Healthy Food & Healthy Living by Dr. Ayala

What 2 weeks of soda can do to your heart

Sugary drinks are linked to obesity, heart disease, high blood pressure and diabetes – and the more soda people drink the more likely these outcomes. The deniers keep arguing that association isn’t proof that one actually causes the other, although when epidemiologic studies show a link again and again, and the mechanism of harm is plausible, it is actually pretty damning evidence. That’s how we proved smoking cigarettes caused disease (there never was a controlled study asigning people to smoking and comparing them to controls). But there’s nothing like controlled experiments, especially double blind placebo controlled ones, to prove cause and effect.

It would be quite difficult to feed experimental groups a certain diet and follow them for the necessary time to see heart disease, diabetes and early death manifest -- I don’t think many would sign up to eat for the sake of research for the rest of their lives no matter what the compensation. But the next best thing when you’re studying heart disease is to look at markers of heart disease risk, such as LDL cholesterol, apoB, triglycerides and uric acid in the blood.

A new study, led by Kimber Stanhope and published online ahead of print in the American Journal of Clinical Nutrition, recruited a group of 85 people aged 18-40, and divided them into 4 groups. For 2 weeks participants drank beverages sweetened with high-fructose corn syrup (HFCS) making up 0 percent, 10 percent, 17.5 percent or 25 percent of their daily caloric requirement.  The participants were blinded to their drink content, and in order to do that the 0-percent drink for the control group was sweetened with aspartame.

Within 2 weeks, the people who were on the HFCS drinks had higher levels of LDL, triglycerides and uric acid, and the higher the HFCS they drank, the higher the level of heart risk factors.

Although the American Heart Association and the World Health Organization recommend that people limit added sugar to no more that 5 percent of daily calories, very few people do so, and levels of added sugar in the 10-20 percent are typical of the American diet. By this study’s assessment, the average American’s sugar intake is enough to increase cardiac risk.

Would replacing HFCS with regular sugar (sucrose) make a difference? The fructose content in table sugar is 50 percent, compared to 55 percent in HFCS – just a slight difference – and since fructose is metabolized in our body in a way that promotes fat production, raises triglycerides and affects cholesterol levels, either one of these sweeteners would probably have the same negative effects; there's no reason to assume that sugar is metabolically much safer than HFCS.

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.

Does restaurant food raise blood pressure?

It is possible to eat healthy when eating out – but it certainly isn’t easy. Tempting foods, countless choices and large portions are just some of the reasons we’ll tend to overdo it when eating out. The fast food to healthy food restaurant ratio definitely also skews to the greasy, salty, sugary side of things. 

Eating out more often is known to be associated with overweight, but a new study in the American Journal of Hypertension found that even for young people, just one more meal out is linked to higher blood pressure. 

High blood pressure your food and your health

High blood pressure, or hypertension, is a risk factor for heart disease and stroke, and the earlier in life it starts the greater the danger. The researchers, from the Duke-NUS Graduate Medical School in Singapore, recruited about 500 healthy students aged 18-40, and collected data about their physical activity, dietary habits and also measurements of blood pressure, weight and height.

In this young group 27.4 percent had prehypertension (defined as systolic blood pressure of 120–139 mm Hg and/or diastolic blood pressure 80–89 mm Hg) and 2.2 percent had hypertension (systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg). Not surprisingly, higher blood pressure was associated with higher BMI, older age and particularly with being male and with lower levels of exercise.

But the new finding in this study was that each additional meal out of home increased the odds of high blood pressure by 6 percent, and the association was stronger the older you got.

Controlling blood pressure is important for prevention of future disease, and while circulating androgens (the probable cause for men’s higher blood pressure) and our genetic makeup are a given, there are plenty lifestyle factors that are up to us. Exercise and controlling our weight are important for ideal blood pressure – as well as for countless other health conditions. And while eating out is fun, and a necessity for many of us, we can definitely try to eat more home cooked meals, and to eat out in a way that‘s more like eating in.

A few tips:

Choose the restaurant, choose the dish: After picking a restaurant with healthier food, opt for the dishes that offer simply prepared healthy options. Stay away from crispy and fried foods and creamy sauces and soups.

Control portions: Beware of all-you-can-eat buffets. If the portions are large don’t be shy – try to order a half portion or share the dish with your dining partner. Boxing half of the entrée for tomorrow is another option.

Pay attention to the drinks: Alcoholic and sugary drinks can add lots of unnoticed calories. Mixed alcoholic drinks can be calorie bombs: they contain both alcohol and sugary additions. Instead, drink water throughout the meal.

Pretend you’re home: Well, I wouldn’t suggest such killjoy steps if you’re eating out as an occasional indulgence – in that case I'd personally dress nicely and eat whatever my heart desires. But if you’re a student and have to subside on cafeteria food, if you’re traveling for a while and therefore eating a restaurant breakfast daily, I do suggest you pick the meal that most resembles a healthy home-meal. Those big muffins do look good and everyone seems to eat them, but the yogurt and bowl of fruit will leave you with fewer regrets.

Dr. Ayala

Carrot, dried apricot and herb baked fritters in pistachio dill pesto

One of my favorite restaurants is Zaytinya in Washington DC, where Jose Andres offers an impressive array of Turkish and Lebanese mezze, each blasting with flavor. His Havuc Kofte – carrot fritters served in an amazing pistachio sauce – is a dish we always look forward to.

I tried to recreate this dish at home, and in one of the trials finished them off in three ways: fried the traditional way, and baked with either a brush of olive oil or a sesame seed topping. The unanimous vote was for the baked version, which surprised me – I don’t like frying and eat fried food infrequently, but my kids actually just thought baking really works well for this dish, and voted on flavor only. I wasn’t sure what to call these anymore: Are they still fritters? Fritters are usually fried, not baked. Whatever you call them (suggestions welcome!), they’re delicious.

I have a feeling Andres’s recipe is more involved and has a few more ingredients, while mine is pretty easy, and relies on the food processor as my little helper – we home cooks don’t have the manpower big kitchens do, so I welcome shortcuts.

The leftovers from the pistachio pesto can be used as a dip, bread spread or thinned into a salad dressing.

Ingredients:

For the fritters:

• 5 large carrots, cut into chunks
• ½ cup whole-wheat breadcrumbs
• 5 dried apricots, coarsely chopped
• 2 green onions, chopped
• 3 tablespoons pine nuts
• ½ teaspoon paprika
• ¼ teaspoon cayenne pepper
• ½ teaspoon salt
• ¼ teaspoon black pepper
• ½ cups parsley or dill, coarsely chopped
• 1 large egg
• Sesame seeds or olive oil for coating/brushing

For pistachio pesto:

• 1 cup toasted pistachio nuts
• ½ cup chopped dill
• 1 clove garlic
• Juice from one lemon
• ¼ cup extra virgin olive oil
• Salt and pepper to taste
• 2 tablespoons water

Preparation:

Fritters:

• In a medium pot steam carrots with a little bit of water until tender. Remove from heat and drain well
• Place carrots in food processor, and pulse until mashed
• Add the breadcrumbs, apricots, green onions, pine nuts, paprika, cayenne, salt, black pepper, parsley and dill and eggs. Pulse until bound together. Mixture should be moist but not too wet. If the mixture is too liquid add more breadcrumbs
• Roll into about 25 balls. Place balls in covered container and refrigerate until ready to bake. The balls keep well for a couple of days.

Pistachio dill pesto:

• Place all the ingredients in a food processor, and process together until the mixture becomes a sauce. Taste and correct with additional lemon juice or spices as needed.
• If you prefer a more liquid consistency add more water.

Baking:

• Heat oven to 400 °F (200 °C)
• Roll carrot balls in sesame seeds, or brush with olive oil, and place on baking sheet
• Bake for 20-30 minutes, until the balls develop a bit of a crust 

To serve:

Spread pistachio pesto on a plate and arrange baked fritters over the sauce.

Serves 4-6.

Enjoy,

Dr. Ayala