Healthy Food & Healthy Living by Dr. Ayala

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 

 

My Mom’s Super Comforting Vegetable Soup

This is the vegetarian version of the all-healing chicken soup.  Works just as well, I think, if not better.

Made of simple, inexpensive ingredients, and requiring very little chopping (thanks to my loyal helper, the food processor) this vegetable soup is one of the best ways to get a lot of the veggies you need all in one dish, and the whole grains in the soup add substance, richness and protein to the mix.  Nothing like a big pot of soup for the cold days ahead!

Ingredients:

• 2 tablespoons canola oil
• 2 large onions, chopped
• 1 leek, white and light green parts only, thinly sliced
• 1 teaspoon paprika
• 1 teaspoon salt
• Freshly ground pepper to taste
• 2-3 celery stalks, stringy tough outer parts peeled, diced
• 2-3 zucchini, peeled
• 4 potatoes, peeled
• 3 carrots, peeled
• 1 large sweet potato, peeled
• 1 parsnip, peeled (optional)
• 1/3 cup pearled barley, rinsed
• 1/3 cup old-fashioned rolled oats
• 8 cups good-tasting vegetable broth
• Finely chopped parsley or chives, to serve

Preparation:

In a large soup pot heat the canola oil over medium-high heat, add the onions and leeks and the seasoning: paprika, salt and pepper. Cook, stirring frequently, until onions are translucent, 5 to 8 minutes.

While the onions and leeks are sweating in the pot, using a food processor, grate all the other vegetables -- zucchini, potatoes, sweet potato, carrots and parsnip – using the course grating plate.

Add the diced celery and the all the grated vegetables. Sauté for about 5 minutes until the vegetables are a bit tender and start to brown.  You may need to add a touch of water if your pot looks too dry.

Add the pearled barley and the oatmeal and stir.

Add the broth and bring the pot to a simmer.

Cook until the barley is soft, about 20 minutes.

Taste, and add more salt and pepper if needed. Finish with chopped herbs and serve

Serves many, and is even better the next day.  Keeps well for 5 days in the fridge.

 

Enjoy in good health,

Dr. Ayala

Reposted in Fight Back Friday

Thanksgiving Healthy Side Dish Recipe Collection

I have much to be thankful for this Thanksgiving and I want to take this opportunity to thank you for your kind readership. 

In case you're still looking to add some color and health to your big meal, or looking for "cleansing" recipes for the coming weekend, I'd like to share a few of my healthy Thanksgiving/fall recipes, most of which can be prepared well in advance and require minimal finishing touches.

I'd also like to share a wonderful New York Times article by John Tierney, emphasizing the health benefits of gratitude.  Tierney writes:

"Cultivating an “attitude of gratitude” has been linked to better health, sounder sleep, less anxiety and depression, higher long-term satisfaction with life and kinder behavior toward others, including romantic partners."  

But how do you get to this heightened level of gratefulness?  Tierney consulted with some of the greatest experts in the field and provides tricks and practical advice -- really simple ideas that I liked a lot! On adopting the "it could be worse" attitude:

"Instead of focusing on the dry, tasteless turkey on your plate, be grateful the six-hour roasting process killed any toxic bacteria."

Wishing you a happy and healthy holiday,

Dr. Ayala

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Roasted squash and chestnut soup with mulling spices

 

This is a terrific fall soup, perfect for the Thanksgiving holiday. It’s easy to make, and requires no pre-prepared soup stock. The aroma of the mulled spices is festive and somewhat surprising in a soup.

Ingredients:

• 2 butternut squash, peeled, halved lengthwise and cored
• 1 large onion
• 1 tablespoon canola oil
• 1 pound peeled roasted chestnuts (you can find peeled chestnuts sold in jars)
• 1-2 tablespoons honey
• Salt and freshly ground pepper to taste

For the mulling spices:

• 2 cinnamon sticks
• 1 teaspoon whole allspice 
• 1/2 teaspoon whole cloves
• 5 cardamom pods, bruised
• Orange peel zest (the outer colorful skin of the orange peel)--about half an orange

Preparation:

Preheat the oven to 400 degrees F.

Place the squashes, cut-side down, on a baking pan and bake until tender, about 30-40 minutes. Cut into large chunks.

Gather the mulling spices into a muslin bag, tea ball or cheesecloth pouch. (The orange peel and cinnamon sticks can be allowed to roam free in the pot; they’ll be easy to fish out.)

In a large soup pot, over medium-high heat, sauté onions until translucent.

Add the chunks of roasted squash, honey, salt, pepper, and half the chestnuts.

Add water to cover by 1.5 inch and bring to a boil, then lower to a simmer.

Add the mulling spices, including the orange peel and cinnamon sticks.

Simmer over moderate heat for 20 minutes. Remove from heat. Remove the mulling spices, orange peel and cinnamon sticks.

Puree the soup with an immersion blender. (This is an inexpensive kitchen tool that saves a lot of cleanup. Immerse the blender into the pot in which the food has been cooked, and easily puree it with a switch of a button. If you don’t have an immersion blender you can use a blender or food processor.)

Crumble the remaining chestnuts into the pureed soup.

Taste and correct seasoning by adding ground cinnamon, more salt or some more freshly ground pepper.

To serve:

Garnish with freshly toasted pumpkin seeds (an excellent source of omega 3), and/or a cinnamon stick.

Serves 8-10.

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Roasted red and golden beets, with reduced balsamic vinegar

 

Beets are easy to find, especially between spring and fall. They make for a very simple, delicious, healthy dish that epitomizes fall color to me.
If you can find golden beets, they make for a delightful color contrast with the red beets. They also taste really great.

Ingredients:

• 3 medium red beets, rinsed, not peeled
• 3 medium golden beets, rinsed, not peeled
• 1/2 cup balsamic vinegar for reduced balsamic glaze
• Fresh herbs to garnish (chives, parsley or tarragon)
• Salt and freshly ground pepper to taste
• Optional - fresh goat cheese (chèvre)

Preparation:

Preheat the oven to 400 degrees F.

Wrap each beet in aluminum foil and place in pan in the oven.

Roast until tender and easily pierced with a fork, about 45 minutes to 1 hour.

Remove from the oven and let cool.

When beets are cool enough to handle, peel and slice them. (Red beets can be peeled and sliced in advance. Golden beets change color when exposed to air, so slice just before serving.)

To make reduced balsamic glaze: In a small pan over high heat, bring vinegar to a boil, then reduce heat to medium, and evaporate balsamic until quantity halves and turns to a light syrup.

Drizzle reduced balsamic over the beets.

Season with salt and freshly ground black pepper.

Garnish with fresh herbs, and add goat cheese if desired.

Serves 8-10 as a side dish.
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Herbed brown rice  

Ingredients:

• 2 cups vegetable stock
• 1 cup parsley
• 1 cup cilantro
• ¼ cup mint leaves
• 1 ½ cup brown rice
• 2 tablespoons olive or canola oil
• 2 large onions, diced
• 1 teaspoon paprika
• 1 teaspoon salt
• Black pepper to taste

Preparation: 

Bring the vegetable stock to a boil

Wash the herbs, remove the large stems leaving mostly leaves (you can cheat a little, since it’s all going into the food processor)

Place herbs and ½ a cup of the warm vegetable stock in a blender or food processor and process until you have a smooth chunk-less puree.  Add the puree to the rest of the stock

Wash the rice in a sieve under cold water

In a medium pot heat the oil on medium high, and sauté the onions and the paprika and salt for a few minutes until translucent

Add the rice, and toss around until the rice is aromatic and coated with oil

Add the herbed broth, bring to a boil, and then reduce to a low simmer

Cook rice according to directions – mine cooks for about 1½ hours

Fluff the rice, check seasoning, and serve with a few leftover sprigs of herbs for garnish.

Serves 8-10 as a side dish.

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Wheat berry salad

 

The trick with hard wheat berries is to plan ahead and soak them overnight. These grains are very hard indeed, and will require a very long cooking time if they’re not pre-soaked.

Ingredients:

• 1/2 cup wheat berries, soaked overnight
• 1 large ripe mango (can be replaced with oranges or persimmon), cut into cubes
• 3-4 celery stalks, (fibery outer parts peeled) diced
• 10 dates, pitted and finely chopped (can be replaced by another dried fruit) 
• A handful of dry cranberries
• A handful of nuts, such as roasted almonds, candied pecans or walnuts 

Dressing: 

• 1 tablespoon of a fine sweet and interesting marmalade. I use organic Adriatic fig spread (sold at Whole Foods) 
• 2 tablespoons extra virgin olive oil
• 1 tablespoon balsamic vinegar
• 1 sprig of thyme, finely chopped

Preparation:

Cook the wheat berries by covering them with two inches of water, then bring them to a boil, lower the temperature to simmer, and cook until chewy—about 20-30 minutes. Drain and let cool.

Add all other salad ingredients besides the nuts.

Combine dressing ingredients.

Add the nuts and dressing right before serving.

Serves 6-8 as a side dish.

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Black rice with roasted butternut squash

Black rice

Ingredients:

• 2 cups black rice (I use “Forbidden Rice” from Lotus Foods, sold at Whole Foods in small packages) 
• 2 and 1/4 cups water (this does not conform to the package instructions.  I find that using less water results in better flavor and texture)
• 1-2  tablespoons canola oil
• 1 large onion, diced
• 1 teaspoon salt or to taste
• Optional: chopped fresh parsley or cilantro.

Preparation:

Rinse rice in a strainer under cold running water for 30 seconds

Heat the oil in a medium pot, over medium-high heat 

Stir in the onion and sauté until golden 

Stir in rice and toss around until coated with oil and fragrant

Add salt and water and bring to a boil

Reduce heat to low, cover, and simmer for 30 minutes. By the time the water is absorbed the rice should be done

Garnish with freshly chopped parsley or cilantro and serve hot.

Roasted butternut squash

Ingredients:

• 1 medium butternut squash, seeded and diced to 1/2’’ cubes
• 1 tablespoon maple syrup 
• 1 tablespoon olive oil
• Salt and pepper 
• Optional: chopped sage.

Preparation:

Preheat oven to 400 degrees F

Toss butternut squash cubes with the rest of the ingredients

Spread the cubes out on a baking sheet and roast in the oven until they are tender and slightly caramelized. This will take 25-35 minutes.

Finishing touches:

You can combine the rice and butternut squash, or (my preference) serve them in a large platter where the rice creates the outer circle, and the squash is placed in the center. I like this presentation visually, and it also allows each diner to choose how much of each of the platter components he wants to eat.

Serves 8-10 as a side dish.

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Roasted French string beans with toasted sesame

 

Ingredients: 

• 1 pound French string beans, both ends removed
• 2 tablespoons olive oil or toasted sesame oil
• 2 tablespoons sesame seeds
• Freshly ground black pepper and salt to taste
• A pinch or two of red pepper flakes (optional)

Preparation:

Preheat the oven to 400 degrees F with the oven pan in the oven.

Toss the string bean with the oil and spices.

Spread the beans in one layer on the pre-warmed oven pan.

Bake for 3-5 minutes, until beans become slightly brow and are sizzling, but are still very crunchy and vibrant.

Correct the seasoning by adding salt or pepper.

Serve hot, or at room temperature.

Serves 8-10 as a side dish.
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Pecan yeast “roses” cake

 

Pecan yeast “roses” cake is a perfect indulgence for the close of the Thanksgiving meal and a fresh take on pecan pie.
This isn’t a difficult recipe -- yeast dough is actually easy to work with. The only real challenge is mastering the patience. You’ll have to factor in the rising time the dough needs to fully develop.
The “roses” part of this cake’s name comes from the delicate shapes formed on the individual cakes.

Ingredients:
For basic sweet yeast dough:  

• 3 1/2 cups unbleached flour (I use King Arthur’s bread flour. All-purpose is fine too. Bread flour is a high-gluten flour called for in many bread and pizza crust recipes where you want the loftiness or chewiness that the extra gluten provides. All-purpose flour is made from a blend of high- and low-gluten wheats, and has a bit less protein than bread flour.)
• 1/2 cup sugar
• 1/2 cup milk
• 1/2 cup heavy cream
• 3 tablespoons melted unsalted butter
• 2 yolks
• 1 envelope rapid-rise yeast 
• 1/2 teaspoon salt

For the pecan filling: 

• 2 cups pecans, finely chopped (in the food processor or blender) 
• 1 cup sugar
• 2 tablespoons butter
• 2/3 cup milk

Preparation:

To make the dough:

If you happen to own a bread machine, put all the ingredients in the mixing bowl and use the dough setting.

If kneading by hand: Put all the dough ingredients in a bowl, combine to make dough, and knead for about five minutes, until the dough is soft and elastic and not sticky at all. (Add a bit of extra flour or milk if you haven’t reached a really workable dough within five minutes, but that rarely happens with this recipe.)

Cover the bowl with a clean kitchen towel, and let sit for an hour and a half in a warm place, until the dough doubles its volume.

To make the filling:

Combine milk, sugar and butter in a small pot and bring to a boil, then lower to a simmer. 
Add the nuts, and continue stirring on low heat for a minute or two.

Remove from heat and let chill completely. (The filling may seem too watery for handling when warm. Don’t worry. Its consistency will improve as it cools down.)

Putting it all together:

Roll the dough on a lightly floured surface to a rectangle, about 25 by 20 inches. Don’t be lazy! If you fail to roll it big enough the cake will have fewer leaves and too much dough between the nut layers. Rolling to a thin sheet is really important!

Spread the pecan filling on the dough and roll the dough.

Cut the roll crosswise into 2 inch pieces and place on a greased 10-inch spring pan, cut side up (will make 12-15 rolls).

Let rise again for about one hour.

Heat the oven to 350 degrees F.

Bake in the heated oven for 25 to 30 minutes, until golden brown.

Remove from oven and let chill on rack.

Serving suggestions:

The cake can be cut to slices (my preference) or separated into its rolls by hand.
This cake pairs very nicely with apple sauce, fresh berries or more simply, a steaming cup of herbal tea.

Serves 14-20

 

 

Herbed Brown Rice

My mother-in-law is the queen of rice.  She has at least a dozen fabulous rice dishes, which she’ll often cook on a bed of crispy potatoes her many grandkids fight over.  Her dill-rice dish inspired this recipe.  I use an assortment of herbs that complement each other, and have replaced white rice with an aromatic and delicious – I kid you not – short grain brown rice.

How to fall in love with brown rice

I wanted to prefer brown rice -- brown rice has the bran and germ of the grain, and contains more vitamins, minerals and phytochemicals than the white, refined version -- but feeling the love was a challenge at first.

I was facing two obstacles: Long cooking time and the rice's taste.

Brown rice takes two to three times longer to cook, but once I became familiar with the grain's behavior, the long cooking time became an advantage, and I now enjoy the slow rhythm it enables.  Provided you’re around, you can leave your pot of cooking rice on a slow simmer, and forget about it while you’re doing something else.  Another upside: Brown rice is more forgiving to overcooking and will retain its shape and texture. 

Do you like the taste of white rice, and find the brown varieties coarse and unappealing?  So did I. I liked aromatic long grain rice and the basmati and jasmine whites were a staple in my home.  When I tried the long grain brown rice I was very disappointed.  But then I saw that there were so many other varieties to try, and hope resurged. 

My current favorite is the short grain brown rice; it is one of the most full-flavored rices out there, it has a beautiful nutty aroma, it is plump and pretty and oh so tasty.  Try it!  Here’s my advice: If you haven’t found your darling brown rice yet stop by a store that sells brown rice varieties in bulk – most Whole Foods Markets do – buy just a cup of each and give them a try. 

A Short note about cooking rice in measured water:  I use much less than what most recipes call for.  The onion adds a lot of fluids to the pot (and I use a lot of onion), and I find that when the rice absorbs less water it is tastier.  For 1-½ cups of short grain brown rice I use 2 cups of fluids.  For 2 cups I’d use 2 ¼ cups of fluids.

Herbed brown rice recipe 

Ingredients:

• 2 cups vegetable stock
• 1 cup parsley
• 1 cup cilantro
• ¼ cup mint leaves
• 1 ½ cup brown rice
• 2 tablespoons olive or canola oil
• 2 large onions, diced
• 1 teaspoon paprika
• 1 teaspoon salt
• Black pepper to taste

Preparation: 

• Bring the vegetable stock to a boil
• Wash the herbs, remove the large stems leaving mostly leaves (you can cheat a little, since it’s all going into the food processor)
• Place herbs and ½ a cup of the warm vegetable stock in a blender or food processor and process until you have a smooth chunk-less puree.  Add the puree to the rest of the stock
• Wash the rice in a sieve under cold water
• In a medium pot heat the oil on medium high, and sauté the onions and the paprika and salt for a few minutes until translucent
• Add the rice, and toss around until the rice is aromatic and coated with oil
• Add the herbed broth, bring to a boil, and then reduce to a low simmer
• Cook rice according to directions – mine cooks for about 1½ hours
• Fluff the rice, check seasoning, and serve with a few leftover sprigs of herbs for garnish.

Enjoy,

Dr. Ayala

Related posts: Delicious, nutritious Halloween rice  

How to pick a tasty watermelon (and what to do if all tricks fail)

One of the best things to enjoy on a warm summer day is a cold watermelon. What could be better? Sweet, crisp, refreshing, red (what a beautiful color!) and nutritious.

My husband sees it as a personal failure when we open a watermelon and find a pinkish disappointment that tastes like a cucumber. He feels there must be a fool-proof way to pick the perfect fruit.

Alas, there’s no fail-proof method, but I can offer a few tips for choosing a good watermelon:

Tapping: Tap the watermelon with the pads of your fingers. A winning watermelon will typically have a slightly hollow sound, like the sound you get when tapping your head rather than tapping your chest.

The all important yellow spot: At the bottom of the watermelon -- where it rested on the ground -- you want to find a yellow or cream-colored spot. If the spot is still white, the watermelon isn’t ripe.  Some say this is the most important clue to watermelon goodness.

Firmness: Press your fingers and thumbs into the watermelon’s skin. A good one should be hard all around with no soft spots.

Weight for size: A good watermelon feels heavy for its size.

I’ve been using these methods for years. Still, I have to admit I’m not convinced that digging through the watermelon bin using these tricks gets you a better success rate than randomly picking the first watermelon your hand touches with your eyes closed. I occasionally end up with disappointing watermelons no matter how hard I try. It just happens!

The good news: a not-so-sweet watermelon makes a wonderful and easy-to-prepare cold soup. (The cucumber in the recipe masks the cucumberness of the not-so-great watermelon.) It looks like a gazpacho, but is even more refreshing.

Watermelon and mint cold soup

Ingredients

6 cups seedless watermelon, diced
1/3 cup finely chopped fresh mint
1 cup cucumber, peeled and finely diced
1 small jalapeño pepper, seeds removed, minced
1 red onion, diced
1/2 cup young celery stalks, diced
2 tablespoons fresh lime juice or to taste
2 tablespoons balsamic or red wine vinegar
salt and fresh ground pepper to taste 

Preparation

Puree the watermelon in a food processor, using the “pulse” setting; pulse several times until the watermelon is still chunky and not too smooth.

Transfer the puree to large bowl. Add the remaining ingredients. Refrigerate until cold (at least an hour).

Garnish with a few leaves of fresh mint and serve.

What’s so good about watermelons?

First and most important – it’s a fruit and it tastes good. And of course its color brightens up the table.

Watermelon is a low calorie nutritious treat: a one-cup serving of watermelon has only about 50 calories.

It’s an excellent source of vitamins C and A. It’s also a good source of vitamins B6 and B1, and minerals such as potassium and magnesium. Red watermelon (yes, there’s a yellow-orange type too!) is also a good source of lycopene (a carotenoid antioxidant). In fact, watermelons are a richer source of this beneficial antioxidant than tomatoes.

Watermelon is 92 percent water so it’s very good for hydration.

While we mostly eat the flesh of the watermelon, all parts are actually edible. The rinds can be stir-fried, stewed or pickled. Watermelon seeds are rich in fat and protein, and can be eaten as a snack (roasted), or made into an oilseed.

Enjoy!

Dr. Ayala

*I am taking a summer break for a few weeks to spend time with my family and travel. Meantime, I'm reposting some of the more popular posts I’ve written over the past almost two years  so that new readers have a chance to catch up. Enjoy this post! - Dr. Ayala

 

Can super-sizing fruits help you shed weight?

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

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

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

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

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

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

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

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

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

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

Can supersizing the fruit serving increase fruit intake?

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

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

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

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

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

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

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

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

What about the vegetables?

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

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

Food for thought!

Dr. Ayala

 

2011’s hottest snack trend (and how to make it yourself in minutes)

 
I’m here to report that the hottest snack trend for 2011 is…flavored popcorn!  Walking the busy and delicious isles of the Fancy Food Show in Washington DC last week, I encountered popped corn in every imaginable combination, from bourbon to smoked almond, from chocolate caramel to bacon.

Popcorn is a great snack! It’s (potentially) nutritious, it’s inexpensive, and its neutral taste opens it to interpretation, so if you’re tired of eating popcorn the old-fashioned (butter and salt) way and feel like trying something new, popcorn innovation is here!

Popcorn nutrition tips

Popcorn is not only tasty and fun, but can also be healthful. Popcorn is a whole grain, high in fiber, relatively low in calories and fat, and it does fill you up.

But just like a banana -- a perfectly good snack -- can become calorie-laden when transformed to a banana split or banana chips, so it is with popcorn, so look out for what’s added to your popcorn.

Many microwavable popcorn brands contain either partially hydrogenated oil or have replaced those with palm oil, which is a highly saturated oil and not much better.

Many popcorn brands use butter flavor.  A few years ago we learned that microwavable popcorn contains diacetyl, a natural flavor that imparts butter aroma.  Heated diacetyl becomes a vapor and when inhaled over a long period of time inflames the small airways in the lungs and scars them. The severe form of the disease is called bronchiolitis obliterans or “popcorn workers’ lung”, which is untreatable and can be fatal.  Since the news of popcorn lung spread, many popcorn makers, lead by Orville, announced they’ve replaced diacetyl with new, safer, butter substitutes.  Recent studies have shown that these substitutes are similar to diacetyl and have produced similar health effects and are therefore just as toxic as what they've replaced.

So read the ingredient list and select a popcorn brand without unwanted additives, or better yet, make your own popcorn at home -- it’s really easy, I’m sure you don’t have diacetyl in your pantry, and since your popcorn will be devoured immediately you can use any healthy oil you’d like, and not worry about “shelf life”.

Spice up your popcorn: DIY popcorn ideas and tips

Feel like making gourmet popcorn at home? Here’s one of my favorites:

Sage popcorn

What you need:

• A large, preferably heavy pot with lid
• 1-2 tablespoons flavorless, high-temperature oil (I use canola)
• 2 tablespoons fresh sage, finely chopped
• ½ cup popcorn kernels
• Salt to taste

Preparation:

• Add the oil to the pot over medium heat.
• Throw a couple kernels of corn in the pot and cover it. When those kernels of corn have popped, your oil is hot enough to start.
• Add the rest of your popcorn, fine salt and the sage. Cover the pot and shake it to coat the popcorn with oil.
• Continue to cook, covered, and shake the pot occasionally (every 20-30 seconds is probably sufficient). Keep this up until the popping almost stops.
• Adjust salt to taste.

Substitutions and additions:

• Rosemary, oregano or thyme- replace the sage. 
• Truffle oil- add 1-2 tablespoons of good truffle oil to the popped corn.

For crispier popcorn: If the pot is very tightly covered, the steam released by the kernels can make the popcorn less crisp. If this happens, set the lid very slightly ajar, or lift the lid a few times to let the steam out.

Homemade microwave popcorn

Don’t feel like washing a pot? You can make your own popcorn in the microwave; all you need is a paper bag: 

• Put 1/4 cup popcorn kernels in a medium size paper lunch bag.
• Fold over the top 3-4 times.
• Put the bag in the microwave for a few minutes. It will pop fantastically and the bag will not burn. Turn microwave off when popping slows down significantly.
• Add butter and salt, or try one of the flavors below: 
  • Lime zest, olive oil and chili powder or go up in spiciness and add anything from cayenne to chipotle to habanero powder – see if you dare! Mix together, then add to popcorn.
  • Finely grated parmesan, paprika and olive oil -- mix together, then add to popcorn.
  • Cinnamon powder, orange zest and olive oil -- mix together, then add to popcorn.

Popcorn popping tip

Rejuvenating reluctant popcorn: If your popcorn doesn’t pop into fluffy, crunchy kernels, it may have lost some of its moisture.  Those unpoppable kernels are called "old maids”, a most politically incorrect term. Popability depends on water; as the kernel heats up, water inside it releases steam, putting more and more pressure on the kernel until it explodes. Revive “dry” popcorn by putting it in a closed jar and adding a little water. Cover and shake occasionally until all the water is absorbed. In two to four days popcorn should be perfect for popping.

Enjoy! And please do add your popcorn innovations below.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays

 

 

 

Forks Over Knives: Can a Plant Based Diet Reverse Disease?

“Isn't it enough to see that a garden is beautiful without having to believe that there are fairies at the bottom of it too?” Douglas Adams

There’s no doubt in my mind that the western diet – characterized as highly processed, animal product rich, sugary, fatty and salty – is bad for our health. Its spread is closely followed by a huge rise in the incidence of obesity and several “western” chronic diseases such as heart disease, hypertension and type 2 diabetes.

Traditional diets and especially plant based diets are associated with much healthier populations and lower risk of many diseases. Ample amounts of evidence show that.

Since I know that a whole foods, plant based diet is the best nutrition advice we can come up with, and I’m a lifelong vegetarian (for a multitude of reasons, the main one being animal welfare) I expected Lee Fulkerson’s documentary “Forks Over Knives” to be music to my ears.

Forks Over Knives

Forks Over Knives follows the research and personal journeys of nutrition scientist Dr. T. Colin Campbell (The China Study) and surgeon Dr. Caldwell Esselstyn. Campbell and Esselstyn independently came to the conclusion that abandoning the American diet and maintaining cholesterol levels well below those historically recommended by health policy experts on a plant based diet can prevent and even reverse heart disease and other illnesses.

The movie is peppered with engaging personal tales of people whose lives were changed by a plant-based diet: A diabetic mother, a diabetic, hypercholesterolemic meat-loving landscaping company owner, a vegan mixed martial artist, and the film’s writer and director, Fulkerson, himself – his Red Bulls and soda habit led to less than stellar lab results. Vegans, we learned, not only are healthy, some of them are really cool and really strong.

The vibrancy on the 70 something year-old vegan doctors and their plant-eating patients and the beauty of the rainbow-colored veggie fruit and grain dishes are in sharp contrast to the footage of obese, sickly, tired people and greasy super-sized unappetizing meaty food.

Forks Over Knives advocates an idea I generally believe to be true. It is a rather entertaining film, and definitely good food for thought.

However, it falls short on nuance, balance and hard facts and pushes a strict vegan way of life beyond what the science presented can support. Here are a few of my qualms:

• Where are the nuts?

The first question that comes to mind when watching a movie about food-as-cure is what’s the recipe? Forks Over Knives isn’t very clear on what the various people shown in the movie are eating. Prominent in their visual absence are the nuts – a mainstay of many plant based diets. I suppose nuts and seeds aren’t mentioned because Dr. Esselstyn’s diet, which arrested and even reversed severe coronary disease, I found out when I pulled out his study, is a very low fat vegan diet, which eliminates not only all animal products including eggs and dairy (except non-fat milk and yogurt), but also nuts, avocados and all vegetable oils. No extra virgin olive oil in this one. Perhaps sharing these details would have made this food-cure less tenable and less of a no-brainer, and that’s why the details weren’t presented.

Dean Ornish’s study, not mentioned in the movie, is an interesting comparison. Ornish’s regimen, which includes stress reduction through yoga and meditation, a low-fat vegetarian diet, smoking cessation, and regular exercise, also not only stopped the progression of coronary artery disease in the 20 patients in the treatment group, but also reversed some of it. The Ornish diet is very similar to the Esselstyn diet, but allows for some nonfat dairy products -- skim milk, nonfat yogurt, nonfat cheeses, nonfat sour cream, and egg whites. (Nuts and oils are out in the Ornish regimen, too.)

What the Esselstyn and Ornish diets have in common is not only very low intake of animal products and lots of wholesome plants – they’re both very low fat diets.

• Could food be the only medicine we need?

Although it is not explicitly said, the movie gives the notion that a plant based diet is all you need to reach a cure. The patients depicted gladly abandon all their diabetes, hypertension and cholesterol lowering meds upon adopting the lifestyle. (Dr. Esselstyn does note that in acute cases a coronary bypass is necessary).

However, in Dr. Esselstyn long term study, on which much of the movie relies, the patients* with severe coronary artery disease were on cholesterol-reducing medications as well as on a plant-based diet. The combination of diet and drugs is what got Dr. Esselstyn’s patients to a blood cholesterol of 150 mg/dL and to no repeat heart events.

• If high amounts of animal food are bad, does it prove that we should eat none at all?

If a little is good, more isn’t necessarily better (think vitamin toxicity), and I don’t think it’s self-evident that if meat consumption is correlated with disease – which is what the China Study showed – consuming any amount of animal products is harmful.

And although Dr. Esselstyn had remarkable results in his study of 17 heart patients on a low fat vegan diet, since there was no non-vegan control group, we can't really conclude that veganism cured his patient’s arteries.

• Can a plant based diet cure metastatic breast cancer?

Perhaps the most disturbing bit in Forks Over Knives was the story of Ruth Heidrich, a breast cancer survivor now in her 70s, 30 years after the diagnosis of metastatic breast cancer. Ruth, a six-time Ironman Triathlon finisher, tells a story of miraculous healing through a vegan diet and exercise. This, unfortunately, is an anecdote – there are no studies showing that a vegan diet alone can treat breast cancer. Suggesting a vegan diet can cure cancer is dangerous and irresponsible, especially when the movie features several authoritative medical doctors and scientists.

Eat food. Not too much. Mostly plants

I was glad I came to Forks Over Knives already “sold” on a plant-based diet, because the movie oversold plant-based diets to the point in which those of us not already in the choir might not think of joining.

Michael Pollan’s less assured and more moderate recipe for healthy eating, summed succinctly in “Eat food. Not too much. Mostly plants”, has, I think, much more of a chance of changing people’s mind and behavior.

Between the convenience-foods/fast-food diet and the strict vegan diet there are many shades of green. Adopting a more wholesome plant-based diet isn’t an all or nothing choice, and you can definitely eat for pleasure – and not just for health – while eating mostly plants.

Forks Over Knives reminds us of the prevention and healing powers of a healthy diet – a power that can’t be denied. I’ll need lots more proof before I believe in fairies, but the garden sure is beautiful!

Dr. Ayala

*Dr. Esselstyn’s study group initially included 22 participants, 5 dropped out within 2 years, 11 completed 5.5 years of follow-up, and at 10 years 6 were still on the diet.

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

The Family Dinner: A healthy ritual to look forward to every day

I have been making dinner pretty much every day for the past 16 years. I’d be lying if I said cooking, serving, participating and cleaning-up have been the highlight of each of my days. After a hectic day at work, the question “what’s for dinner” often felt like an accusation, reminding me that despite my efforts I’m still much behind. And not every meal has been peaceful. When my kids were very little (my kids are so close in age that at some point all three were toddlers — an age group you can expect very little table manners from) dinner was so hectic I could hardly taste the food. I often thought that perhaps we adults should eat our meal after we put the little ones to bed, so that we can feel half civilized. But we persisted, and I’m proud to say that I think we all, as a family, look forward to dinner together, and see it as an institution that renews our “familyness” every day.

This brings me to a Laurie David’s book. If you’re still in search of a realistic resolution for this new year this book may lead you to it. Laurie David is an environmental activist. I’ve been reading her newsletter for years. Food is an environmental issue, so it probably isn’t a huge surprise to see David publish a food book. The focus of David’s book – The Family Dinner — is, I believe, one of the most important, effective and fun lifestyle changes we should all enhance, in order to achieve a long list of good outcomes, and since kids imitate us more readily than they listen to us, family dinner is an opportunity to model to kids what we believe to be the right way to eat, share and interact. Dinner together is time to nourish our bodies, but it’s so much more than that. Dinner is time to reconnect, a time to slow down and share, a time to talk and listen — it’s, as David writes, “an island of calm in a sea of change”.

The book starts with an introduction that will motivate you, providing all the rationale to invest in dinner-time (many studies associate family dinner with lots of desired outcomes: less abuse of drugs and alcohol, lower obesity rates, better grades, better language skills etc.) The rest of the book is a lovely resource for everything you need to make dinner time easy, educational, fun and memorable.

David invited a diverse group of thought leaders — including Jamie Oliver, Alice Waters, Michael Pollan, Billy Collins, Jonathan Safran Foer and Mark Bittman — to share their family dinner wisdom and memories. But my favorite parts of the book were those around table talk and the creation of good conversation. David suggests various ways to get the family interacting, from word games to discussion topics to resources such as commencement speeches (these are published in newspapers yearly, and provide well written, valuable life lessons).

The recipes, by Kirsten Uhrenholdt, are practical without being dumbed down. They offer good, healthy food, and a wide range of flavor, texture and experience, and a plan that gets the whole family together, working in the kitchen and sharing the pleasure and responsibility of making food. Many of the recipes are meatless, and David devotes a whole chapter to her reasons for eating more vegetarian meals. Many of the dishes offer opportunities for personalizing the dish—from ‘choose your toppings’ to different final touches — which kids, I’m sure, will adore.

To give you a taste for the books’ approach to cooking together, I asked the authors for permission to share one of the recipes from the “kids in the kitchen” chapter. In this recipe the kid is boss, and is empowered to pick and choose garnishes, adjust and fine tune the sauce to his liking, and even boss the parents, and sent them off to clean their room, set the table and wash their hands. I tried this recipe with my 11 year-old a few days ago. It was enormous fun. The pictures above reflect my daughter’s creation and choices (the pictures in The Family Dinner, by Maryellen Baker, are much lovelier.)

Pea Nutty Noodles
Adapted from “The Family Dinner”

You Need

For the peanut sauce

• 1 pound of your favorite shaped pasta


• 1 cup peanut butter


• 1/2 cup soy sauce


• 2/3 cup warm water


• 3 tablespoons chopped fresh ginger


• 2 cloves garlic, chopped


• 1 tablespoon toasted sesame oil


• 1 tablespoon honey


• 3 tablespoons white (rice or wine) vinegar

Garnishes: Pick and choose any you please and as much as you want

• Chopped peanuts
• Diced cucumbers
• Diced apples
• Sliced scallions
• Limes cut into quarters
• Sliced cabbage
• Asian chili sauce, if you are brave
• Chopped fresh cilantro or mint
• Shredded carrots

To Make 6 Servings

• Pick out the garnishes you want to serve with the noodles and chop, dice, and slice them. Put them in little bowls.
• Ask your parents, nicely, to boil the pasta until it is al dente (not too mushy). Remind them gently that the pasta water should have enough salt to taste like the sea.
• When it’s done, have them quickly rinse the pasta in cold water. Thank them for helping you.
• Now mix all the ingredients for the peanut sauce together in a big bowl with a big spoon. You will have to stir, stir, stir, until it is all mixed together and smooth (or you could get a parent to mix it all in a blender).
• Taste the sauce…is it perfect? When it is, toss in the pasta and pour into a pile on a big platter or bowl. Put the little bowls of garnishes around the platter, and yell diiiinner!

Enjoy, and do fill me in on your best family dinner moments.

Dr. Ayala

Further resources: http://thefamilydinnerproject.org/

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

Dr. Ayala's Baba Ganoush Video Recipe

This recipe is a Mediterranean favorite. Really easy. Keeps well refrigerated for 5 to 7 days. Let me know what you think of this visual recipe and enjoy!

Dr. Ayala

Healthy summer frozen treats and the dreaded brain freeze

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

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

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

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

Here are a few of our favorites:

Lemon, Verbena and Geranium Sorbet

Ingredients:

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

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

To prepare:

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

Add the lemon juice, lemon Verbena and lemon peel.

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

If you do not have an ice cream maker

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

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

Very Berry Sherbet

Ingredients:

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

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

If you do not have an ice cream maker:

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

Watermelon Mint Slurpee

Ingredients:

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

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

If you do not have an ice cream maker:

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

Serve in tall glass, with a wide straw.

Serving suggestions

These recipes serve 4-6 people

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

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

The dreaded brain freeze

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

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

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

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

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

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

Enjoy the warm weather in good health.

Dr. Ayala

What should Americans eat? The 2010 dietary guidelines

The advice on what to eat for optimal health is reevaluated and dispensed by the government every five years and we’ll be seeing new guidelines published later on this year.

The foundation for the guidelines is an independent, evidence-based report, prepared by the Dietary Guidelines Advisory Committee, which is comprised of independent experts—mostly academics in the fields of nutrition and health. The advisory committees have been giving, in essence, pretty much the same advice for the past thirty years: Eat less solid fats, salt, and added sugars and more fruits, vegetables, and whole grains. Move more. The devil’s in the details—wording, upper and lower limits for nutrients, emphasis on food groups—and this document is usually not received without debate by the food industry and other players.

Yet not much happens. Guidelines aside, obesity rates have continued to climb, and the fast- and processed-food diet is still the most prevalent food pattern observed by Americans.

The Dietary Guidelines Advisory Committee Report of 2010 issued its recommendation recently, the report is now open for comments, and following the public comment period the USDA and US Department of Health and Human Services will take in the comments—let’s hope politics won’t be thrown into the mix—and translate the Advisory Report into the 2010 Dietary Guidelines for Americans.
So what’s new in the 2010 Advisory Committee Report guidelines?

Cut Salt. By a lot.

The 2005 guidelines recommended a daily sodium upper limit of 2,300 mg sodium for the general adult population, and a 1,500 mg per day sodium limit for people with hypertension, African-Americans and older Americans. Since these latter groups comprise 70 percent of US adults, the new 2010 guidelines recommend 1,500 mg per sodium day upper-limit for the general population. It’s quite a challenge, given the vast amounts of salt processed foods contain, and the high levels of salt most people are accustomed to. Most Americans consume more than twice the 2,300 mg “old” upper-limit.

Food patterns: Plant centered patterns promote health, and vegetarian diets get the nod

The new report realizes that people eat food, not isolated nutrients, and counting grams of fats, servings of carbs and milligrams of salt isn’t a tempting lifestyle for most—who wants to walk around with reading glasses and a calculator? Many experts believe that total diet and food patterns are better guides to what we should be eating. The 2005 report mentioned two eating patterns recommended for their health benefits, the DASH (Dietary Approaches to Stop Hypertension) eating plan, and the USDA food guide eating plan—yet these two plans still resemble a diet recipe and not a dietary pattern—they’re still more about counting servings rather than providing food rules and a framework for a healthy diet.

The new proposed guidelines go further, and suggest two eating patterns proven to promote health: the Mediterranean-style and vegetarian-style diets. What these patterns have in common is emphasis on plant-foods. If the vegetarian style diet indeed gets an endorsement in the final guidelines this is going to be quite a shift—the guidelines and pyramids of past were big promoters of animal protein, and vegetarians and vegans seemed like poor step-kids living a life of compromise on inferior substitutions. (Full disclosure: I am a vegetarian, mainly for ethical reasons.)

Here’s the report’s recommended diet in a nutshell:

“Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.
Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium.”

I guess this is as close as we can get to spelling out how we should eat without offending any food industry. May I offer my interpretation in plain-speak?

There are many ways to eat healthy, all of which emphasize plenty of plant foods—fruits, vegetables, whole grains and such—and moderation in pretty much everything else. There’s one food pattern that clearly doesn’t work: the processed- junk- and fast-food diet tends to make people fat and unhealthy. Eat that stuff only on special occasions.

The food environment: We all need to work together to improve it

The guidelines acknowledge that although personal food choices play a central role in the obesity epidemic, our food environment is also a key-player that needs to be addressed urgently:

“In order to reduce the obesity epidemic, actions must be taken to improve the food environment. Policy (local, state, and national) and private-sector efforts must be made to increase the availability of nutrient-dense foods for all Americans, especially for low-income Americans, through greater access to grocery stores, produce trucks, and farmers’ markets, and greater financial incentives to purchase and prepare healthy foods. The restaurant and food industries are encouraged to offer foods in appropriate portion sizes that are low in calories, added sugars, and solid fat. Local zoning policies should be considered to reduce fast food restaurant placement near schools.”

Is there hope for change?

Absolutely. I think the guidelines provide an evidence-based framework on which policies, action and choices need to be made. Although the advice is basically the same over many decades, there are more people listening, a first lady dedicated to the cause, a strong and growing crowd of people who care about this issue, and are eager for change, a health-care system threatening to collapse under the rising costs of obesity-related disease and a food movement rising.

I’m hopeful (as a matter of principle and as a way of life). Are you?

Dr. Ayala

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

The recipe for a long and healthy life

Do you want to live to 100?

For most of us, a long and well-lived life sounds rather tempting. So what can we do to get as much out of life as we can, for as long as we can?

It turns out we know some important things about what influences longevity; there’s even a fun game online that will estimate how old you’ll live to be. All you have to do is answer 40 quick questions related to your health and family history and a calculator (at the end of this post) will do the rest.

I’m not of course making light of issues of life and death; I call this calculator a game only to emphasize that we can’t really know our destiny.

On the other hand, this calculator, designed by Boston University Medical School geriatrician Thomas Perls, can teach us quite a lot about what science knows—and doesn’t know—about what influences longevity. It also offers some excellent health and nutrition advice. Dr. Perls is head of the New England Centenarian Study and is following some 1500 people, including centenarians and their families, and has looked at what made these people reach healthy old age.

One of the exciting findings of this ongoing study is that if you can escape common chronic diseases, such as heart disease, stroke, cancer, diabetes and Alzheimer’s in your 60s 70s and even 80s, you’re on the path to seeing 100. Centenarians generally have a really good quality of life into their 90s, and it seems that aging is delayed by decades for them. As Dr. Perls says: “The older you get, the healthier you’ve been”.

The recipe for longevity

Let’s start with what’s unfortunately beyond our control: Longevity runs in families. More than 50 percent of centenarians have first degree relatives who lived to a very old age.

If you want to live to be 100 you’ll also want to be born a woman. The centenarian club is 85 percent females. Sorry, guys!

Setting those statistical realities aside, most of us have more control over how long we live than we think. The other components of what makes for a healthy and long life have to do with a healthy lifestyle.

Here’s my recipe:

• Eat well

Living to 100 is much more likely if you have a healthy weight—very few centenarians are obese and in fact, most of the men are lean.

But nutrition goals go beyond achieving a healthy weight: The diet that’s most linked to lower risk of chronic disease and a longer life is one that emphasizes moderation, and relies on mostly plant-based foods and less on animal products. It definitely doesn’t include much processed food and it doesn’t resemble the typical Western or American diet.

But you needn’t necessarily become vegetarian.

The longest living Americans (as a group) are probably The Seventh Day Adventists, whose health habits—dictated by their religion—include vegetarianism.

On the other hand, the island of Okinawa, Japan, is home to some of the leanest and longest-lived people on earth. Their diet isn’t vegetarian but light in calories and heavy with plants. They eat mainly foods with low caloric density.

The classic Mediterranean diet—also associated in studies with good health and a longer lifespan—is also plant-rich and relies on vegetables, fruits, beans and grains, fish and a little meat and poultry. It is, in my opinion, extremely delicious, very practical and relatively easy to cook.

• Don’t Smoke!

There’s no doubt about it—smoking is the cause of many serious diseases and shortens life. There are very few people with a substantial smoking history that achieved long and healthy lives and they’re the exception which proves the rule.

• Exercise

Physical activity is key for health maintenance and for prolonging life. Physical activity doesn’t require a gym membership, running a marathon or the latest exercise trend. Walking and leading an active lifestyle are much more typical of the studied centenarians.

If you want to keep your mind fully engaged you’ll need to exercise your brain, too. Mental stimulation improves brain function and protects against cognitive decline, as does physical exercise.

• Reduce stress

Long-lived people seem to be better at handling stress.
There is no universal recipe for stress reduction, though. I personally find that being out in nature is the best stress-relief—it beats even yoga. But I’ll admit I forget all about the importance of stress reduction when I’m busy and stressed.

Social connectedness also appears often in recipes for healthy and long lives. Are meaningful relationships also a tool in stress reduction? Probably, although some might argue with that as they recall, for example, stressful family gatherings.

Dr. Perls also advises good sleep, aspirin (although aspirin for healthy people that aren’t at special risk for heart attacks is falling out of favor lately) and tooth flossing for a longer life—but the topics above are generally considered the biggies.

What about supplements and anti-aging hormones?

Simply stated, there’s no substantial proof that vitamin supplements (excluding vitamin D and calcium, which do seem to have a role in protecting postmenopausal bones) prolong life or prevent disease. The only thing vitamins prevent is vitamin deficiency, which is rare.

Neither multivitamins, nor individual vitamins and minerals, fared well in good quality clinical trials.

The National Institutes of Health gathered an expert panel to review the literature on multivitamins and supplements for chronic disease prevention in 2006. The consensus report noted:

“Most of the studies we examined do not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of three or more…However, several other studies also provide disturbing evidence of risk, such as increased lung cancer risk with β-carotene use among smokers.”

Antioxidants, such as vitamins A, C, and E, beta carotene, folate and the mineral selenium, are heavily promoted as disease-prevention and anti-aging tools. But the antioxidant supplements failed miserably in clinical trials; they haven’t been shown to protect against heart disease cancer or stroke, and in fact their use has been associated with increased mortality.

The booming anti-aging industry adds to the traditional lifestyle advice and supplement recommendations an array of hormones and drugs; testosterone, human growth hormone, and melatonin are some of the commonly used regimens.

But most doctors see these therapies as extremely questionable: There is no good proof that they work, and they can be quite dangerous. Dr Perls is an outspoken critic of the anti-aging industry and calls it quackery.

Game time:

Try the calculator, get your feedback, and please come back to compare notes. Then let’s put in a date for a good hike 55 years from now (that’s when I’ll be 100).

To our health!

Dr. Ayala

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

Are vegetarian diets healthy?

Food has been one of the past decade’s biggest celebrities.

It’s not just star chefs, food so artfully presented it could hang in a gallery and the enchanting Food Network that have been grabbing our attention--there’s also a rising and keen interest in the impact food choices have on our health and the health of our environment. What and how we eat has evolved from a simple nourishment act to a lifestyle, ethical and self defining evaluation--and with choices come questions.

As a lifetime vegetarian, I get many comments and questions about vegetarianism and health and my personal choice, so I'd like to get back to a post I wrote earlier and discuss the current understanding of the health impact of vegetarian diets and where I stand.

Let’s start with a few common definitions--these definitions of course fall short of describing the full range of dietary practices of those who restrict animal products from their plate, and there are many variations not covered by these rather simplistic definitions.

Vegetarians exclude meat and fish from their diet but do eat dairy and eggs. Vegans exclude all animal products, including meat, fish, dairy and eggs. The terms “vegetarian” and “vegan” are not interchangeable from the nutritional science point of view; the two diets are quite dissimilar. This discussion is about vegetarians and not vegans.

Vegetarians choose to abstain from meat for a variety of reasons, ranging from health advantages and environmental priorities, to ethical and cultural considerations. This post is mainly about the health aspects of going vegetarian.

Are vegetarian diets nutritionally complete?

Simply stated--yes!

It’s now proven that a healthy, varied vegetarian diet is nutritionally adequate, doesn’t lead to any deficiencies of macro or micro nutrients and needs no supplementation.

Contrary to popular myth protein isn’t a problem for vegetarians.
Plants--especially pulses (peas, beans and lentils), nuts, seeds and grains--have plenty of protein. Plant proteins do not have all essential amino acids in every bite and are therefore considered incomplete proteins. However, we now know that incomplete proteins can be stored in the body for many days to be combined with other incomplete proteins. Since different plant foods together contain all essential amino acids, it doesn’t matter if the proteins are complete or incomplete and it’s also no longer recommended to bother with combining those different proteins in the same meal.

Contrary to common belief, the risk of iron-deficiency anemia is no larger for vegetarians than it is for omnivores.

Are vegetarians healthier?

A recent paper by Gary E. Fraser in the American Journal of Clinical Nutrition provides a balanced summery of the current science.

As you can imagine, studying large vegetarian cohorts is no easy task. There are a few such large cohorts. The California Adventists have been studied since 1958 and the study’s ongoing. The Seventh-day Adventist church is a Christian denomination that observes Saturday as the day of worship, but it’s also known for promoting a “healthy message,” including a vegetarian diet and avoidance of alcohol, caffeinated drinks, tobacco (they’ve been denouncing smoking for 150 years, well ahead of the medical community) and illegal drugs. Not all Adventists are vegetarian, so the effect of vegetarianism can be isolated within the Adventists. Other large study cohorts include the Health Food Shoppers’ Study and the Oxford Vegetarian Study both from the UK, and the German Heidelberg Vegetarian Study.

Fraser finds consistency in outcomes of vegetarian lifestyles across studies for the following considerations:

• Coronary heart disease is clearly lower for vegetarians. A combined analysis of these cohorts shows that non-vegetarians have 32% higher heart disease mortality than do vegetarians.

• Total LDL cholesterol is lower in vegetarians.

• Vegetarians are thinner than non-vegetarians.

• The risk of diabetes and hypertension is probably lower for vegetarians across studies.

Where Fraser finds inconsistent results is in the incidence of colon cancer. There’s general agreement from studies of non-vegetarians that red meat consumption increases the risk of colon cancer. The Adventists studies show that vegetarian Adventists indeed have a lower incidence of colon cancer, but the EPIC-Oxford study doesn’t show that vegetarians fare any better than the general British population. This of course demands explanation and further study.

Is the evidence suggesting health benefits from a vegetarian diet compelling enough to convince a meat lover to quit all meat? I doubt it.

One might argue--and I'll concur--that although there are studies that show a correlation between vegetarian lifestyles and lower incidence of several chronic diseases, the evidence is far from conclusive, and there are many confounders in the study of a self-selected group such as vegetarians. And although the evidence to support a diet rich in fruits and veggies and whole grains is convincing, there isn’t great proof that consuming quality meat in moderation is harmful.

I believe that most traditional diets, based on mostly plant food have proven themselves over time to be healthful. Indeed, people can thrive on many different diet regimens. The one diet that’s proving to be detrimental to health is our current Western diet of highly processed foods, fast foods and junk.

One hallmark of the American diet is very high consumption of animal products and especially meat (about half a pound of meat a day). What’s even worse is that most of those animal products come from animals raised in feedlots on a diet that’s unnatural to them (grains and even animal by-products, instead of grass, in the case of cows) and regimens of antibiotics and hormones.

So what’s my story?

My dad turned vegetarian when, as a kid, he saw a chicken slaughtered. When I was a teeny toddler my dad told me where meat comes from. He also told me that almost everyone eats meat, but he thinks animals do have a desire to live, show attachment to their young and do experience suffering.

I was convinced and never tasted meat. I am concerned about animal welfare, and I think cruelty to animals—expressed in the extreme in feedlots and industrial slaughterhouses—has reached a point in which most people would be appalled if they actually saw where their meat comes from.

I admit it…for me it’s easy. I have no desire to eat meat and don’t even think of it as food, because I don't have a habit of eating it.

This is my anecdotal proof that what you feed your kids when they're young has a profound impact on their eating habits. I haven’t gone any further than my dad did with animal welfare--I live with no small amount of hypocrisy myself. I do eat cheese and eggs. I’ll try to buy from producers that raise their animals in a humane and sustainable way, but I do realize that it's very difficult to give up foods you enjoy, were raised on and are part of your tradition. I don’t think I’d likely give up dairy completely, even if there were evidence that abstaining from it might benefit my health somewhat. After all, there’s risk everywhere; avoiding risk to the point of not enjoying yourself is risky too.

Every diet is characterized by which foods are eaten, not only by what’s excluded. At this point I think there’re plenty of reasons for everyone to eat more fruits and veggies and eat less animal products; it may turn out that the health benefits seen in vegetarians have more to do with what they eat, and not what they exclude.

There’s much more to talk about concerning vegetarian lifestyles, and I haven’t even touched on the environmental reasons to avoid meat, which are pretty compelling.

I welcome your perspectives.

Dr. Ayala
Related post: Eating green for our planet

Posted as part of Breastfeeding Moms Unite's Vegetarian Foodie Friday.

Recipes for a healthy and happy Thanksgiving

Thanksgiving is a time to give thanks, celebrate fall, and enjoy the bounty of nature and the company of family and friends.

I love this holiday because it’s so important to take a break from focusing on all the problems in our world and in our lives, and spend time reflecting on the good in the world. There’s much to be grateful for, even in hard times.

As a vegetarian cook I follow the traditional Thanksgiving meal quite loosely. The palette of my presentation will definitely abide by the customary colors: the oranges, browns and reds of squashes, pumpkins, cranberries and chestnuts; the typical green of green beans or a fresh salad; and the lovely yellow of corn and corn meal. But otherwise, I let the quality seasonal produce I find show me the way, and I allow myself freedom in interpreting the Thanksgiving classics.

This week, I want to share a few of my healthy Thanksgiving recipes, most of which can be prepared well in advance and require minimal “finishing touches” right before the big meal.

Wishing you a happy and healthy holiday,

Dr Ayala

Roasted squash and chestnut soup with mulling spices

This is a terrific fall soup, perfect for the Thanksgiving holiday. It’s easy to make, and requires no pre-prepared soup stock. The aroma of the mulled spices is festive and somewhat surprising in a soup.

Ingredients:

• 2 butternut squash, peeled, halved lengthwise and cored
• 1 large onion
• 1 tablespoon canola oil
• 1 pound peeled roasted chestnuts (you can find peeled chestnuts sold in jars)
• 1-2 tablespoons honey
• Salt and freshly ground pepper to taste

For the mulling spices:

• 2 cinnamon sticks
• 1 teaspoon whole allspice
• 1/2 teaspoon whole cloves
• 5 cardamom pods, bruised
• Orange peel zest (the outer colorful skin of the orange peel)--about half an orange

Preparation:

Preheat the oven to 350 degrees F.

Place the squashes, cut-side down, on a baking pan and bake until tender, about 30-40 minutes. Cut into large chunks.

Gather the mulling spices into a muslin bag, tea ball or cheesecloth pouch. (The orange peel and cinnamon sticks can be allowed to roam free in the pot; they’ll be easy to fish out.)

In a large soup pot, over medium-high heat, sauté onions until translucent.

Add the chunks of roasted squash, honey, salt, pepper, and half the chestnuts.

Add water to cover by 1.5 inch and bring to a boil, then lower to a simmer.

Add the mulling spices, including the orange peel and cinnamon sticks.

Simmer over moderate heat for 20 minutes. Remove from heat. Remove the mulling spices, orange peel and cinnamon sticks.

Puree the soup with an immersion blender. (This is an inexpensive kitchen tool that saves a lot of cleanup. Immerse the blender into the pot in which the food has been cooked, and easily puree it with a switch of a button. If you don’t have an immersion blender you can use a blender or food processor.)

Crumble the remaining chestnuts into the pureed soup.

Taste and correct seasoning by adding ground cinnamon, more salt or some more freshly ground pepper.

To serve:

Garnish with freshly toasted pumpkin seeds (an excellent source of omega 3), and/or a cinnamon stick.

Serves 8-10.

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Roasted red and golden beets, with reduced balsamic vinegar

Beets are easy to find, especially between spring and fall. They make for a very simple, delicious, healthy dish that epitomizes fall color to me.
If you can find golden beets, they make for a delightful color contrast with the red beets. They also taste really great.

Ingredients:

• 3 medium red beets, rinsed, not peeled
• 3 medium golden beets, rinsed, not peeled
• 1/2 cup balsamic vinegar for reduced balsamic glaze
• Fresh herbs to garnish (chives, parsley or tarragon)
• Salt and freshly ground pepper to taste
• Optional - fresh goat cheese (chèvre)

Preparation:

Preheat the oven to 400 degrees F.

Wrap each beet in aluminum foil and place in pan in the oven.

Roast until tender and easily pierced with a fork, about 45 minutes to 1 hour.

Remove from the oven and let cool.

When beets are cool enough to handle, peel and slice them. (Red beets can be peeled and sliced in advance. Golden beets change color when exposed to air, so slice just before serving.)

To make reduced balsamic glaze: In a small pan over high heat, bring vinegar to a boil, then reduce heat to medium, and evaporate balsamic until quantity halves and turns to a light syrup.

Drizzle reduced balsamic over the beets.

Season with salt and freshly ground black pepper.

Garnish with fresh herbs, and add goat cheese if desired.

Serves 8-10 as a side dish.
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Wheat berry salad

Whole grains are important part for healthy nutrition. Wheat berries are the most wholesome and least processed wheat grain and include the entire wheat kernel—the bran, germ and endosperm. (For comparison, white flour is comprised only of ground endosperm.)
Look for wheat berries in the health food store or in the natural foods section of the supermarket. (Whole Foods usually sells them in bulk, which is great!) I like the hard red wheat berries, which are very high in protein, very nutritious, and have a sweet nutty flavor and a lovely chewy texture.

The trick with hard wheat berries is to plan ahead and soak them overnight. These grains are very hard indeed, and will require a very long cooking time if they’re not well-soaked.

This is a very simple recipe, and a dish everyone seems to love.
Ingredients:

• 1/2 cup wheat berries, soaked overnight
• 1 large ripe mango (can be replaced with oranges or persimmon), cut into cubes
• 3-4 celery stalks, with the fibery outer parts peeled and diced
• 10 dates, pitted and finely chopped (can be replaced by another dried fruit)
• A handful of dry cranberries
• A handful of nuts, such as roasted almonds, candied pecans or walnuts

Dressing:

• 1 tablespoon of a fine sweet and interesting marmalade. I use organic Adriatic fig spread (sold at Whole Foods)
• 2 tablespoons extra virgin olive oil
• 1 tablespoon balsamic vinegar
• 1 sprig of thyme, finely chopped

Preparation:

Cook the wheat berries by covering them with two inches of water, then bring them to a boil, lower the temperature to simmer, and cook until chewy—about 20-30 minutes. Drain and let cool.

Add all other salad ingredients besides the nuts.

Combine dressing ingredients.

Add the nuts and dressing right before serving.

Serves 6-8 as a side dish.
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Roasted French string beans with toasted sesame

Ingredients:

• 1 pound French string beans, both ends removed
• 2 tablespoons olive oil or toasted sesame oil
• 2 tablespoons sesame seeds
• Freshly ground black pepper and salt to taste
• A pinch or two of red pepper flakes (optional)

Preparation:

Preheat the oven to 400 degrees F with the oven pan in the oven.

Toss the string bean with the oil and spices.

Spread the beans in one layer on the pre-warmed oven pan.

Bake for 3-5 minutes, until beans become slightly brow and are sizzling, but are still very crunchy and vibrant.

Correct the seasoning by adding salt or pepper.

Serve hot, or at room temperature.

Serves 8-10 as a side dish.
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Pecan yeast “roses” cake

Pecan yeast “roses” cake is a perfect indulgence for the close of the Thanksgiving meal and a fresh take on pecan pie.
This isn’t a difficult recipe--yeast dough is actually easy to work with. The only real challenge is mastering the patience. You’ll have to factor in the rising time the dough needs to fully develop.
The “roses” part of this cake’s name comes from the delicate shapes formed on the individual cakes.

Ingredients:
For basic sweet yeast dough:

• 3 1/2 cups unbleached flour (I use King Arthur’s bread flour. All-purpose is fine too. Bread flour is a high-gluten flour called for in many bread and pizza crust recipes where you want the loftiness or chewiness that the extra gluten provides. All-purpose flour is made from a blend of high- and low-gluten wheats, and has a bit less protein than bread flour.)
• 1/2 cup sugar
• 1/2 cup milk
• 1/2 cup heavy cream
• 3 tablespoons melted unsalted butter
• 2 yolks
• 1 envelope rapid-rise yeast
• 1/2 teaspoon salt

For the pecan filling:

• 2 cups pecans, finely chopped (in the food processor or blender)
• 1 cup sugar
• 2 tablespoons butter
• 2/3 cup milk

Preparation:

To make the dough:

If you happen to own a bread machine, put all the ingredients in the mixing bowl and use the dough setting.

If kneading by hand: Put all the dough ingredients in a bowl, combine to make dough, and knead for about five minutes, until the dough is soft and elastic and not sticky at all. (Add a bit of extra flour or milk if you haven’t reached a really workable dough within five minutes, but that rarely happens with this recipe.)

Cover the bowl with a clean kitchen towel, and let sit for an hour and a half in a warm place, until the dough doubles its volume.

To make the filling:

Combine milk, sugar and butter in a small pot and bring to a boil, then lower to a simmer.
Add the nuts, and continue stirring on low heat for a minute or two.

Remove from heat and let chill completely. (The filling may seem too watery for handling when warm. Don’t worry. Its consistency will improve as it cools down.)

Putting it all together:

Roll the dough on a lightly floured surface to a rectangle, about 25 by 20 inches. Don’t be lazy! If you fail to roll it big enough the cake will have fewer leaves and too much dough between the nut layers. Rolling to a thin sheet is really important!

Spread the pecan filling on the dough and roll the dough.

Cut the roll crosswise into 2 inch pieces and place on a greased 10-inch spring pan, cut side up (will make 12-15 rolls).

Let rise again for about one hour.

Heat the oven to 350 degrees F.

Bake in the heated oven for 25 to 30 minutes, until golden brown.

Remove from oven and let chill on rack.

Serving suggestions:
The cake can be cut to slices (my preference) or separated into its rolls by hand.
This cake pairs very nicely with apple sauce, fresh berries or more simply, a steaming cup of herbal tea.

Serves 14-20
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