Healthy Food & Healthy Living by Dr. Ayala

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

Jamie Oliver's wish: Teach every child about food

Celebrity chef Jamie Oliver recently received the prestigious TED Prize, an annual award given to a speaker at the TED (Technology, Entertainment, Design) Conference, which entitles the speaker to one wish that can change the world and $100,000 as down payment for the magic wand.

Jamie's wish: "I wish for your help to create a strong, sustainable movement to educate every child about food, inspire families to cook again and empower people everywhere to fight obesity."

This is a wish that can come true--I truly believe that. We all have the power to help make Jamie's wish a reality--for our own sake.

You can jump right in and sign Jamie's petition.

You can take a look at Jamie's plan and needs and see if you can offer assistance.

Or maybe just have your Jamie Oliver moment with your own family tonight: I'll be teaching my kids another simple, nutritious dish they can cook by themselves when they come home from school.

One of the "TED commandments" is the strict time limit of 18 minutes per talk, which Jamie exceeds by a few minutes, but this video is well worth watching. I think it's awesome!

Dr. Ayala

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

More about school lunch at DrGreene.com

I'm blogging about the school lunch program every day this week at DrGreene.com. My first post, "Are school meals healthy?" kicks off the series.

The site -- run by pediatrician Dr. Alan Greene and health experts -- presents information on all topics important to your family’s health. I think you'll find it interesting.

Hope you enjoy the series.

Dr. Ayala

”Let’s Move” to reform school food

School food received some major media attention in the past week.

Michelle Obama launched the Let’s Move anti-obesity campaign last Tuesday, with improving school food as a major program cornerstone. Congress will reauthorize the Childhood Nutrition Act this year—with some planned overhauls and budget proposals underway. And the Obama administration wants Congress to remove sugary snacks and drinks from school vending machines.

Say what? The federal government is trying to limit big food’s footprint in our schools?

If Agriculture Secretary Tom Vilsack gets his way, he intends to do just that: "Food served in vending machines and the a la carte line shouldn't undermine our efforts to enhance the health of the school environment,” he said.

A short introduction to school food

On any school day more than 30 million kids eat a school lunch and 10 million kids eat a school breakfast. Fifty-nine percent of the kids eating a school lunch are from low-income homes, as are 80 percent of school breakfast eaters. The school lunch program operates in all public schools and in many private schools.

The National School Lunch Program was created with a dual purpose—to feed kids and prevent dietary deficiency and to provide an outlet for surplus agricultural commodities. One can already see that the dual purpose of the program throws in some problematic conflicts of interest, but let’s go on.

The government provides $2.68 per day for kids qualifying for a free lunch, $2.28 per day for a reduced-price lunch, and $0.25 per day for all other kids. That sum includes the overhead and facility costs associated with the meal, which leaves just $1—or less—for the food itself. This is clearly not enough money to fund from-scratch cooking or quality, fresh produce. President Obama proposes bumping up the school lunch budget a tad—which will be better than nothing—but the additional funding probably won’t afford a huge amount of change.

What kind of meal can you get for $1?

An adventurous school teacher vowed to eat the school lunch every day this year, and she’s posting musings and photos of her cafeteria meal in a daily blog. Take a look at the pictures (take note of the amount of packaging) and you’ll get the idea.

I’ve devoted several posts to this subject and analyzed the typical school lunch menu, concluding that the best description for this food is “fast-food”. Overall, it’s salty, sweet and fatty; the meat is breaded and crunchy; and it’s been highly processed—even the fruit and vegetables aren’t fresh for the most part. Most of the schools have no kitchens and just heat and un-wrap low-grade foods. Nevertheless, the subsidized school lunch complies with some nutritional guidelines and provides plenty of protein and vitamins, and while I think guidelines based on the nutrient profile of foods alone are an ill-advised way to evaluate food quality, at least some rules exist.

But if the federally sponsored and regulated school lunch program leaves much to be desired wait till you get the full picture, because challenging the school lunch, are what’re called competitive foods.

These competitive foods—comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events—are expressly marketed to our kids and make up a big part of what kids actually eat while they’re in school.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict, in which schools share an interest with the manufacturers of snacks and junk foods.

School candy-land

Here are some facts about the scope of the competitive food problem. (The source is an article in the Journal of the American Dietetic Association that looked at data collected in 287 nationally representative schools and included 2,314 kids.)

Availability:

• One or more sources of competitive foods are available in 73 percent of elementary schools, 97 percent of middle schools, and 100 percent of high schools.

• À la carte foods sold in the cafeteria are common in all school levels.

• Vending machines are available in more than one quarter of elementary schools, 87 percent of middle schools and virtually all high schools.

Consumption of competitive foods :

• 40 percent of school kids consume these foods on any given day.
Consumption is much higher among high schoolers—55 percent.

Energy contribution of competitive foods:

• Kids consume about 280 calories per day from competitive foods, and almost two- thirds of these calories were from “low-nutrient” and “energy-dense” foods. (The study defines “low-nutrient, energy-dense food” to include cakes/cookies, desserts, donuts, toaster pastries, snack chips, French fries and caloric beverages, excluding milk and 100% juice.)

• A typical high school kid gets about 340 calories per day from competitive foods, 65 percent (or 220 calories) of which are from junk food.

The most commonly consumed competitive foods:

• Desserts, snacks (cakes, cookies, candy and ice cream) and sweetened beverages.

So, we have low-quality foods sold in the schools competing with a low-quality school lunch–a competition that’s a lose-lose for our kids. Wherever our kids turn they have snacking opportunities that contribute mostly empty calories.

The only existing federal restriction on foods sold in school is that foods of “minimal nutritional values,” such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors. And although some school districts have taken initiatives to impose restrictions banning some junk food sales in schools, progress is very slow.

It is high time school food begins to resemble a lesson in how to eat healthfully. Right now, the school lunch—and especially the school foods for sale—resemble all that’s wrong in our popular food culture, and explain quite well why one in three American kids is overweight or obese.

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

I applaud the White House and especially our First Lady for taking on this important issue. “Let’s Move” is the politically savvy way to name what will have to really become a “Let’s Eat Less Junk” effort—but whatever it takes let’s indeed move it!

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.

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

10 healthy cooking tips for great flavor with less salt

I devoted last week’s post to salt, and to the fact that we consume, to our detriment, two-to-three times our recommended daily upper limit of salt. The bulk of this excess intake comes unnoticed and hidden in processed and restaurant (especially fast-food restaurant) foods.

The best way to deal with our salt overload is to minimize highly processed foods in our diet. (To be honest, if salt were the only issue with these highly processed foods I wouldn’t get so excited. Not everyone becomes hypertensive, and not every hypertensive person is sensitive to salt, but it so happens that salt is just one more reason, among dozens, to move on from processed foods to a better place.)

The Dietary Guidelines for Americans recommends we consume “less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.” For African Americans, older people or people with hypertension the advice is to consume no more than 1,500 mg of sodium per day.

Now, if you’re cooking at home, the chances are slim you’d be adding salt indiscriminately and in potentially harmful amounts—after all, you’re not in the business of promoting the sale or prolonging the shelf life of your food—but I’d like to close off World Salt Awareness Week on a constructive note, and share some tips about the judicious use of salt in cooking. I’d also love to hear yours.

I’m a humble home-cook, mostly book- and self-taught through many years of experimentation in the kitchen. But I read the pros, and any cook worth his salt will testify that learning how to season properly may very well be a cook’s single and most vital skill. Salt is extremely important to proper seasoning because it enhances flavors that are already there; a properly salted dish tastes flavorful. If it tastes salty it’s over-salted.

Learning when and how much salt to use requires not only a good palate but also some chemistry know-how: Adding salt to boiling water will make some foods—such as fresh vegetables—cook faster, and others—including dried beans—cook slower. Salt is what makes or breaks a good bread; salt helps form good, elastic gluten networks that are so important to traditional dough’s structure and texture.

I am by no means suggesting we need to go low-sodium in home cooking. In moderation, salt isn’t a problem, and it should be no sacrifice of flavor to stay way under the “up to one teaspoon of salt a day” recommendation.

Here are a few tips I’ve learned that help me season well while using salt in moderation:

1. Use great ingredients: There’s a reason I put this tip first—it’s really important! One of the reasons some commercial food manufacturers use so much salt is because their inferior ingredients have no taste on their own. If you use great produce you won’t need much seasoning to make it shine.

2. Add herbs: Basil, chives, parsley, dill, oregano, sage, mint, thyme, ginger and tarragon are just a few options; there really are too many to mention. Most herbs are best fresh, but some herbs are also good dried and all add flavor, color and health.

3. Try spices: Black pepper, paprika, turmeric, cumin, cinnamon—again, too many to mention. Find your favorites and buy high-quality, fresh spices with an aroma that pleases you. Try toasting them for special effect. Spices add flavor, color and health.

4. Drop in vinegar: A few drops of acidity, in the form of vinegar or lemon juice, can sometimes do wonders to bump up flavor and create a nice tingle in your mouth.

5. Heat it up: Hot peppers, chili powder and hot sauces can create an exciting flavor party.

6. Enjoy garlic: Oh, the wonders of freshly pressed garlic! Add it fresh roasted or sautéed. It’s healthy too.

7. Juice it up: Try adding fruit or vegetable juices (or even better—reduced juices) for complex flavors. Juiced vegetables are a wonderful base for sauces! Don’t overlook the fruit peel; lemon and orange zests are so lovely!

8. Make your own dressings and marinades: Salad dressings are easy to make; the basic proportions are 2/3rds good oil (extra virgin olive oil is my staple), 1/3rd good vinegar or fruit acid, a tiny amount of sweetness (I like honey or agave) and some seasoning. Home-made dressings taste better, cost less, and need little or no salt.

9. Just say no: Some dishes don’t need salt at all. Dishes that contain aged cheeses and salty ingredients, such as capers or miso, usually have more than enough salt already.

10. Take it easy: If you’re used to very salty food, and have been heavy handed with the salt up until now, cut back slowly. Research shows that our taste receptors get accustomed to certain levels of saltiness through repeated exposure. If you ease your salt intake over time, you’ll hardly notice the difference, and within several weeks your taste buds will start perceiving lower levels of salt as salty enough.

There’s a whole world of flavor beyond sweet, salt and fat. Expanding our sources of flavor will make our food tastier, more nutritious and much healthier!

Looking forward to hearing your seasoning tips!
Dr. Ayala

Just a pinch of salt for health

Salt runs in the veins of language. There are reminders everywhere of salt’s former glory. The word “salary” is derived from salt (Roman soldiers were paid in salt), and salt is at the root of “sauce”, “salsa” and “salad”.

Ancient wars were waged over the control of salt.

Today, a modern war on salt—salt reduction—is looming in the horizon. And for good reason.

While salt is a dietary mineral we can’t live without, most of us take in two or three times the daily recommended upper limit of salt. Extra salt is typically sneaking into our meals unnoticed through processed and restaurant foods—and too much salt threatens the health of many people.

Recently, New York City’s mayor Michael Bloomberg announced an initiative encouraging food manufacturers and restaurant chains to reduce salt in their products by 25 percent over the next five years.

His call joins the voices of many health advocates: For example, in 2007, the American Medical Association (AMA) published a report calling for a major reduction in the salt content of processed and restaurant foods. They’ve been urging the FDA to revoke salt’s “generally recognized as safe” classification and to develop regulatory measures that limit the amount of sodium used in processed and restaurant foods.

But let’s start with a few words of respect for salt, because I’d hate to see salt described as the new villain, on par with cigarettes and trans-fats.

In defense of salt

Like anyone who loves food and spends lots of time cooking, salt is one of my (little) friends. Salt is the primordial condiment—it is absolutely essential to cooking and flavoring. Salt enhances and modifies other flavors and is indispensable in the traditional preparation of many foods, including bread, cheese and pickles.

Salt also is an essential mineral that our body absolutely needs to function properly, albeit in very small amounts. Sodium is needed for fluid balance, nerve transmission and muscle function; it helps many organs work properly.

Our fondness of salt is probably innate, and has served us well as a species. Salt is an essential nutrient that was very rare until modern times, so having a biological cue to seek salt was a good thing. However, the preference for certain levels of saltiness is acquired and isn’t fixed. Repeated exposure to higher levels of salt habituates our taste receptors to seek saltier foods.

How much salt do we need?

Chemistry time: Table salt is sodium chloride, a combination of one chlorine atom for each atom of sodium. Every gram of salt is 40 percent sodium. (The conversion formula of sodium to salt is milligrams of sodium X 2.5 = milligrams of salt.)

The Dietary Guidelines for Americans recommends we consume “less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.” For African Americans, older people or people with hypertension the advice is to consume no more than 1,500 mg of sodium per day.

But in terms of what our bodies require, there’s a far lower limit: unless we’re running in sweltering heat we need only about 500 mg of sodium daily, which is very, very little.

Contrast this with what you’ll get in a Burger King Whopper with cheese: 1,450 mg of sodium. And that’s in just one part of one meal.

A Caesar salad with grilled chicken at McDonalds packs 1,390 mg of sodium. Dunkin’ Donuts’ breakfast egg and cheese on a bagel gives you 1,120 mg sodium when your day has hardly begun.

Science in the Public Interest paints a worrisome picture with their sodium chart.

Where’s all the extra salt coming from?

Roughly 10 percent of the salt in our diet comes from the salt we add ourselves (the salt we season with while cooking or sprinkle at the table) and 10 percent is naturally occurring. The vast majority of salt—amounting to about 80 percent of daily intake—comes from processed foods.

Salt is added to processed foods to achieve a (very salty) taste profile. In many situations adding salt is what makes cheap, un-tasty food palatable. Salt also is added for stability and preservation reasons. But the amount of salt added is clearly above and beyond what’s required for the safety and function of the food supply.

The simple math leads to the conclusion that going easy with the salt shaker is hardly going to put a dent in the unhealthy amount of salt in the typical American diet.

It’s also hard to trust our taste buds when salt is involved. Some foods taste quite salty because the salt is on the surface, while other sodium-saturated dishes don’t taste salty at all because other flavors and textures (namely, lots of fat and sugars) cover up the salt.

The health risks of excessive salt

The amount of salt in modern diets is having a profound effect on our collective health.

Our kidneys generally excrete extra sodium, but this mechanism isn’t perfect; too much sodium can cause or aggravate hypertension in some people. Roughly a quarter of Americans have hypertension.

The evidence connecting higher intakes of salt to higher blood pressure is pretty strong, and relies on many types of studies, including studies that neatly take away the possibility that people who eat lots of salt might have other lifestyle and diet variables that cause blood pressure to rise. Studies comparing two Nigerian rural communities, identical in all but the fact that one community had access to a salt lake and the other community did not, showed that higher intakes of salt tend to result in higher blood pressure. Similar studies of the Iranian Qash’qai and Pacific Island communities showed similar results. Several treatment trials have shown that a reduction in salt reduced blood pressure.

High blood pressure is a major risk factor for heart disease and stroke. It therefore makes sense to assume that high salt intakes will increase the risk of stroke and heart disease, and studies support this link.

A new paper in the New England Journal of Medicine used computer models to predict the effect of relatively small reductions in salt intake on Americans’ health and found that if everyone consumed half a teaspoon less salt per day, there would be between 54,000 and 99,000 fewer heart attacks each year, between 32,000 and 66,000 fewer strokes and between 44,000 and 92,000 fewer deaths. This small change could save from $10 billion to $24 billion in health care costs annually!

A call to reduce salt in processed food -- worldwide

Since 80 percent of the salt in the American diet comes from processed food, the effective way to reduce salt consumption is by reducing the—really high—salt content of restaurant and processed foods.

In fact, a program quite similar to New York City’s proposed one was initiated by the British government in 2003-2004, and has already achieved a 20-30 percent reduction in the sodium content of processed foods, and further gradual reductions are on the way.
Finland has a systematic approach for salt reduction, and foods high in salt carry a high salt warning. Portugal recently approved a law restricting the sodium content of processed foods. The European Union has salt-reduction initiatives underway with reformulation of processed foods as a major priority.

These public health initiatives are a sensible idea, and it’s good to see similar efforts finally underway in the US.

An editorial accompanying the NEJM article calls for implementing policies to reduce the salt content of processed food, describing these actions as “inexpensive, yet highly effective public health intervention for the prevention of disease.”

We can all take these simple steps to monitor and limit our own salt consumption:

• Select processed foods with less sodium. This could be painful; keeping count of sodium isn’t a practical or enjoyable way to eat. But we can pay attention to the amount of salt in processed foods and make low-sodium choices whenever possible.

• Reduce the amount of prepared and highly processed food we eat (as if we needed another reason to do just that). The best way to control our salt content is by preparing our own food.

I promise to devote another post to advice and tips on how to easily stay within the recommended salt recommendations without sacrificing taste. It isn’t hard!

Kudos to New York City for—once again—being the trailblazer in public health; I think we’ll be hearing a lot more about salt very soon!

Dr. Ayala