Healthy Food & Healthy Living by Dr. Ayala

European study confirms: Sugary drinks linked to diabetes risk

Type 2 diabetes rates are clearly climbing, and have tripled in just 10 years.

The rise in sugary drink consumption has paralleled the rise in obesity and type 2 diabetes, which now afflicts ever-younger patients. And while obesity is a risk factor for type 2 diabetes, researchers have wondered whether sugary drinks are an independent risk factor, regardless of weight gain.  There's something quite special about sugary drinks' sugar concentration and rate of sugar delivery. We're gorging on growing amounts of sugars, which find their way into many of our processed foods. But the major source of added sugar in the Western diet is – you might be surprised – not desserts, but rather sugary drinks, which account for as much as half the daily calories from sugar, and 10-15 percent of kids’ total daily calories.

A study in the Archives of Internal Medicine looked at the relationship between consumption of sweetened soft drinks and fruit drinks and type 2 diabetes in 44,000 African American women, and found that women who consumed two or more soft drinks a day had a 24 percent increase in incidence of diabetes relative to women who drank less than one soft drink per month, a relationship that remains valid after controlling for obesity.

A meta-analysis, published in Diabetes Care in 2010, pooled more than 310,000 participants, and found that higher intakes of sugary drinks were associated with the development of the metabolic syndrome and type 2 diabetes.

Another recent study in PLoS One looked at the relationship between sugar availability and diabetes prevalence in 175 countries. After accounting for many factors, such as obesity, exercise, poverty, age, etc., the study found that the higher the sugar in the countries’ food supply, the higher the diabetes rates. The article’s conclusion: “every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1%.”

Most of these studies were in North American populations. Now, a new study published in Diabetologia takes a European perspective on the sugary drink diabetes link.

The study, which followed a very large population from 8 countries for 16 years, found about 12,ooo people who developed type 2 diabetes during follow-up, and compared them to 16,000 random controls from the same large cohort. It found that after taking into statistical account confounders such as smoking, education, physical activity, diet etc., drinking what amounts to one can of sugary drink a day increased the risk of diabetes by 22 percent. When the data was adjusted for weight (BMI) and caloric intake, the association was still strong, and the extra risk was 18 percent.

The authors discuss:

“The association between sugar-sweetened soft drinks and diabetes was only slightly attenuated when BMI was included in the model, which could indicate that obesity is neither the only nor the main mediator of the association, and that other mechanisms of action might be involved, such as the glycaemic effect of sugar-sweetened drinks and consequent insulin resistance”

In other words, sugary drinks may lead to obesity, which is a risk factor for diabetes, but sugary drinks consumption is a diabetes risk in and of itself.

Their advice:

“Given the increase in sweet beverage consumption in Europe, clear messages on its deleterious effect on health should be given to the population.”

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. 

Can you eat your way out of hot flashes?

Menopause is something I rarely think about. My take is that there’s no reason to anticipate and fret over life events that haven’t yet happened. I’ll dream about my next vacation, even when it’s far off, because it’s a nice respite, but with menopause I’ll deal only when it comes.

But new research I just read makes me think that there might be some merit to planning for this life transition. The study, published in the American Journal of Clinical Nutrition looked at the connection between hot flashes and what women eat, and offers further support to the notion that diet can relieve these very annoying symptoms.

What’s a hot flash? They say that, much like becoming a parent to a newborn, until you get one, you don’t understand what it’s really like. It’s described as a feeling of increased skin temperature, profuse sweating, sometimes accompanied by facial flushing and a rapid heart rate. It’s not dangerous, and it’s extremely common, but when it happens at night it interrupts good sleep, which is the cornerstone of health and wellbeing in my opinion.

Veggies and fruit protective; fat and sugar a risk

The Australian study included about 6000 middle-aged women, who were followed for 9 years. The women were asked about night sweats and hot flashes, and about their food habits.

After adjustment for confounders such as education level, smoking, obesity, physical activity etc., two food patterns were associated with fewer hot flashes: high fruit intake and Mediterranean style diet (veggies, garlic, red wine, tomatoes). On the other hand, high fat and high sugar diets were associated with high rates of reported hot flashes.

What does food have to do with hot flashes? The exact cause of hot flashes is unknown, but it is thought that estrogen withdrawal, which happens during menopause, disrupts our body’s thermostat.  Hormone replacement is one of the most effective treatments for severe symptoms, but hormonal therapy does carry some risk, therefore lifestyle modifications that can offer relief are in high demand.

Foods for hot flashes

Some women recognize certain foods trigger hot flashes for them. General food triggers include caffeine, alcohol and spicy food.

Several years ago, soy products were heavily favored for the prevention of hot flashes. Soy has plant estrogens (phytoestrogens), which were believed to provide natural estrogen replacement. Asian women, who live in countries where soy is a big part of the diet, also report fewer hot flashes than women in western countries (there are of course many lifestyle differences that can explain this phenomenon, and complaining might be cultural, too). The effectiveness of soy for hot flashes still remains controversial, though, with some studies showing benefits, and others showing none. 

Can a more plant-based diet affect the incidence of hot flashes? There are many mechanisms that can provide a logical explanation for why that might be a real connection. Foods affect estrogen metabolism; sugar metabolism and blood glucose levels might affect blood vessel dilation and contraction, for example. The authors of this study say theirs is the first ever study to look at dietary patterns and hot flashes, and it would be interesting to see if further research can confirm these findings.

As a woman, though, if you needed another reason to eat your plants and move away from high fat and high sugar foods, here it is.

Dr. Ayala

Mediterranean potato, onion, tomato and fresh herb bake

This easy, vegan, hearty dish combines the comfort of potatoes, with the light freshness of fresh basil and parsley, and the lovely redness of tomatoes and red spices. Serve with warm rustic bread to soak up the juices at the bottom of the baking dish.

Plan ahead: prep time is short, but for best results this dish may need about 2 hours in the oven, so get things started early.

Ingredients:

• 7 medium potatoes, (preferably Yukon Gold) peeled and sliced
• 5 large tomatoes, sliced
• 4 yellow onion, sliced

• 2 scallions, sliced
• 3/4 cup chopped fresh basil
• 2 tablespoons chopped fresh parsley
• 2 teaspoons dry basil
• 1 teaspoon paprika
• Dash of cayenne pepper (to taste)
• Salt and pepper to taste (start with 3/4 teaspoon salt)
• ½ cup extra virgin olive oil
• Garnish: (optional) ¼ cup chopped fresh basil

Preparation:

Preheat oven to 400 degrees F (200 degrees C)

Combine all ingredients in a large bowl, taste a tomato slice and correct seasoning as needed.

Arrange in a large, deep baking dish, and bake covered by tin foil for 1.5-2 hours, until golden, and potatoes are nice and soft. Remove tin foil 10 minutes before the dish is ready.

Garnish with some extra chopped basil. 

Serves 6-8 

Enjoy,

Dr. Ayala

A miracle diet that prevents cancer?

If you’re ready to believe the sensational titles and overhype in mass media, miracle super foods that decrease the risk of cancer are discovered every other week.

Except miracles are just that: something that rarely happens, and many of these reported ‘proven’ food cures are based on flimsy findings, never again to be reproduced.

Nevertheless, health experts are unanimous about the effect our diet as a whole has on health, and on cancer risk. The World Health Organization estimates that 25 percent of death burden in developed countries is due to lifestyle – completely up to us – risk factors.

8 healthy habits

In 2007, a collaboration between the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) evaluated the evidence and produced consensus recommendations for reducing the risk of developing cancer and for promotion of general good health and wellbeing. The WCRF/AICR report is the largest study of its kind, and its conclusions are as definitive as the available evidence allows.

The report featured eight general diet and lifestyle recommendations for cancer prevention:

“1: Body Fatness: Be as Lean as Possible Within the Normal Range of Body Weight.” Maintaining a healthy weight throughout life may be one of the most important ways to protect against cancer, and being overweight or obese increases the risk of some cancers.

“2: Physical Activity: Be Physically Active as Part of Everyday Life.”

“3: Foods and Drinks That Promote Weight Gain: Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.” Sugary drinks were targeted specifically in the report: “Such beverages appear to exert little influence on total daily self-selected energy intakes and their habitual consumption can lead to rapid and sustained weight gain even in the face of restricted solid food intake”. Another recommendation under this heading is “Consume 'fast foods' sparingly, if at all.”

“4: Plant Foods: Eat Mostly Foods of Plant Origin.” Diets that are protective against cancer are characterized by large intake of foods of plant origin and, indeed, several cancers are responsive to increased intakes of plant-based foods.

“5: Animal Foods: Limit the Intake of Red Meat and Avoid Processed Meat.”

“6: Alcoholic Drinks: Limit Alcoholic Drinks.” (Men-to 2/day, women to 1/day).

“7: Preservation, Processing, Preparation: Limit Consumption of Salt and Avoid Moldy Cereal Grains and Pulses (Legumes).” Salt and salt-preserved foods probably contribute to stomach cancer risk, and foods contaminated with aflatoxins are a cause of liver cancer. Although salt is necessary for human health, typical levels of consumption are vastly excessive.

“8: Dietary Supplements: Aim to Meet Nutritional Needs Through Diet Alone.” Dietary supplements are not recommended for cancer prevention. According to the report the greatest danger associated with the use of dietary supplements is the possibility that consumption of supplements is serving as an alternate to good nutrition, and supplements are taken as “magic bullets” to compensate for cancer-friendly dietary and lifestyle practices.

So, not as easy as popping a supplement or drinking acai juice, but does this recipe for cancer reduction and longevity actually work?

Not a shortcut, but it will get you there

A new study in the American Journal of Clinical Nutrition, including almost 400,000 people from 9 European countries, scored participants’ compliance with the 6 first WCRF/AICR recommendations (there was insufficient data to assess recommendations 7 and 8). Women were also assessed for another WCRF/AICR recommendation specific to women: Breastfeeding. The total possible score for a man was therefore 6, and for a woman 7. The group was followed for about 12 years, and during that time almost 24,000 people died, 48 percent of them from cancer.

People with the highest WCRF/AICR score (5-6 for men, 6-7 women) had almost 34 percent lower risk of dying than those that had the lowest scores (0-2 for men, 0-3 for women). Each additional point in the WCRF/AICR score was associated with a 1.2 year increase in life expectancy, and a higher score was associated with lower risk of death from cancer, cardiovascular disease and breathing problems. The recommendations regarding overweight and obesity, and eating plant food, were the most strongly associated with risk of dying.

We like things fast and now, and the WCRF/AICR recommendations aren’t a shortcut, but isn’t it nice to know that we do have some control over our heath trajectory?

Dr. Ayala