Healthy Food & Healthy Living by Dr. Ayala

Caffeine, coffee and type 2 diabetes

A new study of caffeinated drinks and type 2 diabetes caught my eye. I’m always on the lookout for studies on coffee, because – let’s admit it – I love coffee, and like many other coffee aficionados, I fear that someday this adored pleasure will be found a guilty one. And then what shall we do? Decide it’s worth the risk? Or convince ourselves we never really cared for this delicious, thought brightening, history-defining drink?

For coffee lovers most research news has been reassuring. Years of investigation have shown that coffee in moderation poses no threat to healthy adults – those worries about heart disease and cancer risks end up being unwarranted. What’s more, the coffee habit has even been shown to confer health benefits, and is associated with protection from Alzheimer’s and Parkinson’s disease, stoke, gallstones and liver disease.

Caffeine and diabetes

The new study, published in the American Journal of Clinical Nutrition (online ahead of press), observed a very large population of about 75,000 women and 40,000 men for more than two decades, trying to see if there’s an association between the caffeinated and caffeine-free drinks they consume and the development of type 2 diabetes.

The study looked at all types of typically caffeinated drinks: coffee, tea, sugary drinks and artificially sweetened drinks.

Over the years more than 10,000 of the people developed type 2 diabetes. There are many factors known to increase the risk of developing type 2 diabetes, such as obesity, family history of diabetes, hypertension and smoking. After controlling for those, the researchers set about to see whether caffeinated drinks made a difference.

Here’s what they found:

• Coffee, caffeinated or decaf, was associated with a lower risk of type 2 diabetes.
• Caffeinated tea was associated with a lower risk of type 2 diabetes.
• Sugary drinks, both caffeinated and caffeine free, were associated with a significantly higher risk of type 2 diabetes.

Are coffee and tea protective?

It’s impossible to conclude cause and effect from these kinds of studies. The authors describe a few plausible protective mechanisms in which coffee and tea can affect diabetes: both are rich in flavonoid antioxidants, which may help in reducing inflammation. It’s likely that it’s one of the multitude of compounds in coffee and tea – or several of them acting together -- that have positive health effects, and caffeine, which we treasure for its stimulating properties, has nothing to do with the other benefits.

On the other hand, the association between sugary drinks and diabetes is very suggestive of a direct biologic effect:  sugar and high fructose corn syrup are quickly absorbed and cause spikes in blood sugar and insulin. Several studies have shown that sugary drinks are linked with diabetes independently of the weight gain associated with these drinks.

What this study shows quite well is that it’s the sugars that are associated with the development of type 2 diabetes, not the caffeine. The caffeine content of soda seems irrelevant to the risk of diabetes.

So hurray for coffee – and tea – but before you go on a coffee binge, a few words of caution: most studies showing coffee’s benefits and lack of harm looked at people drinking coffee in moderation. Coffee in moderation is fine, but that doesn’t mean that coffee in large amounts is even better – quite the opposite!

That also doesn’t mean that caffeinated drinks are healthy – it seems that energy drinks can be quite unsafe.

And it doesn't attest to caffeine’s safety for kids. These coffee and caffeine safety studies were done with adults only, and kids’ physiology is quite different.

Dr. Ayala

Image: The shrub on the right, Coffea Arabica, carries coffee berries. On the left: the familiar roasted coffee beans, which are the seeds of the plant.

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.

13 lies dieters tell themselves

The worst lies are the ones we tell ourselves. Before the holiday season eating extravaganza is upon us here are a few common diet lies -- and how your better angel would react if he were awake.

Feel free to add your own in the comment section.

 

Olive oil is good for you

(it is; it also has 120 calories per tablespoon)

 

This pack’s only 100 calories

(that’s when you eat just 1, not 4)

 

It’s only 140 calories

(per serving! There were 3 serving in the pack – all gone!)

 

I’ll sweat this dessert off

(speed-walk for an hour, and it won’t make a dent)

 

It’s fat-free 

(yeah, but did you look at the sugar?)

 

It’s sugar-free

(did you look at the fat?)

 

It says no added sugar

(just evaporated cane juice and fruit juice concentrate. Who are you kidding?)

 

I found this miracle diet

(there are no miracle diets, silly)

 

Chocolate is good for your brain and can help you win a Nobel Prize 

(brain candy is still candy. BTW, who pays for these studies?)

 

Wine is good for your heart

(it’s also bad for your liver, and has 120 calories a glass)

 

It was a small portion

(smaller than a mountain, for sure)

 

After this, I’ll eat nothing ‘till tomorrow

(it’s 2pm!) 

 

But I skipped breakfast!

(skipping breakfast awards no prizes)

 

Final thought:

The scale and your old clothes won’t lie, and on the other hand, some feasts are well worth their caloric price.

Have a happy and healthy Thanksgiving.

Dr. Ayala

Healthy, Guilt-free Thanksgiving Side Dishes

Once you’ve got your main dish planned, it’s time to think healthy, colorful, plant-rich and whole-grain sides.

Here’s a collection of my favorite not-so-traditional, but perfectly seasonal and Thanksgiving-color-palette recipes. They’re all vegetarian, and avoid frying, high-fat, high-sugar treatments, so they offer a healthy way to the festive meal.

And with all these sides, who needs a main dish?

Enjoy, Dr. Ayala

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Crispy kale and fresh herb salad with sesame miso dressing

This salad combines my two favorite kale preparations: raw, very thinly sliced (see technique below), and baked to a crisp (or a chip). These two kale variations, combined with dried currant’s sweetness, delicate herbs’ freshness and the miso saltiness make a salad that explodes with flavor.

Which kale to choose? I like them all, but the flat leaf kale such as lacinato or Tuscan kale is much easier to chop than the curly variety.

Ingredients:

For the salad:

• 20 leaves of kale, stems removed
• Olive oil for brushing
• Salt and pepper to taste
• 2 cups thinly sliced stemmed kale (*directions below)
• 1 cup finely chopped parsley, cilantro or dill, or combination of tender fresh herbs
• 3 tablespoons dried currants
• 2 tablespoons finely grated Parmesan
• optional: 1-2 tablespoons toasted pine nuts

For the dressing: 

• 1 tablespoon mild yellow miso paste
• 2 tablespoons rice vinegar
• 1 tablespoon mirin
• 2 tablespoons toasted sesame oil

Preparation:

Heat oven to 250°F (120°C)

Brush kale leaves with olive oil and season with salt and pepper, and arrange in single layer in 2-3 baking sheets

Bake until kale is crisp, 15-25 minutes

Whisk the dressing ingredients.

Mix the chopped kale, currants, Parmesan and parsley (and toasted pine nuts if using) with the dressing

Add the crisp kale, crushed to bitesize pieces, right before serving 

Serves 4-8

* Kale is rather tough and chewy, but this preparation renders it tender and almost delicate: Break or cut off the tough stems.  Wash thoroughly and dry well in a salad spinner or a towel.  Roll a bunch of leaves tightly, jelly-roll fashion. Slice crosswise as thinly as you can, chiffonade style and separate into strips. 

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Butternut 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 beans 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 brown 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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Roasted root vegetables and pearled barley soup recipe

After Superstorm Sandy (I hope you all have power, and are safe and warm!) and a stormy election season, I thought it would be nice to share a comforting, earthy soup.

Root vegetables become magical when they meet the high heat of the oven. They develop caramelized and mellow flavors, and are so much richer. This soup is the perfect little meal on a cold day.

Ingredients:

• 2 sweet potatoes, diced
• 4 potatoes, diced
• 5 carrots, diced
• 2 parsnips, diced
• 3 tablespoons olive oil, divided
• 1 tablespoon honey (optional)
• 1 large yellow onion, diced
• 8 cups vegetable stock
• 1 teaspoon paprika
• 1 teaspoon dried dill
• 2 tablespoons tomato paste
• 1 cup pearled barley
• Salt and pepper to taste
• 1 cup parsley, finely chopped

Preparation:

• Preheat oven to 400°F (200°C)
• In a large baking sheet, toss sweet potatoes, potatoes, carrots and parsnips with 2 tablespoons olive oil, honey, and some salt and pepper
• Bake for 30-40 minutes, stirring the veggies occasionally, until the vegetables are soft but still chewy and slightly caramelized
• In a large pot, over high heat sauté the onion and the 1 tablespoon of olive oil until golden
• Add the roasted vegetables, vegetable stock, paprika, dill, tomato paste, pearled barley and some salt and pepper, cover the pot, and bring to a boil
• Reduce heat to a simmer and continue cooking until the barley is soft (about 20-30 minutes)
• Add the parsley and correct seasoning

This soup is now ready to serve, but will taste even better the day after, and will keep in the fridge for 5 days.

Yield: serves many (10-12 easy).

Enjoy,

Dr. Ayala

Pediatricians advise on organic food

Do you consult your pediatrician about food? Nutrition evaluation is part of what doctors are supposed to cover in well-child visits, and I’m sure many pediatricians are asked for advice concerning food choices in general, and organic foods in particular.

To that end, the American Academy of Pediatrics gathered the relevant research comparing organic foods to conventionally produced ones, and prepared a report that’s published in the November issue of Pediatrics. There’s no new research here; the report analyses existing studies (many of which have been widely reported), weighs the evidence, and concludes with some advice.

I was glad to see that this report included environmental impacts in its analysis. Not only are environmental issues important in and of themselves, but also we’re kidding ourselves if we think that impacts on the environment will not end up affecting our health. There might be a long delay in that effect, but no insult on the environment goes scot-free.

Here’s what the report finds:

Organic food exposes eaters to fewer pesticides

There’s no doubt that pesticides are toxic. Acute poisoning from pesticides is reported among farm workers regularly, and several studies have shown that chronic exposure to pesticides is associated with health problems, such as breathing problems, skin disorders, neurologic deficits and cancer.

Kids who don’t work on a farm are exposed to pesticides mainly through their food. Organic food has consistently been shown to have fewer pesticides and to reduce exposure. The report cites a study that looked at kids that ate conventional produce, and showed that just 5 days on an organic diet reduced their urinary levels of pesticides to undetectable.

The report also informs that washing reduces some pesticides, but isn’t proven to decrease human exposure. 

But can we undeniably prove that exposure to pesticides in small amounts is harmful? We can’t, and we definitely can’t prove it’s safe; I doubt excellent large prospective studies putting kids on a pesticide residue diet and a pesticide-free one will ever be performed.

Nutritional differences seem minimal

The report finds flaws in many of the studies comparing the nutrient content of conventional and organic produce, and declares the results conflicting. It concludes that although studies show more vitamin C and phosphorus in organic food, for now: “there does not appear to be convincing evidence of a substantial difference in nutritional quality of organic versus conventional produce.”

Meat

Conventional growers feed animals routinely with antibiotics. Of all antibiotics used in the US 40-80 percent goes in animal feed, and animal and human antibiotics are pretty much the same. This leads to antibiotic-resistant bacteria spread through people and food, which the report sees as a reason to prefer organic.

Milk

The report surprised many by declaring that they find no clinical difference between organic and conventional milk. Conventionaly raised cows are supplemented with growth hormones and estrogen, but the Academy claims the former breaks down and isn’t active, and the latter’s quantities are too small to matter.

Environmental impact

The report states that:

“Many believe that organic farming is less damaging to the environment because organic farms do not use or release synthetic pesticides into the environment, some of which have the potential to harm soil, water, and local terrestrial and aquatic wildlife.

In addition, it is thought that organic farms are better than conventional farms at sustaining diverse ecosystems, including populations of plants, insects, and animals, because of practices such as crop rotation.

When calculated either per unit area or per unit of yield, organic farms use less energy and produce less waste.

Organically managed soil has been demonstrated to be of higher quality and have higher water retention, which may increase yields for organic farms in drought years.”

What’s a parent to do?

The report is aimed for pediatricians, so it’s a little technical, but if you care to read through the sections describing the use of growth hormones and sex steroids in conventional agriculture you’ll be introduced to some of the common practices of conventional animal treatment. For example, animals are treated with a range of growth hormones and sex steroids (injected as estrogen pellets under the skin) to increase yields. The report reassures us through studies that the hormone levels found in our food are low, or irrelevant, but I doubt you’ll find it a reassuring read. 

The report suggests pediatricians emphasize the importance of eating lots of fruits, vegetables and whole grains, and respond to the question of “should we go organic” with the facts presented by the report, and admit that in some areas evidence is lacking.

So this is the American Academy of Pediatrics’ advice. What’s yours?

Dr. Ayala

 

A revised food label that isn’t a dream

In a recent opinion piece in the New York Times Mark Bittman dreams about an improved front-of-package food label. “Right now, the labels required on food give us loads of information, much of it useful. What they don’t do is tell us whether something is really beneficial, in every sense of the word,” he writes.

What Bittman proposes is an upgraded traffic light model (green: great choice, yellow: eat sometimes, red: eat sparingly or never), but his fantasy label takes into consideration not only dietary guidelines, but includes also grades for the way each particular food affects the earth, the farm workers, animals and the air we breathe.

Bittman’s proposed label has a 15-point scoring scale. The score is divided to 3 categories, and a food can score up to 5 points in each (see illustrations and examples here):

Nutrition: things such as trans-fat, saturated fat, sugar, vitamins and fiber affect this score

Foodness: assesses whether the food is real, or so processed it can hardly be called food

Welfare: scores how well the animals, factory and farm workers, the land, waterways and air are treated.

How realistic is the Bittman label?

The Institute of Medicine recommended in its 2011 report a single, standardized front of package symbol system that can be easily understood and that would appear on every product.

It's not easy: Getting food producers to agree on front-of-package guidance, guidance that would label many of their foods ‘red’, is a huge undertaking.

But adding a welfare key is a wild dream. Bittman admits it’s the trickiest part, and I think the problem isn’t just a logistical and resource one. Measuring carbon footprint is hard and expensive, and assessing pesticide and herbicide’s pollution of water and air is even harder, but trying to get to an agreement about what animal welfare standards should be is impossible. It is a personal-view kind of question, with moral, religious and subjective subtexts, and I think the Republicans and Democrats will unite on the role of government and abortion before vegetarians agree that organic, grass-fed veal gets a 5 for welfare.

Loads of information, but important information’s still missing

While the package’s guiding system continues to be debated, and Bittman’s dream label is a distant aspiration, there are two information pieces still surprisingly missing from the nutrition panel itself:

- Added sugar: Total sugar is listed in the nutrition panel, but there’s no distinction between the naturally occurring sugar present in, let’s say, fruit, and added sugar in its many forms (including sucrose, HFCS, dextrose, dehydrated cane sugar, fruit juice concentrate and a dozen others) put into so many products by food makers.

Current dietary recommendations call for limiting the amount of added sugar in our food. Scientific studies have shown that added sugar has negative health outcomes – such as heart disease and high level of triglycerides and cholesterol -- and leads to obesity.

So stating the amount of added sugar would be useful and is long overdue. But is such labeling feasible?

According to a recent paper by Jennifer Pomeranz in the American Journal of Public Health, providing the added sugar information is both important and doable. The manufacturers already know how much sugar they’re adding, and random sampling in order to check the accuracy of the manufacturers declaration is technically realistic because each sugar source has unique, traceable, sugar isotopes.

- Genetically Modified Organisms (GMO): While the debate about GMOs effect on agriculture, environment and health continues, many consumers believe they have a right to know if a food item contains them in order to make informed purchases.

GMO labeling is required in more than 60 countries, including Italy, Spain, France, Germany, the UK, Japan, China, Russia, Brazil, Mexico and Saudi Arabia.

The California Right to Know ballot initiative is up vote November 6^th, and if passed will mandate that all foods containing GMOs sold in California be labeled.

If this ballot initiative passes, this might be a precursor to mandatory labeling in other states, so the outcome of the vote goes well beyond California.

Understanding the label leads to better choices

I don’t think that reading the ingredient list is such an arduous task that we have to dumb down nutrition information to a traffic light system (although a clever, straightforward one could potentially help).

I believe that people need to have minimal nutrition knowledge in order to make the right decisions for themselves, based on their personal set of needs and values. Nutrition literacy is key to living in our obesogenic environment. Minimal medical literacy determines how well you’ll be able to care for yourself and to advocate for loved ones, and in much the same way nutrition basic knowledge promises you will be able to navigate your way to healthy food in an ocean of junk.

A de-cluttered front of package, free from misleading health claims and false promises, would give the average person a chance to turn the package around, and quickly read the ingredient list and nutrition facts. I’m always amazed at kids' deep knowledge of sports’ statistics, and the number of player's names they remember. Reading and understanding an ingredient list after a short introduction to food should be quite revealing, and exempting us from reading the label by the instant gratification of a traffic light code makes us less informed and more open to manipulation by food marketers.

And if you’re looking for a good packaged food grading system, based on nutrition facts and ingredient lists, try Fooducate’s (free) app.

Dr. Ayala

 

The unhappy truth about sugary drinks

Happiness in a bottle, or a disease promoting source of gloom? The Center for Science in the Public Interest (CSPI) released a new animated film, repositioning soda and other sugary drinks as obesity and illness causes, and stating a few (well supported) facts. The film features an original song by Grammy-award-winning singer songwriter Jason Mraz.

The bears are not that happy, but the video is quite entertaining. What do you think? 

 

Dr. Ayala

Do lots of choices make you happy or just fat?

When I was a young university student I used to stop by the open-air market for fresh fruit and veggies and take my time selecting what I thought would be the absolute best produce in the pile.

“You’ll never find a husband,” one vendor said to me.

Happy to say he was wrong. I did find love. And I also did feel I selected some of the best apples in town.

But now, when I stand in front of a supermarket isle with 50 different toothpastes to choose from I often feel I’ll never be able to pick the best one, and I have no fun looking through all the options. I know my apples and enjoy handling them, but I’m just looking for ordinary toothpaste, you know, the kind that cleans teeth and tastes like toothpaste. 

How does the enormous choice we have in food affect us?

Variety is the spice of overeating

A summary of 39 studies concludes that having many choices makes us eat more, especially when the extra variety is from energy-dense, tempting foods.

Research also suggests satiety is relative. You may be too full to eat another bite of salad, but when offered dessert you’re hungry enough – and that’s because dessert offers a new, pleasurable, sensory experience.

Most of the studies suggest that the tendency to overeat in reaction to greater variety of food is dependent on the food’s energy density and potential sensory pleasure; offering a greater variety of lettuce, broccoli and oranges doesn’t cause overeating, but presenting a great variety of sweet, fatty and salty options, each with their own taste and mouth feel, does.

Variety is the spice of life, but too much variety is the spice of overeating. It’s hard to stop eating the box of chocolates when you’re excited to find out what comes next.

Back to the supermarket shelf, the one with 100 types of cereal. Why does looking at that selection make me sad? Why does a buffet with 20 kinds of pastry leave me with sense of regret?

What’s wrong with choice?

Psychologist Barry Schwartz explains the suffering caused by over-choice in his book The Paradox of Choice: Why More Is Less.

With too many choices, it’s hard to choose at all. You put the choice off.

Even if you make a choice, you’re less satisfied with your choice. It’s easy to imagine a better choice. With every decision there’s chance for regret and disappointment.

Because when there are lots of alternatives there are lots of lost opportunities and paths not taken.

With ample choices there’s also escalation of expectation -- our expectations go through the roof -- and it becomes difficult to have a pleasant surprise.

That’s why many high achievers opt to simplify their lives by reducing the amount of decisions and choices they need to make. Michael Lewis describes in his recent Vanity Fair profile President Obama’s voluntary simplicity: To maximize his ability to make the right choices, the president creates an environment where he eliminates trivial choices, including what to eat for breakfast or what to wear each day — all of his suits are blue and gray, for example.

A simpler pantry

Some choice is good. Too much isn’t. There’s a secret magic number and we have to figure out what that number is for us. 

Limiting the variety of tempting, high-calorie foods has the potential to help prevent overeating. Increasing the variety of healthy foods might be an easy way to give us the satisfaction of choice without the downside of overindugance.

One of the things I do when I’m in the presence of plenty is to completely ignore the multitude of options. I’ll eat just what I usually eat at home instead of falling for the generous breakfast buffet offerings. I know that might sound boring, but eating the same breakfast every day brings me a sense of calm – and keeps me from tasting it all.

How do you handle endless choices?

Dr. Ayala 

Exercise isn’t the solution

Physical activity is incredibly important to our health.  Exercise improves almost all aspects of physical and mental health, and people who are physically active are also usually thinner.

But that doesn’t necessarily mean that exercise will make you shed extra fat.

The makers of junk and fast food are sponsors of exercise, from backyard games and pee wee leagues to the World Cup and the Olympic Games, and suggest that in this little imbalance we have between caloric intake and caloric expenditure we shouldn’t lay the blame on eating too much but rather on exercising too little.

And it would have been nice if we could go for a brisk walk and forget about inconvenient eat-less guidance. I, too, would like to believe that. But is it true? 

Exercise as a weight-loss tool

A new study in the British Medical Journal (BMJ) looked at 30 randomized controlled trials in which kids were assigned an intervention aimed at promoting exercise. What’s special about this analysis is that the review includes only studies in which physical activity was objectively measured using accelerometry devices (accelerometers measure body movement, and are an unbiased way to sum up activity – they’re much better than asking people how active they’ve been over the day).

The results were disappointing. Kids on exercise regimens added on average only a tiny and negligible amount of active time – about 4 minutes -- to their daily tally compared to controls. These extra 4 minutes would amount to about 15 extra calories burnt. Definitely not enough to justify the sports drink or a fast food meal many kids are rewarded with after they exercise.

How come adding several extra hours of physical activity at school ends up adding close to nothing? Well, one of the explanations the authors offer is that the exercise interventions simply replaced equally intense exercise that would have taken place after school – instead of running in the playground kids were exercising at school. Our natural instinct might be to regulate activity around a set point, and when we expend more than our usual energy we follow that activity burst with inactive periods of rest.

The authors conclude:

“Physical activity interventions have little effect on the overall activity levels of children, which may explain, at least in part, why such interventions have had a limited effect on body mass index or body fat. The outcome of this meta-analysis questions the contribution of physical activity to the prevention of childhood obesity.”

Are we less active than our ancestors?

Kids need plenty of physical activity. Current recommendations are that kids get 60 minutes a day of any activity that makes their heart race and gets them breathing hard – they need to sweat. Only a third of US kids get that much.

On the other hand, while obesity rates have doubled and tripled over the past few decades, physical activity levels have been quite stable over that time period, and studies have shown that kids today move no less than when the obesity rates were much lower. TV was invented a long time ago.

A neat recent study in PLoS ONE further debunks the notion that our sedentary lifestyle is the culprit in the obesity crisis. The study quantified daily energy expenditure (by measuring carbon dioxide production) among the Hazda people of Tanzania, one of the few remaining populations of traditional hunter-gatherers. The researchers found that despite covering many miles a day in search of food, the number of calories that the Hadza burned was pretty much the same as that of typical adults in Europe and the US.

How could that be? The researchers think that the Hadzas’ bodies have adjusted to the higher activity levels required for hunting and gathering by saving energy on other activities. Our bodies spend energy even when we seem not to move much, and their guess is that these ‘background’ activities can be done more efficiently when energy is spent elsewhere.

That doesn't mean that ecercise is a waste of time. Exercise will make you healthier, and is a key habit change that can open the door to healthier eating and other good habits, some of which can also help with weight loss and weight maintenance.

But there’s very little support for the idea that exercising more without eating less can change your weight.

It’s the food; it really is! We’re getting fat because we eat too much and too much of the wrong things. Our food is tempting and sweet and plentiful.

Leading a sedentary lifestyle is another major health issue, one that should be addressed because physical activity is a wonder power for wellbeing.

But addressing physical activity alone will do close to nothing to obesity rates.

Dr. Ayala

The sugary drinks obesity link: 3 new studies added to the evidence pile

You’d think that some things are beyond dispute, that some issues are so obvious that proof and studies are hardly necessary.

When two thirds of the population is overweight or obese and much of this population is consuming 250-300 calories a day in sugary drinks -- calories that are nutritionally naked -- it’s clear that these sugary drinks should be the first thing to go in order to reduce obesity. It’s elementary. 

Cutting sugary drinks is one of the first pieces of nutrition and weight-loss advice one gets from lay people as well as experts because it just makes sense.

It’s obvious, but it’s also scientifically proven: studies have been amassing in support of what we already intuitively know.

Proving the obvious

Large population studies have clearly linked sugary drink with obesity. Even more worrisome are the studies linking sugary beverages to type 2 diabetes, hypertension and heart disease. And then there are the studies that show that liquid calories trick our body and mind to overeat because the calories in beverages don’t cause satiety, suggesting that calories in sweet drinks behave differently from those we eat.

For remaining doubters, and I suspect there are very few of those who’re free of conflict of interest, a fresh batch of studies adding further strong evidence was published last weekend in the prestigious New England Journal of Medicine.

A study led by the Harvard School of Public Health, involving more than 33,000 people, showed that drinking sugary beverages interacts with genes that affect weight, amplifying a person's risk for obesity beyond what heredity alone would predict. In other words, people with the genetic propensity to become fat doubled their chance of becoming obese if they drank sweetened beverages.

The two other studies were all about kids and their sweets.

In one study researchers assigned 224 overweight and obese teens from Boston to receive home deliveries of either sugary drinks or sugar-free ones. The kids on the sugary drink delivery regimen gained about 2 kg (4.5 pounds) more than the sugar-free group. This difference disappeared in the second year of the study, once home deliveries stopped.

The other study involved normal-weight kids. It was a double-blind study (the best type of evidence) and was completed by 477 kids who drank sugared or sugar-free drinks for 18 months. The kids drinking sugar gained about 1 kg (2.2 pounds) extra weight compared to the sugar-free group, and accumulated most of it as fat. 

Why target sugary drinks?

Another obvious weight-loss piece of advice one gets is to stay away from fried food. Frying adds lots of fat, and fat has a lot of calories you don’t need if you’re gaining too much weight.

Yet we don’t see many public health campaigns or proposed laws targeting deep-frying. 

The reason sugary drinks are targeted is because they’re the largest contributor of added sugar to our diet. They comprise 10-15 percent of Americans’ daily caloric intake. A billion dollars are invested in promoting them each year, especially to young people during their habit-formation years. They are everywhere, within easy reach, alluring, super-sized and cheap.

They’re targeted because they’re a central driver of the obesity epidemic, and the lowest hanging fruit when it comes shaving extra calories in a population facing a true health crisis due to too many calories.

Coca-Cola’s chief scientific and regulatory officer Rhona Applebaum told Bloomberg News in reaction to these articles that soda has been unfairly targeted as the cause of the obesity epidemic in the U.S., that there are many factors that are linked to weight gain and that drinks containing sugar can be a part of a healthy and balanced diet.

I agree that playing the blame game isn’t helpful, and that we eat too much of not just soda, but targeting sugary drinks hasn’t been about assigning blame, but rather about finding solutions. We need to cut, and cutting loads of empty calories that provide no satiety, spike our blood sugar constantly, and are so prevalent and highly marketed was obvious even before the proof started piling high.

Drinks containing sugar can be a part of a healthy and balanced diet? Really? Which part is that? But hey, wasn’t that statement awfully nice on the ear? Never underestimate the power of telling people what they want to hear.

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.

Who should be living gluten-free?

According to a new study about one in 140 people in the US have celiac disease.  This is about 1.8 million people who should adopt a gluten-free diet to be healthy.

According to this study, published in The American Journal of Gastroenterolgy, about 1.6 million people in the US are on a gluten-free diet, so it sounds like these two numbers match nicely.

But here’s the interesting part: the study, which looked for celiac in a nationally representative sample of almost 8000 people, (the researchers measured antibodies used to screen for celiac, and surveyed the medical histories and records of all the subjects to make the diagnosis of celiac disease) found that 29 of the 35 people with celiac had no idea they had the disease. 

On the other hand, of the 55 people in the study who were on a gluten-free diet 49 did not have a clinical history or any laboratory evidence of celiac.

Gluten-free as a diet fad

Gluten is probably one of the only food proteins most of us know by name, and now that the name's out and is associated with a bona-fide medical condition – and not an uncommon one – gluten is feared. Gluten avoidance has been adopted not only for celiac, gluten sensitivity or intolerance, but also as a treatment for many other unrelated conditions, and also for weight-loss and as a healthy lifestyle regimen.

Celebrities like Gwyneth Paltrow, Victoria Beckham and Novak Djokovic are touting gluten-free’s slimming powers and positive influence, while other celebrities are feeding gluten-free diets to their kids as an autism remedy.

Is removing gluten indeed a cure-all?

You can lose weight on a gluten-free diet: if you replace muffins and donuts with fruits, veggies and quinoa you’ll also be eating better.

You can also gain weight by going gluten-free if you replace bread with gluten-free chips and cupcakes. It’s not easy to make baked goods without gluten; therefore many gluten-free baked goods have lots of calories and fat.

In fact, gluten-free has nothing to do with weight-loss or with treating autism.

What’s wrong with gluten? 

It’s great that gluten-free standards and products are available -- these foods are important for the health of some of us.

But for 99 percent of the population gluten presence or absence is irrelevant. Gluten-free is as immaterial to the general public as “may contain peanuts” is to people without a peanut allergy.

Gluten-free has become a marketing tool, and we’ve fallen again into the old trap of nutrition confusion feeding us lots of junk. In much the same way that fat-free and low-carb led to highly processed food innovations containing loads of sugars, trans-fat and artificial sweeteners, we’re now running away from gluten, replacing it with whatever’s gluten-free. 

Gluten, my friends, is a component of whole grains, and there’s absolutely nothing wrong with it for most people. Gluten is what gives bread its traditional structure, strength and texture and bread in an historic and cultural staple.

Gluten-free foods can be nutritious or pure junk, and if you're looking to eat well the gluten-free declaration isn't a shortcut -- you'll have look at the ingredient list. 

Dr. Ayala

“Are we really all going to spend our last years avoiding bread, especially now that bread in American is so unbelievable delicious?”

― Nora Ephron, from I Feel Bad About My Neck: And Other Thoughts on Being a Woman

Crunchy crispy kale and fresh herb salad with sesame miso dressing

Suddenly, humble kale is the star veggie, and it’s well deserved stardom: Kale tastes wonderful when properly prepared and is a nutritional powerhouse.

This salad combines my two favorite kale preparations: raw, very thinly sliced (see technique below), and baked to a crisp (or a chip). These two kale variations, combined with dried currant’s sweetness, delicate herbs’ freshness and the miso saltiness make a salad that explodes with flavor.

Which kale to choose? I like them all, but the flat leaf kale such as lacinato or Tuscan kale is much easier to chop than the curly variety.

Ingredients:

For the salad:

• 20 leaves of kale, stems removed
• Olive oil for brushing
• Salt and pepper to taste
• 2 cups thinly sliced stemmed kale (*directions below)
• 1 cup finely chopped parsley, cilantro or dill, or combination of tender fresh herbs
• 3 tablespoons dried currants
• 2 tablespoons finely grated Parmesan
• optional: 1-2 tablespoons toasted pine nuts

For the dressing: 

• 1 tablespoon mild yellow miso paste
• 2 tablespoons rice vinegar
• 1 tablespoon mirin
• 2 tablespoons toasted sesame oil

Preparation:

Heat oven to 250°F (120°C)

Brush kale leaves with olive oil and season with salt and pepper, and arrange in single layer in 2-3 baking sheets

Bake until kale is crisp, 15-25 minutes

Whisk the dressing ingredients.

Mix the chopped kale, currants, Parmesan and parsley (and toasted pine nuts if using) with the dressing

Add the crisp kale, crushed to bitesize pieces, right before serving 

Serves 4-8

* Kale is rather tough and chewy, but this preparation renders it tender and almost delicate: Break or cut off the tough stems.  Wash thoroughly and dry well in a salad spinner or a towel.  Roll a bunch of leaves tightly, jelly-roll fashion. Slice crosswise as thinly as you can, chiffonade style and separate into strips. 

Enjoy, Dr. Ayala

Is organic food healthier? New study fuels the debate

What makes a food healthy? The definition of healthy food and nutritious food is absolutely essential in order to answer the question: “is organic food healthier”.

But a new widely publicized study published in the Annals of Internal Medicine this week answers this question without digging deeper into what defines “healthy”. The study reviewed research comparing organic and conventional foods and concluded that there’s “limited evidence for the superiority of organic foods”.

Let’s see what the study actually found. 

Fewer pesticides, more phenols, no more vitamins

The researchers, led by Dena Bravata and Crystal Smith-Spangler identified 237 of the most relevant organic vs. conventional studies. Those included 17 studies (six of which were randomized clinical trials) of humans consuming organic and conventional diets, and 223 studies that compared either the nutrient levels or the bacterial, fungal or pesticide contamination of various products including fruits, veggies, grains, meats, milk, poultry, and eggs grown organically and conventionally. There were no long-term studies of health outcomes of people consuming organic vs. conventionally produced food – these would be difficult and expensive to do, and have not yet been attempted.

There were two types of nutrients organic food had statistically higher levels of: total phenols in organic produce, and beneficial omega-3 fatty acids in organic milk.

As expected, organic food had fewer pesticide contaminants: conventional produce has a 30% higher risk for pesticide contamination than organic produce. Another study found kids switched to an organic diet for 5 days had significantly lower levels of pesticide residue in their urine.

As for vitamins, overall there wasn’t a significant difference in the vitamin content of organic and conventional plant or animal products.

There was no difference in the risk for contamination of produce or animal products with pathogenic bacteria (yes, organic produce does need to be washed!), but conventional chicken and pork had a higher risk for contamination with bacteria resistant to antibiotics than were organic alternatives.

Obsessed with vitamins 

So is the meta-analysis’ conclusion that organic has little health benefit correct? 

If eating healthy is about getting as much vitamins as possible I guess you can conclude just that. But if eating healthy is about maxing on vitamins your route to health can easily be a vitamin supplement with a fast food meal (an abundant source of protein!). 

Our obsession with vitamins has been fueled for years by nutritionists and marketers. But getting enough vitamins is hardly a central health issue in modern societies. Eating healthy isn’t about getting your vitamins.  Even devoted junk eaters gets plenty of vitamin C and don’t need a vitamin boosted organic strawberry to save them from scurvy. 

What is healthy eating? This is a complicated question. It’s hard enough to even define health; is health the absence of detectable disease, or a state of physical, mental, and social wellbeing? I can’t really answer this question (especially not in a blog post), but healthy food has to be more than the sum of all its vitamins.

Why organic

More and more people are choosing organic. One popular reason is avoidance of chemicals. Conventional food is grown using a multitude of chemical fertilizers, pesticides and herbicides. We now know that these remain in the food, and are absorbed by and present in our body. Although conventional growers and food producers make every effort to convince us that these chemicals are safe and harmless in these amounts, common sense says that they definitely add nothing good to our health, and we’re probably better off without them. This study shows that organic food does have fewer pesticide residues and fewer antibiotic-resistant bacteria -- organic delivers on its promise!

But organic farming is about so much more than our personal health and safety. Organic agriculture is an ecological production management system that has deep environmental implications. Organic production is about respecting the land and all its inhabitants. 

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

An organic farm doesn’t contribute to our worrying dependence on dwindling oil supplies (fertilizers are fossil fuel products). Farm workers on organic farms aren’t subjected to a work environment heavily contaminated by pesticides. Soil fertility is maintained for future generations by organic practices. An organic farm recycles its waste, and doesn’t fill landfills with hazardous waste.

An organic farm promotes biodiversity. Organic practices lead to crops that are more resistant to drought and pests, and probably are more complex in phytochemical composition. (Phytochemicals are chemical compounds derived from plants and fruits; there is evidence from epidemiological studies that phytochemicals in fruits and vegetables can reduce the risk of disease. This is one of the findings this study demonstrated by the higher level of phenols in organic produce). 

And the list goes on and on.

Organic food delivers products with fewer chemicals, preservatives, additives, antibiotics and hormones, and the environmental reasons to go organic are compelling. I doubt informed buyers opt for organic strawberries for their superior vitamin C level anyway.

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, an early adopter of organic practices and foods, and have been promoting good nutrition and healthy lifestyle for many years.

Energy drinks under investigation: Are they healthy or dangerous?

The Wall Street Journal reported this week that New York's attorney general is investigating whether the booming multibillion-dollar energy-drink industry is deceiving consumers with misstatements about the ingredients and health value of its products.

The energy drink market is fast growing, and these drinks -- promising boosts of energy -- have become ubiquitous. It's estimated that 30 percent of college students consume energy drinks regularly.

Are there real benefits in these drinks and are they safe? Health advocates have long been raising concerns about these drinks, especially when consumed alongside alcohol. 

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?

A recent article in Pediatrics reviewed the literature and looked at 121 scientific studies, government reports and media sources on energy drinks. The authors raised some serious concerns and warned that energy drinks are under studied, overused and can be dangerous for vulnerable kids and teens. 

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.

Marketing 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 Pediatrics article includes a chart listing energy drink regulation 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 that energy drinks have no therapeutic benefit, that these drinks may put some children at risk for serious adverse health effects and that labeling of energy drinks as nutritional supplements shields manufacturers from safety testing and labeling required by food and pharmaceuticals makers. 

Renewable energy 

Should kids be running on caffeine? Don't get me wrong: I love my morning coffee, look forward to it, and have to admit it makes loose words in my brain connect into somewhat coherent sentences. Research on coffee’s effect on heath has shown that coffee in moderation probably poses no threat to healthy adults, and has even shown to have benefits in some studies (coffee lovers rejoice every time such a study is published and add it to their collection). But most coffee drinks contain only moderate amounts of caffeine, and since coffee is hot, it is usually consumed slowly. 

That doesn't 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 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 -- and an energy drink should really be called a stimulant drink.

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.

I think it's high time energy drinks get some scrutiny.

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 sugar wars: Is fructose really toxic?

 

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

But does drinking sugar just make us consume too many empty calories, or is there something inherently unhealthy about sugar? Is high fructose corn syrup (HFCS) the villain? Is old fashioned sugar any better or just as bad? Will agave (with its low glycemic profile) save us? And what’s all this talk about fructose being toxic?

Food sugar 101

Our foods and drinks are usually sweetened with sugars that are a combination of the simple sugars glucose and fructose. Sucrose (table sugar) is a two-sugar molecule with one glucose and one fructose bound together, and is therefore exactly 50 percent glucose, 50 percent fructose. HFCS is about 45 percent glucose, 55 percent fructose. Fruit juice concentrate's sugar composition (stripped down concentrated fruit juice is really just sugar!) will depend on the fruit source: Apple juice concentrate is about 30 percent glucose, 70 percent fructose, while orange juice concentrate is about 50 percent glucose 50 percent fructose.

Agave syrup, favored by those adhering to a low glycemic diet, is about 70-75 percent fructose.

What you need to remember is that practically all forms of caloric sweeteners used in food processing are a glucose/fructose mixes. Although only HFCS has fructose in its name, all our commonly added sugars contain both fructose and glucose. Corn syrup stands apart as a pure glucose sweetener, but since pure glucose is less sweet than HFCS or sucrose, it isn’t economic – or tasty -- to use.

Is fructose more harmful than glucose?

A study from the University of California at Davis, led by Peter Havel, made headlines a couple of years ago when it showed that drinking 25 percent of daily calories in fructose for 10 weeks increased triglycerides and cholesterol and caused insulin resistance in people, while drinking the same amounts in glucose didn’t. And while both the fructose and the glucose groups gained weight during the study, the fructose group gained more belly fat.

The study concluded that drinking lots of fructose lead to unique adverse effects on lipid metabolism, insulin resistance and abdominal obesity, effects not seen when drinking the same amounts in glucose.

What explains our body’s different reaction to these two sugars? The authors hypothesized that since fructose is metabolized in the liver, fructose sweetened beverages affect the liver’s metabolism of fats; glucose is metabolized in every cell of the body, doesn’t need as much of the liver’s attention, and therefore the adverse metabolic effects weren’t seen in the glucose beverage drinkers.

But one question lingered: Could high levels of blood sugar and blood insulin explain fructose’s adverse metabolic outcomes?

To answer that question the authors went back to study the blood samples of the people enrolled in their initial study. They published the findings of their new research in the American Journal of Clinical Nutrition. Havel’s group found that the 17 people who were drinking 25 percent of their calories in fructose were actually consuming a diet with a lower glycemic index, and their blood glucose and insulin after meals were lower than the fluctuations seen in the 15 people consuming 25 percent of calories in glucose.

To conclude, in this 10 week study, drinking fructose caused dislipedimia and insulin insensitivity unrelated to blood sugar and insulin levels. On the other hand drinking glucose caused rollercoaster peaks and troughs of blood glucose and insulin, while not causing dislipedemia.

The dose makes the poison

Fructose is metabolized by the liver, and this study supports the notion that its excess consumption plays a part in causing insulin resistance (which leads to diabetes), high cholesterol and triglycerides (all risk factors for heart disease) and the tendency to accumulate belly fat (a risk factor for a myriad of diseases, including heart disease, high blood pressure and cancer).

While drinking glucose may not affect our fat metabolism in the same way fructose does, glucose causes spikes in blood sugar and blood insulin – which are not good either.

If you’re concerned about fructose, you should be concerned with the intake of all the sweeteners that contain fructose -- that includes not only HFCS, but also cane and beet sugar (table sugar), molasses, agave, brown sugar, fruit juice concentrates and honey.

I don’t personally believe glucose or fructose are evil. Our body, especially our brain, runs on simple sugars, and sugars, including fructose, are a natural part of very healthy foods, such as fruits and veggies.

It is excess sugar – of any kind – that is harmful. The dose makes the poison. 

Excess sugar is hard to come by in nature unless you run into a beehive and the bees are willing. It takes a lot of berry picking to hit your liver with the fructose dose that is anything similar to what’s in a can of soda. Only processed foods, and especially sugary drinks, hit your liver with that much fructose at such high speed. Fructose containing foods in nature have fiber (and much less sugar) and break down slowly. On the other hand processed foods and especially sugary drinks have no fiber – just lots of fructose – and we’ve shown a tremendous capacity to chug them down real quick.

Does the study’s experiment resemble real life? On one hand, the study group drank 25 percent of daily calories in sugar. We’re bad but not that bad: A recent study shows that our teens consume 21 percent of their daily calories from added sugar.

On the other hand, the study lasted for 10 weeks. Our kids are ingesting a large proportion of their daily calories as glucose/fructose mixtures for years and years.

Considering the current evidence, this is not an experiment we should be conducting.

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.

Further reading/viewing:
• Dr. Robert Lustig explores the damage caused by sugary food in this controversial & much viewed video: Sugar: The Bitter Truth.
• Gary Taubes’ New York Times Magazine article: Is Sugar Toxic?