real life star athletes usually treat their bodies like a temple. I’m pretty sure they watch what they eat quite carefully, and maximize their potential by eating well. An image that better reflects an athlete’s genuine eating habits is Rafael Nadal’s on-court water and banana combo (Nadal’s often seen snacking on a ripe banana between sets).

A sports drink with breakfast and lunch doesn’t make an athlete – it just makes kids poorly nourished and fat.

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--go join the food fight!

Can you drink your joints healthy?

Functional foods have experienced fast growth in recent years, and supermarket shelves offer a wide array of products that claim to have health benefits beyond basic nutrition. Many of these foods are fortified with nutrients and additives that most people need a dictionary for, but they sure do sound medicinal and technologically advanced. These foods are marketed as disease-preventing and health-promoting.

There are drinks that claim they can make your skin younger (if you believe what’s written on the cosmetics’ package, I guess you can believe that, too), boost your brain function, make you loose weight without a diet and build super-immunity.

One of the product lines that I find most intriguing is the drinks aimed at joint health. Several companies make beverages laced with glucosamine and/or chondroitin aimed at maintaining healthy joint cartilage (see Joint Juice, Elations, Vitamin Water - Balance, Supple, Monavie). Since glucosamine and chondroitin are widely used dietary supplements, I’ve been asked by joint sufferers whether these drinks actually work.

A short introduction to these supplements:

Glucosamine is thought to promote the formation and repair of joint cartilage.

Chondroitin is a cartilage component thought to promote cartilage water retention and elasticity and to inhibit its breakdown. Both compounds are made by the body.

Glucosamine and chondroitin supplements are derived from animal sources (shellfish shells and animal cartilage), but glucosamine can also be derived from vegetarian sources. These supplements are promoted widely, especially by lay media, to treat osteoarthritis, the most common form of arthritis in the US, afflicting about 21 million people. They are hugely popular, with estimated sales of around $730 million in 2004.

So it would be nice to know if these supplements actually work.

There have been several studies that evaluated the efficacy of glucosamine and chondroitin, alone and in combination. Some have demonstrated efficacy, but other studies have shown no benefit. Many of these early studies had serious flaws. A recent meta-analysis in the British Medical Journal summing the results of ten randomised controlled trials concluded that compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space, and therefore these supplements shouldn't be covered by medical insurers.

The largest, most comprehensive and best-designed clinical trial so far is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), a multi-center, randomized, national clinical trial funded by the National Institutes of Health. This study produced two major outcomes so far:

• The first study was published in the New England Journal of Medicine in 2006. In it 1,583 patients with symptomatic knee osteoarthritis were randomly assigned glucosamine, chondroitin sulfate, both glucosamine and chondroitin sulfate, celecoxib (a non-steroidal anti-inflammatory drug) or placebo for 24 weeks. Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee, although exploratory analyses did suggest that the combination of glucosamine and chondroitin sulfate may have some effect in the subgroup of patients with moderate-to-severe knee pain.

• The study’s second outcome was published in the scientific journal Arthritis and Rheumatism. A subgroup of the original GAIT trial participants, consisting of about 570 patients continued the trial for a total of 24 months to see if there’s radiographic evidence that glucosamine and chondroitin, alone or in combination, can affect joint deterioration. And the result: the supplements did not appear to slow the loss of cartilage, taken either alone or together, and performed no better than placebo.

The only good news is that glucosamine and chondroitin have now been tried quite extensively, and while I don’t believe they work any better than placebo, they are generally safe, with only minor side effects reported.

As to the question of putting them into food:

Although many people eat food of very low quality, food that doesn’t offer the benefits of food (i.e., nutrition, taste, tradition, joy and community), they believe some new processed foods with added supplements can deliver wellness better than real food can, and practically act as medicine.

This kind of attitude enables manufacturers to invent new processed foods daily, adding the molecule du jour to the mix, and to market it as the new fountain of health.

Even if a supplement is proven effective (bear in mind that supplements are not required by the FDA to prove efficacy the way drugs do), why add it to a drink full of sugars and color? Why not take it as a pill, without the added junk?

But perhaps the most important question is: Why not go back to some sensibility about food?

• Food should be made from food, not from ingeniously created new additives. Rule of thumb: If you can’t pronounce an ingredient, it’s not real food.
• Foods providing innate nutrition, great taste and joy are really a refreshing change in today’s processed food landscape, and quite good enough. I don’t see how we can expect food to go beyond that and tackle all that ails.
• And above all, while seeking benefits beyond basic nutrition, we forgot basic nutrition. By eating well, keeping active, and maintaining a reasonable weight we can prevent many chronic diseases.

Eating well is good enough. No magic is needed, and if there’s any promise of magic—we should all demand strong proof.

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.

Sports drinks: Are they healthy? Do they improve performance?

I have three athletic kids, and have many opportunities to watch practices and games.

I have been noticing lots of sports drinks.

Engaging in any sport is now almost synonymous with drinking a sport drink.

I’m not discussing performance athletes here, or regimens that involve endurance and extreme conditions. I am talking about kids playing basketball, tennis or soccer for an hour or so, in comfortable situations, with plenty of breaks, and many times hardly breaking a sweat.

Sports drinks were initially designed for athletes. Dr. J. Robert Cade, University of Florida professor of medicine and physiology is credited with creating the first sports drink in 1965.

Before Dr. Cade’s invention the players would practice all day in Florida’s humid heat, with hydration not part of the routine. It is hard to believe, but at that time athletes were discouraged from drinking even water for fear it would cause nausea and abdominal cramps. Many players suffered heat exhaustion at those times, and deaths were not uncommon among football players.

Dr. Cade was asked by the then-assistant Gator football coach Dwayne Douglas the question that launched an industry: Why do players loose so much weight during games, yet hardly urinate? Cade's researchers determined a football player could lose as much as 18 pounds, 90 to 95 percent of it water during the three hours it takes to play a game. Players sweated away sodium and chloride and lost lots of water.

Using their findings the researchers mixed water with electrolytes and sugar for players to drink while playing football. It tasted horrible, but after adding more sugar and lemon juice it was quite palatable, and did prove to benefit the athletes. The Gators enjoyed a winning record and were known as a "second-half team" by outlasting opponents.

After the success story of sports drinks for athletes these drinks were marketed to sporty and health-conscious general consumers. The marketing success has been so great, that, in the belief that this drink will “enhance performance”, “improve recovery” provide “quick rehydration” or “prevent hyponatremia” they now go hand in hand with exercise -- any exercise.

What’s in these sports drinks, and is it better to rehydrate with these for the casual exercise regimen?
This is a typical ingredient list:

• Water
• Sugars- 6% to 9% carbohydrate (glucose, fructose, sucrose, or synthetic polymer maltodextrins)
• Electrolytes- including sodium, potassium, and chloride
• Other stuff- flavors, colors, acids (for flavor and preservation), preservatives and vitamins in some.

For a recreational athlete, the only good ingredient is the water. Our body's glucose and glycogen reserves are not depleted by an hour of exercise and do not need replenishment, minerals are plentiful in food (electrolytes are basically salt), and despite marketing claims, sport drinks show little benefit over water in preventing dehydration in these situations.

The downside of consuming sports drinks regularly are the calories from sugars, getting into the habit of expecting a drink to be sweet, and the potential damage to teeth by constant contact with these drinks. The damage to teeth is from the sugars and the acidity of the drink, which can cause caries and tooth erosion.

Sports medicine has come a long way. Certain nutrition regimens do give athletes an edge, but this does not mean kids should be consuming sports drinks on a regular basis while engaging in routine childhood activity

An interesting idea is the power of suggestion sports drinks have. If you believe the drink will make you better, it will!

Ron Friedman and Andrew Elliot published a study in Psychology of Sport and Exercise that demonstrated across three experiments that just showing a sports drink -- as opposed to showing spring water -- led to greater persistence on physical tasks, consistent with the well-known perceived association between sports drinks and endurance.

I can see uses for that.

How about Happy Water -- marketing genius will convince you that just having it at home makes you happy -- or Peace Water -- shipping it around the world will finally bring world peace.

Let’s drink to that.

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--go join the food fight!

Can vitamin D protect from cancer?

We’re living in the glory days of Vitamin D, which is now touted as a miracle cure-all treatment for, well, practically everything. Doctors are testing their healthy patient’s vitamin D levels and deficient or not, many choose to pop a vitamin D supplement, just in case.

Every day a new study catches the attention of reporters – if only for a brief moment – who are quick to announce that vitamin D deficiency can be blamed on yet another ill. Judging by some headlines the sun vitamin can cure diabetes, heart disease, cancer, hypertension, depression, obesity and even the common cold.

Scientists are known killjoys, and have been trying to curb the enthusiasm for vitamin D supplementation, noting that most of the vitamin D studies are observational, and that much like other vitamin supplementation disappointments (remember the vitamin E, A and C crazes?) it very well might be that healthy people tend to have higher levels of vitamin D (an explanation of why that’s so later), which does not mean that taking vitamin D will make you healthier. Correlation doesn’t prove cause, experts remind us, and they suggest we await further research.

Last November the Institute of Medicine Committee released its report stating that vitamin D is important for bone health, has not been a proven panacea to any other illness, and that most people have adequate amounts of vitamin D (the committee’s lower limit cutoff is 20 nanograms of vitamin D per milliliter of blood, while many labs shoot for 30).

Vitamin D and cancer

Three of the vitamin D experts who were part of the Institute of Medicine’s committee published a new commentary in the New England Journal of Medicine, elaborating why the panel thinks vitamin D isn’t ready for prime-time in cancer prevention.

The beginnings were promising -- several observational studies showed that lower levels of vitamin D were correlated with cancer. But association studies have important limitations, the authors warn, especially where vitamin D and cancer are related.

Obesity, lack of exercise and poor nutrition are known risk factors for cancer. Those precise risk factors tend to be associated with lower levels of vitamin D – vitamin D is sequestered in body fat, therefore overweight people have lower measured levels of this vitamin, non-exercisers tend to spend less time outdoors absorbing the sun and make less of the vitamin, and people who pay less attention to healthy nutrition may get less vitamin D from food or supplements.

And let’s not forget the reverse causation bias: People who are not in great health will stay indoors, eat poorly, and therefore have lower vitamin D levels.

Randomized trials, in which people are randomly assigned to be treated either with an active ingredient, or with a placebo, are much more reliable than observational or case-control studies. There are very few randomizes clinical trials looking at the effect of supplemental vitamin D on cancer incidence. The results of these have been disappointing, inconsistent and inconclusive and research hasn’t established a cause-effect between vitamin D and cancer as of yet. The receptor for vitamin D is expressed in most of our body; therefore it is possible that this nutrient plays a role in cancer prevention or progression.

Several new trials assessing vitamin D supplementation’s effect on cancer are underway, and we can remain hopeful that their results will support vitamin D's benefit for conditions other than bone health, but at this point the authors conclude that “the existing evidence falls short”.

Practical approach to vitamin D

Vitamin D maintains normal blood levels of calcium and phosphorus, and is critical to forming and maintaining our bones.

Our body makes most of its vitamin D: Our skin produces vitamin D after exposure to ultraviolet light from the sun. Just 10 minutes of sun exposure daily will usually get us enough production to prevent deficiency, and the extra vitamin produced is stored for rainy days. Foods with naturally occurring vitamin D aren’t common, and include fatty fish, eggs and mushrooms. Many other foods are fortified with vitamin D: Milk, flour, cereals and margarine are a few examples.

The new reference vitamin D intakes issued by the Institute of Medicine are 600 IU/day for most people aged 1-70 years (see link for other age groups). People who rarely get sun exposure and dark-skinned individuals should probably take vitamin D supplements. While our body never makes too much vitamin D, even if we’re out in the sun all day, day after day, it is possible to suffer vitamin D toxicity (which can cause kidney stones and tissue damage) when we ingest too many supplements, therefore the upper limit recommended by the Institute of Medicine report is around 2000 IU/day.

Wouldn’t it be nice if we could prevent a myriad of illnesses by a treatment as simple as a vitamin pill? Unfortunately, research has not proven that vitamins cure any condition besides vitamin deficiencies (which are very uncommon in the US), and more is not better when it comes to these essential vitamins. For now, I’d stick with Michael Pollan’s rule #40: “Be the kind of person who takes supplements – then skip the supplements.” Becoming that person isn’t easy – it requires adopting good eating and exercise habits – but popping a vitamin isn’t a shortcut to getting the same health benefits.

Dr. Ayala

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

Energy drinks study: No proven benefit, plenty of risk

The energy drink market is booming, enjoying robust annual growth despite the recession and is expected to top $9-billion this year in the US alone. The biggest consumers of these drinks are kids and young adults, which begs the question: Are these drinks safe for kids?

A special article in this month’s issue of Pediatrics reviewed the literature and looked at 121 scientific studies, government reports and media sources on energy drinks. The authors raise some serious concerns and warn that energy drinks are under studied, overused and can be dangerous for vulnerable kids and teens.

What’s in an energy drink?

Caffeine is the main active ingredient in energy drinks — they usually contain 70 to 80 milligrams of caffeine per 8-oz. serving, more than triple many cola drinks. Additional caffeine can come from energy drink’s other ingredients: guarna, kola nut, yerba mate and cocoa.

Energy drinks may also contain taurine (an amino acid), vitamins, herbal supplements such as yohimbine and ginseng and sweeteners.

Are energy drinks safe for kids?

The review found evidence that caffeine may increase kids’ blood pressure and disturb sleep. Caffeine causes dependence, and can lead to symptoms such as headaches and inattention when caffeine is withdrawn. Caffeine also affects food and beverage choices, making kids prefer caffeinated sodas. Caffeine interferes with calcium absorption in early adolescence, and whether because of this trait, or because it replaces milk, caffeinated drinks are associated with lower bone mass. And let’s not forget that most of these drinks contain empty calories from sugar, contributing to obesity and dental problems.

But most worrisome is caffeine’s effect on kids with underlying medical conditions. Kids and teens with heart disease take the risk of heart rhythm abnormalities and even sudden death when exposed to high doses of caffeine. Kids with seizures, diabetes, mood and behavior disorders, hyperthyroidism, kidney and liver diseases may also be especially sensitive to the effects of caffeine.

Energy drinks are marketed primarily to the young

Energy drinks advertising campaigns, brand design and sponsorship strategies are geared towards teens, students and young adults and include sponsoring extreme-sport competitions, athlete sponsorship and product placement in programming and social media that targets a young audience.

Energy drink regulation

The FDA’s upper limit of caffeine in soda is 71mg per 12 fl oz. This upper limit is easily circumvented by labeling energy drinks as dietary supplements. Dietary supplements require no testing, warning labels or restrictions. This leads to the absurd reality in which soda, with a moderate caffeine content, has to list caffeine content, over-the-counter caffeine medications such as No-Doz must carry warnings, adverse effects label and have a minimum age for purchase (12 years), yet energy drinks with as much as 400 mg of caffeine per container aren’t regulated at all. The FDA announced recently that caffeine is an unsafe food additive to alcoholic beverages and that it will prohibit the sale of premixed alcoholic energy drinks (such as Four Loko).

The article includes a chart listing energy drink regulations around the world. In Denmark energy drinks are prohibited entirely. The European Food Safety Authority requires energy drinks with high caffeine to be labeled “high caffeine content”, and the exact content be listed. In Norway energy drinks can only be sold in pharmacies.

The authors, led by Sara Seifert, conclude:

“On the basis of this review, we conclude that (1) energy drinks have no therapeutic benefit, and both the known and unknown pharmacology of various ingredients, combined with reports of toxicity, suggest that these drinks may put some children at risk for serious adverse health effects; (2) typically, energy drinks contain high levels of caffeine, taurine, and guarana, which have stimulant properties and cardiac and hematologic activity, but manufacturers claim that energy drinks are nutritional supplements, which shields them from the caffeine limits imposed on sodas and the safety testing and labeling required of pharmaceuticals; (3) other ingredients vary, are understudied, and are not regulated; (4) youth-aimed marketing and risk taking adolescent developmental tendencies combine to increase overdose potential…”

Renewable energy sources

Should kids be running on caffeine? I love my morning coffee, look forward to it, and have to admit it makes loose dreamy words in my brain connect into sentences. I have been following research on coffee’s effect on heath for a long time and my conclusion (so far) is that coffee in moderation poses no threat to healthy adults, and has been shown to even have benefits in some studies (coffee lovers rejoice every time such a study is published and add it to their collection). Most coffee drinks contain only moderate amounts of caffeine, and since coffee is hot, it is usually consumed slowly.

That does not mean that caffeine is safe for kids, that it’s safe in high doses, or that it can safely be combined with dietary supplements. (It definitely shouldn’t be combined with alcohol.)

The notion that energy comes from a can introduces kids to the false idea that our bodies function on surges of energy in the way a rocket needs its super-fuel to lift off.

Nothing can be further from the truth. Our body regulates its energy in very complex and efficient ways, and healthy people enjoy good, steady levels of energy throughout the day with no need for boosts from stimulants.

The two major sources of energy in energy drinks are caffeine and sugar. Neither source supplies sustained energy -- quite the opposite. Drinking refined sugar and stimulants, such as caffeine, results quite often in highs and lows in energy levels and overall exhaustion. The best recipe for good stamina is to eat well, get enough sleep and be physically active.

Red bull claims to vitalize the body and the mind, increase performance, increase concentration and reaction speed, improve vigilance, improve emotional status and stimulate metabolism. Scientists cannot find good evidence for any of these claims, warn of risks, encourage regulation of these energy drinks and suggest parents and pediatricians discuss energy drinks with kids.

What do you think of our hyper-caffeinated beverage isle?

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--go join the food fight!

Immunity boosting foods? Really?

I'll be taking a a few weeks off to spend time with my family and travel. Meantime, I'll be reposting some of the more popular and relevant posts I’ve written over the past years so that new readers have a chance to catch up.

The connection between diet and health was proposed some 24 centuries ago by Hippocrates, and I can imagine he first heard of it from his mom, who heard it from her ancestors.

Today, grandmas, moms and physicians have piles of scientific evidence supporting their observations and advice. It’s true: Diet does play an important role in health. We’re learning more each day and the discovery is fascinating.

Unfortunately, scientific discoveries are being overly-interpreted to promote the sale of foods, and scientific jargon appears all too often as buzzwords on packaged goods.

Every Flu season and especially the recent spread of the new H1N1 virus have given rise to a new barrage of immunity claims shouting at us from every supermarket shelf and commercial. It’s a perfect time to look at the diet/health connection and these claims.

A short introduction to food label claims

There are several types of claims allowed by the FDA on foods.

A health claim describes a relationship between a food or food component and a disease, and it must:

• Be pre-approved by the FDA. There are currently slightly more than a dozen of these approved claims.

• Be phrased in the specific language the FDA requires. The claim must indicate that the disease may be caused by a variety of causes, and must state that the food should be consumed as part of a healthy diet.

• Appear on food that meets certain nutritional requirements.

A structure/function claim is quite a different animal.

Structure/function claims describe a role of a nutrient, a substance in food or a food supplement in affecting the normal structure or function in the body. Unlike a health claim, it doesn’t relate to a disease or a health-related condition. The verbs “support”, “improve”, “boost” and “maintain” are often a telltale sign of a structure/function claim.

A Structure/function claim:

• Requires no FDA pre-certification.

• Can be attached to any food, including junk food (there are no overarching nutritional requirements).

• Can be phrased in many ways.

• Is the manufacturer’s responsibility. While the claim “must be truthful and not misleading”, there’s no specification about how much evidence is needed to make the claim.

A few quick examples:

“Calcium reduces the risk of osteoporosis” is a health claim; “calcium builds strong bones” is a structure/function claim.

“Fiber may reduce the risk of some cancers” is a health claim; "fiber maintains bowel regularity," is a structure/function claim.

Confused? You’re in good company. Most consumers can’t tell the difference.

Even the pros in the food industry can’t necessarily make sense of structure/function claims. They consult expert lawyers whose entire practices are devoted to advising companies on the language of the label. Creative marketing devises the claim and legal counsel makes sure it’s defensible and at least somewhat based on reality.

What’s clear is that the structure/function claim has been a boon to food manufacturers. Since there are so few limitations on its use and the trusting public can’t distinguish between a health claim and a structure/function one, why not be creative, develop a claim that meets your goals and slap it on the package? Market research shows these structure/function claims really help with sales.

What's the evidence backing these “immunity” claims?

There are, in fact, no approved health claims related to immunity.

What does that mean? It means that no one has presented to the FDA enough evidence of a relationship between a food, a food ingredient or a dietary supplement and reduced risk of contracting or of treating an immune mediated or infectious disease such as the flu to warrant a health claim.

That means the immunity claims you see everywhere are all structure/function claims.

What are the claims based on? The immune system is very complicated, and its integrity depends, among other things, on good nutrition. States of vitamin, mineral or protein deficiency lead to reduced immunity and correcting the deficiency does improve immunity.

But while it’s true that if you had a vitamin C or zinc deficiency you could improve your health and immunity by eating a vitamin-fortified cereal or a vitamin supplement, it’s clear that shouting “Immunity!” from the cereal box is misleading. Vitamin deficiencies are rare, and therefore the cereal might be yummy, but it’s not doing much for your immune system.

Most food contributes to one’s health, so by that token we can add a structure/function claim to pretty much anything:

• Sleep, for example, is very important to immunity; should we advertise mattresses as immunity boosters? All mattresses or only some brands?

• Exercise improves immunity. Maybe “immunity now!” should be painted on sidewalks?

• Stress reduction improves immunity; how about an “immunity massage”?

• Why, even breathing air supports immunity.

These immunity claims are all without much substance I’m afraid, but it’s especially outrageous to see them on junk food. Cocoa Krispies is 40 percent sugar, but hey, don’t you need to maintain normal sugar levels for good immunity? Correcting potential hypoglycemia is critical for good immunity, isn't it?

Thankfully, after receiving a letter from San Francisco’s city attorney last November, Kellogg announced it would phase out the immunity claims on Cocoa Krispies.

Will misleading claims ever end?

Two scenarios I can imagine:

• Consumers will start rejecting these claims, viewing them as a hyped and misleading insult to their intelligence, and move toward products that are marketed in a more sensible and honest way.

The only reason these claims abound is because we’re buying them.

And here comes my question: Do people really believe that they can buy immunity in box? Or are they buying it knowing that an easy fix is a fantasy, but it still feels good to dream?

• The second option is the litigious route: A few really big class action suits, representing misled consumers who saw no health benefits from investing their hard-earned money in products that failed to deliver can change everything. In that respect, the recent FDA warning letters to manufacturers who post misleading or false claims could act as important evidence and actually make a difference.

I prefer the first scenario.

There’s actually a third possibility.

The FDA can overhaul the whole health-claim structure/function scene, crackdown on false and misleading claims and help consumers understand that good health (and building a strong immune system) has nothing to do with buying products that make health claims. People need to just eat well by consuming healthy, real foods over a long period of time.

Sorry, but that’s the truth—eating well is about good habits and good food, not about sprinkling vitamins, anti-oxidants and omega 3 on processed food. The Center for Science and Public Interest (CSPI) is urging the FDA to do just that in a report it recently sent. (It’s 158 pages, but well worth a read, and it includes lots of pictures.)

So, what to make of these medicinalized foods?

I think it’s best to simply leave them on the shelves and opt for good, healthy choices. As Hippocrates said, “To do nothing is sometimes a good remedy.”

Happy healthy new year!
Dr. Ayala

Kombucha: Health elixir or risky experiment?

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

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

What is kombucha? Where’s the alcohol from?

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

Is kombucha truly magical?

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

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

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

Is alcohol the only concern? Should we be concerned?

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

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

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

What’s next?

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

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

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

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic culinary herb infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.
Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Organic is healthier…but you can still get fat

We like to eat. We especially like indulgent foods – desserts, snacks and tasty treats.

We’d love to believe it’s okay to heap our plates with foods we perceive as “healthy".

In fact, studies have shown time and again that foods perceived as healthy or foods with a health aura drive us — if only subconsciously — to eat more. Foods with "low fat" or "low calorie" claims lead to overconsumption of snacks. A study using hidden cameras at Italian restaurants showed that people dipping their bread in olive oil will eat more fat and calories than if they instead spread some butter.

Organic food labels can lead to overeating, too. In presenting findings from their new study, Jenny Wan-Chen Lee and Brian Wansink showed that the organic seal appears to make people believe their organic snacks have a lot fewer calories than they do. For example, people who ate cookies labeled as "organic" believed that their snack contained 40% fewer calories than the same cookies that had no label.

Now, I’m a huge proponent and an early adopter of organic produce, but the organic seal, of course, has absolutely nothing to do with calories.

The benefits of organic food

The organic seal promises that the food and its ingredients have been farmed according to the organic standards — which are better for you and for the environment.

Organic practices are about sustainability, how we grow food, and how we treat our environment. These practices also tie to our personal health, given that the multitude of chemical fertilizers, pesticides and herbicides used to produce conventional food actually remain in the food. While it’s hard to prove that any single one of them, in small amounts, causes disease, it’s impossible to prove that they don’t; personally I’d rather minimize exposure to what’s clearly not meant for human consumption (read more about why organic matters in my post here).

The jury’s still out on whether organic produce has more measureable nutrients than conventionally-grown produce.

What organic food isn’t

Organic produce isn’t necessarily clean. All too often I see people skipping the washing of organic produce, forgetting that it comes from a field, and has been handled by many hands. Organic produce does need to be washed — thoroughly. While organic food isn't sprayed with chemicals, microbial life is teeming on and between the leaves. Wildlife visits the fields and can contaminate produce in any number of ways we don’t like to consider when we think of food. There’s also the bacterial mixture from a multitude of human hands that have touched your produce before it gets to your table.

Organic food isn’t automatically healthy, or something we should necessarily consume in large quantities. Organic candy, organic soda or organic French fries — while a tiny bit better for us because they’re free of pesticides — are still junk food, and should be eaten infrequently.

Bottom line

People are generally an optimistic and trusting bunch, and the temptation to believe what we want to be true sometimes overcomes lessons we’ve been taught about the prudency of healthy skepticism.

If you want to have a clearer idea of what you’re eating, just read the ingredient list and nutrition facts, regardless of the atmosphere created — or the claims-to-health — on the front of the package.

Read the labels on organic foods as carefully as you’d read any other food label. If the food is full of sugars, fats, salt or calories, it should be viewed as a dessert, and should be eaten in moderation.

Dr. Ayala

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

Kids’ food: Innocent fun or a bad habit?

First Mom Michelle Obama said to food makers recently: “If there is anyone here who can sell food to our kids, it’s you. You know what gets them to drive their parents crazy in the grocery store.”

We parents are quite aware of a TV ad when we see one, but marketing efforts go way beyond direct advertising on TV and internet games. Kids are exposed to slick marketing and a call for their eyeballs everywhere and especially where food is sold—manufacturers design food and packaging in a way that appeals specifically to kids and affects their choices, or at least their nagging choices.

These “fun foods” are very easy to recognize—let any toddler loose in a supermarket and they’ll spot them from a mile--it’s the rare kid who will pick milk, apples and baby carrots as kids’ food.

Food and beverage companies spend $2 billion a year on marketing food to kids. They have excellent reasons to do so: Toddlers have been known to sing the tunes and repeat the message after being exposed to some ads just once, and they’re likely to stay loyal to a brand forever.

Foods designed for kids usually aren’t nutritious

Foods marketed to kids have several “fun” design and message elements in common: Specific colors, iconography (including cartoons), graphics, language and shapes (animals and cars) allure the kids, beckoning them to take a look. Packages offer free games, tie-ins with popular kids’ programs and films, and “let’s have fun” messaging. Kids know immediately that this is a food playfully designed for a kid.

But these foods have something else in common: Unfortunately, most of the marketing efforts promote highly processed foods of low nutritional value.

Professor Charlene Elliott from the University Of Calgary, Canada, studied 367 products targeted specifically at kids to assess their nutritional value. The results appeared in a study in the journal Obesity Reviews.

The study included only “regular” foods within the dry goods, dairy, produce and frozen food categories. The study excluded typical “junk food”—candy, soft drinks, cakes, potato chips etc., as these are expected to be of poor nutritional value, and don’t need testing.

The assessment of nutritional value was done using the criteria outlined by the Center for Science in the Public Interest (CSPI): Healthy food should not derive more than 35 per cent of its calories from fat (excluding nuts and seed and nut butters), should have no more than 35 per cent added sugar by weight, and upper limits for sodium levels are defined depending on the food category.

This is what the study found:

• 89% of the kids’ products studied were classified as having poor nutritional quality”

• Within the dry goods kids foods (including granola bars, cereal bars, pasta, soups), high sugar levels were the main culprit.

• Within the refrigerated and frozen foods (packaged lunches, pizzas), many products had high fat or sodium.

• Less than 1% of the foods specifically targeted at children in a Canadian supermarket are fruits and vegetables; the only “kids’ foods” in the produce section were small apples and baby carrots.

Nutritional claims abound, tricking harried parents to give-in to nagging

Fun foods don’t portray just happy drawings and cartoons. The majority of these foods (62.7%) had nutrition claims on the box such as “low fat,” “good source of calcium,” “trans-fat free,” etc.

Among the 326 fun foods that were of poor nutritional quality, 202 (62%) had nutritional claims.

So while the nutritional claim of “low fat,” “no trans-fat” or “good source of iron” might lead one to think the whole product is nutritious, that isn’t necessarily the case—the product may be full of sugar, non trans-fat or sodium.

The nutrition claim is aimed at the gatekeeper—the parent—and gives us an excuse to go ahead with the purchase.

Kids’ food is a bad idea

The notion that kids need their own food is very wrong in my opinion. Beyond infancy, children don’t require any special diet. The same foods that are good for adults are good for kids, the only emphasis would be that it’s even more important for kids to eat nutritious food, as this is the time their body is growing, and their eating habits are formed.

From both the health and the practical point of view, I really don’t see why parents would make (or buy) one meal for their kids and another for the adults. There’s no such thing as “grown-up” food—there’s just good nutritious food for sensible humans, and since kids are smaller, they should get a smaller portion.

I often get upset by kids’ menus in restaurants. I think there should be an option to order a smaller, lower priced dish from the regular menu for kids—something like a half-price/half-portion for young diners sounds like a simple way to go. But the typical kids menu is often the same old French fries, hot dogs, butter-and-cream-drowned macaroni and cheese; as if that’s the only thing kids can imagine eating.

If we raise our kids with the expectation that food for them should be dumbed down to “fun food” with toys, how are they supposed to learn what good food is?

I find great pleasure in preparing and eating real food. I’m using the word “pleasure” and not “fun,” because fun in the context of food has come to mean the silly, artificial and superficial way to have a good time. Kids that grow up expecting food to have rainbow colors, glow in the dark, pop in your mouth and be shaped like Batman have no understanding of food, or its connection to the natural world and our health. I honestly believe they also don’t get real pleasure from their food; their meal is an extension of their entertainment.

Fun food usually isn’t nutritious. The standards for nutritious food set by this study are quite minimal, and were met by only about 10% of the fun foods. Fun food also replaces the real joy a kid can get from helping make a meal from basic ingredients, of tasting food that has real food quality, and of connecting to people—understanding where the food came from, talking with the people who grew the food (farmers markets can be a real source of fun) and sharing the same meal with everyone in their household.

I hope food makers will adopt higher standard regarding foods marketed to kids--I think they're starting to do so--but it’s really up to us parents to be the gatekeeper and to explain to our kids that Toucan Sam has nothing to do with breakfast.

I'd love to hear your thoughts!

Dr. Ayala

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

A originally wrote this post as a guest on Kidappeal. Kidappeal blogger, Jenna, is a foodie, nutrition enthusiast, mother of two, and business owner, and I love her blog's tagline: one meal, one snack, one bite at a time .

Another apple-a-day may save more lives than the Toyota recall

Many health organizations, including the World Health Organization and the National Cancer Institute, recommend five servings of fruit and vegetables daily to help ward off disease.

Some people (I’m not one of them) go even further and propose that eating enough fruits and vegetables provides strong protection from cancer.

Cancer is a complex group of diseases. We still know very little about what causes some cancers, but it’s probably safe to say that increased risk for most cancer types usually stems from a combination of factors—some genetic and environmental, which are hard to control, and some that we have much more power over. Smoking, exercise, obesity, diet and sun exposure have all been shown to affect cancer risk.

A healthy lifestyle has many components, and I personally don’t believe any one healthy diet habit by itself—even if practiced religiously over a lifetime—has a hugely dramatic effect on cancer incidence in a population.

Having said that, every little bit helps, and while we shouldn’t exaggerate any intervention as the “solution” to cancer, these small measures together do add up and help prevent some disease.

That, by the way, is why I see all health claims on food as at least a little misleading. The diet-health relationship is real, but is always more complicated and variable than what a simplistic statement implies.

A new study in the Journal of the National Cancer Institute got quite a lot of coverage in the past few days; it found what the authors called only a weak association between high fruit and vegetable intake and reduced overall cancer risk. The headlines in many news publications (“Eating Vegetables Doesn’t Stop Cancer " in the New York Times, “Fruit and vegetables have little effect on cancer risk, study finds ” in The Guardian) suggested deep disappointment over fruits and veggies’ “poor performance” against cancer.

Is this a blow to the five-servings-a-day advice? Let’s first take a closer look at the study.

Paolo Boffetta of the Mount Sinai School of Medicine in New York and colleagues analyzed data from the EPIC study (European Prospective Investigation into Cancer and Nutrition), which included almost 500,000 participants from ten Western European countries. In about nine years of follow-up, more than 30,000 participants were diagnosed with cancer.

The authors found a small but statistically significant association between high intake of fruits and vegetables and reduced overall cancer risk--the higher the intake the lower the risk.

The data shows a 3 percent lower risk of cancer for every 200 grams, or seven ounces, of fruits and vegetables a day a person eats. People who ate five or more servings a day had 11 percent fewer cancers than those who ate 0-1.5 servings a day.

These results were consistent across the countries studied.

Higher intakes of fruits and vegetables in this study group were associated with other healthy behaviors, such as smoking avoidance, limited alcohol consumption and exercise, which may also be protective from cancer. But the small protective effect of fruits and veggies persisted even after adjusting for these factors.

How significant is 3 percent protection from cancer?

Numbers are often hard to understand without context—they aren’t as absolute as they sound. Is 3 percent a small number?

There is of course no one right answer to that.

Let’s take a look at the Toyota recall and compare risk/benefit ratios.

The chance of an owner of a recalled Toyota experiencing a deadly acceleration problem is assessed at 2.8 in a million. (There were 17 fatal accidents related to acceleration in 10 years, before six million cars were recalled. New complaints are now pouring in, which is quite typical after a recall and law suits are announced.) But we all expect Toyota to recall and fix all relevant cars, and we’re angry they failed to address this problem sooner.

The yearly cancer incidence in the U.S. is estimated at 4,600 in a million; one and a half million Americans are diagnosed with cancer each year, and 1,500 die of cancer daily. If, as this study suggests, eating an additional seven ounces a day of fruits and veggies can reduce cancer incidence by 3 percent we’d have 40,000 fewer Americans receiving the diagnosis of invasive cancer yearly.

In Toyota's case we demand action when the current risk is as small as 2.8 in a million, yet with cancer, where the disease risk is as high as 4,600 in a million, some suggest that a reduction of 3 percent in risk does not make much of a difference.

I wouldn’t perhaps recommend a drug with many side effects if it reduced a rare disease’s risk by 3 percent, but for an “intervention” as benign as eating an additional apple a day, and a disease as serious and common as cancer a 3 percent risk reduction looks like a decent size reward.

What if fruits and veggies offer no protection from cancer?

When a study shows only a small difference in outcome between the studied groups, there’s also the possibility that this difference can be explained by chance, and by something other than the variable studied. In this case we have to bear in mind that eating more fruits and veggies is generally associated with a healthier lifestyle, and no matter how hard the authors try to control for the other healthy lifestyle factors, some bias may remain.

So even though this study and several others show a probable small reduction in all-cancer risk, let’s bear in mind that it’s also possible that eating your veggies might offer no significant protection from cancer.

Yet, this “worst case” scenario still leaves us with many excellent reasons to continue promoting fruits and veggies. Here’s a partial list of good reasons to eat plenty of fruits and vegetables:

• They help lower the risk of heart disease and stroke (a study showed a 30 percent lower risk in people eating five servings a day, compared to those who eat only 1.5 servings a day)

• They help lower blood pressure

• They help lower diabetes risk

• They help lower risk of eye (cataract and macular degeneration) and digestive (constipation and diverticulitis) problems

• They provide lots of fiber, both soluble fiber, which helps lower cholesterol and regulate sugar, and insoluble fiber, which is important to digestive health

• They provide vitamins, minerals and many other beneficial plant molecules—phytonutrients—many of which we’re only starting to understand. (And I’m sure there are a few we have yet to discover. My mom knew nothing about lycopene, for example, when she fed me tomatoes and watermelon.)

• They have high nutritional value and low caloric density, so eating many fruits and vegetables (rather than practically any other food) helps lower caloric intake and maintain optimal weight

• They taste good, are beautiful to look at, and connect us to nature

My last item on the virtues list is completely non-objective; I’m guilty of total fascination with colorful growing things that we can also eat.

If, in all the years that fruits and vegetables have been consumed and studied, the worst we can say about them is that they’re not as thick a shield against all cancers as some had hoped, this speaks to just how good for us they really are.

So keep those fruits and veggies coming!

Dr. Ayala

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

This entry has been posted as part of The Kathleen Show's Prevention not Prescriptions