Healthy Food & Healthy Living by Dr. Ayala

Exercise for the diet resistant

Exercise is a fundamental and super important key to wellness. Physical activity helps prevent diseases, it slows aging, and boosts mental function. It makes you look and feel better. 

But despite what junk and fast food manufacturers suggest in their clever marketing, tying sugary drinks to athletes and the olympic games, exercise will not enable you to burn off all that many extra calories, and on its own – without a reduction on caloric intake – exercise yields less than expected weight loss. 

An exercise deficit issue?

We can’t really outrun the fork and out-exercise a poor diet. 

Obesity isn’t an exercise deficit problem, it’s mostly an overeating and poor diet problem, Americans aren’t that much less active than they were a few decades ago, and exercise alone isn’t a weight loss plan, studies have shown. The calories burnt by exercise are at least partly compensated for, through energy conservation during the rest of the day and by a vigorous appetite and post-workout eating.

Most overweight people who try to lose weight don’t respond to exercise alone that much, but that doesn’t mean that exercise doesn’t help you lose weight. Exercise not only helps burn calories and keep muscle mass during weight loss, it also helps with improving your diet, as people who pursue fitness often find it easier to eat better – exercise often starts and perpetuates a virtuous wellness cycle. 

And now, a new study in eBiomedicine, part of the Lancet, finds that exercise may play a pivotal role in weight loss for a subset of people. For these people, exercise isn’t just a few more “calories out” in the energy balance sheet – exercise actually changes their metabolism.

Most people lose weight when they reduce their caloric intake, but a subset of people lose much less than expected despite adhering to diet programs. The researchers looked at the clinical records of 5000 women, and identified the 20 percentile who were most and least sensitive to diet, based on their weight loss on a 6-week 900 calorie/day supervised diet. They then studied 10 diet-resistant and 10 diet-sensitive obese women among them. These 20 women were put on a closely supervised exercise regimen. Exercise included weight lifting and treadmills, and was done 3 times a week for 6 weeks. The women were followed by weight and body composition measurements, as well as blood and muscle function tests, and muscle composition studies, using a muscle biopsy.

Flawed one size fits all 

The exercise training had minimal effect on the diet-sensitive women, but among the diet resistant women it changed body composition and muscle metabolism – it increased the mitochondrial content and metabolism in their muscle – and enhanced fat loss.

Besides offering hope for the people who find weight loss especially challenging, this study emphasizes that a personalized approach to obesity is warranted. “In cases in which diet-adherent individuals fail to achieve successful weight loss through caloric restriction, exercise may preferentially enhance their weight loss capacity by reprogramming skeletal muscle metabolism to enhance oxidative processes, consistent with our findings in biopsied muscle and derived primary muscle cells,” the authors write. 

Exercise is recommended for every human out there, for fitness’ sake, and definitely for people trying to lose weight. It may play an especially crucial role for a subset of us, whose positive and weight-altering reaction to exercise is uniquely greater, and in which physical activity over-performs.

Dr. Ayala

The diet that keeps you young

Age’s just a number, goes the saying, years since birth don’t accurately predict ability, health or how much time’s left. 

Lifestyle often does. Eating well and being active are linked with lower incidence and later-in-life occurrence of chronic diseases such as heart disease, cancer, diabetes and stroke, and with greater likelihood of survival into old age.

How does food increase longevity? There are many mechanisms in which your diet can affect disease, as certain foods affect lipid profiles, sugar metabolism and inflammation, for instance, and all these play a role in disease onset and progression. 

Genetic makeup also predicts disease and lifespan.

Can food change our genes? Diet of course doesn’t change our coded DNA sequence, but diet can modify genes’ expression: which genes are more active and which are suppressed. This fascinating field of study is called epigenetics. Gene expression can be controlled through chemical changes such as methylation, the addition of a methyl group to the DNA chain in an area that doesn’t code for the gene itself. Methylation can occur in many places, and thousands of these sites are known to be correlated with aging, acting like “clocks”, which predict biological age, chronic diseases and mortality. People whose epigenetic age is older than their chronological age are thought to be biologically older and at greater risk of disease, while those with young epigenetic ages are at lower risk.

Diet and lifespan

A new study in the American Journal of Clinical Nutrition looks at the diet and at the methylation patterns of almost 2700 women. Diet quality was assessed in reference to four recommended healthy diet indexes, such as the DASH (Dietary Approaches to Stop Hypertension) and the Alternative Mediterranean Diet.

And the results: Higher diet quality was strongly inversely linked with two widely recognized epigenetic clocks that predict mortality – better diets predicting long lives and younger biological age. The authors conclude: “In summary, we found that healthy eating patterns are associated with some methylation-based measures of biological age. The benefits of healthy eating appear to accrue particularly in women reporting lower levels of physical activity. These findings support the hypothesis that a higher diet quality may slow aging and lower disease and mortality risks.”

Another recent study, including 2000 people, also looked at the overall diet quality using a DASH score, and at methylation profiles using 3 different verified epigenetic aging measures. The DASH score evaluates the intake of dietary components giving high scores for consuming more vegetables, fruit, nuts, legumes, whole grains and low-fat dairy, and for consuming less red and processed meat, sugary drinks, sweets and salt. The study demonstrated that higher diet quality was associated with slower aging according to the methylation epigenetic scores. What’s more, during the 10-year follow up in this study 297 participants died, and both a lower DASH score and the three epigenetic age acceleration measures were significantly associated with all-cause mortality. 

Several other studies look at how certain foods change methylation patterns, suggesting that high intake of plant-based foods slows the clock, that high intake of poultry predicts an accelerated aging, as does red meat. A study of 120 people aged 65-79 year showed slower epigenetic aging when people ate a Mediterranean-style diet for a year.

Anti-aging from within

Anti-aging skin care routines promise young looking skin (the most proven anti aging skin treatment however is ultraviolet radiation avoidance and blocking) and longevity supplements promise death defying miracles – without much evidential support.

But we actually know that certain habits are linked with delayed aging, disease and death. Chief among them are eating well, exercising, avoiding smoking and nurturing social ties. It’s not as  easy as taking a pill or a potion, and you need to stick to it long term.

What does eating well mean? There are very many ways to eat healthfully, and all of them center on emphasizing whole plant-based foods (vegetables, fruits, nuts, legumes, whole grains) and minimizing highly processed foods (fast-food, processed meats, sugary drinks). 

Dr. Ayala

Can good food make you younger?

Diet quality affects health, and eating well is associated with lower incidence and later-in-life emergence of chronic diseases such as diabetes, heart disease and stroke, and with longer lifespans. There are several mechanisms – diet influences lipid profiles, sugar metabolism, inflammation and obesity rates for example, which are all culprits – that can account for the life extending traits of food. 

Could food also change how our genes are expressed?

Food doesn't change our coded DNA sequence – it isn’t gene therapy. But food and other lifestyle habits as well as our environment can modify how our genes are expressed and which areas of the genome get more active. This biomedical field is called epigenetics. Gene expression can be controlled through chemical changes such as methylation which is the addition of a methyl group to the DNA chain in an area that doesn’t code for the gene itself. There are millions of places where methylation can occur, and thousands of these sites correlate with aging. In this way the gene’s control switch is either repressed or activated. These changes can be stable over time and over many replications of the cell.

Methylation is the most studied of epigenetic mechanisms. Methylation status can predict lifespan; it’s like a biological clock that reflects biological age, as opposed to our chronological one. These methylation clocks predict mortality as well as disease better than knowing one’s birthdate. Previous studies looked at how certain foods change methylation patterns, suggesting that high intake of plant-based foods slows the clock, and high intake of poultry predicts an accelerated aging. Another small study of 120 65-79 year olds showed cellular slower aging when people ate a Mediterranean-style diet for a year.

A new study in the American Journal of Clinical Nutrition looks at the overall diet quality of a large group of almost 2000 people, to see if aging is affected on the molecular level.

Diet and aging

The diet of the participants was assessed by the DASH score, which evaluates the intake of dietary components: You get high scores for consuming more vegetables, fruit, nuts, legumes, whole grains and low-fat dairy, and for consuming less red and processed meat, sugary drinks, sweets and salt.

Blood tests were drawn for methylation profiling using 3 different verified epigenetic aging measures.

And the results:

During a 10-year follow up 297 participants died. The DASH score and the 3 epigenetic age acceleration measures were significantly associated with all-cause mortality. 

As you might have guessed, participants with high DASH scores tended to be women, thinner, not smoke, drink less alcohol, and use less medications for hypertension. But after adjusting for age, sex, smoking status, BMI, physical activity, alcohol consumption, and energy intake, eating lower quality diets was still clearly associated with a DNA methylation pattern that was “older” than the chronological age.

“Our study emphasizes that improving diet quality is important to delay the aging process,” the authors conclude.

Anti-aging the safe way

Some predict that tremendous technological and biomedical breakthroughs on the horizon are going to enable major gains in average human life expectancy. The anti-aging marketplace is already capitalizing on a bounty of (unproven) wrinkle defying creams, placentas, donkey milk, resveratrol and anti-aging pillows. But we actually already know that certain habits are associated with delayed aging. Chief among them are eating well, exercising, avoiding smoking and nurturing social ties.

What does eating well mean? There are very many ways to eat healthfully, and all of them center on emphasizing whole plant-based foods (vegetables, fruits, nuts, legumes, whole grains) and minimizing highly processed foods (fast-food, processed meats, sugary drinks). 

Dr. Ayala

Two proven ways to halt aging and disease

A milestone birthday, a forehead wrinkle and a temporary bout of morning stiffness lead many to seek all kinds of creams, supplements and regimens in search of lasting youth. Less hopeful individuals sigh and accept these as a sign of inevitable decline.

There’s no sound scientific support for those youth-in-a-bottle miracles.

There is, however, plenty of evidence that the decline and disease associated with age can be dramatically altered.

Several metabolic risk factors are known to lead to type 2 diabetes, heart disease and cognitive decline: abdominal obesity, high blood pressure, abnormal lipid profile, insulin resistance and high blood sugar. The clustering of three of these metabolic risk factors (abdominal obesity measured by waist circumference, elevated blood glucose at fasting, high blood pressure, unfavorable cholesterol and high triglycerides) is defined as the metabolic syndrome. And these risk factors, when present in people’s thirties, forties and fifties, can lead to deteriorating health later in life.

Age-associated diseases are lifestyle dependent

These risk factors, however, are highly amenable to lifestyle choices. Diet and exercise are super important. Many studies show that adhering to a healthy diet lowers the risk of the metabolic risk factors of disease mentioned above. Many studies prove that exercising regularly, and avoiding a sedentary lifestyle help prevent this myriad of metabolic risks. 

And now, a new study in the Journal of the American Heart Association looks at the effect of each modality, and, more importantly, at the protection they offer when combined.

The researchers followed almost 2400 people aged 18 and up from the Framingham Study, looking at their adherence to diet and exercise recommendations. Physical activity was assessed by wearing an accelerometer for eight representative days, to assess moderate and vigorous physical activity. Diet was assessed by questionnaires, and compared to the recommended Dietary Guidelines for Americans.

Among the participants, only 28 percent followed both diet and exercise, while almost half followed just one of them, diet or exercise.

When the participants achieved the desired minimum of 150 minutes of moderate to vigorous activity per week, the risk of metabolic syndrome was reduced by half. 

When the participants adhered to the dietary guidelines, the risk of metabolic syndrome was reduced by a third.

Metabolic syndrome risk was 65 percent lower in people who adhered to both fitness and diet recommendations!

And for all these lifestyle choices, there's a dose response link: the more people exercise and the better they eat, the better the outcome.

Bear in mind that this study doesn’t define adherence to a healthy lifestyle too ambitiously. Two and a half hours of moderate to vigorous activity per week and eating according to the American Dietary Guidelines – which are no more than a sensible dietary pattern that emphasizes nutritious choices, while allowing moderate amounts of pretty much everything else – isn’t a tall order.

While according to this study you don’t need to be a health fanatic to reduce your risk of disease, we know that sadly, very few American’s eat well and exercise, and metabolic health is pretty rare in the US. According to a recent study of 9000 Americans whose metabolic health was assessed by measuring five parameters (blood pressure, waist circumference, fasting blood glucose, triglycerides and cholesterol) only 1 in 8 people had optimal levels of all five.

Joyful prevention 

We’ve been focusing on lowering our disease risk at considerable sacrifice this year – preventing Covid-19 spread kept us to ourselves and six feet apart for more than a year.

Now that we’ve been practicing preventive measures to improve our health, here’s some good news: The measures needed for keeping our arteries and brain supple don’t involve the type of deprivation we engage in to prevent Covid-19 spread. They don’t involve isolation; quite the contrary! Most exercise activities can be social, and usually keep you social with the sort of people that will keep you young. And eating healthfully can be super delicious – look at the Mediterranean Diet with all its mouthwatering fresh delights, look at the colorful bounty of the markets.

Dr. Ayala

The positive mindset: Can you think yourself fit?

I usually feel quite good about my activity level.

But there’s a group of women I occasionally hang out with that both inspires me and makes me feel like a sloth – these wonder women average about 2 hours of exercise daily and occasionally run marathons.

The inspired part is brilliant. But it appears that feeling like you’re slacking, just feeling less fit in comparison, isn’t good for you.

Placebo exercise?

A new study led by Octavia Zahrt and published in Health Psychology, found that people who thought themselves less active than others were 71 percent more likely to die, even after accounting for their actual activity level.

The study analyzed data from three nationally representative studies, included more than 60,000 people and gathered many health parameters, covering actual activity levels, weight, smoking and many others. It also asked participants how much exercise they think they’re getting compared to their peers.

Feeling that you exercise less than others predicted a remarkably worse outcome regardless of illness, age, and the amount of actual active time. Perceived under-exercising seemed bad for overall health.

The power of thinking positively

Accepting the power of the mind requires no magical thinking.

Our mental and emotional states influence our body. Recall the last time you were scared — you felt your heart beat faster, your breathing become rapid, your hair standing on edge, and all thoughts about food evaporate. This is called the startle response, and it’s an extreme example of how our state of mind enacts a cascade of physiological responses.

It should come as little surprise that other thought processes translate into more subtle changes in all our organs. Our body secretes hormones, releases transmitters, conveys electrical signals, activates immune cells and enacts an incredible array of actions in response to what our brain thinks or perceives.

It is indeed wondrous, but if you think about it again, not that surprising, that there is healing power to our thoughts and our beliefs. This has been called by different names including the power of suggestion, the power of positive thinking, and the cure within. The phenomenon though is well known, and what it describes is that sometimes symptoms and health status can be alleviated or worsened as a result of an individual expecting or believing that they will.

Apparently, the placebo effect works for fitness as well.

And in the case of exercise, perception can affect our physiology directly, and can also become a motivator. When people believe they’re way behind others it might make them give up rather than step up to the challenge. On the other hand, thinking you’re ahead of the crowd can motivate you to improve even further to maintain that perceived advantage.

Getting motivated about exercise

Inactivity is a major health issue, and positive peer pressure has been one of the great inspirations to push us to do more. But then, there’s also that messaging centered on scaring us all the way to the gym. And for any given level of activity, people may perceive the amount of energy they’re expending and the number of steps they make as a good effort, or as terribly deficient.

This study shows that these perceptions matter.

Stress, being overweight, and eating poorly affect our health negatively, but worrying about these risks to our health is even worse – we’re adding another dose of ill effect that’s a product of our mind. Stressing over stress can kill you!

That of course doesn’t mean that actual exercise isn’t important. It’s super important. But just as believing that a medical procedure or medication will have positive results augments the intervention’s efficacy, exercise amplified with a positive attitude increases its power.

Last weekend I climbed a mountain with my husband, and as we were passing a much younger couple my dear man said “we’re at the top 0.1 percentile of fitness for our age.” Instead of analyzing the sentence’s accuracy, I thought: What a great attitude!

This study reinforces the notion that we should not only do good, but also feel good about it.

At the end of the day, tell yourself that you’ve given your body the gift of sufficient activity. The saying that you’re as young as you feel appears to also be also true for fitness.

Be kind to you.

Dr. Ayala

Is soda bad for your brain? How about diet soda?

Soda ads feature young, vibrant, clear-eyed, athletic people. It has already been proven that in fact, soda is actually associated with the opposite: obesity and a myriad of chronic diseases that are the stark contrast of athleticism.

And now, researchers from Boston University, led by Matthew Pase, have shown that it may also dull your mind. It is already known from animal studies that excess sugar leads to Alzheimer’s findings in mice brain tissue. Its effect on human brains hasn’t been examined extensively until now.

The researchers used data from the Framingham Heart Study – a large cohort that is followed every 2 years for decades.

In the first study, published in Alzheimer’s & Dementia, more than 4200 people with different levels of soda intake underwent neuropsychological assessment as well as MRI scans. And the results: The more sugary drinks the participants had, the lower their brain volume and the poorer their memory scores – these findings are consistent with early Alzheimer’s. This held true even after adjustments for diabetes, smoking, exercise and weight.

How about diet soda?

The second study, just published in Stroke examined the connection between sugary and artificially sweetened drinks in almost 3000 people for stroke and in about 1500 for dementia. The volunteers were followed for about 10 years.

It found that diet soda was associated with both stroke and dementia. This was true after adjustment for age, education, smoking, caloric intake and physical activity.

This isn’t the first time diet soda has been correlated with stroke: The Nurses Health Study and the Health Professionals follow-up study both found that diet soda was correlated with stroke. This new study for the first time implicated diet soda with dementia.

Bottom line

Although association, as shown in these studies, isn’t definitive proof – yet – that soda is detrimental to our your brain, there certainly is absolutely no upside to drinking soda, regular or diet.

Sugar is a clear target for reduction in the latest Dietary Guidelines for Americans, and there’s no better place to start than your drinks. Drinking your added sugar it the worst possible way to consume it, as sugary drinks do not lead to satiety, go in unnoticed, at a really fast rate, and cause spikes in blood sugar and insulin.

The motivation to change habits differs from person to person, for some a warning that soda will ruin your figure is powerful, for others, hearing about the risk of diabetes is scarier.

For me, there’s nothing as alarming as the risk of losing my mental capacity.

These new studies offer yet another finding that can help convince people to rethink the way they drink.

Dr. Ayala

Is anti-inflammatory food for real?

Inflammation is the body’s useful reaction to injury and infection by outside invaders such as bacteria and viruses. Low grade chronic inflammation -- an immune system that’s a bit overactive at all times -- on the hand, is detrimental to our health and leads to serious trouble: from heart disease to cancer, depression, Alzheimer’s and arthritis, not to mention the role it plays in aging. Reduce undue inflammation and you’ll reduce the risk of these diseases.

The fascinating finding is that we can affect inflammation not just with powerful drugs but also with our fork.

What’s in our plate affects disease and health, so let’s take a look at which foods have that power, and at the latest science looking at the food - inflammation - disease connection.

The diet for controlling inflammation

To paint with a broad brush and help you remember, think of a stereotypical American diet -- low on fruits and veggies, high on meat, refined grain, highly processed foods, desserts and sugary drinks – and you’ve described the pro-inflammatory diet. Add to that obesity and sitting on a chair most of the day, and you’re imagining the perfect conditions for a pro-inflammatory state that predisposes our bodies to degenerative diseases.

To paint with another broad brush, an anti-inflammatory diet would be a classic Mediterranean diet – centered on fruits, veggies, spices and herbs, whole grains, garlic, onion, olive oil, fish and wine.

To be more specific, the tool used in most research into pro- and anti-inflammatory foods is the Dietary Inflammatory Index. To create the index thousands of scientific articles were reviewed, and each food and nutrient got a score.

Foods and nutrients that have strong anti-inflammatory activity include turmeric, fiber, tea, wine, ginger, all these wonderful phytochemichals in plant-foods, -- flavones, flavonols, flavonones, anthocyanidins, isoflavones -- vitamins such A, E, D, C, and many from the B family, magnesium, mono and poly unsaturated fats, and omega-3 fats.

Foods and nutrients with pro-inflammatory activity include total fat, saturated fat, protein, carbs and iron.

Do anti-inflammatory foods reduce disease?

 A growing body of research certainly suggests so.

A pro-inflammatory diet was associated with higher hypertension incidence in the 7000 women followed in a recent study. It was also associated with higher risk of colorectal cancer in another study that followed about 35,000 women.

Another study in the International Journal of Cardiology found that an anti-inflammatory diet lowered the incidence of heart disease in 3000 Greek volunteers followed for 10 years – at least for those of them that didn’t already have metabolic syndrome.

A brand new, large prospective study published in the Journal of Nutrition found that an anti-inflammatory diet lowered the risk of depression, especially in men.

Add to that the vast evidence linking Mediterranean diets with better health outcomes and, at least for me, it’s reason enough to pay attention to anti-inflammation foods – it’s an intriguing topic I’m sure we’ll hear more about.

The take home message: try to limit the pro-inflammatory foods – refined carbs, fried foods, soda, red and processed meat, margarine and lard, and try to include more foods that fight inflammation, such as fruits, veggies, spices, herbs, nuts and fatty fish.

Dr. Ayala

Anti-aging with cocoa?

The good news keeps on coming. After a large study found that coffee can save your life (well, not really, but coffee drinkers had lower mortality rates), a new study suggests cocoa can make your skin supple and radiant during that long, happy life, brought to you by 3-5 coffee cups a-day.

Cocoa is very rich in antioxidants -- flavonoids and flavonols in particular. Our skin suffers ultraviolet damage from exposure to the elements, leading to photo aging, and antioxidants can potentially mitigate those effects.

This is what researchers were testing in a neat new study, reported in the American Journal of Clinical Nutrition, in which 64 women consumed chocolate drinks for 24 weeks. Half of them had drinks with 4 grams of real cocoa powder, a powder produced so that it preserves the naturally occurring flavonols (each drink had 320 mg cocoa flavonols). The other half drank a nutrient and taste-matched cocoa-flavored beverage with no flavonols. The participants and the researches were unaware of which group they were in (a double blind, randomized placebo controlled study, which is the gold standard of studies).

After 24 weeks, the women treated with cocoa showed improvement of wrinkles in the crow-feet area, and their skin was more elastic – these results were objectively and elaborately measured and are not personal impressions. These improvements didn’t appear immediately, but rather 12 weeks into the experiment.

A good-for-you pleasure?

Over the years, cocoa, used in traditional folk medicine, has demonstrated quite a few health benefits, and has been shown to lower blood pressure and cholesterol, and aid in insulin resistance.

And a series of recent studies have hinted that not only will you look young, cocoa can also help keep your mind supple. A study published in Nature Neuroscience, showed that healthy 50 to 69 year-olds who drank a mixture rich in cocoa’s flavonols for three months improved their cognitive function. In another new study researchers gave 90 elderly people who were cognitively intact one of 3 cocoa drinks: high, medium or low in flavonol. The groups that drank the intermediate and high flavonol drinks showed improved cognitive performance and improvement in some mental tasks. A similar study with older people that already suffered mild cognitive impairment showed that high cocoa flavonol drinks improved verbal fluency and speed of mental processing.

Before you start a chocolate binge

As a chocolate lover I really enjoy these studies, but before we see this as permission to eat chocolate in all its delicious incarnations let’s be honest: Most of the chocolate in the market is mostly sugar. Cocoa flavonol content isn’t listed in the nutrition label, and many chocolate foods have very little of it. So if you love chocolate, here's your excuse to enjoy it; if you’re not into it, there isn’t compelling evidence to start a cocoa habit at this point, even if your laugh lines are digging into permanency.

Looking for flavonoid rich cocoa foods? Here are a few tips:

Cocoa powder: This is pure cocoa solids: fermented, dried cacao beans, with the cocoa butter separated out, and the remaining solids ground into a fine powder. Processed right, it is one of the most antioxidant rich foods in the world. Natural cocoa powder has more antioxidants than the Dutch-processed or alkalized version.

Cacao nibs: These are pieces crumpled from whole cacao beans, with pure chocolaty flavor, but no sweetness at all. They can be added to both sweet and savory dishes and are super rich in antioxidants.

Dark chocolate: Cocoa solids in dark chocolate vary, and are often listed on the pack, the higher the percentage the more flavonols it packs.

Milk chocolate: By definition the milk varieties will have less cocoa solids than the dark versions, but some fine milks have as much as 35-45 percent cocoa solids, while others have as little as 10 percent, making them a good source of – let’s admit it – sugar.

Dr. Ayala