Healthy Food & Healthy Living by Dr. Ayala

European study confirms: Sugary drinks linked to diabetes risk

Type 2 diabetes rates are clearly climbing, and have tripled in just 10 years.

The rise in sugary drink consumption has paralleled the rise in obesity and type 2 diabetes, which now afflicts ever-younger patients. And while obesity is a risk factor for type 2 diabetes, researchers have wondered whether sugary drinks are an independent risk factor, regardless of weight gain.  There's something quite special about sugary drinks' sugar concentration and rate of sugar delivery. We're gorging on growing amounts of sugars, which find their way into many of our processed foods. But the major source of added sugar in the Western diet is – you might be surprised – not desserts, but rather sugary drinks, which account for as much as half the daily calories from sugar, and 10-15 percent of kids’ total daily calories.

A study in the Archives of Internal Medicine looked at the relationship between consumption of sweetened soft drinks and fruit drinks and type 2 diabetes in 44,000 African American women, and found that women who consumed two or more soft drinks a day had a 24 percent increase in incidence of diabetes relative to women who drank less than one soft drink per month, a relationship that remains valid after controlling for obesity.

A meta-analysis, published in Diabetes Care in 2010, pooled more than 310,000 participants, and found that higher intakes of sugary drinks were associated with the development of the metabolic syndrome and type 2 diabetes.

Another recent study in PLoS One looked at the relationship between sugar availability and diabetes prevalence in 175 countries. After accounting for many factors, such as obesity, exercise, poverty, age, etc., the study found that the higher the sugar in the countries’ food supply, the higher the diabetes rates. The article’s conclusion: “every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1%.”

Most of these studies were in North American populations. Now, a new study published in Diabetologia takes a European perspective on the sugary drink diabetes link.

The study, which followed a very large population from 8 countries for 16 years, found about 12,ooo people who developed type 2 diabetes during follow-up, and compared them to 16,000 random controls from the same large cohort. It found that after taking into statistical account confounders such as smoking, education, physical activity, diet etc., drinking what amounts to one can of sugary drink a day increased the risk of diabetes by 22 percent. When the data was adjusted for weight (BMI) and caloric intake, the association was still strong, and the extra risk was 18 percent.

The authors discuss:

“The association between sugar-sweetened soft drinks and diabetes was only slightly attenuated when BMI was included in the model, which could indicate that obesity is neither the only nor the main mediator of the association, and that other mechanisms of action might be involved, such as the glycaemic effect of sugar-sweetened drinks and consequent insulin resistance”

In other words, sugary drinks may lead to obesity, which is a risk factor for diabetes, but sugary drinks consumption is a diabetes risk in and of itself.

Their advice:

“Given the increase in sweet beverage consumption in Europe, clear messages on its deleterious effect on health should be given to the population.”

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. 

Can you eat your way out of hot flashes?

Menopause is something I rarely think about. My take is that there’s no reason to anticipate and fret over life events that haven’t yet happened. I’ll dream about my next vacation, even when it’s far off, because it’s a nice respite, but with menopause I’ll deal only when it comes.

But new research I just read makes me think that there might be some merit to planning for this life transition. The study, published in the American Journal of Clinical Nutrition looked at the connection between hot flashes and what women eat, and offers further support to the notion that diet can relieve these very annoying symptoms.

What’s a hot flash? They say that, much like becoming a parent to a newborn, until you get one, you don’t understand what it’s really like. It’s described as a feeling of increased skin temperature, profuse sweating, sometimes accompanied by facial flushing and a rapid heart rate. It’s not dangerous, and it’s extremely common, but when it happens at night it interrupts good sleep, which is the cornerstone of health and wellbeing in my opinion.

Veggies and fruit protective; fat and sugar a risk

The Australian study included about 6000 middle-aged women, who were followed for 9 years. The women were asked about night sweats and hot flashes, and about their food habits.

After adjustment for confounders such as education level, smoking, obesity, physical activity etc., two food patterns were associated with fewer hot flashes: high fruit intake and Mediterranean style diet (veggies, garlic, red wine, tomatoes). On the other hand, high fat and high sugar diets were associated with high rates of reported hot flashes.

What does food have to do with hot flashes? The exact cause of hot flashes is unknown, but it is thought that estrogen withdrawal, which happens during menopause, disrupts our body’s thermostat.  Hormone replacement is one of the most effective treatments for severe symptoms, but hormonal therapy does carry some risk, therefore lifestyle modifications that can offer relief are in high demand.

Foods for hot flashes

Some women recognize certain foods trigger hot flashes for them. General food triggers include caffeine, alcohol and spicy food.

Several years ago, soy products were heavily favored for the prevention of hot flashes. Soy has plant estrogens (phytoestrogens), which were believed to provide natural estrogen replacement. Asian women, who live in countries where soy is a big part of the diet, also report fewer hot flashes than women in western countries (there are of course many lifestyle differences that can explain this phenomenon, and complaining might be cultural, too). The effectiveness of soy for hot flashes still remains controversial, though, with some studies showing benefits, and others showing none. 

Can a more plant-based diet affect the incidence of hot flashes? There are many mechanisms that can provide a logical explanation for why that might be a real connection. Foods affect estrogen metabolism; sugar metabolism and blood glucose levels might affect blood vessel dilation and contraction, for example. The authors of this study say theirs is the first ever study to look at dietary patterns and hot flashes, and it would be interesting to see if further research can confirm these findings.

As a woman, though, if you needed another reason to eat your plants and move away from high fat and high sugar foods, here it is.

Dr. Ayala

A miracle diet that prevents cancer?

If you’re ready to believe the sensational titles and overhype in mass media, miracle super foods that decrease the risk of cancer are discovered every other week.

Except miracles are just that: something that rarely happens, and many of these reported ‘proven’ food cures are based on flimsy findings, never again to be reproduced.

Nevertheless, health experts are unanimous about the effect our diet as a whole has on health, and on cancer risk. The World Health Organization estimates that 25 percent of death burden in developed countries is due to lifestyle – completely up to us – risk factors.

8 healthy habits

In 2007, a collaboration between the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) evaluated the evidence and produced consensus recommendations for reducing the risk of developing cancer and for promotion of general good health and wellbeing. The WCRF/AICR report is the largest study of its kind, and its conclusions are as definitive as the available evidence allows.

The report featured eight general diet and lifestyle recommendations for cancer prevention:

“1: Body Fatness: Be as Lean as Possible Within the Normal Range of Body Weight.” Maintaining a healthy weight throughout life may be one of the most important ways to protect against cancer, and being overweight or obese increases the risk of some cancers.

“2: Physical Activity: Be Physically Active as Part of Everyday Life.”

“3: Foods and Drinks That Promote Weight Gain: Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.” Sugary drinks were targeted specifically in the report: “Such beverages appear to exert little influence on total daily self-selected energy intakes and their habitual consumption can lead to rapid and sustained weight gain even in the face of restricted solid food intake”. Another recommendation under this heading is “Consume 'fast foods' sparingly, if at all.”

“4: Plant Foods: Eat Mostly Foods of Plant Origin.” Diets that are protective against cancer are characterized by large intake of foods of plant origin and, indeed, several cancers are responsive to increased intakes of plant-based foods.

“5: Animal Foods: Limit the Intake of Red Meat and Avoid Processed Meat.”

“6: Alcoholic Drinks: Limit Alcoholic Drinks.” (Men-to 2/day, women to 1/day).

“7: Preservation, Processing, Preparation: Limit Consumption of Salt and Avoid Moldy Cereal Grains and Pulses (Legumes).” Salt and salt-preserved foods probably contribute to stomach cancer risk, and foods contaminated with aflatoxins are a cause of liver cancer. Although salt is necessary for human health, typical levels of consumption are vastly excessive.

“8: Dietary Supplements: Aim to Meet Nutritional Needs Through Diet Alone.” Dietary supplements are not recommended for cancer prevention. According to the report the greatest danger associated with the use of dietary supplements is the possibility that consumption of supplements is serving as an alternate to good nutrition, and supplements are taken as “magic bullets” to compensate for cancer-friendly dietary and lifestyle practices.

So, not as easy as popping a supplement or drinking acai juice, but does this recipe for cancer reduction and longevity actually work?

Not a shortcut, but it will get you there

A new study in the American Journal of Clinical Nutrition, including almost 400,000 people from 9 European countries, scored participants’ compliance with the 6 first WCRF/AICR recommendations (there was insufficient data to assess recommendations 7 and 8). Women were also assessed for another WCRF/AICR recommendation specific to women: Breastfeeding. The total possible score for a man was therefore 6, and for a woman 7. The group was followed for about 12 years, and during that time almost 24,000 people died, 48 percent of them from cancer.

People with the highest WCRF/AICR score (5-6 for men, 6-7 women) had almost 34 percent lower risk of dying than those that had the lowest scores (0-2 for men, 0-3 for women). Each additional point in the WCRF/AICR score was associated with a 1.2 year increase in life expectancy, and a higher score was associated with lower risk of death from cancer, cardiovascular disease and breathing problems. The recommendations regarding overweight and obesity, and eating plant food, were the most strongly associated with risk of dying.

We like things fast and now, and the WCRF/AICR recommendations aren’t a shortcut, but isn’t it nice to know that we do have some control over our heath trajectory?

Dr. Ayala

Is sugar making the world fat, diabetic, and hypertensive?

We’re moving towards a world with a shared diet. Pizza Hut, Taco Bell, KFC, McDonald’s, Coca Cola and Pepsi can be found worldwide and consumers around the world and in developing countries have developed a taste for our highly processed food.

The shift from traditional diets in developing countries towards a Western diet – a diet high in refined sugars, animal based foods and vegetable oils – is known as nutrition transition. While this shift affords more food security and cheaper food, the move towards a Western diet has major health consequences, chief among them being obesity, diabetes and heart disease.

What is it about the Western dietary pattern that puts populations at risk?

Sugar, obesity and disease

A new study in Public Health Nutrition, looked at the rates of overweight, obesity and high blood pressure (which are major risk factors for heart disease) in countries around the world, and these countries’ availability of foods, including cereals, sugars, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood.

The study, led by Mario Siervo, found that sugar consumption was directly associated with overweight, obesity and high blood pressure. Low intake of cereals and physical inactivity were also contributors, but nothing predicted how fat a country would be as much as how much sugar it consumes.

Coincidentally, another article looking at what people eat around was just published in PLoS One. This widely publicized article, by Sanjay Basu, Paula Yoffe, Nancy Hills, and Robert Lustig looked at the relationship between sugar availability and diabetes prevalence in 175 countries. After accounting for many factors, such as obesity, exercise, poverty, age, etc., the study found that the higher the sugar in the countries’ food supply, the higher the diabetes rates. Their conclusion is: “every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1%.”

What is it about sugar?

In a fascinating article about the science of creating addictive food in the New York Times, Michael Moss describes the well known recipe to increase sales: “one of the cardinal rules in processed food: When in doubt, add sugar.”

Sugar makes food craveable. That’s why sugar’s in everything.

So does sugar just make us consume too many calories because it makes food tastier and more desirable, or is there something inherently fattening and unhealthy about sugar?

Dr. Robert Lustig is one of the leading voices warning that sugar is a major culprit in obesity and disease, and that sugar punishes us beyond the 4 calories per gram it sneaks in. Sugar, and especially its fructose component, Lustig claims, when consumed in excess, hits the liver rapidly, and drives a whole cascade of metabolic outcomes, and causes fat production and insulin resistance. Lustig’s new PLoS One article supports this theory.

Lustig has his critics, of course, and other obesity and nutrition experts believe sugar drives obesity and disease just because of the quantities and rates we consume of the sweet stuff.

Regardless of how we explain the sugar disease connection, there’s no doubt that to improve health we need to reduce sugar intake.

The World Health Organization recommended in 2003 that “added sugar” be limited to 10% of a person's caloric intake. The American Heart Association (AHA) went further and recommended that women should consume no more than 100 calories of added sugars per day (6 teaspoons), and most men, no more than 150 calories (9 teaspoons). One 12-ounce can of Coke contains 130 calories in added sugars, which puts women over the AHA upper limit – no room for bread, sweetened yogurt, and just forget about dessert.

Unfortunately, we don’t even know how much added sugar is in our processed food, as our food label only lists total sugars — both innate carbs and added sugar — in the sugar component of the label. 

Efforts to curb sugar consumption in the US face strong opposition from industry.  The Yale Rudd Center summarizes progress and efforts to reduce sugary drink consumption in different states in this nifty interactive map. Although sugar consumption is very high in the US and in other developed countries, it has plateaued, and even declined in the last decade. The new study in Public Health Nutrition reminds us that in developing countries sugar intake continues to rise – and will probably result in an increase in chronic conditions such as diabetes and heart disease – therefore the developing world needs policies that limit added sugars, hopefully before the train leaves the station.

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 more sugary drinks you drink, the more you eat

That drinking can make you overeat does sound a bit odd. We have one stomach, after all, and filling it with a caloric drink should reduce the amount we eat -- the drink takes its stomach share and supplies calories, right?

But that’s not the way it is, and accumulating evidence shows that our body has a hard time registering calories from beverages in the tally towards satiety.

When women were served water, diet soda, regular soda, orange juice, milk or no drink with lunch, those drinking caloric beverages consumed about 100 additional calories for that meal. In another study researchers proved that solid candy is better for your waist than soda: when they gave men and women 450 calories a day of either soda or jellybeans for a month, candy eaters ate less food, compensating for the extra calories, while soda drinkers did not, so they ate more calories than usual. Another study looking at the effects of food form (solid, semi-solid or liquid) on appetite, fed participants either a whole apple, applesauce or apple juice of equivalent caloric value. The apple juice reduced hunger the least, the whole apple reduced hunger the most and the applesauce response was intermediate  -- people who had apple juice where ready for their next meal almost an hour earlier than those that had a bitable apple. 

The more you drink the hungrier you get

Not only do drink calories go uncounted, some studies also show that when you drink calories you may add not just the calories of the drink, but even some extra food.

A new study in the American Journal of Clinical Nutrition looked at what 13,704 people drank over 24 hours, and what and how much these people ate.

The correlation was straightforward: people reporting higher caloric intake from sugary drinks also consumed more calories from food. They also tended to eat foods with higher caloric density, and eat more saturated fat, sugar and salt. This study also showed that the more calories people drank, the more snacking they did, and the longer their snacking episodes got.

This study further demonstrates that calories that you drink aren’t well compensated for: the people in this study who drank an average of 1000 calories a day ate an additional average of 22oo calories, bringing their total daily caloric intake to 1100 higher than people on the lower range of sugary drink intake – and 350 of these extra calories came from extra food.

Drinking and eating: a vicious cycle

This is a correlation. It seems like people who drink more calories (mostly from added sugars) eat more, and eat less healthfully, but does that mean that drinking leads to eating? This study can’t prove that. Maybe bad habits just cluster.

The authors speculate that while drinking more calories might lead to eating more food and eating poorly, it’s also possible that each bad habit begets the other -- drinking soda leads to eating a lot, and eating calorically dense foods leads to drinking more soda – a vicious cycle feeding itself.

Watching what you drink can break that cycle, and that’s why all reasonable weight loss and healthy nutrition advice emphasize elimination or reduction of sugary drinks. Getting rid of the sugary drink’s calories is the first bonus, but for many people changing the sugary drink habit holds the promise of other positive eating behavior changes that can follow, much more easily.

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.

 

 

 

13 lies dieters tell themselves

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

Feel free to add your own in the comment section.

 

Olive oil is good for you

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

 

This pack’s only 100 calories

(that’s when you eat just 1, not 4)

 

It’s only 140 calories

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

 

I’ll sweat this dessert off

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

 

It’s fat-free 

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

 

It’s sugar-free

(did you look at the fat?)

 

It says no added sugar

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

 

I found this miracle diet

(there are no miracle diets, silly)

 

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

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

 

Wine is good for your heart

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

 

It was a small portion

(smaller than a mountain, for sure)

 

After this, I’ll eat nothing ‘till tomorrow

(it’s 2pm!) 

 

But I skipped breakfast!

(skipping breakfast awards no prizes)

 

Final thought:

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

Have a happy and healthy Thanksgiving.

Dr. Ayala

A revised food label that isn’t a dream

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

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

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

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

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

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

How realistic is the Bittman label?

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

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

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

Loads of information, but important information’s still missing

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

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

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

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

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

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

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

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

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

Understanding the label leads to better choices

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

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

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

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

Dr. Ayala

 

The unhappy truth about sugary drinks

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

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

 

Dr. Ayala

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

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

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

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

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

Proving the obvious

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

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

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

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

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

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

Why target sugary drinks?

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

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

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

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

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

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

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

Dr. Ayala

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

Energy drinks under investigation: Are they healthy or dangerous?

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

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

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

What’s in an energy drink?

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

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

Are energy drinks safe for kids?

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

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

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

Marketing to the young

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

Energy drink regulation

The FDA’s upper limit of caffeine in soda is 71mg per 12 fl oz. This upper limit is easily circumvented by labeling energy drinks as dietary supplements.

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

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

The authors, led by Sara Seifert, conclude that energy drinks have no therapeutic benefit, that these drinks may put some children at risk for serious adverse health effects and that labeling of energy drinks as nutritional supplements shields manufacturers from safety testing and labeling required by food and pharmaceuticals makers. 

Renewable energy 

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

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

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

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

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

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

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

Dr. Ayala

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

The sugar wars: Is fructose really toxic?

 

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

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

Food sugar 101

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

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

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

Is fructose more harmful than glucose?

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

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

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

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

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

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

The dose makes the poison

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

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

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

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

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

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

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

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

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

Dr. Ayala

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

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

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

 

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.

 

Flat Belly Tip: Eat More Fiber

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

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

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

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

Lifestyle and belly fat

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

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

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

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

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

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

Fiber: soluble, insoluble, and where to find it

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

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

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

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

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

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

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

Fiber for a flat belly

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

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

Dr. Ayala