Healthy Food & Healthy Living by Dr. Ayala

Zucchini “pappardelle” with lemon and herbs

As spring turns to summer, here’s a wonderfully fragrant and fresh light dish that uses what’s best this season. Serve it cold on a warm night, or heat it up (microwave is fine!) for extra comfort on a chilly evening.

Ingredients:

• 4-5 medium zucchini
• 2 lemons
• 5 garlic cloves
• ¼ cup olive oil
• 2 tablespoons capers
• A few sprigs of thyme
• Pinch of red pepper flakes
• 4 tablespoons finely grated parmesan
• 3 tablespoons pine nuts
• 2 tablespoons finely chopped mint leaves
• Salt and pepper to taste

Special equipment: mandolin, or a good vegetable peeler

To make:

Using a mandolin or peeler, cut the zucchini lengthwise into long thin ribbons. Cut those pieces lengthwise into narrower strips. Set aside in a large serving bowl

Cut the lemon into very thin – almost transparent – slices, using the mandolin. Pile the slices, and cut into 4. Add to the large bowl

Sliver the garlic cloves into the thinnest slices – again, mandolin is best.

To make the dressing, place the olive oil, garlic slices, thyme leaves, capers and pepper flakes in a large skillet. Turn the heat onto medium. Don’t preheat the pan. As the oil heats up watch carefully so that the garlic doesn’t burn. Stir the garlic gently. Continue cooking until the garlic is slightly golden, about 1 minute. Let cool

Add into the large bowl with the zucchini the rest of the ingredients: Parmesan cheese, pine nuts, mint, salt and pepper, and the toasted olive oil/garlic dressing

Mix well, correct taste and serve

Serves 4-8

Enjoy,

Dr. Ayala

The downside of gluten-freeing your kids

The gluten-free food industry has seen tremendous growth, and while celiac disease – which requires lifelong complete avoidance of gluten – is also on the rise, consumers who do not have celiac or any other medical reason to avoid gluten are the main engine propelling the gluten-free boom.

Why do they do this, and is this a healthy trend?

Norelle Reilly, gastroenterologist and director of the Celiac Disease Center at Columbia University Medical Center, in a commentary in the Journal of Pediatrics, cites a 2015 survey of 1500 American adults. “No reason” is the most common reason for going gluten free – 35 percent of those surveyed explained their choice just so. 26 percent choose gluten-free food because they think it’s a healthier option, and 19 percent perceive it as better for digestive health.

If gluten-free foods are indeed a healthy trend, the fact that 20 percent of Americans are seeking them for no medical reason might be a good thing. If, on the other hand, gluten free carries risk, this fad might be an expensive gamble.

The risk of gluten free

For people who do not have celiac, wheat allergy, or non-celiac gluten sensitivity, there is no data to support the notion that gluten free is healthy, states Dr. Reilly. In fact, packaged gluten-free food often contains more sugar and fat, and has higher caloric density. Contrary to what people believe, going gluten free without medical supervision can lead to packing extra weight, to insulin resistance, and to vitamin deficiencies, since gluten-free foods are not fortified the way wheat is.

And then there’s arsenic. Gluten-free diets often rely heavily on rice, and rice quite often, contains arsenic, which comes from the soil. The amounts are small, and probably not a problem if one eats a varied diet, but on a gluten-free diet rice becomes the predominant grain, and that can be especially problematic for babies and pregnant women.

A gluten-free diet, just like many other exclusion diets, comes with a quality of life price tag. And these specialty foods often cost more and are sold at a premium.

And since in kids there are only two indications for excluding gluten from the diet: celiac disease and wheat allergy (non-celiac gluten sensitivity has not been described in kids), putting kids on this diet carries risk with no apparent benefits. There is no support to the misconception that gluten is toxic, and no evidence that gluten-free diets treat a myriad of afflictions such as autism, arthritis or obesity.

Dr. Reilly concludes:

“Patients self-prescribing a GFD (gluten-free diet) should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation.”

The food industry uses the health halo of the gluten-free health claim to better sell. It’s really important to emphasize that just like one knows that foods that are peanut free are not generally healthier, gluten-free foods are not a panacea; avoiding gluten isn’t a recipe for health for those of us who don’t have a sensitivity or autoimmunity that involves gluten.

Dr. Ayala

The Biggest Loser’s biggest disappointment

What happens after the happily-ever-after of a show’s finale? Researchers followed 14 of the original 16 The Biggest Loser Season 8 contestants for 6 years to find out, and their findings made quite a splash.

It was disappointing but hardly surprising to find that after 6 years most of these very successful dieters regained a significant amount of what they lost, and 5 of the 14 in the study were right were they started, or even above their initial pre-show weight. Nevertheless, about 60 percent of Biggest Loser contestants in the study maintained at least 10 percent of their weight loss. As dismal as this sounds, these results, published in the journal Obesity, are better than the incorrect belief that no one -- ever --achieves permanent weight loss, and better than results usually seen in other diet programs: It’s estimated that 20 percent of dieters maintain 10 percent of the weight loss a year after the diet ended.

What was unforeseen was that even after 6 years, even after the participants regained weight, their metabolic rate was significantly lower than expected – hundreds of calories lower than the caloric expenditure of people of the same size and activity level. It’s well known that the body adapts to weight loss in a way that makes weight gain really easy – the body becomes very efficient with energy, and starts doing more with less, practically needing fewer calories for its usual maintenance. That even 6 years and after losing weight, and even after weight regain this metabolic adaptation was still in action was a new, quite shocking finding.

And the metabolic rate issue is, of course, only one aspect of the fight to keep weight off after weight-loss diet. There are also psychological, hormonal and social factors that might be even more important determinants of weight regain.

The reality of weight loss and weight stigma 

Overweight people face bias and discrimination every day – despite being the majority in the US and many other countries. The gigantic, ever-present weight loss industry makes it seem that weight loss is totally controllable and that it’s within each individual’s power to change. The Biggest Loser shows that with enough willpower and hard work one can reach weight loss extreme makeovers.

This kind of portrayal is not only unrealistic; it might also fuel greater negative attitudes and bias toward obese people.

Another study in Obesity examined how a 40-minute episode of The Biggest Loser affected viewers' anti-fat attitudes. Undergraduate students were randomly assigned to watch an episode of The Biggest Loser or a nature film, while being told that the purpose of the study is to test the effect of media consumption on processing speed. Watching The Biggest Loser did not improve attitudes towards obese people. It made them worse. The participants who watched The Biggest Loser reported greater dislike of obese people and greater belief that weight is controllable.

Despite the attention this recent study got, I doubt any network is proposing a reality show about the trials and tribulation of keeping lost weight off – it just doesn’t make for good TV.

And neither, I’m afraid, does the message of prevention.

Curing grave illness, last-minute rescues and extreme weight loss inspire the imagination. Preventing disease, avoiding risk and evading weight gain have no compelling visuals to attract our short attention spans.

Yet when one looks at what weight loss really looks like it is clear that the best strategy, as a society, is to avoid weight gain. We, as a society, have not changed genetically in the last 30 years. Our food has. Unless we move towards a culture that makes eating sensibly easier, many of us who want a healthy weight will have to continue to struggle with losing weight and then – forever -- with keeping it off.

It’s becoming clear that the keeping-lost-weight-off part is at least just as hard as shedding those pounds.

Dr. Ayala

Does candy make you fat?

Nutrition and public health experts specifically target sugary beverages as a key diet ingredient to cut if we want to improve health and avoid obesity. I devoted a recent post to the rationale behind that advice.

There are, of course, many sugar-rich treats, and when kids think of sweet delights the image is of candy and chocolate, rather than of sugary drinks. Are these sweet foods as much to blame for overweight and obesity as soda?

A group of Australian researchers, led by Constantine Gasser, assumed that would be the case. Candy is a major source of added sugar in the American diet (although it’s dwarfed by the amounts consumed through drinks – on average kids take in 5 times more calories from drinks than they do from candy) and although chocolate has some health benefits, they assumed that chocolate and candy would be associated with obesity and its related diseases. In a new analysis in the American Journal of Clinical Nutrition they collected all studies that looked at the relationship between candy consumption and overweight and obesity, and found 11 such studies, which together included almost 180,000 kids and teens.

To their surprise, the meta-analysis found that the more chocolate and candy kids ate, the slimmer they tended to be. The odds of being overweight or obese were 18 percent lower among the most avid consumers of chocolate and candy.

Do thin people eat chocolate?

The authors discuss the counterintuitive results and say that: “Just like expected findings, unexpected findings can reflect the truth, bias, residual confounding, and/or chance.“

They don’t think their findings are just by chance due to the large number of people in the studies and the consistency they saw in the association between chocolate and candy and weight.

If the results are true, it might be that these sweets are quite satiating, and that people tend to eat reasonable amounts of them.

Another option is reverse causality: Kids who are overweight cut chocolate from their diet, while thin kids allow themselves some candy.

And yet another possibility is that overweight kids underreport their chocolate intake.

Overall, though, it seems like although sugary drinks and chocolate both contain high levels of sugar, the former is consistently associated with obesity and overweight and the later is not. It might be that liquids are not ‘sensed’ the same way chewable food, or that the amounts of sugar one typically gets from soda are much larger, compared to what a typical serving of chocolate would provide, or maybe it’s something else.

This isn’t permission to binge on chocolate, but every reasonable guideline allows some discretionary calories for fun and pleasure – the Dietary Guidelines for Americans suggest limiting sugar to less than 10 percent of calories per day.

To me, chocolate -- one of life’s great joys -- remains a good little thing to splurge on.

Dr. Ayala