Healthy Food & Healthy Living by Dr. Ayala

What do burgers and fries have to do with diabetes?

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

Morgan Spurlock gained 25 pounds and suffered physically and emotionally after eating exclusively at McDonald's for just one month in his excellent documentary Super Size Me.

But that’s not the reason “minimize fast food” is the rallying cry of almost all serious health and weight-loss advocates.

Spurlock’s personal experiment makes for good entertainment, but personal stories aren’t scientific proof, and can also lead to the wrong conclusion. There are, in fact, a few well- publicized stories of people losing weight on a McDonald’s regimen (read carefully, though: what these unusual customers ate was a low-calorie diet, consisting of salads without the dressing and apples without the caramel).

The case against fast-food

From a nutritional point of view, if we were to invent the worst diet ever—with an ingredient list designed solely for unhealthy weight gain and cardiovascular and metabolic morbidity—we’d be hard pressed to imagine one worse than the typical fast-food regimen: Highly processed, lots of saturated fats, hydrogenated fats and refined sugar, salt by the teaspoons, very little fiber, very few vegetables and fruit, and many additives driving the “great taste” that keeps us coming back for more.

But the proof of un-health is not just in the ingredient list.

There’s a growing body of evidence pointing at fast-food as a major contributor to obesity and disease. I’ll mention just a few studies.

A prospective study in the prestigious scientific journal Lancet followed more than 3,000 young adults for 15 years, and showed that those who ate at fast-food restaurants more than twice a week had gained an extra ten pounds and had twice the risk of insulin resistance (a risk factor for type 2 diabetes) compared to those that ate fast-food less than once a week.

A study in the Journal of the American Dietetic Association showed that adults eating at fast-food restaurants consume 205 more calories per day than those who don’t eat out.

To this growing body of proof a new study in the American Journal of Clinical Nutrition shows for the first time a connection between fast-food and the risk of type 2 diabetes.

The study followed more than 44,000 African American women aged 30-69 years for 10 years, evaluating by questionnaires every two years their medical history, weight, exercise, smoking, alcohol use, diet and other variables.

The researchers found:

• 2,873 women (6.5 percent!) developed type 2 diabetes during the 10 year follow-up.

• Eating frequent restaurant meals of burgers and fried chicken was associated with type 2 diabetes. After adjusting for age, family history of diabetes, TV watching, exercise and education, women who ate burgers more than twice a week had an almost 60 percent higher risk of developing diabetescompared to those that consumed no burgers for the past year.The increased risk for fried chicken was even higher—85 percent!

• Burgers and fried chicken probably affect diabetes mostly through body fat. Indeed, women in the study who consumed lots of restaurant meals had higher rates of obesity, and when controlling for Body Mass Index (or BMI), the correlation between the burgers and fried chicken and diabetes was still present but lower.

The authors discuss:

“Fast-food consumption has been associated with higher intakes of energy, fat, saturated fat, sodium, and carbonated soft drinks, and lower intakes of vitamins A and C, fruit and vegetables, and milk. In the present study, participants who reported frequent consumption of food from restaurants also had higher energy and fat intakes and drank more sugar-sweetened soda. Portion sizes tend to be larger in restaurant meals than in meals eaten at home. Large portion sizes can lead to overconsumption of calories, thereby leading to weight gain and obesity. The energy density of restaurant foods such as burgers, fried chicken, and French fries is very high, which can lead to “passive overconsumption,” the tendency of humans to consume a similar bulk of food with little reference to its energy density, which in turn can cause obesity. Fried foods also contain large amounts of partially hydrogenated oils, which may lead to insulin resistance.”

The worst thing about fast-food

A few facts about fast-food that probably will surprise no one:

• One in four Americans visits a fast-food restaurant daily.

• Almost half of American meals are eaten outside the home andhalf of these are fast-food meals.

• Fast-food meals are calorically dense and come in large portions.

• Fast-food is so heavily advertized that most kids can recognize McDonald's before they know how to speak.

But the worst thing about fast-food, in my opinion, is that it’s so cheap!

Many families resort to fast-food because it’s the cheapest way to feed an American family.

Fast-food restaurants are especially abundant in poor and minority neighborhoods. In fact, in many low-income neighborhoods, cheap fast-food joints are the only dine-out option—a practical, convenient and inexpensive option for busy people who work hard, have little time on their hands, and can’t afford healthier options. Poverty is associated with obesity—at least in the US—and as long as fast-food is cheaper than making a simple, healthy meal at home, it will be very hard to get even motivated people to find the ingredients and the time to do so regularly.

Fast-food may be cheap in the short term but it’s very expensive in the long run—obesity and diabetes cost a fortune.

And that’s a real shame!

Dr. Ayala

 

Drive safely this summer!

I'm taking a few weeks off to spend time with my family and travel, and will write infrequently during this time. Meantime, here's a reminder about staying away from distracted driving -- all year round.  Happy, safe summer!

I overheard a short exchange between my three kids a few years ago. My daughter is my youngest, her brothers just a few years older than her, and she must have been no more than 5 years-old at the time.

My daughter: “You don’t know how to handle dad. I’ll handle him for you.”

Her brothers: “How?”

“You go into his office when he’s really busy and ask for it. He’ll say yes because he wants you to go away. Then you leave. Grown-ups don’t go back on their words”.

“And mom”?

“She hates overruling dad”.

Outwitted by preschoolers! My daughter figured out how to use distracted decision making to her advantage, and we grown-ups are dumb enough to believe we’re great multi-taskers.

My husband is a huge multi-tasker. He’s actually not bad at it. But even he’s not as good as he thinks, and definitely not good enough for my daughter.

And all this could be quite funny if this over confidence in our ability to engage in more than one thing didn’t cost so many lives.

Distracted driving

Here are a few facts, courtesy of Distracted.gov, the “Official US Government Website for Distracted Driving” (I‘m sure they didn’t mean it that way—they must be against distracted driving…):

• In 2008, almost 20 percent of all crashes in the year involved some type of distraction (National Highway Traffic Safety Administration - NHTSA).

• Nearly 6,000 people died in 2008 in crashes involving a distracted driver, and more than half a million were injured (NHTSA).

• The younger, inexperienced drivers under 20 years old have the highest proportion of distraction-related fatal crashes.

• Drivers who use hand-held devices are four times as likely to get into crashes serious enough to injure themselves (Source: Insurance Institute for Highway Safety).

• Using a cell phone while driving, whether it’s hand-held or hands-free, delays a driver's reactions as much as having a blood alcohol concentration at the legal limit of .08 percent (Source: University of Utah).

One would think that common sense and a few statistics would be enough to prevent us from fumbling with an electronic device while driving, but that ain’t so. 

So, thirty states have put into law bans on texting while driving. It’s a welcome, rational step, but unfortunately instead of turning the device off it has led overconfident drivers to put the device lower in their lap, where it can’t be seen by police.

Self-confidence is a beautiful thing. Cockiness enables people — including young kids — to occasionally do unbelievable stuff. But when it comes to driving it’s a huge mistake to believe that you’re an above-average driver.

First of all because you’re not – statistically speaking it’s unlikely – and besides, handling heavy machinery at high speed is not an innate human skill, and even if you’re better than most you’d better be humble. We’re incredibly attuned to some things in our surrounding – I believe many of us can hear an infant‘s cry even with a lot of background noise – but not to the unexpected dangers of the road. To be a decent driver we need both hands and our head as engaged as much as humanly possible.

A crop of new apps and gadgets surface daily since the no-texting bans were signed into law. Some are no more than clever ways to stay within the letter of the law while providing new – equally distracting – ways to text, email and call while driving.

If you feel you have to have an app for that here’s what you should look for: an app that helps you stop using the phone. Even SAFECELLapp, which rewards drivers with cash for not using their phone when the app is turned on and the car’s moving, is much more distracting than simply turning the device off.

What if someone needs to reach you? They’ll reach you later, or find another solution. The world worked just fine fifteen years ago, when most kids could not reach mom at all times and executives weren’t constantly plugged.

Please, just think about this: Would you feel comfortable if your kids’ school-bus driver texted while driving?

I welcome your comments,

Dr. Ayala

 

Can Google be trusted with your health?

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

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It’s the middle of the night. Your baby’s sick. You’re sick with worry.

Ever thought of Googling his symptoms for some free medical advice or a second opinion?

Many people use the Internet for health-related information, and used correctly it’s a great resource. But how reliable or accurate is a search engine without medical guidance?

A group of British researchers found that health information on the Internetranges from poor to excellent, depending on the topic and the resource. They Googled UK-based websites on five common pediatric issues in which the best practice is pretty clear, and found that only about 200 of 500 sites offered correct information. The results of their study were published in the Archives of Disease in Childhood.

The five search topics chosen for the study were "MMR autism" (current practice: there’s no association between the vaccine and autism), "HIV breastfeeding" (current practice: HIV-positive moms are advised not to breastfeed), "mastitis breastfeeding" (current practice: a mom with mastitis should breastfeed), "baby sleeping position" (current practice: a baby should be put to sleep on his back) and "green vomit"(current practice: if baby vomits green, go see a doctor).

Their analysis showed that governmental sites were accurate every time. Educational sites, companies, interest groups and individual’s sites performed rather well, and were accurate around 80 percent of the time. News sites did poorly (they had a 55 percent “correct” rate), and no sponsored site gave correct advice.

The authors conclude:

“Healthcare professionals should continue to strive to be the main source of information for patients but we should be aware that most will continue to use the internet to gather information. We suggest that in addition to verbal and written information, patients and parents should be signposted to NHS (National Health Service), governmental or other preapproved websites”

Google has no clinical judgment

This study posed to Google questions to which there are only two possible answers. Most health questions are much more complicated, and a search result brings in an enormous amount of information to sift through.

If your child has a fever—perhaps the most common reason to see a pediatrician—a search engine is practically of no help at all. A study looking at advice for kids with a fever found only three out of 22 sites visited gave information which matched current "best practice" guidelines. You may wind up worrying your head off over exotic and life-threatening causes of fever which have no relevance to your child. But how would you know? A study of Internet information on lumbar disc herniation ("slipped disc") found that less than 10 percent of relevant websites were of high-quality. Try searching “headache” and see what comes up.

Doctors don’t have secret information. Even complicated medical knowledge is widely available. The Internet is full of good information—and bad information and misinformation, too. Making sense of the information is what’s become harder and harder to do.

Doctors work many years to master clinical judgment—the application of information gathered from talking to and examining patients, combined with knowledge of the science of medicine, and that impossible-to-define art of medicine—that’s what makes a good doctor.

There’s no recipe for acquiring clinical judgment. The knowledge-base needs to be there (a service Google provides fairly well), but the thoughtful application of information comes from immersion in the care of patients, experience, interaction with peers and mentors, and a constant refinement and learning process. I don’t think a machine will ever be able to learn clinical judgment.

The Internet is one of my favorite inventions of all time, but it will never be able to answer complicated health questions, nor will it ever be able to offer comfort or compassion. Surfing health issues on the Internet is a great example of how a little knowledge can be a very dangerous thing.

Nevertheless it’s a great resource for gathering information—provided you use reliable and authoritative sources—and that knowledge can be a great starting point for a discussion with a health professional who can help make sense of it all, put things in perspective and individualize it to your specific health issue.

Do you use the Internet for health related issues? Who do you trust?

I promise to share some of my favorite online sources of reliable medical information in a future post.

Dr. Ayala

 

Can You Sleep Yourself Thin?

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

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“A good laugh and a long sleep are the best cures in the doctor's book.” ~Irish Proverb

Eat fewer calories and exercise more – that’s the age old recipe for weight-loss – the rest is gimmicks. But a new study suggests that we should perhaps add one more element to the regime: Get a good night’s sleep.

Sleep is one of the central pillars of good health. Sleep is absolutely critical to keeping us sane and happy. Yet we don’t give sleep as much respect as it deserves.

Several studies have shown a link between obesity and lack of sleep, but the association by itself doesn’t give much of a clue as to which came first and doesn’t prove causality. Obesity can cause sleep problems (the most serious of which is obstructive sleep apnea). Being awake at night can increase appetite and night-time-snacking (which usually isn’t green salad), and sleep deprivation can lead to poor food choices and inactivity.

But this new study in the Annals of Internal Medicine isolated the effect of sleep quite nicely; it looked at overweight adults on a weight-loss diet, and showed that all other things being equal, lack of sleep hindered the dieter's ability to shed excess body fat.

The study recruited ten overweight healthy adults who were fed a moderate calorie-restricted diet. Dieters were randomly assigned to sleep either 5.5 hours or 8.5 hours each night, for two weeks on each regimen, in a closed clinical research environment. The researchers measured weight, but also measured body fat directly (using dual-energy x-ray absorptiometry or DXA), so they could calculate how much of the weight-loss was loss of fat, and how much of it was lean tissue or muscle loss. The results in this small group were quite clear:

• Overall weight loss was similar whether the dieters slept 5.5 hours or 8.5 hours

• Sleep restriction resulted in more loss of muscle and less loss of fat: More than half the weight lost during the 8.5 hours sleep condition was fat, compared to just one quarter in the 5.5 hour sleep condition.

• During the two weeks of sleep restriction, dieters felt hungrier

Can a good night's sleep help preserve muscle during weight-loss?

When we ingest fewer calories than we expend – which is what happens on a weight-loss diet – the body goes looking for energy stores, and will break down both fat and protein to make sugars for energy.

The goal of any diet is to lose fat, not muscle. Not only do we like our muscle’s look and strength, muscles are active metabolically and burn energy, and loss of muscle during weight-loss diets is part of the reason people who've lost weight are so prone to regain it, and actually need to consume fewer calories just to keep their new weight stable. Preserving muscle is one of the reasons there’s such an emphasis on exercise during a weight-loss diet – working those muscles and building them is protection from dwindling muscle mass and slow metabolism. (For the sake of preserving muscle-bulk it’s also a good idea to avoid extremely low-calorie and nutritionally unbalanced weight-loss regimens.)

So a regime that protects muscle and leads to more fat-loss is very valuable. But don’t get excited just yet: This study involved only ten healthy participants, studied for a short while. But if results are confirmed by other studies this finding could be very important.

How could sleep affect fat loss? The researchers measured the levels of the hormone ghrelin and found that when dieters where on the sleep deprivation regimen ghrelin levels rose. Ghrelin, they reason, has been shown to signal hunger, reduce energy expenditure, hinder the breakdown of fat and increase the liver’s production of sugar. In this calorie deprived state of high ghrelin, the liver needs to make sugar while fat stores aren’t really open for providing building blocks, so it will break down muscle to fill the demand. There are, of course, many other possible ways in which lack of sleep may hamper fat-loss: fatigue may cause a dieter to be less active, and move less, for example.

Sleep isn’t a waste of time

Sleep is precious. Sleep isn’t always easy to get. Some people suffer from insomnia. Some work night shifts. Some have babies that make life look like a 
night shift. But for those of us for whom going to bed late is just a habit, I think it’s time to rethink sleep. I used to turn in after midnight – for no particular reason – it made me feel that there are bonus hours to my day. When I moved to the street I live on now I was surprised to see that most homes were dark by 10:30pm. I asked my neighbors what the lights-out was all about; they were astonished by the question. The thought of going to sleep at 10:30 never occurred to me, but I gave it a try, and was absolutely shocked by what a difference it made to my general well-being.

If you’re sleep deprived give sleep a try. Adequate sleep is underappreciated, and I believe it to be one of the most important ways to achieve optimal health. I’ll be curious to see if further studies confirm sleep’s role in fat-loss.

Dr. Ayala

 

 

Healthy summer frozen treats and the dreaded brain freeze

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

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My dear kids bought me an ice cream maker for Mother's Day—they know my favorite gifts are connected to the kitchen and food. To their delight, I’ve been experimenting with frozen healthy treats for the past few weeks, and they get to sit on the sunny steps outside our kitchen where they taste, comment and compare.

These recipes call for an ice cream maker. Not every kitchen has or needs one—I give instructions for making these fruit treats without one—but if you have the space in your kitchen these small appliances aren’t expensive (under $50), and will probably earn their keep.

When making frozen desserts at home you’ll be using pure fresh ingredients, and none of the stabilizers, gums, colors and preservatives that are often found in the in prepared versions from the frozen food section of your supermarket.

Here are a few of our favorites:

Lemon, Verbena and Geranium Sorbet

Ingredients:

• 2 cups boiling water
• 1/2 cup sugar
• 5-8 leaves of rose geranium* (can be replaced by French tarragon or 1 teaspoon lavender flowers)
• 1 cup lemon juice
• 1 tablespoon minced fresh Lemon Verbena 
• ½ teaspoon grated lemon peel (yellow part only)

*Another option is to replace rose geranium with 1 bottle of Ayala’s Herbal Water Lemon Verbena Geranium. If you do this, use just ½ cup of boiling water to melt the sugar.

To prepare:

Stir the sugar and rose geranium leaves in the boiling water until sugar is dissolved. Chill completely. Remove leaves just before making the sorbet.

Add the lemon juice, lemon Verbena and lemon peel.

Freeze in an ice cream maker according to manufacturer's directions 25-30 minutes.

If you do not have an ice cream maker

 Place mixture in freezer-proof container 
 Freeze for one hour
 Remove from the freezer and beat the mixture using an electric mixer 
 Repeat this entire process two more times (it’s worth it)

In case you’re wondering how I make the lemon zest spirals--it’s really easy, use a lemon zester in a circular motion around a washed lemon (see picture).

 

Very Berry Sherbet

Ingredients:

• 1 pound mixed berries. I like using a combination of sweet and tart berries: blueberries, strawberries, raspberries and blackberries. Frozen berries also work; let them thaw just a little before preparation
• 2-4 tablespoons sugar or agave (depending on berry sweetness)
• 1 cup milk (I use 2%)

To prepare:
Process all the ingredients coarsely in a food processor or blender.
Freeze in an ice cream maker according to manufacturer's directions, 20-25 minutes.

If you do not have an ice cream maker:

 Place mixture in freezer-proof container
 Freeze for one hour
 Remove from the freezer and beat the mixture using an electric mixer 
 Repeat this entire process two more times

Watermelon Mint Slurpee

Ingredients:

• 1 pound sweet ripe watermelon 
• 10 mint leaves, finely chopped
• Lime juice from half a lime
• a pinch of salt

To prepare:

Process all the ingredients in a food processor or blender.
Freeze in an ice cream maker according to manufacturer's directions for about 10-15 minutes. The consistency needs to be slurpable through a straw, so this one’s not supposed to completely freeze.

If you do not have an ice cream maker:

 Place mixture in freezer-proof container
 Freeze for one hour
 Remove from the freezer and beat the mixture using an electric mixer
 Repeat this entire process one more time 

Serve in tall glass, with a wide straw.

Serving suggestions

These recipes serve 4-6 people

Sorbets may be served as a dessert or between courses to refresh the palate.

The texture of the sorbets varies by ingredients, preparation and temperature. These recipes are designed to be served immediately. If you do store the sorbet in the freezer, make sure you allow a short time to thaw before serving.

The dreaded brain freeze

Ice cream can teach us a very important healthy eating lesson—eat slowly. Although it’s always good advice to pace our meals, allow satiety to sink in and give ourselves time to really enjoy our food, ice cream, sorbets and other very cold foods often provide a very clear reminder to slow down: The dreaded ice-cream headache. This “brain freeze” not only causes us to momentarily stop our own eating, but if anyone else happens to cry out as they suffer this stinging pain, we all almost instinctively slow down in order to avoid it ourselves.

According to an editorial by neurologist Joseph Hulihan in the British Medical Journal, the ice cream headache is the most common cause of head pain, and affects a third of the population. It has no connection to other forms of headache. The pain begins a few seconds after gulping down cold foods or beverages--when really cold food touches the roof of the mouth--and peaks in 30-60 seconds. The good news is that it doesn’t last long.

Scientists aren’t sure about what causes this pain. One leading theory suggests that the cold food or drink may temporarily constrict blood vessels and cause pain in much the same way a migraine does. In any case, no need to worry. Hulihan concludes with:

“No treatment is usually required, and sufferers rarely seek medical attention. Since the posterior aspect of the palate is most likely to produce the referred pain of ice cream headache, avoiding contact of the cold food with this area can effectively eliminate the symptoms. Most people arrive at such preventive measures without the advice of doctors. Ice cream abstinence is not indicated.”

And you can always call on the classic trick to speed up recovery from brain freeze: press your tongue to the roof of your mouth until the pain subsides.

Your comments on summer treats or brain freezes are as always welcome.

Enjoy the warm weather in good health.

Dr. Ayala

 

Can super-sizing fruits help you shed weight?

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

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I’m very skeptical of promises that sound too good to be true.

No field is as rife with these as the diet industry, where new dream diets are invented daily and claim to have found a magic trick allowing us to eat as much as we want yet lose weight.

But here’s one worth checking out: Can eating more fruit help you shed weight?

This diet is worth a second look because we have many other good reasons to increase our fruit consumption—fruit and vegetables are an important component of a healthy diet and have a protective effect against many chronic diseases, such as heart disease, cancer and diabetes.

There’s also a plausible explanation for why eating fruit may protect against weight gain: Fruits have a relatively low-energy density, they have a lot of water and dietary fiber, and add lots of bulk. Studies show that food intake may be regulated by the weight of the food, and how long it takes to consume, therefore filling your plate with fruits would lead to greater satiety and less consumption of other foods.

A recent paper in Obesity Reviews analyzes the published studies on the association of fruits and weight loss. The authors specifically sought studies which look at fruit only, and not fruit and vegetables as one category (there are many studies showing that fruit and vegetable intake has an inverse relationship with overweight and obesity).

Of the sixteen human studies that met the inclusion criteria, eleven showed that increased fruit intake facilitated a significant reduction in body weight, decreased the risk of overweight or obesity or was associated with less overweight. The remaining five studies found no significant association, and no studies showed increased weight related to increased fruit consumption.

The studies included in this review were of three different types: Intervention studies, in which a study group is randomly assigned to receive an intervention—in this case increased fruit—and compared to a control group which receives a placebo or no intervention, prospective observational studies, in which a cohort with known exposures (in this case fruit intake) is followed for a health outcome over time (in this case weight), and cross-sectional studies, in which a population is observed at a certain point in time, looking for possible connections between, in this case, fruit consumption and weight. Each kind of study has its strengths and weaknesses.

Results from all three types of studies pointed towards an association between high fruit intake and lower weight. The authors call for large behavioral, randomized, controlled intervention studies to further clarify this issue. 

Can supersizing the fruit serving increase fruit intake?

I think we’re all sold on the idea of including more fruit in our daily diet for a multitude of reasons, but many parents struggle with just how to do it—less than ten percent of kids consume their daily recommended number of fruit and veggie servings.

This brings me to another recent fruitful study, this one from the scientific journal Obesity. 

Many studies show that increasing the size of the serving of food—entrees, snacks or soda—leads to increased intake, and supersizing the portion leads tosupersized eating and supersized people. The authors asked the interesting question: Will supersizing the fruit and vegetables portion lead to higher intake of those in kids?

Forty-three Philadelphia-area kids aged five and six years were included in the study. They were twice fed dinner consisting of pasta with tomato sauce, broccoli, carrots, unsweetened applesauce and milk, with the portions of broccoli, carrots and unsweetened applesauce doubled in one of the meals randomly, while the pasta and milk portions stayed the same.
The results are pretty interesting:

Doubling the portion of fruit and vegetables side dishes resulted in a significant increase of 43 percent in the intake of the fruit—applesauce—but not the vegetables.

Doubling the portion of fruit and vegetables side dishes resulted in a significant decrease in the intake of the pasta dish, with the extra fruit displacing the more energy-dense pasta.

Overweight kids showed a bigger response to over-sizing the fruit and vegetables portion than normal weight kids; they ate more of the fruit and vegetables offered.

 

The study shows doubling the size of fruit and vegetables portions as a valid method for increasing fruit intake, but also maybe of controlling weight gain, as the fruit displaced a higher calorie food (pasta).

What about the vegetables?

A more careful look at how the vegetables were presented might offer an explanation: the broccoli and carrots were thawed from a frozen pack and served plain, with no seasoning or fat. I think even the most ardent vegetable lovers wouldn’t get too excited by those. Perhaps a more appealing preparation (broccoli sautéed with some olive oil, garlic, fresh ground pepper and salt anyone?) would have gotten a different result.

I think that if you’re plating a meal for yourself or for others increasing the size of the vegetable and fruit component is worth trying. It may very well be that the most obvious way to increase fruit and vegetables consumption is by making them show up in plenty! If they’re on the table, prepared in an appealing way, ready to eat and constantly available they’ll be what we eat when we’re hungry. That’s part of the way manufacturers of sugary drinks and junk foods make sure we consume more—they’re just everywhere and in plenty.

Food for thought!

Dr. Ayala

 

Sports drinks: Do you really need them?

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

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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: A history

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 in a sports drink?

Is it better to rehydrate with a sports drink after a 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.

Sports drinks' disadvantages

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.

 

5 tips for developing kids’ healthy flavor preferences

Research shows that although there’s a natural attraction to sweetness and saltiness, taste preference has much to do with exposure, especially early exposure. Infants usually accept whatever they’re fed, and that’s why kids around the world reflect the culinary traditions of their parents. In some cultures kids will eat spicy, sour and even bitter foods, while in others kids have a narrower range, and stick with sweet fat and salty.

When do babies develop flavor preferences?

The window of maximum plasticity in flavor openness probably occurs very early on. Studies suggest that babies whose mothers ate certain foods during pregnancy or breastfeeding tended to like these same foods later on (the flavor of foods is reflected in amniotic fluid and in breast milk, therefore the baby is exposed to mom’s flavor preferences).

A study from the Monell Center in Philadelphia, published in The American Journal of Clinical Nutrition, tried to figure out the time frame of that sensitive period – the time in which baby’s mind and palate are open and accepting to new flavors – by an interesting experiment.

The study recruited about 70 babies whose parents selected to formula feed, and assigned them to either ordinary cow-milk based formula (Enfamil), or hydrolyzed protein formula (Nutramigen) at different ages and for varying periods of time.

Now, I don’t know if you’ve tried baby formulas, but I have. Mostly out of curiosity, I’ve tasted lots of the (vegetarian) food stuffs designed for babies. I mean no offense, and this is of course just my personal opinion, but infant formulas have a unique appeal to babies only – I doubt any adult would add this milk to his morning coffee. But even more astoundingly weird tasting are the hydrolyzed protein formulas. These are the formulas that use amino acids instead of whole proteins, and are given to babies with serious allergies and intolerances. Let’s just say that they have a distinct taste and smell and are a little bitter and sour. In fact, most babies older than 4 months will outright reject the hydrolyzed protein formulas unless they’ve been exposed to it in the first months of life.

The researchers in this study, led by Julie Mennella, found that exposing babies to hydrolyzed protein formulas for 1 month was enough to make the baby open to its taste at the age of 7.5 months. Exposure to hydrolyzed protein formulas for 7 months, as opposed to 3 or 1 month, made babies more accepting of the formula, suggesting that the dose and duration of exposure matter, but what mattered most was timing.

Exposing babies to the unusual flavor was most effective when it occurred really early, and the babies accepted hydrolyzed protein formulas better at 1.5 months and 2.5 months than at 3.5 months. At 3.5 to 4 months the flavor acceptance window seemed to close and the babies just refused the Nutramigen!

Not all is lost

Although it’s easiest to introduce new flavor during the maximum acceptance window, it’s never too late to expand your kid’s palate and broaden their interest in healthy food. As we know, young kids will absorb a new language quickly if immersed in it – grammar, accent and all – while older kids and adults will have to put in more of an effort. But I think learning to enjoy new, healthy flavors is always possible, just like it’s always possible to acquire a new language – it will just take more work, and perhaps a dedicated tutor.

Five tips for developing kids’ healthy flavor preferences

• Eat well as a mom-to-be: If mom eats her fruits and veggies, baby is exposed to their flavor in-utero, a double win! 

• Breastfeed if you can: Breast milk is the ideal baby food for so many reasons. When it comes to flavor development remember that unlike formula, which is uniform, no two breast milk meals are the same, as breast milk reflects mom’s diet; therefore a breastfed baby is exposed to more flavors than a baby who is formula fed. Studies show that breastfeeding may facilitate the acceptance of new foods in childhood.

• Stay away from the sweet-salty-fatty trap: Babies and kids have a natural affinity to sweet and salt. Our job as parents is to expose our young ones to what’s good and healthy, not to what they’ll surely eat. Do your kids a favor and don’t create an expectation that all food should be sweet – expecting the usual sweet –salt-fat trifecta is a preference that can lead to a poor diet and obesity.

• Expose young kids to a variety of healthy foods: Let them experience many flavors and textures, especially in their first two years of life.

• Repeat exposures: Many studies show that repeated exposure works. Even if a vegetable is initially disliked it’s worth persisting at least eight times – kids do change their mind.

Early exposure matters, but it’s never too late to move to healthier eating habits and develop a fondness of wholesome, plant-based foods!

Dr. Ayala

 

The quest to become the healthiest man alive

Self-described experimental journalist A. J. Jacobs has done a few extraordinary things in the pursuit of self improvement: He read the Encyclopedia Britannica cover to cover to protect his slipping IQ, and then went on to try to improve his spiritual life by living by the bible, obeying hundreds of its ancient laws.

And now comes the third lag of his journey – chasing perfect health. Realizing he can’t take his health for granted after a bout of tropical pneumonia, Jacobs sets to change his ways and seek maximum health by any means available, and for a guy in New York City, these are many.

I enjoyed Jacobs’s previous books – he’s a very funny writer, and a joy to read, but I had expectations coming into this book.  In his previous adventures Jacobs had a way of distilling years of self-experimentation and lots of thoughts, stories and information into just the essence – honing in on what’s really important.  I wondered whether Drop Dead Healthy would leave me with the same kind of big-picture-but-let’s-enjoy-the-fine-details feel.

Jacobs interviews researchers and experts for his Health Project, reads many books, buys lots of equipment and takes us along to try what both the sane and the slightly crazy do in the name of health.  Although he claims he had forgotten most of what he learned from his Britannica adventure, there are lots of know-it-all fun facts seeping through his writing, and these are a treat. Did you know that the Graham cracker was invented as a functional food, and designed to be bland, in order to empty a teen’s might of carnal desires (much like other foods with health promises, it doesn’t work), or that dolphins’ two brain hemispheres (halves) take turns resting, therefore dolphins can only be half asleep, or that we can blame Coco Chanel for skin cancer because she started the tan craze?  Among the anecdotes I learned some great stuff: looking for an aphrodisiac to enhance his sex life (current understanding is that sex is healthy) he learns from Dr. Helen Fisher that there are only two true aphrodisiacs: testosterone and dopamine. Before you ask for a dopamine prescription, here’s your natural aphrodisiac: do something new and exhilarating with your partner. Novelty, excitement and thrill get dopamine flowing in the brain – try a vacation.

What to eat

As you can imagine, the pursuit of perfect health involves dealing with many contradictory and confusing diet plans.

Jacobs goes Raw. Two weeks of juicing and dehydrating fruits and veggies leave him light yet hungry (and flatulent) – even light-headed. He also can’t find lots of scientific support to the belief that undercooked triumphs cooked.

He goes caveman. The Paleo diet makes him feel full, but he finds science is skeptical about this diet plan’s effect on the heart, and about what our ancestors actually ate.

Going no-sugar for two weeks proves super hard but beneficial. Jacobs says he had “more energy, fewer aches and pains and better workouts.” But “I’m a weak man,” he concludes – no-sugar is just too hard. Instead, he decides to cut sweet-talk from his language, and replaces his usual pet name for his wife from Sweetie to Pumpkin.

And since no health quest is complete without a cleanse Jacobs enlists his wife, Julie – always the voice of reason in the narrative – to the adventure. Julie lasts all of 9 hours.  A. J. completes the 3-day regimen; “waiting for an epiphany” he’s hungry, cranky and spacy. He’s also read the cleanse-debunking science -- nothing whatsoever to support a juice cleanse.

What Jacobs eats for the most part during Project Health is a sort of Mediterranean diet – a plant based diet recommended by the majority of scientists. The fact that it’s recommended by the majority of scientists doesn’t mean they can’t all be wrong, but it does make it a safer bet.

Distilled wisdom: Eat less, move more, relax!

So what does the guy who got to try almost everything keep when the project’s over? That is to me the extra bonus from this book. Sure, it’s a one-person experiment and has no statistical significance, but you can learn a lot from Jacobs’s two-year (and over) immersion project.

It’s a happy ending for Jacobs: 16 pounds lost, 2 belt sizes down, perfect lipid profile, lots of push-ups, and half the body fat.

I don’t want to spoil the book for you, so let me just say that Jacobs, like many others, sums health advice in 5 words: Eat less, move more, relax.

And he also heeds plenty of warnings against health overzealousness. Mortality makes a few appearances, some of them unexpected. One of the favorite pieces of advice Jacobs received during the project is from Steven Bratman, M. D.:

“Don’t be so obsessed with healthy food that you end up sitting alone in the corner eating organic kale and silently judging your friends.”

A healthy lifestyle is, many say, about moderation, moderation in all things, including the pursuit of health.

Dr. Ayala

 

The best two pieces of advice for a healthier lifestyle

Habits tend to cluster.  People who exercise will often also watch their weight, consider the nutrition label, avoid smoking and get enough sleep. On the other end, unhealthy behaviors bunch together, too, and many of us have a long list of practices their doctor would like them to change in order to lower their risk of disease.

But who wants a long shopping list of to-dos and not-to-dos? 

The ideal plan would involve one or two guidelines that could drag with them other positive behavior changes.

Oh, and what if we could also achieve that remotely, with something as simple as a phone app? Wouldn’t that be useful?

Eat your veggies and turn the TV off

A new study, published in the Archives of Internal Medicine studied about 200 people who skimped on fruits and veggies, ate plenty of saturated fats, didn’t exercise much and had a sedentary lifestyle, (sounds like someone you know?) trying out a mobile technology aimed at behavioral change.

The participants each got one dietary behavior to change – either eat more fruits and veggies or lower your saturated fats intake -- and one activity behavior goal – either decrease sedentary leisure (less TV) or increase exercise. That made 4 treatment groups.

The participants got a personal digital assistant, and were asked to report on their diet and activity. The treatment phase lasted 3 weeks, with 20 weeks of follow-up during which the researchers tracked how much of the behavior change persisted.

This was a compliant group – perhaps because participants were rewarded $175 for achieving the 3-week target. All but 1 participant were able to adhere to both the dietary and activity goals within 3 weeks. 

But here’s the interesting part: the group that was instructed to eat the 5-a-day fruits and veggies and reduce screen time achieved not just these goals, but also, without being told, decreased saturated fat intake. 

And those benefits persisted to some degree after the treatment phase was completed, and the participants were no longer paid for adherence or even asked to keep up the positive change. In the 5 months of follow-up this group was still eating more than double the fruits and veggies compared to what they ate before the experiment started, watching an hour and a half less TV, and eating significantly less saturated fat. 

On the other hand, the group that got the more traditional diet regimen of eat less fat and exercise more achieved less healthy change: The participants didn’t eat more fruits and veggies, and lounging in front of the screen was unaltered. 

Healthy chain reaction

As Charles Duhigg discusses in The Power of Habit some habits are keystone ones. Changing one thing, such as starting to exercise, may have a beneficial domino effect, improving diet, stress and productivity unintentionally.

This study suggests that reducing screen time not only offers the advantage of reducing inactive time, but also automatically reduces high-fat intake. There are plenty of studies showing that more TV is linked with higher energy intake and high-fat snacking. I can’t think one good outcome arising from hours in front of the TV.

Mind you, the eat-your-veggies-&-limit-TV advice didn’t get people in this study exercising. Exercise needs its own nudge.

The 5, 2, 1, 0 advice for healthy active families from the American Academy of Pediatrics captures all the important recommendations very simply:

• 5 fruits and vegetables a day,
• 2 hours or less of screen time (TV, computer, video games) per day,
• 1 hour of physical activity a day, and
• 0 limit sugar-sweetened drinks.

These are small changes that can bring about bigger ones!

Dr. Ayala

 

Non-caloric sweeteners on the rise: Should we be concerned?

Americans eat a lot of sugar – 15 percent of daily calories are from added sugar alone. Sugar’s high caloric price as well as its rising market cost are moving consumers and food makers to replace sugar with ever rising amounts of low-calorie sweeteners such as Equal, NutraSweet, Splenda, Sweet'N Low, Stevia and many others. Replacing sugar with no-calorie sugar substitutes potentially saves many calories, but also raises concerns about what happens when you dissociate sweetness from energy: how does non-caloric sweetness affect appetite, eating habits and weight?

And since the sugar-substitute experiment is long underway, it’s a good idea to stop and see how the trial is faring: are low caloric sweeteners helping in the obesity fight?

Food and nutrition experts met in the spring of 2011 in Washington DC to do just that in a workshop called: “Low-Calorie Sweeteners, Appetite and Weight Control: What the Science Tells Us”. The presentations of this workshop are summarized in a upcoming supplement of the Journal of Nutrition and make for some interesting reading.

Does sweetness promote overeating?

Tasting something sweet activates pleasure centers in the brain.  Do you know what else activates these neural reward pathways? Addictive drugs such as alcohol and opiates work on the same brain mechanisms. That of course doesn’t mean that drug addiction and our affection for sweet food are the same thing – but it does help explain how strong and well conserved our sweet preference is.  Loving sweet is innate and present even before birth. It probably served our species well, leading babies to crave mother’s milk and all other aged humans to seek ripe fruit.

A few interesting findings from the article about sweetness and food preference:

• Sweet taste makes pain go away: a Cochrane review showed that sweet tasting solutions reduced the reaction to pain in babies. Sweetness continues to act as an analgesic in childhood.

• We sense sweet taste through taste receptors in the mouth, but receptors are present also in our intestine and our pancreas. Stimulating these receptors leads to a cascade of physiologic reactions, including insulin and other hormone secretion, stomach emptying, appetite control and gut motility. These receptors can’t tell caloric sweeteners and non-caloric sweeteners apart -- they react to both, to a degree that isn’t completely understood. 

• Young kids prefer super sweet -- the sweeter the better. They’ll always gravitate to sweet rather than plain. Kids can also discriminate between sweet-tasting foods differing in energy content, preferring those that are more energy dense. 

• Preferring sweetness is natural, but also learned: babies and young kids exposed to sweet foods and drinks prefer sweet foods, and eat more of them. Through their experience with food kids ‘learn’ what should and shouldn’t taste sweet. Repeated exposure to sweet drinks leads to preference of sweet drinks. 

• The ready availability of sweet, highly rewarding foods, can promote overeating and weight gain. Adding sweetness (caloric or non-caloric) to foods that are not naturally sweet -- think cereal, water, yogurt or milk -- creates dietary habits of overconsumption. It’s just human nature.

The science of non-caloric sweeteners

Thanks for hanging in there up until now. I bet you’re curious to know the bottom line verdict of this workshop. Two years ago, the new Dietary Guidelines for Americans concluded that:

“The replacement of sugar-sweetened foods and beverages with sugar-free products should theoretically reduce body weight. Yet many questions remain, as epidemiologic studies show a positive link with use of nonnutritive sweeteners and BMI. Additionally, whether use of low calorie sweeteners is linked to higher intake of other calories in the diet remains a debated question.”

I’m afraid not much has changed.

The workshop concluded that the bulk of epidemiologic, observational studies, but not all of them, reported that use of low-caloric sweeteners is associated with obesity and weight gain. However, association doesn’t prove causality. Real evidence, the experts say, can only come from well-performed randomized controlled clinical trails, in which people will be assigned randomly to consume either non-caloric sweeteners for long periods of time, or serve as controls.

Until then, the large-scale non-randomized population experiment is ongoing, we’re all part of it, and I don’t think it’s going too well. I choose to be in the control group.

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 health and weight of the (young) nation

It has been many a pediatrician’s nightmare prediction: rising obesity rates are likely to cause an increase in type 2 diabetes in teens, in much the same way these two conditions are linked in adults.

And this fear has come to pass. Type 2 diabetes, unheard of in kids just a few decades ago (it used to be called adult-onset-diabetes for just that reason!), has become unexceptional in pediatric practice.

But what we’ve seen so far seems to be just the tip of the iceberg. A new article in Pediatrics looked at a group of about 3400 nationally representative teens (aged 12-19), and found that diabetes and pre-diabetes nearly tripled in less than 10 years, jumping from 9 percent in 1999-2000 to 23 percent in 2007-2008.

The authors, led by Ashleigh May, warn that these results should be interpreted cautiously: Diabetes and pre-diabetes were diagnosed by a single fasting blood sugar test. The true prevalence of type 2 diabetes in kids is hard to know unless blood tests are done because the disease can have little or no symptoms for a very long time. The numbers do look high, and it’s going to be interesting to see if other large-population studies corroborate them.

Teens at serious cardiovascular risk

High blood sugar wasn’t the only cardiovascular risk factor facing the teens in the study. Overweight and obesity were common – 16 percent of the kids were overweight and another 18 percent were obese.

On top of that, 14 percent of kids had pre-hypertension or hypertension, 22 percent had borderline or high LDL (bad) cholesterol, and 6 percent had low HDL (good) cholesterol.

All these above mentioned risk factors were seen much more frequently among the kids with overweight and obesity, in fact, among obese teens 61 percent had at least one cardiovascular risk factor on top of their weight status, and 8 percent of the obese teens had 3 or more of the tested risk factors. But even among normal weight teens 37 percent had a cardiovascular risk factor (the most common of which was high LDL), showing that even when teens aren’t overweight they can benefit from interventions promoting a better diet and more physical activity.

A bit of good news if I may: it seems like obesity rates have leveled off and they haven’t changed much during the 9 years covered in this study. For overweight and obesity to level off at a third of the pediatric population is of little comfort, though

Diabetes in teens carries extra burden

Kids with diabetes not only have more years to accumulate the disease’s serious complications – the longer one has diabetes the more likely heart, kidney, eye, nerve and other body systems are to suffer its consequences. Type 2 diabetes is also proving to be much harder to treat in young patients according to recent studies.

It doesn’t have to be so!

I assume that the vast majority of the kids in this study had pre-diabetes – a condition that if left unattended can, and often will, develop into diabetes (the article doesn’t differentiate between diabetic and pre-diabetic teens). But pre-diabetics can reverse their metabolic state with just modest weight loss and exercise.

And for all of us, type 2 diabetes is mostly a lifestyle disease. It is really up to us to feed kids better and help them become more active so they’re not doomed to develop totally preventable disease and disability as young adults.

What to do? HBO’s excellent Weight of the Nation looks at this complex issue in depth and with compassion. If you haven’t seen it yet, I highly recommend the Children in Crisis chapter (I actually think it’s a good idea to watch the chapters out of order – I found the first installment, Consequences, to be so depressing that I have a feeling some viewers might have just given up on both the series and on dealing with obesity before that chapter was over).

As Dr. Tom Frieden, CDC director, says: The weight of the nation is not healthy. And to get it healthy, we’re all going to have to do our part.

 

Dr. Ayala

 

Study proves school nutrition standards work

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

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

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

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

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

Vending machines with fewer calories

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

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

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

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

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

Fewer calories, perhaps no better nutrition 

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

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

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

Does public policy impact kids’ health?

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

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

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

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

Dr. Ayala

 

Put those fruits and veggies a little closer

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

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

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

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

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

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

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

Within arm’s reach

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

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

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

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

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

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

Dr. Ayala

 

Preschoolers suffering nature and exercise deficits

A happy day is one in which some time is spent outdoors.

Dog owners take their dogs out daily, and pediatricians suggest we extend the same kindness to our kids.

No, seriously, kids need the outdoors quite critically. Outdoors translates to physical activity and fitness, and the more time kids spend outdoors the less likely they are to become obese. Kids don’t exercise in gyms; they have bursts of intense, vigorous, heart racing activity while playing in a large open space, when they’re chasing a friend or a squirrel, or repeatedly going up and down a slide. Playing outdoors also helps kids’ development and growth and does wonders to their vision, coordination, vitamin D levels and mood!

Experts say that free play — especially outdoors — is crucial to a kid's health, but chances to play outside have been on the decline over the past few decades. Busy lives, over anxiety about safety, screen based entertainment and lack of awareness are keeping kids indoors.

Not enough outdoors time

A new study in the Archives of Pediatrics & Adolescent Medicine looked at the frequency at which parents took their kids to play outside. The authors, led by Pooja Tandon, used a nationally representative sample of about 9,000 4-year-olds, whose parents were asked how often they took their kid out to play. 

They found that about half of the preschoolers were taken out by their parents daily.

Is another caregiver taking these kids out? Possibly — daycares are supposed to take kids out. But even among the 20 percent of children in the study who didn’t attend any day care or preschool at all, only 58 percent went outside daily with mom or dad.

Is safety the issue?  

An important barrier to spending time outdoors could be perceived or actual concern for safety. This study found that the vast majority of parents thought that their neighborhood was either very safe (58 percent) or fairly safe (35 percent), with just 5 percent assessing their area as fairly unsafe and only 2 percent as very unsafe. So dangerous neighborhoods were not the issue.

Has TV replaced playing outdoors? The researchers found that the 4-year-olds in the study spent almost 4 hours a day in front of a screen — which is a lot, and almost double the (generous) American Academy of Pediatrics’ suggested upper limit — nevertheless, screen time wasn’t correlated with how often parents took their kids out to play.

There was also no correlation with household income or mom’s marital status. 

There were, however, two interesting variables that increased the odds of getting regular fresh air: boys were taken out more often than girls, and moms who exercised regularly were more likely to the take their kids out.

It seems like active parents raise their kids to be more active, and perhaps the known statistic that boys are generally more active than girls can be partly explained by the fact that boys are given more opportunities for activity. 

Get outside!

Being active starts at home and with the parents.

Barring dangerous weather, kids — and adults — I do believe, will do themselves some good by spending some time outdoors every day. Regardless of what happened at day care or school, parents should encourage kids to go out, run around, look at trees and birds, meet some insects, get dirty and come back tired. I can’t think of a better way to take a break from work, media and chores than to leave them all behind and go out with the kids. Soon enough these young kids will be able to enjoy the outdoors without adult supervision, and if you’ve collected some great outdoor memories you’ll be rewarded with outdoor enthusiasts for life.

Dr. Ayala

“Sunshine is delicious, rain is refreshing, wind braces us up, snow is exhilarating; there is really no such thing as bad weather, only different kinds of good weather.” ~John Ruskin