Healthy Food & Healthy Living by Dr. Ayala

Does food texture affect how much we eat?

Crispy and crunchy make us anticipate deliciousness while oily or grainy aren’t great selling points. Chefs and recipe developers know about the importance of texture and mouthfeel; texture adds another dimension to the food experience and makes food more interesting and enjoyable.

There’s growing evidence that texture may also affect satiety.

We already know that people will consume more calories when they’re eating liquid foods -- that's one of the reasons sugary drinks are linked so tightly with weight gain. Liquids are at the lowest end of texture, require no chewing, and pass through our mouth quickly. But even within the solid foods texture complexity varies a lot. A bag of crispy chips may deliver terrific texture, but much less texture complexity than a spinach salad containing some crunchy nuts, diced apple, creamy goat cheese and finely chopped onion.

A new study in Appetite, claiming it is the first of its kind, looks to see if textural complexity affects satiety regardless of how much time the food stays in one’s mouth. In order to check that, the researchers, led by Danae Larsen, used specially designed foods with either low textural or high textural complexity. These test foods were identical in nutritional density and in flavor, and since the samples were very small the time they typically stayed in the mouth was similar. The basis of the test food was a gel, layered with either just finely ground poppy and sunflower seeds, or with several layers including whole poppy and sunflower seeds, a hard disc of dough and other chewy gums. These 4 bite-size samples were given before an eat–as-much-as-you-please meal, in which the first course was pasta with tomato sauce, and the second was chocolate cake. This was a randomized crossover experiment in which each of the 26 volunteers was assigned to both arms of the experiment.

And the results: After the high complexity appetizer people ate 160 grams -- 360 calories -- less pasta. When it came to dessert the high complexity group ate just about 20 grams less cake, which isn’t significant. Overall, complex texture in the appetizer shaved about 400 calories from the meal and left the volunteers equally satisfied.

The take home message: Texture complexity is probably as beneficial to appetite control as it is for flavor. Try adding a bit of crunch from seeds or nuts and a sprinkle of crisp, chewy fresh herbs to your dishes.

Anything that slows our eating helps us enjoy more with less. Adding texture to food does this in a wonderful way.

Dr. Ayala

Coffee and cancer?

You might have been surprised by the news coming out last week, announcing that the World Health Organization (WHO) found that coffee isn’t carcinogenic after all. If I were in the coffee business I’d want this news item to get as little publicity as possible, as I doubt anyone was worried about coffee’s carcinogenicity before they were told not to fret.

So what’s this all about?

The last time the WHO’s International Agency for Research on Cancer (IARC) evaluated coffee was in 1991, and at that time it gave it a “possibly carcinogenic to humans“ classification because of limited evidence associating coffee and bladder cancer in case-control studies (which are not the best evidence).

For this evaluation 23 scientists from 10 countries met in Lyon, France, and evaluated 1000 observational and experimental studies that have accumulated in the meantime.

Overall, cancer risk and coffee seem to be unrelated, they concluded.

The group also evaluated mate, a drink popular in South America and steadily gaining popularity elsewhere. Hot mate was classified as “probably carcinogenic to humans” in 1991 based on limited evidence. The new evaluation, based on the latest knowledge, concludes that while the high temperatures in which some people drink their tea or mate might act as a tumor promoter, the researchers think the mate itself is not a problem. Beware of very hot drinks, they advise:

“Drinking very hot beverages at above 65°C was classified as “probably carcinogenic to humans.”

Should we worry?

The WHO’s findings are a scientific evaluation, not a set of recommendations on what to eat.

The categories used by the IARC can be quite confusing.

The highest, most dangerous category, category 1: Carcinogenic to humans, includes processed meats (bacon, ham, hot dogs, sausages). And also cigarettes. Does this mean that meat is as carcinogenic as smoking tobacco? It definitely doesn’t. More than 85 percent of lung cancers result from tobacco smoking, yet according to the WHO’s report 50 grams (about 2 ounces) of processed meat daily might increase colorectal cancer by 18 percent -- smoking is much more likely to cause cancer than eating processed meat, even though both are in the same category. In this same category 1 you can also find ethanol in alcoholic beverages, secondhand smoking, engine exhaust, air pollution, and sun exposure. The sun’s rays, X rays and gamma radiation are all in the same category 1, but that doesn’t mean that beach vacations are as risky as getting a weekly CT scan.

Now, lets visit the category coffee’s in, it used to be 2B: Possibly carcinogenic to humans, and now it’s group 3: Not classifiable as to its carcinogenicity to humans. Coffee shares this distinguished category with tea.

This is science speak, so the best, most benign score you can get is category 4: Probably not carcinogenic to humans – scientists are very careful, and will never declare certainty.

Once the “can it cause cancer” question is raised to the IARC the best possible outcome can be: Probably not. When you ask a scientist: Is this – pertains to practically anything -- 100 percent safe? the answer can never be a simple: Yes.

A better place to look for practical dietary advice is the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, which concluded:

“Currently, strong evidence shows that consumption of coffee within the moderate range (3 to 5 cups per day or up to 400 mg/d caffeine) is not associated with increased long-term health risks among healthy individuals. In fact, consistent evidence indicates that coffee consumption is associated with reduced risk of type 2 diabetes and cardiovascular disease in healthy adults. Moreover, moderate evidence shows a protective association between coffee/caffeine intake and risk of Parkinson’s disease. Therefore, moderate coffee consumption can be incorporated into a healthy dietary pattern, along with other healthful behaviors…However, it should be noted that coffee as it is normally consumed can contain added calories from cream, milk, and added sugars. Care should be taken to minimize the amount of calories from added sugars and high-fat dairy or dairy substitutes added to coffee.”

I wouldn’t be at all surprised if one day we’ll discover that worrying about cancer may cause cancer.

Dr. Ayala

Getting your kids to say no to a second cupcake

Throughout the animal kingdom, parents guide their young about what’s good to eat and where to find it. In our temptation rich and junk-food plentiful society a lot of nourishment education has shifted into guidance about what not to eat, and direction to ignore food although it’s there. It’s quite an unnatural task that I doubt parents enjoy.

Should parents comment about what their kid puts on his plate at a party? Evidence suggests that efforts to restrict kids’ intake are actually associated with childhood obesity. The expert committee on prevention and treatment of child and adolescent overweight and obesity advised to “allow the child to self-regulate his or her meals and avoid overly restrictive feeding behaviors” -- parents are guided to try to overcome the urge and to use other, non-restrictive, ways to influence kids’ choices.

But how we parents frame the restriction must matter, too.

A new study, led by Megan Pesch, in the journal Appetite, looks at the tone and emotion, as well as the actual words, mothers used when their kid is faced with an opportunity to overeat.

Mothers and children -- 237  pairs -- were given the opportunity to try chocolate cupcakes. They were served with large portions, 2 cupcakes each, and their interaction was videotaped. The mothers’ cupcake restricting comments (both words and tone) were then categorized as either neutral or positive (gentle, caring, humorous), or negative (harsh, critical, unkind). Examples of a positive affect restriction were: “One’s enough,” or “Honey, you don’t have to clean it up, ok?” Negative urges sounded like: “Are you starving or what? Eh, stop acting like that. Get a napkin and wipe your face off or I'm going to call this off right now if you don't stop. You're acting like a little piglet,” (said critically with exasperation after child gets some chocolate on face) or “Don't you think they're gross? Of course not,” (said harshly with sarcasm.)

The researchers found that the majority of restrictive comments were positive, and only about 15 percent of moms made negative ones. 53 percent of moms urged their kid to eat less but in a positive tone, and these kids were more likely to be obese. The kids of moms that admonished their kids to eat less were even more likely to be obese.

This, of course, does not necessarily mean that you’re-eating-too-much comments cause obesity, or that shaming kids with these kind of comments has an even stronger effect. It is, though, quite plausible that parental regulation hampers kids’ self-regulation – directed by appetite and satiety – and that negativity causes over-eating as rebellion and defiance. Indeed, there are experimental studies that show that the mere act of prohibiting foods elevates their desirability and consumption. But the association might also be in exact reverse. Maybe when kids get chubby their mom and dad urge them to eat less. And maybe when gentle reminders don’t work, and kids continue to gain weight parents resort to harsher tones.

Guidelines aside, it’s almost impossible to shut up when you think there’s a better choice for your kid. The authors suggest that telling us parents not to speak is asking for the unmanageable:

"Mothers need guidance on how to effectively and sensitively restrict their child's intake of unhealthy foods, not to simply be told not to engage in restriction at all. There is a need for research into which types of restrictive approaches may be effective to decrease food intake while not promoting maladaptive eating behaviors."

It seems intuitive, and this study supports the notion that negative comments and tone of voice are even more counterproductive diet-wise, and they certainly lead to a bad atmosphere and hurt feelings.

What should a parent do? Here are a few of my tips:

• Lead by example: what you eat matters much more than what you say they should eat
• Protect your space: Make your home a sanctuary of nothing but healthy wholesome foods
• Eat home-made/-provided: Make or provide as many of the meals your family eats that you can manage
• Explain, don’t preach: provide an explanation for your objection to foods/quantities you think aren’t good to eat
• Make healthy pleasurable and tasty: Junk food will look more and more like the cheap imitation it really is if kids know good food
• Patience: Try not to worry about imposing your rules out of home. Out of home kids should know what their parents think, but then use their own judgment. Know that making better choices might take a while.

Dr. Ayala

Drink like a music celebrity?

What do the fit, beautiful music celebrities whom our teens admire eat and drink? According to the ads they help make it’s junk food and sugary drinks that got them into the great shape they’re in.

Which I seriously doubt. I’d bet that they actually treat their health as a great asset, and protect that asset by being very, very careful with what they eat.

A new study, led by Marie Bragg, in the journal Pediatrics, compiled a list of top music celebrities associated with the Billboard Hot 100 Chart, and then looked at foods and drinks these musicians endorsed and helped advertise.

Sixty-five of the 163 music celebrities in the study endorsed foods and drinks. Fifty-one of them endorsed beverages, mostly full-calorie sugary drinks. Most of the foods endorsed (80 percent) were energy dense and nutrient poor, i.e. junk food. Baauer, will.i.am, Britney Spears, Justin Timberlake, Maroon 5, Pitbull, and Jessie J were the most prominent food and drink endorsers. And the food and beverage companies are certainly getting their money’s worth: There were 312 million You-Tube views of the 94 celebrity food and soft-drink ads in the researchers’ sample – and that’s just one media channel.

Does Justin Timberlake really drink soda? Here’s what he told Bon Appetit about how he eats:

“I’m such a Type A personality–when it comes to a road trip, I plan my food so far in advance. I roll hard with a cooler. I don’t mess around. I want to avoid ending up eating fast food. I try to stay away from that.”

Britney Spears recently stunned the world with her amazing abs, and she, too, didn’t get there by drinking soda, but rather, as her trainers report, by eating clean, unprocessed food and good carbs. This is how Spears describes the way to her beach body:

“I’m really into raw food — sushi, basically…any kind of fruit.”

The authors admonish the practice revealed by this study:

“Obesity has become such a pressing public health issue that society must acknowledge the human suffering and costs associated with diabetes, obesity, and associated comorbidities. Musicians, actors, and other celebrities can be tremendously influential, particularly for the young fan base that may be swayed by their endorsements. Celebrities should leverage their influence to promote more healthful messages, and more effort should be made to reduce the exposure of children and adolescents to marketing, particularly for unhealthy food and nonalcoholic beverages."

The same author headed another study in Pediatrics several years ago that similarly showed the extent and reach of star athlete endorsed junk food. That study found that 24 percent of all the top athlete endorsement deals were for foods and beverages, almost all for junk food and sugary drinks. 

Associating junk food and sugary drinks with fitness, strength, vigor, success, health and beauty is pretty ironic. But I guess that as long as we’re buying into it, these endorsements will continue.

Dr. Ayala

Full disclosure: I co-founded Herbal Water, which makes 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.

Light therapy for your food choices

In food choices everything matters. This is the premise of Brian Wansink and the Cornell Food and Brand Lab’s work. Their research has unveiled some of the many occasions in which environmental cues such as plate size, packaging, label claims and placement influence our eating. Terms such as "mindless eating" and "health halos" are also the fruit of Wansink’s team’s work.

Now, let’s think of lighting. We know if affects our mood: People may feel more optimistic on sunny days, and the light and color of interiors may affect the state-of-mind of those inhabiting brighter rooms.

The smell and the music in a restaurant affect our feeling and food choices. Could light be doing the same? A new study, to be published in the Journal of Marketing Research examined the food choices of diners in a series of experiments, and found that in well-lit rooms people were 16-24 percent more likely to order healthier food (grilled/baked fish, veggies) rather than unhealthy items (fried food or dessert). When the researchers looked at sales receipts they found that the caloric content of meals ordered in dim rooms was almost 40 percent higher.

The authors, led by Dipayan Biswas conclude:

“In terms of consumer wellbeing, dining in brightly lit ambient settings might be a good option if the goal is to enhance choice likelihood for healthy options. Since dim (vs. bright) ambient light reduces mental alertness level, dining in dimly lit environments might lead to greater likelihood of yielding to the temptation of going for the sumptuous, but unhealthy, chocolate dessert.”

According to this study, a dimmer switch may influence the food choices – and the bottom-line – in a dining establishment.

But then, being alert and cognizant when we select food would make us less vulnerable to environmental manipulations. Mindfulness and food knowledge could shine a permanent, independent light on our choices.

Dr. Ayala