Healthy Food & Healthy Living by Dr. Ayala

Can olive oil and nuts prevent heart attacks?

A new study, just published online in the prestigious New England Journal of Medicine, was able to prove that diet – a tasty and rather easy to keep one at that – was able to reduce stroke and heart disease by 30 percent.

The study, led by Dr. Ramón Estruch from Barcelona, Spain, involved 7447 people, aged 55 to 80, all at higher risk for heart disease due to diabetes or at least 3 risk factors or heart disease, such as obesity, smoking, high blood pressure, elevated levels of bad cholesterol, or a family history of early heart disease.

Participants were randomly assigned to one of 3 groups:

• Mediterranean diet supplemented with approximately 4 cups a week of extra-virgin olive oil (OVOO);
• Mediterranean diet supplemented with an additional ounce daily of walnuts, hazelnuts and almonds;
• Control group that was counseled to eat a low-fat diet that did not include olive oil or nuts. This group received small nonfood gifts.

Both Mediterranean diet groups were encouraged to consume olive oil, nuts, fresh fruits and veggies (at least 5-a-day), legumes, white meat and wine in moderation with meals, and discouraged from soft drinks, commercial bakery goods such as pastries and sweets and red meat. Sofrito (a sauce made with tomatoes, onions, garlic and herbs, slowly simmered with olive oil) was also recommended – at least 2 servings a week. 

The control group was advised to eat low fat dairy, fruits and veggies (at least 5-a-day), lean fish and seafood, and discouraged from vegetable oils (including olive oil), commercial bakery goods, nuts, fried foods, red and processed fatty meat and fatty fish. 

To be fair, the study doesn’t really compare the Mediterranean diet to a low fat one, because the control group didn’t really adhere to a low-fat diet – they must have found it hard. So the comparison is really between a Mediterranean diet and a ‘whatever goes’ diet. 

Although people in all 3 groups had similar diets before the study started, compliance with the Mediterranean diet was good, and was verified not just by participants’ report, but also by measuring urinary hydroxytyrosol, a marker of olive oil intake, and blood alpha-linolenic acid, a marker of walnut consumption.

The participants were followed for the occurrence of heart attacks, strokes, and death from heart disease. After an average follow up of almost 5 years, 288 such events happened. Both Mediterranean diet groups experienced 30 percent less such events compared with the control group.

Quite encouraging! Especially since neither group was given a low calorie diet, or advised to lose weight – which could of course reduce heart disease and stroke risk, but isn’t easy to do. As a matter of fact the Mediterranean diet with OVOO group was encouraged to eat 4 tablespoons of the oil each day, which is 450 calories in OVOO alone! The Mediterranean diet with nuts group was supplied with about 200 calories-a-day in walnuts almonds and hazelnuts.

What’s special about this study?

The Mediterranean diet has shown its protective benefits against several diseases in many studies. A meta-analysis in the American Journal of Clinical Nutrition combined the findings of many prospective studies, pooling more than 2 million people, and showed that greater adherence to a Mediterranean diet – in line with pretty minor lifestyle changes, like eating a good amount of fruits and some nuts – was associated with 8 percent reduction in death, 10 percent reduction in cardiovascular illness and cardiac death, 6 percent reduction in cancer and 13 percent reduction in neurodegenerative diseases, such as Alzheimer’s, and to offer some protection from stroke and mild cognitive losses.

This study adds to previous evidence, and stands out due to its scientific rigor – it is a large, randomized controlled clinical trial, in which people were allocated by chance alone to eat in a certain way, were followed for a long time and were compared to a control group. Its results were also so conclusive that the trial was stopped early in order to report the results and allow the control group to enjoy the benefits of the Mediterranean treatment.

What’s the health-promoting ingredient in the Mediterranean diet?

So what should it be? Should we dip bread in olive oil twice a day or snack on almonds?

Let’s remember that this study tested the effects of a Mediterranean diet on heart disease and stroke. As much as we’d like to learn a magic trick from its findings, we cannot conclude that avoiding commercially baked goods, avoiding soda, eating sofrito, replacing red meat with fish or nibbling walnuts saves lives. The people in the study changed many eating habits during the study period.

The Mediterranean diet is an eating pattern, a total plan, and should adopted as one. We don’t know which part of the package confers the most benefit, all we know is that the pattern works as a whole; all parts of it are probably beneficial, and it very well might be that they work in combination with each other. The Mediterranean lifestyle – allowing for leisurely food enjoyment and social interaction – might be just as important.

I think the Mediterranean diet would be worth adopting for the sheer pleasure of it, and the health benefits are just another great reason to go Mediterranean.

But I’d stop short of the at-least-4-tablespoons-OVOO-daily the participants in this study were advised to eat. Way to many calories – leaves too little to play with if you’re also aiming for an energy balanced diet.

Dr. Ayala

 

Eat Healthy! Everybody’s Doing It!

What do you think is going to lead more students to the salad bar, telling them that most of their friends eat vegetables, or stating that eating vegetables is good for you?

We know that peer pressure can push people to do the right – or wrong – thing. What we think is “normal” or “typical”, and our perceptions of what others have and do, influences our decisions. Many campaigns encourage us to join the majority: “Four out of five dentists surveyed recommend…" and “billions and billions of people served” led us to believe the decision has already been made by everyone, so it must be a good idea. Social psychologist Robert Cialdini showed in a series of studies that when hotel guests were told that the majority of guests reused their bath towels, they were more likely to reuse them, too. This social norm message outperformed environmental reasoning and even a promise to donate money if guests helped reduce towel laundry.

Educational information about nutrition could appeal to those seeking to eat better, but on the other hand telling kids what’s good for them might seem like unwelcome pressure, and might backfire and cause resistance rather than adoption of the good habit.

So which approach, if any, would you use?

Your friends eat here

A new study in Appetite (online ahead of print) conducted an experiment in an on-campus food court in an eastern American university. The experiment took place in an area with two food stations: a salad bar and a grill area serving hamburgers, chicken tenders and fries. The 220 students who participated in the study saw one of three signs:

1. “Every day more than 150 [name of university] students have a burger for lunch here”, accompanied by the university’s logo and photos of the grill area.
2. “Every day more than 150 [name of university] students have a tossed salad for lunch here”, accompanied by the university logo and photos of the salad bar.
3. “Have a tossed salad for lunch”, accompanied by a picture of the salad bar and the university’s logo.

In the control condition no signs were posted.

Message 2 resulted in more students choosing salad compared with the control condition. Message 3, surprisingly, did not lead to significantly more salad choices compared to the control condition. Message 2 and 3 did increase the number of salad choices when compared to the message 1 condition.

What if the norm isn’t healthy?

The sign telling students that salad is a popular choice outperformed the message suggesting that eating salad is what they should do.

But in order to use social norm messaging people need to believe the norm described is indeed true and real. In other words, we need to reach a point in which a majority is indeed following a positive habit in order to market the healthy choice as what everyone’s doing.

When it comes to healthy eating this is rather hard to do. Eating unhealthy, calorically dense foods is very common in many social circles, and research even suggests weight gain ‘spreads’ in social groups, perhaps because people tend to follow the choices of their peers.

So how can we support an “everybody’s doing it” healthy behavior? 

Perhaps we should look at admired groups of people in which this behavior is indeed the norm. Do actresses eat a lot of veggies? Do tennis players follow a healthy diet? I’m sure we can find a trendy group of people in which “four out of five” or at least the majority are role models for healthy eating.

And let’s not forget that perceived social norms (some of them not normative at all) are also created – quite intentionally – by clever, repeated depiction in movies, TV, music and ads. I’d love to see healthy eating inserted into media in place of alcohol, junk food and sugary drinks.

Any suggestions?

Dr. Ayala

 

Love and chocolate: super chocolatey cookies recipe

If you’re looking for a homemade gift for Valentine’s Day (reminder: it’s this coming Thursday) these cookies are perfect – textbook for the serious chocolate lover and great for cookie fans too. I’ve received a recipe request from every recipient of this cookie gift who dares to bake. 

Chocolate's my favorite treat.  Chocolate is, to me, pure pleasure.  These cookies are as close as it comes to eating pure chocolate while still serving a dessert.  They’re rich, chunky, delicious and decadent, and hit the chocolate craving spot right on. 

Ingredients:

• 500 grams/17.6 ounces 72% dark chocolate, broken into cubes or pieces
• 500 grams/17.6 ounces milk chocolate, broken into cubes or pieces
• 2/3 cup all purpose flour
• 1 teaspoon baking powder
• Pinch of salt
• 1 cup sugar
• ½ stick (4 tablespoons) unsalted butter at room temperature
• 4 eggs
• 2 teaspoons vanilla extract
• 1 cup chopped walnuts (optional)

Preparation:

• Preheat oven to 350°F
• In double boiler over hot water, melt bittersweet and milk chocolate
• While the chocolate is melting sift together flour, baking powder and salt
• Using an electric mixer or a whisk, cream the sugar and butter.  Add the eggs one at a time, and then the vanilla extract, and continue beating until well combined
• Beat in the flour mixture, and then mix in the melted chocolate and nuts if using.  The final batter is thick and dark.
• Line 4 baking sheets with parchment paper or Silpat (or you can bake the cookies in batches using fewer pans).  Using two tablespoons drop 12 cookies in each pan, spreading them 2 inches apart. 
• Bake for 9-11 minutes, until the cookie tops get glossy and crack a bit.  Cool the cookies for a few minutes before removing from the pan.
• Store in an airtight container.  The cookies are best fresh, but will keep well for a good 5 days.

Makes enough large cookies for a crowd — 48 is my average.

Enjoy, 

Dr. Ayala

“All you need is love. But a little chocolate now and then doesn't hurt.” ~ Charles M. Schulz

 

Are kids going to eat less junk in school cafeterias?

The days of snacking on candy, soda and chips in schools may soon be over. Last Friday, the US Department of Agriculture (USDA) announced new proposed standards for snacks sold at schools. The standards limit the amount of calories, fat, sugar and sodium of most foods sold at school, and encourage whole grains, low fat, fruits and veggies. A few examples: Yogurt, granola bars, trail mix, dried fruit and fruit bars, pizza on whole grain crust and baked potato chips are in. Candy, caloric soda, sweetened fruit juice, and most cookies are out.

Perhaps anticipating the backlash, the proposal exempts fundraisers, afterschool sports events and treats sent by parents – including birthday and holiday party goodies. It also allows for a yearlong transition.

The rules, required under the child nutrition law passed in 2010, are an effort to combat childhood obesity and close an obvious loophole: while the government-subsidized school lunch has to comply with nutrition rules, what’s sold a la carte, in school stores, snack bars, or from vending machines, and competes for kids’ stomach share and lunch money, isn’t federally regulated at all, and can be of no nutritional value whatsoever.

Is it going to make a difference?

Is there evidence that stricter rules at school will encourage kids to eat less junk? Since many states and cities have already established regulations regarding foods sold at schools, there are already some comparisons that can be made. 

California was one of the first states to implement rules for vending and selling foods in schools; these rules limit the caloric content, fat and sugar in snacks, and ban soda and sweetened beverages. Last year I reported on a study in the Archives of Pediatric & Adolescent Medicine that compared California high school students’ daily intake to the intake of students from 14 states without any school nutrition standards, and showed that California kids ate fewer calories and consumed less fat and sugar per day at school -- 170 fewer – compared to high school students in other states. And the kids didn’t load up the missed calories after school. The Californian students took in 158 fewer calories a day, overall -- a reduction of 158 calories is a big deal as we gain weight very gradually, and reducing even 100 calories a day can prevent weight gain and put a dent in the obesity crisis.

Another study in Health Education & Behavior compared 3 middle schools that implemented a healthier snack and beverage nutrition policy with 3 that had no guidelines. Removing these items not only resulted in lower consumption of junk food at school and overall (no compensatory junk eating at home), it also didn’t seem to result in negative preoccupation with weight.

The New York Times recently reported that after decades of rising rates of obesity, several cities are reporting a decline. Philadelphia, my hometown, reported a 5 percent decline, and has seen this decline among minorities, and not just among high-income families. Philadelphia has implemented broad policies to fight obesity, including a ban on sugary drinks in school vending machines, and school snack guidelines that limit calories, fat and serving size. It’s hard to credit any one public health policy for the changing trend in childhood obesity rates, but the results are encouraging.

The importance of a healthy school environment

It will take a while until the snack food regulations are installed, and even longer until we can see their effects on kids’ diets.

But I think that paying attention and debating the foods sold at schools will have immediate educational outcomes.

As Agriculture Secretary Tom Vilsack said in a press release last Friday: "Parents and teachers work hard to instill healthy eating habits in our kids, and these efforts should be supported when kids walk through the schoolhouse door".

School, or government, doesn’t determine what kids eat, but it can definitely set minimum standards that promote healthier choices, or at least not undermine healthy nutrition efforts by condoning and profiting from the sale of junk within school walls.

Discussing unhealthy snacks, and removing them from the cafeteria, has an educational purpose. I wouldn’t be surprised if it influences the bottom line of what kids actually consume (kids do eat more than half their daily calories at school), but it’s worth doing, regardless.

When the vending machine changes what’s in its belly, kids consciously or unconsciously, notice; this exposure can change minds, and hopefully also what’s in kids’ bellies.

The USDA proposal will be open to public comment for 60 days. In the meantime, I’d love to hear your comments here. 

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.