Healthy Food & Healthy Living by Dr. Ayala

How much is too much?

Moderation is such a welcome word! Avoiding excess or extremes – especially in eating and even more so in politics – sounds like the soundest of advice, and after decades of crazy diets the everything-in-moderation mantra is popular again, with craveable and unhealthy foods accepted, as long as they’re in sensible amounts.

But what is a sensible amount? Can we be trusted with moderating moderation? Is moderation modulated after what we think we should eat? What we see our friends eat? Or, in the case of food we really enjoy, on how much we’d like to eat?

A new study by led by Michelle vanDellen, in the journal Appetite, looks at people’s definition of moderate consumption.

In the first study, 89 students were given a bowl with 24 chocolate chip cookies. They were asked how many cookies one should eat, how many cookies constitute moderate eating, and what amount would be indulgent.

Moderation, by the majority of this group, is a number of cookies greater than one should eat – the group thought they should eat 2 cookies, but that a moderate amount is 3 cookies.

In the second study 294 participants were shown a picture of 24 gummy bear candies, and were asked how many should be eaten in one sitting and what consists moderate amount. Here, too, eating in moderation amounted to 2 extra gummy bears over what the participants thought should be eaten. Another interesting finding was that the more the participants liked the candies, the greater the number they suggested as a moderate serving.

In the third experiment 121 people were asked to report how often they consume foods and beverages and how many servings they take, and to assess whether they’re exercising moderation. The researchers found that participants rated their consumption as moderate, and when asked to define moderate consumption defined moderate amounts as greater than what they eat – if they drink one soda can a day moderate amounts would be assessed as greater than one a day. In other words, their personal consumption was always moderate or better (lower) than moderate.

Everyone’s above average

According to this study moderation is a number greater than what one should eat, and forever greater than what people personally ate – a completely biased definition.

If this is so, messages of moderation may sound good, but are unlikely to reduce consumption to healthy amounts, unless moderation advice contains specific information.

We are an optimistic lot, this study shows. Unless it’s spelled out that moderate amounts of alcohol are at most 1 drink a day for women, 2 for men, that moderate sugar intake is 6 teaspoons a day for women, 9 for men, and that no smoking at all is the only reasonable amount, people easily fall into self deception, believing that what they do is better than average.

Dr. Ayala

Eating with your ears wide open

Foods that need thorough chewing have a reputation for controlling hunger better. These foods stay longer in your mouth, and you get more eating experience from them, compared to softer foods.

A new study by Ryan Elder and Gina Mohr suggests it may not just be the texture of these foods that matters; maybe the sound that chewy, crunchy foods produce acts as a sixth flavor that affects our appetite and sense of fullness.

The sound of food is a neglected field. It’s been shown that everything in the food environment matters: the size of the dish, the ambient light, the smell in the room and the color of the package all affect how much people eat. Likewise, the ambient sound and music in a restaurant have been found to affect how quickly or slowly one eats, as well as diners’ mood and enjoyment of food. Although we know that the crispness of a potato chip makes us think it’s fresh – maybe because many fruits and vegetables are fresh when crisp – food’s sound influence on intake had not been studied, according to the authors.

Masking the sound of eating affects how much you eat

In the new paper in Food Quality and Preference, the authors showed, across several different studies, that paying attention to the sound of food chewed reduced food intake. In one of the studies 71 students were given a bowl of pretzels, and told to eat at least one, and then as many as they wish. Through headphones, they were played either loud or quiet white noise – the loud ambient noise masking the sound of their chewing. Those who listened to loud noise consumed about 50 percent more pretzels. In another experiment pita chips were advertised to 156 students with either their sound effects emphasized: “the crunch you crave”; “crispy sound to each bite”, or their taste highlighted: “the taste you crave…delicious flavor of each bite.” The participants ate significantly fewer (about 20 percent less) chips when the food sound was emphasized.

Now, imagine yourself eating popcorn in a movie theatre, watching a quiet dialogue passage, rather than a loud action scene. Are you aware of your munching sounds? Do you think it might affect how much you’d eat? This study suggests that mindfulness of food sounds can be a tool in curbing overconsumption.

We know that foods’ appearance affects how much we eat. The way food sounds might provide cues as well. You wouldn’t want to miss on the smell of food, and the authors urge us not to miss the sensory input of foods’ sound.

Here are a few suggestions:

Choose healthy crunchy foods: this study used pretzels, cookies and pita chips, but many fruits and vegetables are known for their crunch. Honeycrisp apples, carrots and celery sticks each have unique crunchy sounds – their sound effects can be an added bonus.

Reduce ambient noise: Loud music, earbuds and background TV all mask the sound of eating. These distractions might block our ability to pay attention to food and thus monitor our ideal intake.

Pay attention to sound: Noticing foods’ origin, preparation and characteristics enhances the experience, even changes its flavor, and can help you be satisfied with smaller portions. Sound is another aspect of food that can be savored and appreciated.

Dr. Ayala

Downton Abbey finale has a lesson in nutrition

I’m going to miss Downton Abbey. Escaping into the lives of the Crawleys was a wonderful Sunday night treat – that always left me grateful to be living in our era, especially as a woman.

For those of us nostalgic for old times, and especially those who claim nutrition science is useless, there was a small lesson to be learnt from the drama-packed finale.

(If you haven’t been following the series it really doesn’t matter; read on. Spoiler alert for those who haven't watched the chapter yet, although I'm not giving away much.)

Lord Merton, Isobel’s onetime fiancé discloses that he has a terrible diagnosis. He was feeling weak, and visited the best doctors in London, who ran all the tests and diagnosed anemia. Isobel’s worried face lightens up hearing this, but Lord Merton quickly brings her hopes down. At this point I thought he was going to say he has leukemia, but what he has is pernicious anemia – and Isobel realizes his end is near.

Pernicious means dangerous, destructive, deadly.

So what’s Lord Merton malignant condition? Are Isobel’s gloomy tears justified?

Pernicious anemia was described by English researchers in the mid nineteenth century. Patients had anemia with all its symptoms (fatigue, pallor, rapid heart beat), and also mental slowness, memory loss, numbness and tingling of hands and feet, walking difficulties and mild dementia. In the lab, a blood smear would show megaloblasts: abnormally large immature blood cells. It was an invariably fatal, rapidly progressive disease.

Nowadays, pernicious anemia’s death sentence is overturned within 1-2 days – with one injection.

What causes this mystery fatal illness?

Pernicious anemia is B12 deficiency. This vitamin was finally discovered and isolated in 1948 – many decades after the disease was first described and 23 years after the time described in this Downton Abbey chapter. B12 deficiency is usually a result of inability to absorb the vitamin, but can also develop in cases where intake of the vitamin is very low – such as in vegans who don’t take B12 supplements and their exclusively breast-fed infants. Only animal-origin foods have B12: dairy, eggs fish and meat and shellfish are all good sources.

There might be pieces of the past we wish we could have held on to, but with all the criticism we rightfully have of modern medicine let’s be thankful for all the suffering it has helped us avoid. It’s because we now know so much more about nutrition that the classic nutritional diseases (such as scurvy, beriberi, pellagra and rickets) are rare and easily treated.

People often say nutrition science is confused, that advice changes every other week. Well, nutrition science is a young science, and like all science it is moving towards the discovery of truth – sometimes taking an unfortunate detour on a path that leads nowhere before correcting course. The main problem is the abuse and hype nutrition science suffers by the hands of weight-loss and food marketers. Diet and exercise programs sometimes latch onto flimsy evidence, twisting and exaggerating findings, and creating an enormous amount of hype – to their gain and the general public’s confusion.

Science is complex and slow moving. Nutrition science it especially difficult, because it deals with people eating – at their own will – diverse foods throughout a lifetime. We are moving towards answers and consensus at a much faster rate than we did in Downton’s time, and with some patience and perspective – and less distractions – we will know much more.

I’m going to miss Downton Abbey, and its reminders of how far we’ve come.

Dr. Ayala

Eating Clean's Golden Bell Pepper Soup

Ten years of chronic health issues led Manhattan based personal chef and culinary nutritionist, Amie Valpone, to figure out how to be healthy in a REAL way. She has a new beautiful book, and she paused her busy schedule to answer a few of my questions and share a delicious recipe.

Q: What are your favorite herbs and spices?

Amie: Fresh basil, fresh cilantro and fresh parsley. I make salads that have more herbs than lettuce because there is so much flavor in fresh herbs and they're packed with nutrients. When you start to add fresh herbs into your lifestyle, you'll see you no longer need processed salad dressings! Olive oil and lemon juice will create amazing flavor with the herbs and that's all you need!!!

Q: Where do herbs and spices fit into your Eating Clean plan?

Amie: They're in all of my meals and snacks from breakfast to snacks. I tossed them into my Millet Tacos for breakfast and my Grain-Free Crackers for snacks as well as my main dishes such as Paella and my Panzanella with Gluten-Free Herbed Croutons, Cherry Tomatoes and fresh herbs, plus a whole lot of other recipes that are full of fresh herbs for maximum flavor!

Q: What are your go-to snacks?

Amie:I love all veggies with hummus, guacamole and salsa. That's a staple in my home. I also love munching on my grain-free crackers or grain-free breads made from almond four, coconut flour, and chickpea flour.I have an incredible flatbread recipe in my cookbook and two more coming soon to my blog that are amazing. I’ll wrap them in parchment paper along with my homemade nut cheese and I’ll be set for a long plane ride to California! 

Q: Which kitchen tool can’t you live without?

Amie:My food processor! When I had colitis, I had to eat out of a food processor for an entire YEAR- hence the reason for the HUGE condiment and soup and dip, spread and puree chapter in my new cookbook, Eating Clean. I'm still in love with pureed dips and dressings and nut butters that I make from my food processor. It's the best!!

Q: If you’re traveling and need to eat out, where do you go and what do you select?

Amie: I go to Whole Foods Market --that's my first stop for EVERY trip! I load up on avocados, raw walnuts, raw almonds, LOTS of veggies, hummus and a few other ingredients to hold me over until my meals. I usually eat this when I'm traveling as well as chia seeds and ground flaxseeds for omega 3's and healthy fats to keep me satisfied. I store it all in my hotel fridge and have a picnic. It's fabulous; more about this in my cookbook, Eating Clean, that's in stores nationwide this week. Yay!!

Golden Bell Pepper Soup

Serves 6 to 8

Ingredients: 

¼ cup extra-virgin olive oil

½ small onion, diced

2 medium carrots, peeled and diced

1 celery stalk, diced

Sea salt and freshly ground black pepper, to taste

8 yellow, red and/or orange bell peppers, chopped

1 large sweet potato, peeled and chopped

4 cups low-sodium vegetable broth

3 teaspoon finely chopped fresh marjoram

1 recipe Gluten-Free Herbed Croutons, for garnish

Sliced avocado, for garnish; optional

Finely chopped fresh cilantro, for garnish; optional

Drizzle Seriously Sensational Sriracha Sauce, for garnish; optional

 

Preparation: 

In a large pot, heat the oil over medium heat. Add the onion, carrot, celery, and a pinch of salt and black

pepper. Cook until the vegetables are tender, about 4 minutes. Add the bell peppers and cook until soft,

about 6 minutes. Add the sweet potatoes and broth. Season with salt and black pepper, cover the pot,

and bring to a boil. Lower the heat and add the marjoram. Simmer until the vegetables are tender,

about 20 minutes.

 

Let the soup cool slightly, and then, in batches, transfer to a blender and puree until smooth. If needed,

thin the soup with water. Adjust the seasoning with salt and black pepper if necessary. Return the soup

to the pot to keep warm until serving. Serve garnished with the Herbed Croutons and, if desired, the

avocado and cilantro on top and Seriously Sensational Sriracha Sauce on the side.

  

Try it! It's amazing!

Dr. Ayala

 

Text excerpted from EATING CLEAN, © 2016 by AMIE VALPONE. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.

Learning from others: How to make school (lunch) great

Steve Jobs famously said: “we have always been shameless about stealing great ideas.” In his latest documentary, Where To Invade Next, Michael Moore “invades” country after country, looking for lifestyles worth appropriating – so that he can plant the American flag upon them and bring them home.

Of particular interest to me were his school visits.

The French school dining experience

Moore sits for a 1-hour lunch in a French school cafeteria and is served a 4-course meal, in real plates, with water in a real glass. He brings a can of Coke with him, and asks the kids if they ever drink that. None of them do, and none are interested in trying. There are no sugary drinks or vending machines in French schools. Meals are planned by a chef and a planning committee and cooked from scratch. There’s always a cheese course – the favorite cheese in that particular school is Camembert. There are no “kids' foods” served and French fries are a biannual dish.

Moore visits an ordinary school, he claims, in a lower-income neighborhood. I do believe that he didn’t cherry pick a French school lunch, as there are multiple such reports, and the nutrition standards of the school lunch are set by government policy. French kids do eat better, and that they get a culinary education at school that lasts a lifetime, and results in better health and lower obesity rates. Their school cafeteria reflects widespread French values, and the school environment is consistent with what many parents do at home.

The question is can we import this, and how.

Forget homework, be happy!

Moore also visits a school in Finland, a small country with one of the best education systems in the world. According to the movie the secret to the Finns’ success is little or no homework, no standardized tests, and that play, freedom and happiness are the teachers’ top priority. The kids spend only 3-4 easygoing hours at school, where they learn a variety of skills, such as cooking, arts and crafts.

According to the film all you need is to set kids free – less is apparently more.

Could it really be so simple? This sounds too much like a miracle diet – the kind that promises that fat will melt away while you’re eating lots of cookies.

Well, the Finnish school system did vastly improve its reading, math and science scores but ditching homework was hardly the only or the main thing on the road to success. You don’t need to dig deep to find that editing out things-kids-hate is not the only difference between the US and Finland. Teachers in Finland are professionals, selected from the top of the nation’s graduates, and all have a master’s degree in education. Teaching is a very prestigious and selective job that’s highly sought-after and is well paid. Classes are small. Schools are small, and most teachers know all the kids not just in their class, but also in all others. There are no private schools -- all schools are equal. There are no hungry or homeless kids, and everyone has the same, free, healthcare. Parents get a year of paid leave to care for their new baby.

And it took 40 years to turn Finland’s schools around – 40 years of sustained effort, prioritization, planning and funding. The international science scores rose only in the last decade. Finland’s education overnight success was decades in the making.

Unfortunately, this is the real nature of change. It’s usually hard, protracted, sometimes ugly work. It also doesn’t make for great entertainment and would leave little screen time for the invasion of other countries – I found Moore’s Germany and Iceland invasions especially compelling.

But it can be done. Others have done it. The movie ends kind of optimistically with the thought that positive change sometimes takes a leap; Moore reflects on the fall of the Berlin Wall, pointing that advances sometimes surprisingly accelerate all of a sudden. But even the drama of November 9th 1989 was actually preceded by a gradual collapse behind-the-scenes.

Leaps can hardly be expected. School food is improving bit by bit, in small incremental changes, and although the kids of today deserve a perfect school lunch, we can take some solace knowing that things are moving in the right direction. I’m all for big dreams, as long as we don’t get discouraged by how long it usually takes to implement change and improve things in a big old system.

I’m hopeful. And I think Moore wants us to be jealous, angry, ashamed enough to do something -- but in the end optimistic.

Dr. Ayala