Healthy Food & Healthy Living by Dr. Ayala

Cinnamon’s for eating, not inhalation

Common sense is slow to develop in humans, and many a time young people will sit around throwing around silly ideas – and then go on to act on the silliest of them all.

And as if kids can’t come up with enough stupidity all on their own, access to a world wide web of thoughts feeds them more tricks and dares – YouTube is great at that.

The cinnamon challenge is nothing new, but I heard about it from my kids only a couple of years ago. The challenge: swallow a tablespoon of ground cinnamon in 60 seconds, without drinking fluids.

Fail to swallow a spoonful of cinnamon, and you might still have your moment of glory in this viral sensation: more than 50,000 YouTube clips, one popular clip with 30 million views (these numbers might be irrelevant by the end of today) and it’s all over Twitter. Subjecting the Cinnamon Challenge to a Google fight (fun site in which you can battle two words or phrases against each other to see which is more Internet popular) shows that cinnamon challenge with its 15 million search results is more popular than chewing gum (7 million). 

Cinnamon sounds innocent enough – every baking home has some, and what can be more natural than an ancient spice from tree bark.

So here’s an opportunity to teach kids a few basic principles in toxicology:

• Dose matters. As Paracelsus famously said: The dose makes the poison. Even water and oxygen – which we can’t survive without -- can be toxic if you have too much of them.
• Safe to eat doesn’t mean it’s safe to introduce into your body in any other way. Do you like hot peppers? So do I. They’re pleasant only by mouth. Water is fine to swallow, and to wash with, but if you inhale it it’s called drowning.

Back to the cinnamon challenge.

An article in the recent issue of Pediatrics warns that the cinnamon challenge isn’t all fun and games. Inhaling cinnamon can damage the lungs and airways, and although the effects are usually temporary, it has led to many emergency room visits, hospitalizations, and a few teens even requiring ventilator support for collapsed lungs.

You see, the cellulose fibers in cinnamon, once in the lungs, do not dissolve or break down – they stay there and are not inert. The authors, led by Steven Lipshultz, cite a study in which cellulose was introduced through the windpipe of rats. This caused inflammation and lung damage, and the results were apparent even a year after the exposure.

When a teen attempts to swallow a large mount of cinnamon there’s a pretty high risk of breathing in some of the cinnamon powder. The powder can damage the lining of the airways and lungs and even cause permanent scarring. Introducing a foreign substance into the airways is even more dangerous for people who have asthma. 

Bottom line, there are better – tastier, and more creative – uses for cinnamon.

I’m just afraid that warning kids about the dangers of the challenge – or locking the cinnamon along with the liquor as some parents have suggested – will introduce it to the few that haven’t heard about it yet, and just increase its allure.

Dr. Ayala

Is there a better way to 5 a day?

We’re constantly nudged to eat our 5-a-day of fruits and veggies, but never seem to quite get there. Surveys show that just 14 percent of Americans eat 5-a-day, and the numbers are lower for teens, with only 9.5 percent eating 2 fruits and 3 veggies daily.

Are people unaware of the recommendation? Probably not. The 5-a-day message has been quite successful, and surveys show that the majority of people are aware that they should eat a minimum of 5; it’s the details and portion sizes that are less clear.

Is the message poorly delivered, or is the 5-a-day so pie in the sky that many people don’t even try?

Maybe we should set a more realistic, small step goal – after all, one would assume that suggesting 30 minutes of exercise twice a week would be more doable than urging a daily session.

Big goals, or small steps?

A new study, published ahead of print in Appetite, set out to see if asking students to eat just 1 more fruit or veggie worked better than encouraging them to eat 5-a-day. The researchers hypothesized that just-1-more would have better results. Would that be your prediction?

The authors, led by Nadine Ungar, randomly divided 84 psychology students, who started off with under 4 servings a day, into 3 groups. The just-1-more group was asked to increase fruits and veggies by one more a day for a week. The 5-a-day group was asked to eat 5 servings, and the control group was told to eat as usual. After the week of treatment the participants returned their food diaries, and a week later they were asked to fill in a questionnaire again, reflecting their intake post the trial period.

This is what happened: the 84 students ate about 2.5 servings before the intervention. During the intervention just-1-more participants indeed increased their intake by almost 1 serving (0.96 serving, to be precise).  5-a-day increased intake precisely to 5-a-day – an additional 2.5 fruit and veggies servings. The control group, surprisingly, increased intake by 0.7 servings.

One week after the intervention. The just-1-more went back to almost baseline (fruits and veggies were at 0.27 above base, not significantly different from the controls), while 5-a-day were at 1 additional serving.

5-a-day was more effective, and the researchers state that setting the higher goal – and a more specific one – worked better, at least for this group.

Unfair competition

I hear a lot about the struggles people have with eating better, and with getting their kids eat more veggies.

I do feel the pain, but I don’t think it has all that much to do with fruits and veggies.

Eating veggies and fruits is not like going to the doctor for shots, or even like flossing teeth. It is not something you do just because it’s healthy. 

People ate fruits and veggies a plenty well before they knew they were healthy (indeed, people once thought tomatoes were deadly poisonous).

I think the main reason people don’t eat enough fruits and veggies nowadays isn't because they’re not tasty, or because they don’t know it’s good for them.

The main reason, I think, is the competition.

The competition, high caloric density foods and foods that are highly rewarding because of their sugar, fat and salt content, are ubiquitous. They are endlessly promoted, and often cost less than fruits and veggies. Combine our natural tendency towards densely caloric, tempting foods, with greater availability and the allure created by ads, fruits and vegetables turn pale and humble despite their bright colors, wholesome beauty and very appealing – yet mellow compared with the competition’s -- taste.

My suggestion is to inform about the importance of 5-a-day -- it’s should actually read at least 5-a-day, and has been swapped in the US by MyPlate on which half the plate is devoted to fruits and veggies – because knowing the science-based guidelines is imperative. But I wouldn’t beg and plead, or even endlessly remind; it’s annoying, and counterproductive.

Perhaps the most effective way to get the fruit and veggie habit going is to remove some of the competition. If you serve 2-3 vegetable sides, and small portions of the protein entrée, if you present a bowl of strawberries and nothing else as an afternoon snack, there’s a much better chance that the fruits and veggies will be welcomed than if you served these together with loads of pasta, fried foods, sweet and salty snacks and other highly competitive options. 

When fruits and vegetables are viewed by themselves, very few people find them objectionable, and many will name favorites. But fruits and veggies are in an unfair competition for stomach share, and since it is quite proven that a more plant based diet can benefit us all, I suggest we work on removing some of the competition, at least at home.

Competition is usually healthy, but when it comes to salad competing against a hamburger with French fries, the competition makes the healthy choice ever so difficult.

Dr. Ayala

Eat Healthy! Everybody’s Doing It!

What do you think is going to lead more students to the salad bar, telling them that most of their friends eat vegetables, or stating that eating vegetables is good for you?

We know that peer pressure can push people to do the right – or wrong – thing. What we think is “normal” or “typical”, and our perceptions of what others have and do, influences our decisions. Many campaigns encourage us to join the majority: “Four out of five dentists surveyed recommend…" and “billions and billions of people served” led us to believe the decision has already been made by everyone, so it must be a good idea. Social psychologist Robert Cialdini showed in a series of studies that when hotel guests were told that the majority of guests reused their bath towels, they were more likely to reuse them, too. This social norm message outperformed environmental reasoning and even a promise to donate money if guests helped reduce towel laundry.

Educational information about nutrition could appeal to those seeking to eat better, but on the other hand telling kids what’s good for them might seem like unwelcome pressure, and might backfire and cause resistance rather than adoption of the good habit.

So which approach, if any, would you use?

Your friends eat here

A new study in Appetite (online ahead of print) conducted an experiment in an on-campus food court in an eastern American university. The experiment took place in an area with two food stations: a salad bar and a grill area serving hamburgers, chicken tenders and fries. The 220 students who participated in the study saw one of three signs:

1. “Every day more than 150 [name of university] students have a burger for lunch here”, accompanied by the university’s logo and photos of the grill area.
2. “Every day more than 150 [name of university] students have a tossed salad for lunch here”, accompanied by the university logo and photos of the salad bar.
3. “Have a tossed salad for lunch”, accompanied by a picture of the salad bar and the university’s logo.

In the control condition no signs were posted.

Message 2 resulted in more students choosing salad compared with the control condition. Message 3, surprisingly, did not lead to significantly more salad choices compared to the control condition. Message 2 and 3 did increase the number of salad choices when compared to the message 1 condition.

What if the norm isn’t healthy?

The sign telling students that salad is a popular choice outperformed the message suggesting that eating salad is what they should do.

But in order to use social norm messaging people need to believe the norm described is indeed true and real. In other words, we need to reach a point in which a majority is indeed following a positive habit in order to market the healthy choice as what everyone’s doing.

When it comes to healthy eating this is rather hard to do. Eating unhealthy, calorically dense foods is very common in many social circles, and research even suggests weight gain ‘spreads’ in social groups, perhaps because people tend to follow the choices of their peers.

So how can we support an “everybody’s doing it” healthy behavior? 

Perhaps we should look at admired groups of people in which this behavior is indeed the norm. Do actresses eat a lot of veggies? Do tennis players follow a healthy diet? I’m sure we can find a trendy group of people in which “four out of five” or at least the majority are role models for healthy eating.

And let’s not forget that perceived social norms (some of them not normative at all) are also created – quite intentionally – by clever, repeated depiction in movies, TV, music and ads. I’d love to see healthy eating inserted into media in place of alcohol, junk food and sugary drinks.

Any suggestions?

Dr. Ayala

 

Are kids going to eat less junk in school cafeterias?

The days of snacking on candy, soda and chips in schools may soon be over. Last Friday, the US Department of Agriculture (USDA) announced new proposed standards for snacks sold at schools. The standards limit the amount of calories, fat, sugar and sodium of most foods sold at school, and encourage whole grains, low fat, fruits and veggies. A few examples: Yogurt, granola bars, trail mix, dried fruit and fruit bars, pizza on whole grain crust and baked potato chips are in. Candy, caloric soda, sweetened fruit juice, and most cookies are out.

Perhaps anticipating the backlash, the proposal exempts fundraisers, afterschool sports events and treats sent by parents – including birthday and holiday party goodies. It also allows for a yearlong transition.

The rules, required under the child nutrition law passed in 2010, are an effort to combat childhood obesity and close an obvious loophole: while the government-subsidized school lunch has to comply with nutrition rules, what’s sold a la carte, in school stores, snack bars, or from vending machines, and competes for kids’ stomach share and lunch money, isn’t federally regulated at all, and can be of no nutritional value whatsoever.

Is it going to make a difference?

Is there evidence that stricter rules at school will encourage kids to eat less junk? Since many states and cities have already established regulations regarding foods sold at schools, there are already some comparisons that can be made. 

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. Last year I reported on a study in the Archives of Pediatric & Adolescent Medicine that compared California high school students’ daily intake to the intake of students from 14 states without any school nutrition standards, and showed that California kids ate fewer calories and consumed less fat and sugar per day at school -- 170 fewer – compared to high school students in other states. And the kids didn’t load up the missed calories after school. The Californian students took in 158 fewer calories a day, overall -- a reduction of 158 calories is a big deal as we gain weight very gradually, and reducing even 100 calories a day can prevent weight gain and put a dent in the obesity crisis.

Another study in Health Education & Behavior compared 3 middle schools that implemented a healthier snack and beverage nutrition policy with 3 that had no guidelines. Removing these items not only resulted in lower consumption of junk food at school and overall (no compensatory junk eating at home), it also didn’t seem to result in negative preoccupation with weight.

The New York Times recently reported that after decades of rising rates of obesity, several cities are reporting a decline. Philadelphia, my hometown, reported a 5 percent decline, and has seen this decline among minorities, and not just among high-income families. Philadelphia has implemented broad policies to fight obesity, including a ban on sugary drinks in school vending machines, and school snack guidelines that limit calories, fat and serving size. It’s hard to credit any one public health policy for the changing trend in childhood obesity rates, but the results are encouraging.

The importance of a healthy school environment

It will take a while until the snack food regulations are installed, and even longer until we can see their effects on kids’ diets.

But I think that paying attention and debating the foods sold at schools will have immediate educational outcomes.

As Agriculture Secretary Tom Vilsack said in a press release last Friday: "Parents and teachers work hard to instill healthy eating habits in our kids, and these efforts should be supported when kids walk through the schoolhouse door".

School, or government, doesn’t determine what kids eat, but it can definitely set minimum standards that promote healthier choices, or at least not undermine healthy nutrition efforts by condoning and profiting from the sale of junk within school walls.

Discussing unhealthy snacks, and removing them from the cafeteria, has an educational purpose. I wouldn’t be surprised if it influences the bottom line of what kids actually consume (kids do eat more than half their daily calories at school), but it’s worth doing, regardless.

When the vending machine changes what’s in its belly, kids consciously or unconsciously, notice; this exposure can change minds, and hopefully also what’s in kids’ bellies.

The USDA proposal will be open to public comment for 60 days. In the meantime, I’d love to hear your comments here. 

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

Looking for admiration? Serve some veggies!

I happen to be one of the people that can get seriously excited about a particularly fresh, colorful vegetable, prepared just right, or even served raw, sliced just so and dressed well. Most people aren’t as eager to eat their veggies – they’re looking forward to biting into a juicy steak, or whatever’s the ‘main’ dish. Veggies are at most a sideshow.

And since most people aren’t excited about eating veggies they don’t eat enough of them.  Although the five-a-day campaign has been successful in making Americans aware they should be eating more fruits and veggies, only 11 percent actually do so, and while My Plate, the new nutrition guide from the USDA, devoted half the plate to fruits and veggies, only 23 percent of Americans have any vegetables on their dinner plate.

So how do we convince people to put more veggies on the dish?

Brian Wansink Misturu Shimizu and Adam Brumberg from Cornell University’s Food and Brand Lab have a new argument that can certainly appeal to moms, dads and any other food provider who wants to be a hero: Putting veggies on the plate gives the perception of a loving, capable cook.

Serving vegetables makes you a 'good cook'

In their new study, to be published in Public Health Nutrition, Wansink’s group asked 500 American moms who had at least two kids at home to evaluate meals. The participants assessed the personality of women who either prepared -- or did not prepare -- veggies with a family meal, and rated four different meals that either included a vegetable or had no veggies. Respondents were asked to describe the cook and to evaluate the meal itself. 

They found that having a vegetable on the side made the main dish rate higher for taste: Steak with broccoli was favored over steak alone, or steak served with a starch.

This is something restaurant owners know. In professional menus sides help the main course look good – the side helps sell the main dish -- and chefs know that dishes have more appeal if served over, under and garnished with veggies.

But here’s the most interesting part: When asked about their perception of the cook that made the meal the participants selected descriptors such as “loving” “thoughtful”, “attentive” and “capable” to the meal preparers that included veggies. Mind you, preparing the veggies in the proposed meal was no more involved than heating up a bag of frozen green beans – how’s that for return on investment. The attributes selected for the cooks who served steak, chicken or pasta without veggies were more often “neglectful”, “selfish” and “boring”.

So this is what moms thought in a sterile study environment. Does it guarantee kids would see it the same way? It’s hard to say, but I find that eventually kids tend to adopt their parents’ habits and point of view regarding food.  Being admired by other grown-ups can’t hurt either.

Pleasure, not just health

Kids hardly care about health. Making an “it’s good for you” argument doesn’t carry much clout, and asking kids to eat their veggies for the thousandth time doesn’t make for interesting dinnertime conversation.

I found this study inspiring because it demonstrates that serving veggies for hedonic reasons alone makes sense and can have a positive impact. That’s in fact, how my mom got me to love my veggies. In the end, it’s the pleasure of the food and the experience around it that create good eating habits. 

And speaking of pleasure, can you guess which veggies are most favored? Broccoli tops the list for most family members, except for young boys who prefer corn and carrots to broccoli. Are you surprised?

You may want your family to eat veggies for their health and weight maintenance qualities, but who can resist some adoration? Do you need a better motivation?

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

 

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 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?

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

 

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 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