Healthy Food & Healthy Living by Dr. Ayala

Study: Teens take in 480 calories in added sugar daily, risking heart health

Sugar used to be a special treat, enjoyed occasionally, but those days are long gone. Sugar is now a major food group, and sugars in soft drinks are now the largest single source of calories in the American diet.

And while we’re all eating (and drinking) lots of added sugars, the age-group that tops the charts of sugar consumption is teens. Teens, in fact, consume more than 20 percent of their calories from added sugars. This appetite for refined sugar is a health concern, since added sugars contribute to obesity and its many consequences, can undermine normal satiety levels, motivating kids to eat more than they need, and perhaps even create food cravings. Sugary drinks and snacks replace nutritious food, and the repeated contact with sweet drinks also adds nothing to dental health.

But can teens also be risking their young heart and blood vessels?

A new study, lead by Jean Walsh, and published in this week’s Circulation: Journal of the American Heart Association, looked at the sugar intake of 2157 nationally representative teens (ages 12-18) as reported by diet questionnaires, and compared it to the teens’ measured blood lipids. The measured blood fats are well established indicators of heart disease risk: HDL (‘good’) cholesterol, LDL (‘bad’) cholesterol, and triglycerides (high levels of which also increase risk).
This is what the researchers found:

• Teens consumed an average of about 120 grams (more than 4 ounces) added sugar a day, which amount to 28 teaspoons of sugar and 480 calories! Teens got 21 percent of their daily calories from added sugar.

• Added sugar was positively associated with known risk factors for heart disease: Teens who consumed the higher levels of added sugars had lower good cholesterol levels, higher bad cholesterol and higher triglyceride levels than those with lower sugar intake.

• Overweight or obese teens who consumed the highest levels of sugars had increased signs of insulin resistance.

These results suggest that long-term exposure to the high levels of sugar intake, typical of the American diet, may place teens at risk for heart disease later in adulthood.

How much sugar is too much?

Recently, The American Heart Association’s (AHA) issued new guidelines recommending that daily intake of added sugars should be limited to 5 percent of total calories — 100 calories daily (6 teaspoons) for women and 150 calories (9 teaspoons) for men — as a strategy for preventing heart disease. The AHA explains that added sugars have been linked with obesity and overeating, may raise blood pressure, can elevate blood triglycerides levels (a risk factor for heart disease) and raise the risk of several metabolic abnormalities and adverse health conditions.

The 2005 US Dietary Guidelines advice about sugar is rather foggy: “choose and prepare foods and beverages with little added sugars or caloric sweeteners”. That’s pretty much like telling a teenager not to go to sleep too late. Many are wondering if the new guidelines — the 2010 Dietary Guidelines Update is a tad overdue but is expected by the end of this month — will be a little more specific. The 2010 Dietary Guidelines Advisory Committee called for a significant reduction of foods containing added sugars in its report.

And the picture above isn’t some random sugar pile. It’s actually what 480 calories in solid sugar looks like. Seems a bit much? I guess that liquefying it makes it go down quite smoothly.

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.

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

What can the census report tell us about the American diet?

The census bureau recently published the official count of people living in the US — there are more than 308 million of us. But the bureau does much more than tally people — it also gathers lots of interesting information about Americans and the American economy, and this treasure trove is available in the 2011 statistical abstract. The New York Times had a fun visual portrait of America by the numbers last weekend, which inspired me to take a look at the data, while concentrating on food and nutrition. The census data provides an interesting snapshot of our changing food habits, and since the data covers several decades, it’s interesting to see whether it sheds some light on why obesity became so prevalent over the past 30 years.

Before you get all paranoid, let me emphasize that the government doesn’t know what you’re eating: The consumption information is estimated and computed dividing food availability (which is how much food is there after subtracting exports, residual stocks and non-food use) by the resident population. We don’t know if the food ends up wasted, or fed to the family dog, but the trends over time are quite telling.

Our collective food pantry: Food trends by category

Animal products:
Red meat consumption went down by about 14 percent from 1980 to 2008, but that still leaves 5 servings of red meat a day for each of us. At the same time poultry went up 80 percent.

Dairy products consumption also went up in the same time period, but the interesting information lies in the details: While beverage milks have gone down by 25 percent, cheese consumption went way up in the past 3 decades, from 17.5 pounds/person/year to 32.4, a rise of 85 percent! And I’m sure you’ve noticed the proliferation in the yogurt isle — yogurt has become a major seller, and we’re consuming 370 percent more of it than we did in 1980.

Fats:
We’re eating more fats and oils. In fact, our total fat consumption went up 50 percent from 1980 to 2008.

Flour and cereal products:
There’s been a significant per capita increase in grain consumption, from 150 pounds/person/year in 1980 to 197 pounds/person/year in 2008, which amounts to a 36 percent increase, but the most dramatic increase is in corn products intake — consumption rose by more than 156 percent in that time period!

Sugars:
Caloric sweetener consumption rose by about 13 percent in the past 3 decades. While refined cane and beet sugar actually declined, high fructose corn syrup intake went up 180 percent!

Fruits and veggies:
Fruit consumption is down by 15 pounds/person/year (5 percent) since 1980, and down 36 pounds/person/year (12 percent) since 2000 (fruit consumption went up in the 90’s, and then sank to new lower levels). Veggies fared no better: Total veggie intake is down 33 pounds (8 percent) since 2000.

Total calories:
The total calories available per person in the US rose from 3200 per day in 1980 to 3900 in the 2000s.

We’re eating more, and of the wrong foods

The census data provide further support to what we already know from scientific studies which rely on diet records: Overall, we’re eating more, and of all the wrong things. Although it seems we’ve been somewhat responsive to the advice to cut some red meat, we’ve replaced red meat by other sources of animal products, mainly cheese. We’re eating lots more fat, lots more sugar (mostly corn based sugars—because they’re cheap) and lots more refined grain products, many of them made of corn. Our appetite for fruits and veggies – the low-calorie food group we’ve never come close to meeting the daily recommendation for – has diminished further.

Farm policies explain much of these trends. Our farmers are encouraged financially to produce commodity grains and animal products, while fruits and veggies aren’t subsidized.

I have to end on a few positive notes: Smoking continues to decline, it’s down by 3 percent from 2000 to 2008, clearly not good enough, but the direction is positive; and organic farming boomed — total organic certified farmland grew by 170 percent, and we have added 550 percent more organic milk cows during those recent eight years.

Can you guess which vegetable we consume the most of?

Dr. Ayala

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

Can video games be a tool for better nutrition and more exercise?

I’m very old fashioned when it comes to video, computer and all other electronic games. OK, I’ll admit it: I don’t even fully understand why playing them is fun, or as my kids say, I just don’t get it. My imaginary migraine-inducing chamber-of-torture is a video arcade – but that’s just my personal inclination, and I’m in the minority. According to the Kaiser Family Foundation’s recent survey kids spend an average 7 hours 38 minutes a day in front of a screen. A typical kid spends 65 minutes a day playing video games, and the majority of kids have a game console in their bedroom. So I guess video games are entertaining.

But spending hours in front of a screen is one of the least desirable uses of a kids’ time, and there’s plenty of evidence to back this assertion. The American Academy of Pediatrics recommends limiting screen time to less than two hours a day, and keeping screens out of the bedroom. That’s because screen time’s usually sedentary, and is linked with obesity and metabolic risk factors. Prolonged screen time is also associated with inferior academic performance.

Hours of inactivity are only one harmful outcome of sitting in front of a screen. Here’s another reason why screen time can make kids fat: Advertisers look for eyeballs wherever they can find them, and screen time, whether it’s TV, video, hand-held or computer, is soaked with ads. Guess who’s willing to pay top dollar to get your kid as a loyal customer for life? Fast-food and junk-food makers top the chart of kid oriented ads in electronic media.

There’s another really sad outcome of electronic games: Kids aren’t playing the way they used to. Kids’ play is the unstructured, messy, imaginative way in which kids create an inner world, interact with the real world, interrelate with friends, negotiate, solve problems, and work as a team. An old bed sheet becomes a toga, which turns into a sultan’s turban, which doubles as a magic carpet that can transport the princess to the castle (the castle’s roof made of the same cloth). A vivid example of child play is depicted in Toy Story 3 (one of the best movies I’ve seen this year). Kids’ play is a healthy way for kids to learn so much of the skills they’ll need, while having serious fun, and often while breaking a sweat.

Video games to the rescue?

Active video games debuted a few years ago, and my kids were excited to inform me that the Wii gets you moving and that “everyone has them” (to which I said: That’s great! you’ll be able to play them at your friends’ house).

Exergames indeed get you moving. Somewhat moving. A recent review in the Archives of Pediatric and Adolescent Medicine looked at these games and concluded that they enable light to moderate physical activity. To put it in other words, the Wii is better than sitting on the couch, but won’t improve aerobic fitness — to improve fitness kids need intense exercise and real sports, the kind that gets them sweating and their heart racing. Perhaps the groups that can benefit most from these exergames are patients undergoing physical rehabilitation and the elderly.

I asked my kids recently if the Wii’s still popular among their friends, and their conclusion was that the Wii gets rather boring after a while — and once a kid has a gaming console he’ll find something more exciting to play.

Here’s another attempt to make gaming healthy. A new study published in this months’ issue of the American Journal of Preventive Medicine examined the effect two epic video games, “Escape from Diab” and “Nanoswarm: Invasion from Inner Space”. These games incorporate behavior change procedures woven into the gripping stories, and were designed to improve diet and increase physical activity and were especially planned to lower risks of type 2 diabetes and obesity.

The 103 Kids playing these video games did increase their fruit and veggies intake when compared to kids playing diet and physical-activity knowledge-based games on popular websites, but only by about half a serving a day. They did not drink more water or engage in more physical activity (as measured by an accelerometer), nor did they improve body composition.

There are hidden messages in any programming. If the hero in a film smokes it may glorify smoking , yet if he eats vegetables it might make veggies cool. That’s what’s so good about Popeye. So by all means, I’m all for trying to get the right subliminal messages in. Every little bit helps.

The good, the bad and the violent

Video games are just a medium. Any medium can be used for good or bad. A better video game is possible — there are educational and active games, just like there are excellent TV programs — but they are the exception that proves the rule.

I hope you’re not feeling too sorry for my kids. They don’t have a gaming console — they’ve stopped asking for it — and we strictly limit screen time. But, could these kids play! They have an amazing capacity to play with each other and with friends, and whether it’s in the sun outside or on a cold day inside, they never fail to come up something wonderful to do.

Dr. Ayala

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!