Healthy Food & Healthy Living by Dr. Ayala

Can you drink your joints healthy?

Functional foods have experienced fast growth in recent years, and supermarket shelves offer a wide array of products that claim to have health benefits beyond basic nutrition. Many of these foods are fortified with nutrients and additives that most people need a dictionary for, but they sure do sound medicinal and technologically advanced. These foods are marketed as disease-preventing and health-promoting.

There are drinks that claim they can make your skin younger (if you believe what’s written on the cosmetics’ package, I guess you can believe that, too), boost your brain function, make you loose weight without a diet and build super-immunity.

One of the product lines that I find most intriguing is the drinks aimed at joint health. Several companies make beverages laced with glucosamine and/or chondroitin aimed at maintaining healthy joint cartilage (see Joint Juice, Elations, Vitamin Water - Balance, Supple, Monavie). Since glucosamine and chondroitin are widely used dietary supplements, I’ve been asked by joint sufferers whether these drinks actually work.

A short introduction to these supplements:

Glucosamine is thought to promote the formation and repair of joint cartilage.

Chondroitin is a cartilage component thought to promote cartilage water retention and elasticity and to inhibit its breakdown. Both compounds are made by the body.

Glucosamine and chondroitin supplements are derived from animal sources (shellfish shells and animal cartilage), but glucosamine can also be derived from vegetarian sources. These supplements are promoted widely, especially by lay media, to treat osteoarthritis, the most common form of arthritis in the US, afflicting about 21 million people. They are hugely popular, with estimated sales of around $730 million in 2004.

So it would be nice to know if these supplements actually work.

There have been several studies that evaluated the efficacy of glucosamine and chondroitin, alone and in combination. Some have demonstrated efficacy, but other studies have shown no benefit. Many of these early studies had serious flaws. A recent meta-analysis in the British Medical Journal summing the results of ten randomised controlled trials concluded that compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space, and therefore these supplements shouldn't be covered by medical insurers.

The largest, most comprehensive and best-designed clinical trial so far is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), a multi-center, randomized, national clinical trial funded by the National Institutes of Health. This study produced two major outcomes so far:

• The first study was published in the New England Journal of Medicine in 2006. In it 1,583 patients with symptomatic knee osteoarthritis were randomly assigned glucosamine, chondroitin sulfate, both glucosamine and chondroitin sulfate, celecoxib (a non-steroidal anti-inflammatory drug) or placebo for 24 weeks. Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee, although exploratory analyses did suggest that the combination of glucosamine and chondroitin sulfate may have some effect in the subgroup of patients with moderate-to-severe knee pain.

• The study’s second outcome was published in the scientific journal Arthritis and Rheumatism. A subgroup of the original GAIT trial participants, consisting of about 570 patients continued the trial for a total of 24 months to see if there’s radiographic evidence that glucosamine and chondroitin, alone or in combination, can affect joint deterioration. And the result: the supplements did not appear to slow the loss of cartilage, taken either alone or together, and performed no better than placebo.

The only good news is that glucosamine and chondroitin have now been tried quite extensively, and while I don’t believe they work any better than placebo, they are generally safe, with only minor side effects reported.

As to the question of putting them into food:

Although many people eat food of very low quality, food that doesn’t offer the benefits of food (i.e., nutrition, taste, tradition, joy and community), they believe some new processed foods with added supplements can deliver wellness better than real food can, and practically act as medicine.

This kind of attitude enables manufacturers to invent new processed foods daily, adding the molecule du jour to the mix, and to market it as the new fountain of health.

Even if a supplement is proven effective (bear in mind that supplements are not required by the FDA to prove efficacy the way drugs do), why add it to a drink full of sugars and color? Why not take it as a pill, without the added junk?

But perhaps the most important question is: Why not go back to some sensibility about food?

• Food should be made from food, not from ingeniously created new additives. Rule of thumb: If you can’t pronounce an ingredient, it’s not real food.
• Foods providing innate nutrition, great taste and joy are really a refreshing change in today’s processed food landscape, and quite good enough. I don’t see how we can expect food to go beyond that and tackle all that ails.
• And above all, while seeking benefits beyond basic nutrition, we forgot basic nutrition. By eating well, keeping active, and maintaining a reasonable weight we can prevent many chronic diseases.

Eating well is good enough. No magic is needed, and if there’s any promise of magic—we should all demand strong proof.

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.

Three healthy habits to fight childhood obesity

I'll be taking a little time off to spend time with my family and travel. Meantime, I'll be reposting a few popular and relevant posts I’ve written over the past years so that new readers have a chance to catch up.

One in three American kids is overweight or obese. Many of our kids start accumulating extra weight—or develop the habits that will lead to weight gain later on—in very early childhood, setting them up for a lifelong struggle with both weight and a multitude of chronic diseases.

But many parents don’t pay much attention to obesity prevention advice; they don’t believe it’s relevant to their kids. They’re more focused on making sure their kids develop well, and they’re the last to notice when their kid puts on the pounds. And of course everybody hates “eat less” type of advice.

That’s why obesity-fighting tactics that aren’t directly related to what to put on kids’ plates have the potential of being successful.

A recent study in Pediatrics examined the association between childhood obesity and three household routines—regularly eating dinner as a family, getting enough sleep, and limiting TV-time—and found that 4-year-olds exposed all three routines had about a 40 percent lower prevalence of obesity than those exposed to none of these routines.

The study involved 8,550 nationally representative four-year-old American kids, and included measurements of height and weight as well as collection of background data, including ethnicity, maternal weight and education, and household income.

Eating dinner together regularly was defined as having the meal with at least some family members six or seven times a week. Adequate sleep for a four-year-old was categorized as 10.5 hours or more a night. Limited TV time was anything less than two hours a day during weekdays.

Here are the main findings:

• More than 18 percent (!) of the four-year-olds were obese.

• About half the families had a family dinner routinely.

• A little over a half of the four-year-olds got what the study considers enough sleep.

• 40 percent of four-year-olds had their TV time limited to less than two hours a day on weekdays.

• One in seven kids had all three household routines (family meals, enough sleep and limited TV time) and one in eight kids had none of these routines in place.

• Each of the routines was associated with significantly lower obesity rates. Kids who had all three routines had 40 percent less prevalence of obesity even after adjusting for maternal obesity and other socioeconomic characteristics.

Anything surprising in this data?

Unfortunately we’re getting used to seeing 18 percent obesity—yes, obesity, defined as a Body Mass Index (BMI) above the 95 percentile—not merely overweight in four-year-olds. That’s nearly one in five young kids!

Yet I still cringe whenever I see these numbers.

The finding that 60 percent of four-year-olds log more than two hours a day in front of the TV on weekdays is especially troubling to me. And I suspect these TV viewing times are an underestimate since parents tend to give socially desirable responses when asked about their habits, and only TV viewing at home and on weekdays was figured-in into this study.

Most large studies show that the more TV kids watch, the more likely they are to be overweight. How does TV contribute to obesity? Although common sense would say that TV displaces more active pursuits, that point isn’t well proven, as of yet.

What is very clear is that when our kids watch TV they are exposed to billions of dollars’ worth of well-crafted food ads, most of them for junk-foods: fast-food, sugary cereals and candy. These ads are so slick, and the marketing is so clever and entertaining that some toddlers have been known to sing the tunes and repeat the message after being exposed to some ads just once.

Most toddlers can’t tell programming and advertising apart—furry, cuddly friends and super-heroes abound in both—and it takes maturity and training to teach kids how to counteract the impact or to even notice the persuasive intent of advertising.

That’s why marketers want to get kids while they’re young; it’s like shooting fish in a barrel, and they’ll be loyal to the brand forever. That’s also why we parents should want to keep marketers away from our kids, especially when they’re very young and impressionable.

These days some food companies participate in a self-regulatory program but self-regulation doesn’t seem to be doing much to ensure responsible advertising to children. I actually don’t think there is such a thing as fair and responsible advertising to toddlers.

The American Academy of Pediatrics recommends limiting “children's total media time (with entertainment media) to no more than 1 to 2 hours of quality programming per day” and “discourage television viewing for children younger than 2 years”. TV is a babysitter every parent might want resort to every once in a while (we all need a break!) but common sense suggests that the upper limit should be lower than the Academy’s guide, and unfortunately, even quality programming is often flanked by ads.

Should we adopt these three habits?

This study is cross-sectional and observational, meaning it looks at a population at a certain point in time and proves an association between family meals, good sleep and limited TV and lower rates of childhood obesity. It cannot prove causality, nor did the study examine the key influencers of obesity—diet and physical activity levels. It very well may be that these three habits are the habits of families who eat better and move more.

Yet even without further proof that these three habits curb obesity, I would absolutely recommend them to families, mainly because family meals, good sleep and limited TV-time make so much sense. There are other reasons to adopt these habits (for example, eating together is simply a good way to keep family ties strong), and there’s very little downside to embracing them.

But there are possible drawbacks. Your kids may suffer some arguments over the dinner table, have occasional bad dreams while they sleep, and miss some educational and entertaining stuff on TV.

On the other hand, they’ll be learning the pleasures and skills of dining in company rather than gulping down food, they’ll get enough sleep to sustain growth and health, and I’m pretty sure that most alternatives to TV (playing, reading or even being bored) offer better stimulation and sustenance to a child’s developing brain. If these three habits also protect young children from obesity, that’ll be a nice added bonus.

I’d take the risk.

Dr. Ayala

Sports drinks: Are they healthy? Do they improve performance?

I have three athletic kids, and have many opportunities to watch practices and games.

I have been noticing lots of sports drinks.

Engaging in any sport is now almost synonymous with drinking a sport drink.

I’m not discussing performance athletes here, or regimens that involve endurance and extreme conditions. I am talking about kids playing basketball, tennis or soccer for an hour or so, in comfortable situations, with plenty of breaks, and many times hardly breaking a sweat.

Sports drinks were initially designed for athletes. Dr. J. Robert Cade, University of Florida professor of medicine and physiology is credited with creating the first sports drink in 1965.

Before Dr. Cade’s invention the players would practice all day in Florida’s humid heat, with hydration not part of the routine. It is hard to believe, but at that time athletes were discouraged from drinking even water for fear it would cause nausea and abdominal cramps. Many players suffered heat exhaustion at those times, and deaths were not uncommon among football players.

Dr. Cade was asked by the then-assistant Gator football coach Dwayne Douglas the question that launched an industry: Why do players loose so much weight during games, yet hardly urinate? Cade's researchers determined a football player could lose as much as 18 pounds, 90 to 95 percent of it water during the three hours it takes to play a game. Players sweated away sodium and chloride and lost lots of water.

Using their findings the researchers mixed water with electrolytes and sugar for players to drink while playing football. It tasted horrible, but after adding more sugar and lemon juice it was quite palatable, and did prove to benefit the athletes. The Gators enjoyed a winning record and were known as a "second-half team" by outlasting opponents.

After the success story of sports drinks for athletes these drinks were marketed to sporty and health-conscious general consumers. The marketing success has been so great, that, in the belief that this drink will “enhance performance”, “improve recovery” provide “quick rehydration” or “prevent hyponatremia” they now go hand in hand with exercise -- any exercise.

What’s in these sports drinks, and is it better to rehydrate with these for the casual exercise regimen?
This is a typical ingredient list:

• Water
• Sugars- 6% to 9% carbohydrate (glucose, fructose, sucrose, or synthetic polymer maltodextrins)
• Electrolytes- including sodium, potassium, and chloride
• Other stuff- flavors, colors, acids (for flavor and preservation), preservatives and vitamins in some.

For a recreational athlete, the only good ingredient is the water. Our body's glucose and glycogen reserves are not depleted by an hour of exercise and do not need replenishment, minerals are plentiful in food (electrolytes are basically salt), and despite marketing claims, sport drinks show little benefit over water in preventing dehydration in these situations.

The downside of consuming sports drinks regularly are the calories from sugars, getting into the habit of expecting a drink to be sweet, and the potential damage to teeth by constant contact with these drinks. The damage to teeth is from the sugars and the acidity of the drink, which can cause caries and tooth erosion.

Sports medicine has come a long way. Certain nutrition regimens do give athletes an edge, but this does not mean kids should be consuming sports drinks on a regular basis while engaging in routine childhood activity

An interesting idea is the power of suggestion sports drinks have. If you believe the drink will make you better, it will!

Ron Friedman and Andrew Elliot published a study in Psychology of Sport and Exercise that demonstrated across three experiments that just showing a sports drink -- as opposed to showing spring water -- led to greater persistence on physical tasks, consistent with the well-known perceived association between sports drinks and endurance.

I can see uses for that.

How about Happy Water -- marketing genius will convince you that just having it at home makes you happy -- or Peace Water -- shipping it around the world will finally bring world peace.

Let’s drink to that.

Dr. Ayala

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

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

Are women more susceptible to food ads than men?

Kids are very responsive to the messages in ads, often not even aware of their persuasive intent. We’d like to think that we adults know better, and are somewhat immune to the power of commercials.

But the mere presence of ads -- and knowing how much money is invested in them -- is probably proof enough that these ads do work. Research also supports the notion that seeing certain foods in ads, and seeing eating these foods as a highly rewarding act – which is how it’s invariably presented in ads – increases desire for and consumption of the advertised foods.

A study in this month’s Appetite looked at the direct effect food ads had on snacking. The studied group of 82 young students consisted of an equal number of men and women, all of normal weight, all unaware of the purpose of the study.

The students watched a 30 minute nature movie, seated on a comfortable couch, next to which, on a side table, snacks (chips and peanut M&Ms) were freely available. The movie was interrupted by two commercial breaks, in which half the study group was exposed to three ads for energy dense foods and five non-food ads, and the other half was exposed to eight non-food ads. The amount of snacks consumed during the viewing was measured, and the students completed several questionnaires and had their height and weight measured.

The women in the group snacked more when they were exposed to the food commercials. In fact, the women who watched food ads ate, on average, an extra 65 grams of the snacks (I’d estimate that as an extra 300-350 calories) in the short 30 minute of viewing.

The men didn’t seem to be affected in the same way. The men actually snacked more when shown the non-food ads.

Why would women be more susceptible to food ads?

Is it that women see ads for junk-food as permission to eat – because, hey, that’s what everyone’s doing? Advertisers are genius at presenting the product they’re selling as the social norm.

Or is it that the ad puts women in a good mood? Elated and free from concern, they indulge in some snacking.

Or do women identify with the happy, pretty (usually thin) mom in the ad and want to adopt whatever it is she’s doing?

Or is it that women are more likely to restrict snacking? Getting women to lose their guard by distraction perhaps opens the floodgates to uncontrolled eating.

The authors, led by Doeschka Anschutz, consider these possible explanations. Advertisers usually target women when designing food ads, as women are considered the gatekeepers to the pantry and do most of the food shopping. That might explain why the food ads worked on women. It would be interesting to see if beer ads – directed mostly at men – would affect men’s snacking habits. Indeed, maybe men in this study ate more when viewing the non-food ads because the non-food ads were for a car, a camera and a bank – ads typically targeted mainly at a male audience – and these ads grabbed their attention and therefore increased their snacking.

The TV obesity link

Several studies have shown that concentrating on something else makes over-eating more likely. Therefore blending TV viewing with high calorie snack foods is a recipe for weight gain. The food commercial breaks probably just add to the food craving.

Food commercials work. They work especially well on kids, and this study suggests they work their wonders on women, too. If we want to encourage healthier eating we’d be wise to keep junk-food ads away as much we can.

Do you feel that food ads affect you?

Dr. Ayala