Healthy Food & Healthy Living by Dr. Ayala

Do sugary drinks affect blood pressure?

A few years ago, a large study of more than 150,000 women helped clear poor, vilified coffee of the suspicion it was contributing to hypertension.

But while that 2005 study found no connection between even many daily cups of coffee and high blood pressure, it pointed a finger at another suspect (indeed –one of the usual suspects): It found that soda intake—regular and diet alike—was associated with higher blood pressure.

A new study in Circulation: Journal of the American Heart Association explored the sugary drink-hypertension connection further, and found that by cutting daily consumption of sugary drinks by just one can a day, people can lower their blood pressure significantly.

The study followed 810 pre-hypertensive (people whose blood pressure is elevated but shy of the definition of hypertension) and hypertensive adults, who received diet and exercise advice and behavioral interventions. Blood pressure was measured several times over the 18 months’ study period, and correlated with diet and other factors known to affect hypertension (such as exercise, salt intake and body weight).

Here’s what the study found:

• Reduction of sugary drinks intake is associated with lower blood pressure: After known risk factors of high blood pressure were controlled for, a reduction in sugar-sweetened beverage consumption of one can (12 oz.) per day was associated with a drop of 1.8 mm Hg in systolic pressure and 1.1 mm Hg in diastolic blood pressure over 18 months.

• All types of caloric sweeteners are implicated: Change in blood pressure was significantly and positively associated with changes in sugar intake in of any type, including glucose, fructose, sucrose, high fructose corn syrup and combined sugars.

• Caffeine seems to have no effect: There was no significant relationship between change in caffeine consumption and change in blood pressure.

• Diet beverages have no effect: Change in consumption of diet beverages wasn’t associated with lower blood pressure

Doesn’t soda affect blood pressure only through body-weight change?

Sugary drinks are the leading source of added sugar in the US diet, clearly contribute to weight gain, and obesity is a very strong risk factor for hypertension, so the researches set out to see whether reducing soda lowers blood pressure by simply facilitating weight loss.

After adjusting for weight loss the results showed that lowering soda intake was still effective at reducing blood pressure, even among people whose weight was stable.

Is lowering blood pressure a tad going to make a difference?

Hypertension is a major health problem in the US--two thirds of adult Americans have hypertension or pre-hypertension—and hypertension is an established risk factor for heart disease, stroke, kidney disease and early death.

According to the authors, led by Dr. Chen, the public health benefits of reducing soda intake could be significant:

“In view of the direct, progressive relationship of BP (blood pressure) with cardiovascular disease, even small reductions in BP are projected to have substantial health benefits. For example, it has been estimated that a 3-mm Hg reduction in SBP (systolic blood pressure) should reduce stroke mortality by 8% and coronary heart disease mortality by 5%. Such reductions in SBP would be anticipated by reducing SSB (sugar-sweetened beverages) consumption by an average of 2 servings per day. Currently, the average intake of SSB is 2.3 servings per day for US adults. In our study, one third of participants reduced SSB consumption on average of 1.3 servings per day over the 18 months and had an average of 1.5 mm Hg more reduction in SBP compared with participants who did not change their SSB consumption, suggesting that such reduction in SSB consumption should be achievable and could be beneficial.”

Rounding up the usual suspect

We already know that sugary drinks contribute greatly to (empty) caloric intake (the average American takes in about 300 calories a-day in sugary drinks), and that their consumption has been driving the obesity epidemic, with all of its consequences. But in case anyone needed any more proof that it’s time to drop—or at least moderate—our soda habit, this study implicates sugary drinks with yet another health problem—hypertension, and it’s not the first study to do so.

The accumulated evidence against sugary drinks is vast and continues to grow, and soda sales are slowly going down. But what stands in the way of real and sweeping behavioral change regarding soda are two things: soft drinks’ remarkably ingenious and ever-present marketing and advertizing, and their equally remarkable low price. Attempts to change pricing through a soda tax are meeting a bold and no-expense-will-be-spared fight from the beverage industry—one that the beverage industry seem to be winning federally and at the state and city level.

This brings us back to the power of information. I hope that awareness of the ill effects of excessive sugary drink intake and simple logic can help people realize that the simplest and easiest first step towards better nutrition, less weight gain and better health is to give up some—or all—sugary drinks.

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 lifesyle for many years.

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

Are food allergies really on the rise?

A new study in The Journal of Allergy and Clinical Immunology reports that the rate of peanut allergies in kids more than tripled in just ten years.

According to the study, 1.4 percent of kids reported peanut allergies in 2008, as opposed to just 0.4 percent in 1997. The rate of combined peanut and tree nut allergies reported in kids was 2.1 percent in 2008, compared to 0.6 percent in 1997.

Alarming, but before we panic, let’s take a closer look at the study design: This study randomly surveyed more than 5,000 homes in the US by phone, and the allergies were self-reported.

Is self-reporting an accurate way to assess the prevalence of food allergies?

On the one hand, who knows kids’ food reactions better than their parents, right? But when it comes to food allergies, it seems that even medical experts can’t really agree on what makes a diagnosis of food allergy, so parents’ testimony of their kids’ food allergy status (as opposed to asking them a simple factual question, such as “Did your child get a tetanus shot?”) may very well reflect parental heightened awareness of this medical issue (which is definitely on the rise), rather than a true increase in food allergies themselves.

We know less than we think about food allergies

A recent systematic review in the Journal of the American Medical Association shows the complexity and confusion in the field of food allergies. The researchers, led by Dr. Jennifer J. Schneider Chafen, pored over more than 12,000 studies on food allergies—most of which, they found, were poorly conducted. Only 72 studies met the authors’ criteria for scientific rigor, and when analyzing the data the conclusion was, in plain words, that we know much less than we think.

Here are a few surprising issues the researchers uncovered:

• There’s no agreement on the definition of food allergy.
The lack of clear definition leads to much confusion between what is a food allergy (in which the immune system is involved) and other reactions that are not immune-mediated, such as food intolerance.

• There’s no agreement on how to test for a food allergy, and many tests aren’t definitive. The common tests used to aid in the diagnosis of food allergies aren’t very good at predicting who will actually react to a certain food; test results in isolation (without a good clinical picture and evaluation) aren’t more helpful than a coin toss.

The current gold standard for diagnosing food allergies is the food challenge, during which a physician gives the patient a sample of the suspected allergenic food, and monitors for an allergic reaction. This kind of testing is expensive and requires specialized personnel and therefore isn’t often done (it also isn’t covered by many insurance plans). More commonly used tests are the skin-prick test, during which a dilute extract of the potential allergen is placed under the skin, and a blood test determines the presence of food-specific allergic antibodies known as IgE.

Unfortunately, neither of these two tests is very specific; in fact they aren’t definitive at all. Kids with non-specific symptoms, such as a rash or digestive complaints, and a positive skin-prick or blood test actually have less than a 50 percent chance of indeed having a food allergy.

If definition and testing aren’t clear-cut, it becomes quite evident that the prevalence of food allergies is hard to assess.

The researchers found that in general, studies that used self-reporting found much higher rates of food allergies than studies that used the skin-prick test, IgE blood test and food challenges. The authors comment that it’s even hard to say for sure whether food allergies are in fact on the rise because the data is so inconsistent.

Their best estimate is that the prevalence of food allergies is anywhere between 1 or 2 percent and 10 percent, which is a difference of 500 percent or more. So much for accuracy.

It is generally the feeling in the medical community that food allergies are indeed on the rise, but there’s no doubt that misdiagnosed food allergies are on the rise, too.

And if food allergies are misdiagnosed?

Inappropriate diagnosis of food allergies denies kids nutritious foods and creates unnecessary anxiety around food. Misdiagnosed food allergies also are a waste of money, as specialized diets don’t come cheap.

Over-diagnosis and misdiagnosis of food allergies also may trivialize the seriousness of real, potentially life-threatening food allergies. We all know the story of the boy who cried wolf.

Hopefully, better clarity ahead

The way ahead is promising. The National Institute of Allergy and Infectious Diseases is creating comprehensive clinical guidelines for the diagnosis and management of food allergies. Guidelines from a 25-member expert panel are due this fall and will provide much needed direction.

In the meantime let me offer some prudent advice: If you think your child may have a food allergy, it’s best to consult an experienced physician. Over-diagnosis may lead to unnecessary food limitations and undue reduced quality of life, but not taking real food allergies seriously enough and not learning what to do about them can threaten life itself.

Dr. Ayala

Related posts:
The gluten-free health fad: the good and the bad - part 1

The gluten-free health fad: the good and the bad-part 2

Want milk? Lactose intolerance shouldn’t stop you

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

Seven thoughts on Jamie Oliver’s Food Revolution

Thanks to Hulu and a few sleepless nights due to jet lag, I’m finally caught up on all six episodes of Food Revolution.

In the series, celebrity British chef Jamie Oliver goes to Huntington, WV—noted in 2008 by the Centers for Disease Control as one of the unhealthiest and most obese cities in America—to reform the town’s school lunch program and teach it some healthy cooking.

Jamie won over Huntington’s hearts and minds. Those he didn’t charm with his personality and passion were persuaded by his arguments for health and community. Any remaining naysayers seemed to be swept away by his authenticity and generous spread of love and good cheer.

But was his food revolution a success? What can we learn from Jamie’s attempt to change a town’s eating habits? Here are some of my thoughts:

1. Let’s start with the kids

Jamie’s move to change targets kids’ food at school and at home; he motivates parents and other adults as he taps into our irresistible urge to do the right thing for our kids—because we love them and because they are the future.

And also because the kids actually are more open to change. It seems that in Huntington, too, kids were more receptive to Jamie’s ideas for change than the grown-ups were, and many were eager for the empowerment the ability to cook could give.

2. Placing kids’ interests first doesn’t mean letting kids rule

In our child-centric society we sometimes forget that making kids’ interests the priority doesn’t mean “kids rule”. Early in Food Revolution, kids got to chose between Jamie’s cooked-from-scratch meal and highly processed pizza and French fries, and between chocolate and strawberry milk (”more sugar than soda pop”) and plain milk.

Guess what they chose.

Don’t get me wrong, I don’t believe in authoritarian parenting or schooling, but I do think we have the duty and authority to lead kids to good choices.

It would be very easy for most kids to sleep in every single day, skip classes, rot in front of a TV or video game and not brush their teeth. We don’t give them those options.

So why do we buy into adding sugar to everything in order to please our kids? Of course meals with more sugar, fat and salt will be better liked by kids—it’s human nature. It’s hard—but very possible—to retrain kids’ taste buds with wholesome from-scratch cooking. But not if we’re competing against sugar, fat and salt.

We should give kids autonomy over their food choices—provided all options are acceptable ones. I wouldn’t argue with a kids’ preference for peas over broccoli (or for studying French rather than Italian for that matter). But the option of eating junk rather than healthy food shouldn’t be available in our homes or our schools, just like the option of skipping math doesn’t exist. We’re the grown-ups; it’s our duty to set some boundaries.

There’s a lot to undo here. Under the pretext of “kids will eat more of the good stuff” sugar, color and shapes have been added to food, making our kids food something completely removed from its natural state, and very unhealthy. Just last week the American Beverage Association senior vice president for science policy, Dr. Maureen Storey said to NPR about soda (“90 percent water”): “...Children who have been exercising may not drink enough water to get back to the hydration point that they need to be at. So with a little bit of flavoring and a little bit of sweetness, they will drink enough then to get back to where they need to be.”

Yes, kids will drink more water and milk if it’s loaded with sugar, and will eat more potatoes if they’re deep fried.

They’ll also sleep more if we give them sleeping pills.

But the ends don’t necessarily justify the means. Given time, good alternatives and less competition and brainwashing from junk and fast food, kids will eat real food, especially when they’re hungry.

3. It’s about money

It’s sad but true: better food costs more, and Jamie’s Food Revolution gives us a glimpse of how critical funding is to changing the food landscape. Cheap, processed food costs so much less than healthy food that it’s irresistible to budget-blasted schools; despite good intentions, it’s the cheap stuff that fills the freezers in school kitchens because price matters.

4. Food culture at an all time low

Just when gourmet food, fine dining and the food-as-entertainment trend hit new highs (especially in relatively well-off communities), Jamie shows us that, for many people, the understanding and experience of food has hit a hard-to-believe low. The elementary school in the show has no cutlery knifes (lunch is usually eaten with no cutlery), and the kids can’t recognize a potato or a tomato (we’re not talking leeks and rutabaga here—basic stuff).

5. “Rubbish guidelines”

That’s what Jamie calls the USDA nutrition rules under which a warmed-up highly processed chicken nuggets and French fries meal passes as a nutritious one, yet his cooked from scratch meal, with plenty of grain, vegetables and fresh meat doesn’t.

Our school lunch program, designed long ago during lean times, needs serious revision. It specifies a lower-calorie limit, but not an upper one. It emphasizes protein, vitamins and calories, regardless of their—usually highly processed and artificial—source. It doesn’t promote fruits and vegetables. And it usually supplies too many calories, fat and salt.

6. Can home cooking cure a town?

No. But it’s a good start. Jamie’s Food Revolution focuses on bringing back fresh from-scratch food to schools, and providing a kitchen where anyone could learn how to cook.

In many ways Jamie is selling the most attractive aspects of what needs to be done to improve our nutrition and health: bring back the pleasures of a food culture, and its connection to the land, our food makers, our health and our communities. The goal is romantic and gratifying, and achievable once you get over the difficulty of change.

But there’s another difficult reality to confront: we need to eat less.

Twelve-year-old Justin Edwards, featured in the show, weighs 318 pounds; his problems won’t be over once hamburgers are made from scratch.

The show doesn’t address the constant snacking and continuous sipping of high-calorie snacks and drinks, so typical of our times. Nor does it say a word about vending machines in schools and the a-la-carte foods sold in the cafeteria, which compete with the school lunch.

Jamie doesn’t address eating less; he concentrates on eating different.

7. More an evolution than a revolution

Just as we came to this sorry state of obesity and unhealthy eating slowly and gradually, there’s no quick fix that can undo the damage instantly. There’s no evil dictator to topple, and no oppressed public waiting to be freed from the grasp of fast-food. Most of us are comfortably stuck in our ways and resistant to change.

Jamie sows seeds in Huntington, and then goes back home. When he comes back to check on things three months later, he finds weeds have taken over, threatening his food revolution seedlings. The school freezer is full of processed food, which will be served on “processed food Fridays,” chocolate milk is back, and parents are sending paper bag lunches from home that contain an astounding array of candy and chips to compete with the from-scratch lunch the dedicated staff fought for and worked so hard to produce.

“This ain’t a happy ending,” says Jamie.

No, Jamie, it’s just the beginning. And it may not be a “revolution” that happens. I’d be perfectly happy with an “evolution” in thinking and actions.

Actually, I much prefer the term “movement” to the term “revolution” when it comes to our struggle for healthier food and less obesity. Things are moving. We may even be close to a tipping point. Last week the White House task force on childhood obesity presented to the President its recommendations and a more realistic goal: reverse obesity within a generation.

Jamie Oliver’s most significant contribution was to package some important ideas in an entertaining reality show. Whether most of what we saw was in fact reality or show, he certainly inspired more conversations and thinking around how we eat. I applaud Jamie for using his tremendous popularity and celebrity to promote this worthy cause, and for presenting a complex and we-don’t-want-to-hear-about-it subject is such an engaging way.

And I do think that talking about a revolution can start one.

What did you think of Jamie Oliver’s Food Revolution?
Dr. Ayala

Related post: Jamie Oliver's wish: Teach every child about food

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

Organic is healthier…but you can still get fat

We like to eat. We especially like indulgent foods – desserts, snacks and tasty treats.

We’d love to believe it’s okay to heap our plates with foods we perceive as “healthy".

In fact, studies have shown time and again that foods perceived as healthy or foods with a health aura drive us — if only subconsciously — to eat more. Foods with "low fat" or "low calorie" claims lead to overconsumption of snacks. A study using hidden cameras at Italian restaurants showed that people dipping their bread in olive oil will eat more fat and calories than if they instead spread some butter.

Organic food labels can lead to overeating, too. In presenting findings from their new study, Jenny Wan-Chen Lee and Brian Wansink showed that the organic seal appears to make people believe their organic snacks have a lot fewer calories than they do. For example, people who ate cookies labeled as "organic" believed that their snack contained 40% fewer calories than the same cookies that had no label.

Now, I’m a huge proponent and an early adopter of organic produce, but the organic seal, of course, has absolutely nothing to do with calories.

The benefits of organic food

The organic seal promises that the food and its ingredients have been farmed according to the organic standards — which are better for you and for the environment.

Organic practices are about sustainability, how we grow food, and how we treat our environment. These practices also tie to our personal health, given that the multitude of chemical fertilizers, pesticides and herbicides used to produce conventional food actually remain in the food. While it’s hard to prove that any single one of them, in small amounts, causes disease, it’s impossible to prove that they don’t; personally I’d rather minimize exposure to what’s clearly not meant for human consumption (read more about why organic matters in my post here).

The jury’s still out on whether organic produce has more measureable nutrients than conventionally-grown produce.

What organic food isn’t

Organic produce isn’t necessarily clean. All too often I see people skipping the washing of organic produce, forgetting that it comes from a field, and has been handled by many hands. Organic produce does need to be washed — thoroughly. While organic food isn't sprayed with chemicals, microbial life is teeming on and between the leaves. Wildlife visits the fields and can contaminate produce in any number of ways we don’t like to consider when we think of food. There’s also the bacterial mixture from a multitude of human hands that have touched your produce before it gets to your table.

Organic food isn’t automatically healthy, or something we should necessarily consume in large quantities. Organic candy, organic soda or organic French fries — while a tiny bit better for us because they’re free of pesticides — are still junk food, and should be eaten infrequently.

Bottom line

People are generally an optimistic and trusting bunch, and the temptation to believe what we want to be true sometimes overcomes lessons we’ve been taught about the prudency of healthy skepticism.

If you want to have a clearer idea of what you’re eating, just read the ingredient list and nutrition facts, regardless of the atmosphere created — or the claims-to-health — on the front of the package.

Read the labels on organic foods as carefully as you’d read any other food label. If the food is full of sugars, fats, salt or calories, it should be viewed as a dessert, and should be eaten in moderation.

Dr. Ayala

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

Kids’ food: Innocent fun or a bad habit?

First Mom Michelle Obama said to food makers recently: “If there is anyone here who can sell food to our kids, it’s you. You know what gets them to drive their parents crazy in the grocery store.”

We parents are quite aware of a TV ad when we see one, but marketing efforts go way beyond direct advertising on TV and internet games. Kids are exposed to slick marketing and a call for their eyeballs everywhere and especially where food is sold—manufacturers design food and packaging in a way that appeals specifically to kids and affects their choices, or at least their nagging choices.

These “fun foods” are very easy to recognize—let any toddler loose in a supermarket and they’ll spot them from a mile--it’s the rare kid who will pick milk, apples and baby carrots as kids’ food.

Food and beverage companies spend $2 billion a year on marketing food to kids. They have excellent reasons to do so: Toddlers have been known to sing the tunes and repeat the message after being exposed to some ads just once, and they’re likely to stay loyal to a brand forever.

Foods designed for kids usually aren’t nutritious

Foods marketed to kids have several “fun” design and message elements in common: Specific colors, iconography (including cartoons), graphics, language and shapes (animals and cars) allure the kids, beckoning them to take a look. Packages offer free games, tie-ins with popular kids’ programs and films, and “let’s have fun” messaging. Kids know immediately that this is a food playfully designed for a kid.

But these foods have something else in common: Unfortunately, most of the marketing efforts promote highly processed foods of low nutritional value.

Professor Charlene Elliott from the University Of Calgary, Canada, studied 367 products targeted specifically at kids to assess their nutritional value. The results appeared in a study in the journal Obesity Reviews.

The study included only “regular” foods within the dry goods, dairy, produce and frozen food categories. The study excluded typical “junk food”—candy, soft drinks, cakes, potato chips etc., as these are expected to be of poor nutritional value, and don’t need testing.

The assessment of nutritional value was done using the criteria outlined by the Center for Science in the Public Interest (CSPI): Healthy food should not derive more than 35 per cent of its calories from fat (excluding nuts and seed and nut butters), should have no more than 35 per cent added sugar by weight, and upper limits for sodium levels are defined depending on the food category.

This is what the study found:

• 89% of the kids’ products studied were classified as having poor nutritional quality”

• Within the dry goods kids foods (including granola bars, cereal bars, pasta, soups), high sugar levels were the main culprit.

• Within the refrigerated and frozen foods (packaged lunches, pizzas), many products had high fat or sodium.

• Less than 1% of the foods specifically targeted at children in a Canadian supermarket are fruits and vegetables; the only “kids’ foods” in the produce section were small apples and baby carrots.

Nutritional claims abound, tricking harried parents to give-in to nagging

Fun foods don’t portray just happy drawings and cartoons. The majority of these foods (62.7%) had nutrition claims on the box such as “low fat,” “good source of calcium,” “trans-fat free,” etc.

Among the 326 fun foods that were of poor nutritional quality, 202 (62%) had nutritional claims.

So while the nutritional claim of “low fat,” “no trans-fat” or “good source of iron” might lead one to think the whole product is nutritious, that isn’t necessarily the case—the product may be full of sugar, non trans-fat or sodium.

The nutrition claim is aimed at the gatekeeper—the parent—and gives us an excuse to go ahead with the purchase.

Kids’ food is a bad idea

The notion that kids need their own food is very wrong in my opinion. Beyond infancy, children don’t require any special diet. The same foods that are good for adults are good for kids, the only emphasis would be that it’s even more important for kids to eat nutritious food, as this is the time their body is growing, and their eating habits are formed.

From both the health and the practical point of view, I really don’t see why parents would make (or buy) one meal for their kids and another for the adults. There’s no such thing as “grown-up” food—there’s just good nutritious food for sensible humans, and since kids are smaller, they should get a smaller portion.

I often get upset by kids’ menus in restaurants. I think there should be an option to order a smaller, lower priced dish from the regular menu for kids—something like a half-price/half-portion for young diners sounds like a simple way to go. But the typical kids menu is often the same old French fries, hot dogs, butter-and-cream-drowned macaroni and cheese; as if that’s the only thing kids can imagine eating.

If we raise our kids with the expectation that food for them should be dumbed down to “fun food” with toys, how are they supposed to learn what good food is?

I find great pleasure in preparing and eating real food. I’m using the word “pleasure” and not “fun,” because fun in the context of food has come to mean the silly, artificial and superficial way to have a good time. Kids that grow up expecting food to have rainbow colors, glow in the dark, pop in your mouth and be shaped like Batman have no understanding of food, or its connection to the natural world and our health. I honestly believe they also don’t get real pleasure from their food; their meal is an extension of their entertainment.

Fun food usually isn’t nutritious. The standards for nutritious food set by this study are quite minimal, and were met by only about 10% of the fun foods. Fun food also replaces the real joy a kid can get from helping make a meal from basic ingredients, of tasting food that has real food quality, and of connecting to people—understanding where the food came from, talking with the people who grew the food (farmers markets can be a real source of fun) and sharing the same meal with everyone in their household.

I hope food makers will adopt higher standard regarding foods marketed to kids--I think they're starting to do so--but it’s really up to us parents to be the gatekeeper and to explain to our kids that Toucan Sam has nothing to do with breakfast.

I'd love to hear your thoughts!

Dr. Ayala

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

A originally wrote this post as a guest on Kidappeal. Kidappeal blogger, Jenna, is a foodie, nutrition enthusiast, mother of two, and business owner, and I love her blog's tagline: one meal, one snack, one bite at a time .