Healthy Food & Healthy Living by Dr. Ayala

What to eat to protect your liver

When too much fat is stored in the liver it can damage this vital organ, leading to liver inflammation, which may cause liver scarring, liver failure and liver cancer in some susceptible people. In the past most fatty liver disease was caused by heavy alcohol use. Nowadays the most common cause of excessive fat accumulation in the liver is nonalcoholic fatty liver disease – it’s unfortunately extremely common and affects about a quarter of the world population. Among people who are obese the incidence is an astounding 70 percent. The obesity epidemic is fueling the rapid rise in liver disease.

There are no FDA approved medications for nonalcoholic fatty liver disease but the good news is that this liver affliction is reversible. Diet changes and physical activity are known to improve this condition. Studies have shown that vegetables and fiber are associated with less risk of fatty liver disease, and a Western diet, high meat consumption, and soft drinks are linked with elevated risk.

A new study in the Journal of Nutrition looks at the diets of a large multiethnic group of 1682 people, whose liver composition was measured using the gold standard: MRIs quantifying fat in the organ.

The foods and nutrients linked with higher liver fat are total fat, saturated fat, cholesterol and meat.

On the other hand, fiber, vitamin C and vitamin E are significantly linked with leaner livers.

People obviously don’t eat vitamins and cholesterol as such, they eat food, and these findings suggest that the diets that are linked with liver fat storage are those high in fat, rich in animal products; those that are associated with less liver fat are more plant based (that’s where the fiber and vitamins come from). The authors conclude: “we found strong positive associations between liver fat and intakes of total fat, percentage energy from fat, and saturated fat, with meat intake a likely contributor.”

The study’s findings confirm those of previous ones. A study of 1128 Dutch people found that people with fatty liver ate more animals, soft drinks and snacks, and less fiber, and several studies show that dietary fiber is associated with lower incidence. A meta-analysis shows a dose-dependent connection between sugary drinks and non-alcoholic fatty liver disease – the more sugary drinks the higher the risk of nonalcoholic fatty liver disease. 

How do you know if you’re developing fatty liver disease?

Nonalcoholic fatty liver disease is usually silent and manifests no symptoms. People may come to medical attention if their liver enzymes – those are measured in blood tests done routinely as part of a regular checkup – are abnormal. These liver enzymes (including ALP, ALT, AST, GGT) can be an indication that the liver is inflamed or injured, and fatty liver disease is one of the common reasons for that. These tests can be followed up with imaging studies of the liver, such as an ultrasound, CT or MRI.

Lifestyle measures to protect your liver

To protect your liver avoid stressing it out: Excessive alcohol damages the liver, as can some medications. The pandemic has unfortunately led to a significant spike in alcohol consumption.

A healthy diet rich in fruits, vegetables and whole grain is as good for your liver as it is for pretty much every other part of your body. Avoid excessive added sugars, especially in drinks. Same goes for exercise. The diet-exercise holy duo also helps with avoiding weight gain, controlling cholesterol, triglycerides and abnormal sugar tolerance – which all increase the risk of extra fat deposits in your liver. 

Dr. Ayala

The inconvenient science-based truth about the upper limit of sugar and alcohol

Covid times have brought two conflicting realizations to the fore. We’re ever more aware that our general health is key to the way our body deals with a medical challenge – such as an infection with a virus. On the other hand, it’s been hard not to double down on the very things that undermine our wellbeing, which is understandable, given the stress and isolation of the recent year, and how hard it is to change our habits. 

As pubs and restaurants closed, people stocked up on alcohol at home. According to Neilsen, alcohol sales from stores grew 21 percent, while online alcohol sales skyrocketed and are up 234 percent. People gravitated to larger sizes and to higher alcohol content. Alcohol consumption is up especially among people prone to alcohol abuse, and binge drinking rose about 20 percent for every week on lockdown according to a recent study.

Unhealthy eating patterns also rose, especially in already at-risk populations. In a recent study about a third of participants reported that they’re eating less healthfully and have gained weight, 44 percent reported increases in unhealthy snacking, as well as increased intake of sugary drinks and candy. 

A guiding hand

Unrelated to the pandemic, the 2020-2025 Dietary Guidelines were recently published. These recommendations are developed using a report by a scientific advisory committee of 20 nationally recognized experts in the field of nutrition and health. After reviewing the relevant science, the committee’s advice, published last summer, was to cut back further on sugar and on alcohol. Alcohol intake is on the rise the committee notes “excessive alcohol consumption is a leading behavioral risk factor for a variety of morbidity and mortality outcomes, social harms, and economic costs”, and “consuming higher average amounts of alcohol is associated with increased mortality risk compared to drinking lower average amounts.” Men who drink alcohol, the expert panel advises, should limit their alcohol intake to 1 drink a day – the upper limit for women – down from the 2-a-day upper limit in the 2015 guidelines. 

Likewise, the scientific committee had new advice regarding the upper limits of added sugar. Previous dietary guidelines had the upper limit at 10 percent, a tall order by itself, as per the committee’s data, the average American consumes about 13 percent of daily calories as added sugar. The committee’s added sugar conclusion: “Evidence suggests that adverse effects of added sugars, particularly from sugar sweetened beverages, may contribute to unhealthy weight gain and obesity-related health outcomes... the Committee suggests that less than 6 percent of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10 percent energy from added sugars."

The committee’s advice regarding cutting back on alcohol and added sugar was not incorporated into the 2020 guidelines, however.

Although the 2020 guidelines admit that added sugars, and especially sugary drinks, can add to our alarming obesity rates, and that alcohol is linked with certain cancers and cardiovascular disease, the guidelines remained unchanged.

Drinking less sugar and alcohol is better

To which one can say, who listens to the guidelines anyway? Well, it’s true that years of recommending 5-a-day of fruits and veggies achieved the common knowledge that we should eat more veggies and fruit, but not the actual practice of doing so – only 1 in 10 Americans eat enough fruits and veggies. Most Americans don’t follow the guidelines, and the average American scores 59 out of 100 on the Healthy Eating Score.

But the Dietary Guidelines for Americans are the basis of educational materials and policies, such as the federal nutrition assistance and school lunch programs, so the guidelines do have real-world consequences. People are also aware, like never before, that poor diets are linked with chronic diseases and bad outcomes, so communicating the science matters.

And for people struggling to improve upon an unhealthy habit, vague or ambivalent advice, especially from a voice of authority, is permission to struggle less. It’s all too easy to read the current guidelines as entitling men to 14 drinks a week under the guise of moderate drinking, and shooting for a diet of 10 percent added sugar as a recipe for health – and we know we're already cheating ourselves when we count our dietary indiscretions.

So yeah, alcohol and junk food can give some comfort, and a little indulgence shouldn't be denied, especially when we’re deprived of many other things we used to enjoy. Alcohol sales have also been a bright spot for many retailers and food service businesses struggling in these hard times.

But the truth is still the truth.

The fact that health food stores like Whole Foods Market have several aisles devoted to alcohol doesn’t mean that alcohol is a whole food that nourishes you. It reflects consumers’ desire to buy the retailers' need to sell. Wine is delicious, so is cake, but these, evidence shows, should be consumed in moderation; moderation can't be defined by our desire to consume or by the wishes of those who profit from sales, but by evidence. 

I, too, wish that ice cream could become the new kale nutrition-wise, unfortunately, this is not the case.

Dr. Ayala

Can one big holiday meal make you gain weight?

Sticking to your best eating practices can be challenging around the holidays. It’s hard to say no to food around festive meals, even harder to exclude yourself when everyone’s joining in, and hosts don’t enjoy guests who just move food around with their forks.

Should you just give up for a bit? How much harm could one Thanksgiving meal do?

The numbers are on your side

Let’s start with some comforting information. You can’t gain serious weight in one meal, no matter how hard you try.

To gain one pound you’d need to eat an excess of 3500 calories, so if your daily caloric intake is 2000 calories, you’d need to eat 5500 calories to gain one pound. Which is perhaps doable, but unless you’re in an eating contest, quite difficult. Even then, your body may not absorb the calorie attack, and this binge may be followed by a natural compensatory loss of appetite, or an automatic urge to move and exercise to burn some of it off. But even in the worst-case scenario, you can see that there’s only so much damage you can do in one meal.

Weight is usually gained over time. That’s why your habits and routines matter so much. Even if a festive meal breaks your calorie bank, your healthy habits will bring you back on track.

Or are they?

Let’s not forget that Thanksgiving is just the beginning of a 6-week holiday season – marked by parties, special meals, high-caloric treats at every corner and more free time to enjoy all of these. People who say they gained 5-10 pounds over the holidays might be outliers, but the holiday season weight gain phenomenon is quite real.

A review in the journal Obesity included six studies in adults, and five of them showed significant weight gain over the holidays. One of the studies observed 195 adults over 6 weeks, from late November to mid-January, and showed that they gained an average of 0.8 pounds – which they did not lose in a one year follow up. In the 4 other studies weight gain was even greater: holiday season weight gain ranged from 1.2 to 2 pounds!

The review also looked at six studies of people trying to lose weight, and those didn’t fare any better: they gained on average 0.6 to 2 pounds. Even when the intent was to lose weight, the holiday season packed extra weight on.

Tips for the holiday season

Be merry: By all means, loosen up and enjoy yourself! Holidays are for appreciating good food with family and friends, and rules are meant to be broken. That being said, you don’t have to eat food just because it’s there. Your cousin baked an elaborate cake for Thanksgiving? Go for it! But you don’t have to try everything that ends up on the coffee break table in the month of December. Be a snob!

Tomorrow is another day: Overindulgence happens. That absolutely doesn’t mean you’re on a slippery slope or that you might as well just give up. As mentioned above, one day of gluttony can only do so much harm, guilt is futile, and you can surely get back on track.

Watch what you drink: Alcoholic and sweet drinks pack lots of calories, and tend to go uncounted and unnoticed. Space caloric drinks (wine, cocktails, beer) with water, sparkling water, or other non-caloric non-sweet drinks. Sugary drinks should be a rare special occasion treat.

Veggies and fruit to the rescue: Fill at least half your plate with veggies, these will load you with nutrients, fiber and antioxidants, help lower your caloric intake and benefit your health. When choosing deserts and snacks, look for delicious fruit – it's not that you should never eat cake, but your sweet tooth may be satisfied with dried or fresh fruit too.

Celebrations aren't only about eating: It’s not all about food. Go for a walk, play a board game, volunteer together, have a tea tasting afternoon – there are many non-caloric, even calorie-burning celebration activities to try together in between the feasts.

Happy holiday season,

Dr. Ayala

Experts’ latest advice on good – and bad – foods for your heart

Love, connection and gratitude are good for your heart, on that most people agree. But when it comes to food, there’s no shortage on controversy.

Studying the effect of food on health outcomes is difficult, because unlike medications that can be prescribed, and compared to a placebo, people eat whatever they choose over a lifetime, and the narrowing of arteries – atherosclerosis – develops over many decades, so even when the best studies are devised, they’re never long enough. On top of that, there are influences from many stakeholders, adding to both controversy and hype. Nevertheless, the accumulated research, which includes studies of many designs – epidemiological, case-control, cohort studies, randomized control studies etc. – have advanced our knowledge a whole lot.

A group of experts from the American College of Cardiology Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council studied the evidence, and debated the trending nutrition controversies last year.

And this summer, they’re back with a sequel. The new article in the Journal of the American College of Cardiology covers topics that doctors are asked about often, so the group gathered the evidence, reviewed, debated, and came up with conclusions to guide physicians' advice to their patients. Let’s take a look at some of them.

Nutrition hypes and controversies

Is dairy good for your heart?

The study of dairy products and heart health is fraught by industry-sponsored trials, and most studies are observational – which aren’t the best evidence. The bottom line:

“It appears that there is no clear consensus in the published data or among experts on the effects of dairy products on CVD (cardiovascular disease), although there seems to be a link between some dairy products and increases in LDL-C (the ‘bad’ cholesterol) concentration, fractures, and overall mortality, in addition to lowering of BP, but the magnitude of these effects is unclear. Importantly, however, there is general consensus that full-fat dairy products are major sources of saturated fat and sodium in the U.S. diet, and thus, should be limited; nevertheless, reduced fat dairy products remain a convenient source of some essential vitamins and minerals, as well as high-quality protein.”

Is sugar a problem?

People today eat 25 times the amount of sugar they did 250 years ago. Sugar is added to 75 percent of processed foods, but it’s the soda and soft drinks that supply about one half of all the added sugar in the US diet. Excess added sugar has been linked with heart disease and stroke, and this expert group joins many others with finding the evidence against added sugar conclusive, and it recommends:

“Individuals should limit added sugar to <10% of calories and preferably <100 calories daily for women and <150 calories daily for men. Clinicians should recommend consumption of a whole foods diet with a low intake of processed foods, careful selection of foods with no or low amounts of added sugars in any form, and elimination of SSB (sugar sweetened beverages).

Is coffee okay?

Coffee got a clearance from the heart experts, as long as you don’t add other things to it:

“Overall, large analyses indicate that coffee intake is correlated with a dose-response protective benefit: habitual consumption of coffee is associated with lower risks of all-cause mortality and CVD (cardiovascular disease) mortality, but not with an increased risk of arrhythmias, hypertension, or hyperlipidemia. It should be noted that coffee-based drinks may be loaded with sugars and fats that reduce their health benefits.”

How about alcohol?

The connection between alcohol and heart health is complicated, and although some studies have shown reduced heart disease with moderate wine intake, even moderate intake has been shown to increase the risk of breast cancer in women. The experts’ bottom line:

“There is not sufficient high-quality evidence to recommend specific alcoholic beverages for CV (cardiovascular) risk reduction. There is also some risk of falls, certain cancers, and liver disease. As such, it is not recommended that individuals initiate alcohol consumption for CV benefit, and for those already drinking, consumption should be limited to recommended amounts, preferably consumed with meals. Mixing of alcoholic beverages with sodas, creams, and sweeteners adversely affects their health benefits.”

Should I be eating mushrooms?

There’s growing interest in mushrooms, as, beyond their taste – delicious, in my opinion– studies have shown they can be heart protective, as they modulate the immune response, lower cholesterol levels and blood pressure. They can also provide vitamin D.

The experts’ bottom line:

“Although there is no high-quality evidence of improved CV (cardiovascular) health outcomes, mushrooms may be associated with improvement in inflammatory and antioxidative pathways and may have beneficial effects on known CVD (cardiovascular disease) comorbid risk factors. Caution should be made that some wild mushrooms are poisonous.”

What other heart friendly foods should get my attention?

Legumes. These include beans, chickpeas, lentils, peas and soybeans. They are inexpensive, rich in protein and fiber, and studies have linked their consumption with lower body weight, lower cholesterol, heart attack risk and blood pressure. The authors’ conclusion:

“Legumes are an affordable and sustainable source of protein and fiber. Consumption is associated with a reduction in CHD (coronary heart disease) incidence and improved blood glucose, LDL-C (low-density lipoprotein ‘bad’ cholesterol), systolic BP (blood pressure), and body weight. Western populations’ current consumption of pulses and derived products (bean dip, hummus, etc.) is very low despite their health benefits. Legumes should be part of any diet aimed at promoting cardiometabolic health.”

Heart disease is the leading cause of death for both men and women. Luckily the risk of heart disease is highly modified by healthy diet and lifestyle. A heart healthy diet – more plant food, whole grains, fiber and healthy fats, portion control, less added sugar etc. ­– combined with physical activity, are proven to keep your arteries and heart young, and are a remedy with no adverse side effects.

Quite the opposite: The side effects of a heart-healthy diet and physical activity include better mood, productivity, alertness and general well being.

Dr. Ayala

How to beat college weight gain without even trying

The college year is coming to an end, and many first-year students will be dismayed to find that their clothes have gotten a bit tight – while the freshman 15 might be a bit of an outlier, students gain an average of 7.5 pounds in the first year of college. It’s hardly surprising that when students have tempting food options and all-you-can-eat situations under the college meal plan, they may overeat and gain weight.

Students are therefore encouraged to be wise and careful in the college cafeteria, to weigh their options and portions, so that the extra weight won’t creep up on them.

Which is quite hard to do, especially since there are so many other changes and challenges in college.

An alternative to guiding every single student toward better choices – ones they’ll have to make repeatedly – is to make the better choice the natural, easy one to make. This doesn’t eliminate choice; it just nudges towards the healthier option and makes it the default.

Strategies from behavioral economics

Making the healthy meal the default relies on some powerful behavioral tendencies. People choose defaults because they are the path of least resistance, because the default seems like the ‘normal’, recommended or popular choice, because it lets them avoid decision making and investigation, and because they may not even notice there are other options. Applying default options has proven to get more people to save for retirement and to take a flu shot.

So why not try it in the cafeteria?

A new study published in Public Health Nutrition tests this idea.

In an experiment involving 129 first-year students in two campuses, the students dined in 3 different lunch settings. In one, the default was optimal nutritionally, emphasizing energy dense foods and lower fat and energy items; in the second the default was suboptimal – it had more fat and saturated fat, and in the third the students had complete free choice with no defaults. In both optimal and sub-optimal settings the default was described in larger fonts, and was available immediately. Alternatives were in smaller fonts and entailed a 15-minute wait.

The defaults affected students’ choice a great deal.

In the optimal default setting 94 percent of students made what the nutritionist considered optimal choices. With the sub-optimal default none of the students made optimal choices. Without defaults, when the menu was wide open to any choice, 47 percent of students made the optimal choice. Likewise, caloric intake was greatest in the suboptimal default, followed by the free array menu, and lowest with the optimal default.

This proof-of-concept study suggests that defaults could steer undergrads to make lower-calorie, healthier choices.

Ways to stay fit at college

This is just one of many tools that can be tried in order to curb weight gain. And until school cafeterias make it easier to chose wisely, here are a few great tips:

Seek good options

Former Miss Massachusetts and 2016 college graduate Alissa Musto was training to compete at Miss Massachusetts and eventually Miss America and knows just how hard it can be to stay on track with healthy eating while in college. “One rule that I like to stick with in dining halls or buffets is dedicating 75% of my plate to foods where I can visually identify all of the ingredients: raw vegetables, hard boiled eggs, plain rice, garbanzo beans, fruits, etc.  Added salt and sugar can easily sneak up on you in the more processed and prepared foods, as well as sauces and dressings.”

Kelly Morgan, professor of health and certified health coach suggests to look up your school’s dining website. “Most schools provide nutrition information, and some even provide healthy eating tips tailored to the options on campus.” In between meals, with the rush of the day, plan ahead: “Prepare snacks or small meals that you can carry with you for long days on campus. Finding time to eat between classes is critical for keeping your energy up as well as maintaining focus. The snacks will also keep you from binging on the less healthy options in the dining hall or quick stop food places around campus.”

Get creative, suggests Rachel Graham, who while in college started an Instagram account devoted to eating healthier on campus. “Don’t be afraid to ask the employee serving you lunch at the diner if you can have today’s lunch on a bed of greens instead of bread. Can’t go to the diner? Have a back-up recipe that you can make in your dorm.”

“Invest the time in some free cooking lessons,” recommends Registered Dietitian and Nutritionist Chris Shuff. “There are few things more attractive than finding out your date can cook delicious and healthy food. Develop cooking skills to gain a competitive edge in the dating world through physical and culinary seduction.” Another piece of advice from Chris: “Don’t practice your new freedom of choice by intentionally eating junk. There are plenty of ways to enjoy the independence without intentionally overeating on junk foods,”

“Avoid keeping junk food snacks in your dorm room to limit temptation,” advises Registered Dietitian Juliana Shalek. “Keep nutritious snacks on-hand such as Greek yogurts, nuts, whole grain crackers, low-fat cheese to eat between meals; your body often craves sweets during times of stress (aka studying for a big exam), so try not to keep sweets around to avoid munching on them.”

Watch what you drink

Yoga teacher Lilia Karimi gained the classic freshman 15 when studying abroad her freshman year. “As soon as I returned home and cut down drinking, I lost ten pounds. When you are drinking, your sleep patterns are off and you're typically also eating later at night- not helping out your metabolism.”

“Liquids are the biggest culprit of hidden calories, so stay away from excess juice, soda, and alcoholic beverages,” Says Academic Life Coach Nikki Bruno. “Carry a water bottle with you at all times. Get used to drinking your coffee black. Definitely avoid artificial sweeteners as they can actually cause you to crave more sugar and snack more!” 

Keep active

College campuses offer endless opportunities to work your body, and involvement in physical activities often also leads to better eating habits.

As the girl who gained (and lost) her Freshman 15, exercise physiologist and personal trainer Kathryn Alexander encourages every student to get involved as soon as possible: “There are so many active things you can do! You can join rec sports, play pick up basketball, jog around pretty neighborhoods, or even do more extreme sports like mountain biking. Check out your rec center – they probably have things you’ve never even heard of. You’ll be working on your health and fitness while meeting new active friends with similar hobbies.”

Get enough sleep

Set a sleep schedule, urges Registered Dietitian Julie Upton. “Sleep is involved in appetite regulation so when you skimp on sleep or stay up late (and likely snack), it's a double-whammy on achieving or maintaining a healthy weight. Most college students need at least 7 hours a night but many likely need more. When you are sleep-deprived, you are hungrier but the other issue is that the lack of sleep affects your willpower and resolve, so you'll eat unhealthy foods that you normally wouldn't touch."

Seek balance

“Start a meditation practice - even five minutes a day can help you gain more body awareness,” advises Lilia Karimi. “Finding this awareness helps you get more in touch with your body, your emotions, and having a better relationship overall so that your focus is on health - and not just losing weight.”  

“Remember, you get to live your life the way you want. You don’t have to plan and carry every meal with you – and you also don’t have to throw caution to the wind and live with wild abandon either,” concludes Kathryn Alexander. “You can go drink and have fun without having 10 beers.”

 

I’ll drink (some water) to that!

Dr. Ayala

Is alcohol really a double-edged sword?

Many health conscious people believe that drinking in moderation is good for you.

I, like most doctors, was trained on this advice. The Dietary Guidelines for Americans – and for many other nations – used to recommend 1-2 alcoholic beverages a day, stating that “alcohol may have beneficial effects when consumed in moderation.” 

The science has since moved on, as have the nutrition guidelines, but public knowledge has not. The last thing the 2 billion people who enjoy alcohol want to hear is that alcohol’s alleged health benefits stand on shaky legs, and there are too many interested parties that continue to push this belief.

It’s an inconvenient truth, but the time has come to revisit the widely held idea that alcohol promotes health, because better data contradicts it.

Good for your heart?

The makings of wine as a health food are closely associated with the French paradox. Epidemiologic studies in the 1980s reported the paradoxical observation, that French people have lower rates of heart disease, despite their luxurious, butter-heavy diet. A 60 Minutes broadcast on the subject, ending with Morely Safer holding a glass of red wine, suggested that the secret to heart health “may lie in this inviting glass.” Sales of red wine shot up 40 percent the next year, and wine makers quickly adopted the health food halo.

Wine contains antioxidants and resveratrol, and might increase HDL, the good cholesterol. It seems perfectly plausible that it could improve vascular health.

Alas, there probably is no French paradox. Further studies found the paradox to be an illusion, a distortion, a result of inconsistent disease reporting and other factors.

The most persuasive evidence tying moderate drinking with health is the famous J curve, in which studies show that the risk of death declines with low levels of alcohol intake and then rises proportionately with higher levels of drinking. In other words, moderate drinkers have a lower risk than teetotalers.

Better research, however, flattened the J curve. After adjusting for confounders – the most important bias is reverse causality: sick, frail people tend to stop drinking – it looks like the more people drink the greater their risk of all kind mortality. Apparently, the question “do you drink” is very different from “have you ever been drinking.” When you remove recent quitters from the studies the positive effect of moderate drinking greatly diminishes.

What is moderation?

A new study that included 600,000 from 19 countries, published in the Lancet looked at alcohol consumption and the risk of cardiovascular disease, including heart attacks, stroke and heart failure. The study included only people who currently drink, in order to avoid the bias risk posed by including sick people who avoid alcohol for health reasons.

Alcohol was associated higher risk of stroke, heart failure, aortic aneurism and hypertensive disease, the greater the drinking the higher the risk, and there was no threshold at which drinking was safe, or seemed beneficial.

When it came to non-fatal heart attacks, however, moderate alcohol intake slightly lowered the risk.

Alcohol consumption was positively associated with all cause death, with the lowest odds of dying among people who drank about 5 drinks a week or less.

The authors estimate that for men, reducing drinking from the current suggested upper limit of 2 drinks a day, to no more than 5 a week, would add on average 1-2 years of life.

This study reached the same conclusion as better-conducted recent studies, and studies using genetic randomization.

As alluded above, it’s very hard to disentangle people’s lifestyle habits, and if you look at populations of never-drinkers, such as Seventh-day Day Adventists, who do have lower rates of heart disease, you can’t really know if not drinking alcohol improved or worsened their outcomes, as they usually lead a healthier than average lifestyle, and don’t smoke or eat meat. There is, however, a gene variant that is associated with lighter drinking that has been helpful in alcohol research. People who inherit a certain genetic variant of the enzyme that breaks down alcohol tend to drink less because they feel alcohol’s unpleasant side effects – such as nausea, headache and flushing – more readily. This, in effect, randomizes society by genes, and not by socioeconomic influences. 

People with this gene variant drink less, have fewer incidences of binge drinking, and many more of them abstain altogether, but there still was a wide variation in drinking among them, supporting the notion that there are societal influences, and that drinking culture affects drinking behavior – even among people with a genetic predisposition to drink less.

If alcohol in moderation indeed caused better heart health, we’d expect the people with the alcohol dehydrogenase 1B gene variant to show both above average and below average cardiac outcomes, and we’d expect those of them with the very lowest consumption – the abstainers– to have higher rates of heart attacks. 

But that’s not what studies found. Quite the contrary: those with the gene had 10 percent less coronary heart disease, as well as lower blood pressure, lower BMI, and lower ‘bad’ cholesterol levels across the board.

What about the rest of your body?

While the heart benefits of moderate drinking are questioned, the harms to many other organs are well known, and not in debate.

Alcohol is a known carcinogen.

A statement of the American Society of Clinical Oncology declares that alcohol drinking is an established cancer risk factor: “In the United States, it has been estimated that 3.5% of all cancer deaths are attributable to drinking alcohol. Alcohol is causally associated with oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer. Even modest use of alcohol mayincrease cancer risk, but the greatest risks are observed with heavy, long-term use.”

Alcohol is a leading cause of liver disease and liver cirrhosis.

Alcohol during pregnancy may harm the fetus and can cause Fetal Alcohol Syndrome.

Alcohol abuse affects more than 6 percent the US population; about 90,000 people die of alcohol related causes each year in the US.

Which brings us back to the question, is alcohol really a double-edged sword? Is alcohol in moderation beneficial?

Assessing risk and benefits

To reduce the risk of heart attacks, you can adopt several proven steps such as eating more vegetables and walking regularly. Not as seductive as a glass of wine, but almost risk free.

Not that I’m suggesting abstaining altogether. Alcohol, and wine especially, are a deeply cultural culinary joy, and I’m definitely not one to suggest that life should be approached with extreme caution and as an exercise of life prolongation.

On the other hand, alcohol is pushed so very hard that it becomes really hard to ignore or say no to it. Alcohol is almost the co-star in so many movies and TV shows, and is depicted as the ultimate way to relax or have fun – Grace in Grace & Frankie and Alicia in The Good Wife seem to sustain on a liquid diet. And why are there pink ribbons and tie-ins with breast cancer charities on alcoholic drinks? – reminder: alcohol is a risk factor for breast cancer, it’s particularly cynical to promote drinking to fight breast cancer.

I also have no idea why alcoholic drinks are one of the only products still exempt from displaying nutrition information. The caloric burden of alcohol might have tipped people who count every slice of bread towards greater moderation – every small glass of wine is about 120 calories.

Driving a car carries risk. Most of us assume that risk, because we want and need to go places. Taking on a calculated risk is fine. Not thinking about the risk might also be a fair enough choice.

But we can no longer pretend that alcohol – even in moderation – is something we should be doing for our health. 

Dr. Ayala

The time for New Year’s resolutions is right now

 

October’s the new January and the time for New Year’s resolutions might be right around the corner. Let me explain.

According to a new study, if you’re an average American, your weight today is lower than what your scale will display by January, and it will take you five months, or more, to lose what you’re about to gain in the next three.

And this isn’t just relevant in the US. We’re lucky enough to have holidays, with lots of tempting foods and festive eating opportunities. The study, led by Elina Helander, and reported briefly in the New England Journal of Medicine, followed the weight of about 3000 people in the US, Germany and Japan. Thanks to new technology, researchers can now collect objective daily weight measurements without a weigh-in at the office – in this study the data was collected from wireless scales.

Fall weight gain took 5 months to lose

In all three countries, weight rose within 10 days of Christmas, but the joy of festive meals was not limited to December; in each country there was a steady climb in weight around other holidays too. In the US it’s Halloween, followed by Thanksgiving (if you’re Jewish, add several more food-rich holidays, that come one right after the other this October), while in Japan it’s Golden Week (a cluster of holidays in late April to beginning of May) that pack the pounds.

Overall the almost 1800 US participants gained about 1.3 pounds from October to January.

Half of that gained weight stayed put until the summer – and beyond.

So think about it come October. It might be easier to exercise a little bit of control October to December, rather than a lot of control – a diet’s never easy – come January.

A few October resolutions tips 

Add veggies and fruit: Fill at least half your plate with veggies, these will load you with nutrients, fiber and antioxidants, help lower your caloric intake and benefit your health. When choosing deserts and snacks, look for delicious fruit – not that you can never eat cake, but your sweet tooth may be satisfied with dried or fresh fruit too.

Watch what you drink: Alcoholic and sweet drinks pack lots of calories, and tend to go uncounted and unnoticed. Space caloric drinks (wine, cocktails, beer) with water, sparkling water, or other non-caloric non-sweet drinks. Sugary drinks should be a rare special occasion treat.

You don’t have to eat it just because it’s there: If you really want this special piece of candy, go ahead, but don’t go for it just because someone sent it, or because it’s lying there on the coffee break table. Be mindful!

Enjoy a few non-food celebrations these holidays: It’s not all about food. Go for a walk, play a game, volunteer together, have a tea tasting afternoon – there are many non-caloric, even calorie-burning celebration options to try together in between the feasts.

Have a lovely fall season,

Dr. Ayala

Thanks to the Cornell’s Food and Brand Lab for sharing these study findings and the image above with me.

News you won’t like: Wine isn’t a health food after all

I’m not sure who started suggesting that moderate amounts of alcohol are good for your health; it’s certainly a long-held – and awfully convenient – belief, based on some observational studies.

The UK recently published its new alcohol guidelines and after reviewing evidence accumulated over the 21 years since its previous guidelines, it concludes that any level of alcohol increases cancer risk.

What about the heart health benefits we were promised? Well, that turned out to be relevant only in women aged 55 and over, and only when they limited their drinking to 2 glasses of wine a week.

Bottom line: there is no justification to drinking alcohol to your health, since even in the small subgroup of 55-and-over-women the advantages to the coronaries are outweighed by the negative effects to other parts of the body.

Risks and benefits

We sometimes have a naïve attitude towards risk, and will be reassured only when it’s absolutely zero. In reality, most of the actions we take carry potential risks and potential benefits. Although alcohol has – we have come to realize – very little if any health benefits, it does have many other really important benefits. Wine is one of the most civilized of pleasures, and the joy of drinking in company, with good food, shouldn’t be trivialized. I rarely regret having a good time.

That’s why the UK guidelines suggest an upper limit that they consider an acceptable low risk level of drinking. Just like other risky behaviors, such as driving a car, no one suggests you stay at home – we do drive, but buckle our seatbelt, comply with speed limit and stay alert.

Their advice – for men and women – is to drink no more than 14 units a week. Translated: 14 units are a bottle and a half of wine a week, or 7 cans of regular beer a week. They also suggest not save up for a night of binge drinking, but rather to try and spread this allotment over three or more days.

The new Dietary Guidelines for Americans’ advice is not much different.

“If alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age. For those who choose to drink, moderate alcohol consumption can be incorporated into the calorie limits of most healthy eating patterns. The Dietary Guidelines does not recommend that individuals who do not drink alcohol start drinking for any reason.”

The guidelines specifically warn against the combination of high-caffeine drinks (such as in energy drinks) and alcohol:

“Mixing alcohol and caffeine is not generally recognized as safe by the FDA. People who mix alcohol and caffeine may drink more alcohol and become more intoxicated than they realize, increasing the risk of alcohol-related adverse events. Caffeine does not change blood alcohol content levels, and thus, does not reduce the risk of harms associated with drinking alcohol.”

Who needs these guidelines?

Guidelines are just so: a suggestion, take it or leave it, but in the case if those issued by governments, they are based on a huge body of evidence, analyzed by – usually unbiased – experts in the field. Yes, politics may get in the way of the final recommendations, and that’s unfortunate, but the advisory committee’s report advising these guidelines really provides the most up-to-date, comprehensive, carefully examined data possible, and I know of no better source for evidence-based, non-anecdotal nutrition information.

I wouldn’t panic from the knowledge that alcohol is a carcinogen, because the dose does matter; a lot.

But clarifying that less is better when it comes to alcohol is a good idea. Alcohol – to our disappointment – isn’t a health food. It has risks, and many calories. It’s also a wonderful, deeply cultural food that can be enjoyed without over excessive risk. But if you regularly drink to unwind and can achieve the same result with a cup of tea, the UK ministry of health encourages a swap.

Nutrition isn’t as simple as good foods and bad ones, miracles or poisons, but then, what in real life is?

Dr. Ayala

Further reading:

Easy to digest info about excessive alcohol use from the CDC here.

And another perspective on the topic from my archives here.