Healthy Food & Healthy Living by Dr. Ayala

Why food helps instill true gratitude

This Thanksgiving will be different. As Covid-19 cases climb, many have cancelled their traditional Thanksgiving to protect the health of family members. When we celebrate this Thursday our joy will be shadowed by the collective pain and loss of this roller coaster year. But no matter how unusual this coming holiday will be, some parts of it should never be cancelled: The Thanks and the Giving. 

Our blessings aren’t always obvious – hardship and bad luck are more apparent – but this year they’re perhaps easier to notice. 

And food can be a constant reminder of how lucky you are; nature's bliss as well as human ingenuity, labor and love compactly combine into the dishes that nourish and delight you. Getting enough food used to be a daily struggle for most humans. The reason most religions and cultures pray before meals is because having enough food was rare, took great effort, and was greatly appreciated. 

This year, food gratitude is easier to sense. Food insecurity was already rampant before the pandemic: 14% of American households were food insecure at least part of the time in years past. Undernourishment – lack of access to adequate and healthy food – was already widespread. The presentation of undernourishment is often, paradoxically, obesity, as highly processed calorically dense foods are cheaper and more accessible than a whole foods diet rich with fruits and vegetables. This hidden hunger has now been overtaken by visible depression-era lines in food pantries.

A recent article in the American Journal of Clinical Nutrition warns that “food insecurity during the COVID-19 pandemic could have serious and long-lasting health consequences” – lack of nutritious foods may lead to dramatic rises in the rates of heart disease, type 2 diabetes, hypertension and early death. While food lines are painfully apparent, their long-term chronic disease consequences will be witnessed only much later on. 

Food insecurity affects health in three pathways, the authors explain: household stress, behavioral, and through inflammatory pathways.

Not having enough food is a major stressor that can lead to sadness, shame, guilt, anxiety and hopelessness, and this stress can even build up to depression, violence and abuse.

Food insecure individuals engage in behaviors that undermine their health, such as involvement in risky ways to earn money, they may skip necessary medications and treatments, and consume cheap, calorie dense highly-processed foods.

And finally, food insecurity activates inflammatory pathways in our body, and this state of chronic inflammation promotes disease. Food insecurity is a powerful stressor, this stress, and high intake of pro-inflammatory foods typical of the diet in food-insecure households, is associated with inflammation.

Food gratitude

This year was a stark reminder of the frailty of human health and the fragility of our food supply chain. We no longer assume the things we used to take for granted, and as we sit at the Thanksgiving meal, even if we’re fewer, even if it's simpler, or over Zoom, let’s give some thought to the wonders of what made our meal possible. 

Food, especially healthy food, is a poignant reminder to be grateful, this holiday, and every single day, for the nourishing gifts we receive. Growing plant foods – veggies, fruits, grains, legumes, spices, herbs – takes the accumulated knowledge of humankind, the graces of the sun, blessed rain, dew and irrigation, pollinators, and the labor of a whole chain of people, from the farmer who sowed the seeds to the cook that crafted the dish. As to animal foods: Animals very lives were sacrificed for it. 

And if you have plenty, this is the time to share. 

Happy Thanksgiving, 

Dr. Ayala

Is diet soda better for your heart?

There’s a long standing debate over diet soda and weight loss. 

Non-caloric sweeteners came to the scene decades ago, offering the intense sweetness we naturally prefer, without the caloric price tag. Sweeteners such as aspartame (NutraSweet, Equal), sucralose (Splenda), saccharin (Sweet'N Low) acesulfame K (Sweet One) and neotame are practically calorie free, so replacing added sugar with them should cut calories from our daily intake, and fewer calories should translate to weight loss, right?

Short-term clinical trials were promising: Artificially sweetened soft drinks may indeed produce short-term weight loss when they replace sugary drinks. However, there are very few long-term studies looking at what artificially sweetened beverages do to weight, and since body weight regulation is super complicated, it very well may be that over time the calories saved by switching to artificial sweeteners are replaced by other foods; in other words, diet soft drinks may not help you lose weight after all. Several studies actually suggest that these artificially sweetened sodas fuel, rather than fight the obesity epidemic.

Sugary drinks pose risks beyond weight gain though; they increase the risk of heart disease, type 2 diabetes and other chronic diseases. Are diet sodas better? 

Is diet soda safe?

While the weight loss benefits of diet sodas are still questioned, several safety concerns are being raised.  On the one hand, despite recurring worries about sweeteners and cancer risk no such link has been found. Artificial sweeteners in the market are approved by the FDA and considered safe.

However, there’s disturbing evidence showing a correlation between the consumption of diet soft drinks and the metabolic syndrome as well as type 2 diabetes, even when obesity is controlled for. Sweet tasting drinks without calories may send signals that trigger hunger, increase cravings and interfere with weight regulation, and lately, studies have indicated that artificially sweetened soda may induce glucose intolerance by altering gut microbes.

A new study reported in the Journal of the American College of Cardiology looks at artificially sweetened drinks and heart health. The study includes 100,760 people, who reported on their beverage intake every 6 months. Incidents of cardiovascular disease, including heart attacks and strokes, were marked from the fourth year of study, to control for reverse causality (cardiovascular disease pushing people to quit sweet drinks rather than sweetened drinks driving cardiovascular disease).

And the results: After taking into account confounding factors, people who consumed drinks sweetened by added sugar as well as people who drank artificially sweetened soft drinks were at significantly higher risk of cardiovascular disease, the higher the consumption the greater the risk. The authors conclude that artificially sweetened beverages “might not be a healthy substitute for sugary drinks.”

A temporary fix

For sure, excessive added sugar isn’t good for our health – and it’s especially harmful in liquid form – but even if artificial sweetened soft drinks are better, it may not be by much. 

A science advisory from the American Heart Association advises against long term consumption of diet soda, especially for kids. For adults who consume large amounts of sugary drinks, they suggest that diet drinks may be a useful strategy to reduce soda intake while moving towards more desirable options. Ultimately, though “other alternatives to SSBs (sugar sweetened beverages), with a focus on water (plain, carbonated, and unsweetened flavored), should be encouraged.”

Overcoming the soda habit is the best option. Treats are one of life’s joys, but intense sweetness with everyday hydration isn’t good for you – even when no calories are involved.

Dr. Ayala