Healthy Food & Healthy Living by Dr. Ayala

Your gut needs some exercise

The closest thing to a silver bullet for wellness is exercise. Want to keep your mind sharp? Exercise. Want to fend away type 2 diabetes and heart disease? Move more. Feeling down? Try working out.

How does physical activity achieve all that? Exercise strengthens the heart and improves blood circulation, it releases endorphins, it reduces inflammation, it increases muscle strength and endurance, builds stronger bones, and can improve sleep – yet another keystone of wellness.

But there’s another mechanism connecting physical activity and our physiology: our gut inhabitants. Each of us is a universe of microorganisms: We host trillions of microbes. Bacterial cells outnumber our cells 9 to 1, their genetic material outweighing ours 150 to 1. 

A healthy microbiome is essential for maintaining overall health and well-being. The gut microbiome plays an essential role in digestion, nutrient absorption, immune system function, and even mental health. Our gut bacteria also produce beneficial metabolites, such as short-chain fatty acids that can improve gut health, reduce inflammation, and even affect brain function. 

Fitness shapes the gut

We already know that athletes have unique microbiomes. But athletes lead unique lifestyles, are often lean and adhere to strict nutrition regimens. Would exercise by itself affect the microbiome in non-athletes?

A new study in the FASEB Journal looked at how duration and intensity of physical activity and muscle strength (as measured by a dynamometer which assesses hand grip) affects the gut microbiome in 350 people aged 40 and 65 years with normal and overweight BMI. 

And the results: Physical activity increases the richness and diversity of those in the study that exercised more. Exercise has more of an effect on the gut microbiome in normal-weight people than overweight people. Also, people with normal weight who had stronger grip strength had more of a certain type of beneficial gut bacteria.

How much exercise does it take? Moderate physical activity for more than 150 minutes a week was enough to positively affect the gut microbiome.

Exercise will likely improve your gut microbiome, and don’t forget the most important behavior linked with a healthy microbiome: eat whole plant foods, lots of fiber, and reduce refined and highly processed foods. Focus on vegetables and fruits, and foods high in fiber. Dietary fiber, including non-digestible carbohydrates “roughage” provide food for intestinal bacteria. In consuming these dietary nutrients, the bacteria produce their own byproducts, which make their way into our bloodstreams and affect our metabolism in a beneficial way.

Dr. Ayala

Is honey really better than sugar?

We’re encouraged to limit sugar and sweeteners in our diet. The American Heart Association advises no more than 6 teaspoons a day for women, 9 for men, and for added sugar to provide no more than 5-10 percent of daily calories. Excess added sugar is linked with obesity, and many chronic diseases such as type 2 diabetes, metabolic syndrome and heart disease.

And since we like sweet food –  to prefer sweet foods is to be human – are there healthier ways to sweeten food? Are honey, maple syrup, agave and date syrup any better?

Sugar is sugar?

Honey is made by honeybees from the nectar of flowers, and contains, besides sugars, a whole array of organic acids, enzymes, proteins, amino acids, minerals, vitamins, and bioactive substances. It has been shown that honey has beneficial effects on sugar control, weight maintenance, inflammation, lipid profile, and as a common cold remedy.

A new systematic review published in Nutrition Reviews including 18 controlled clinical trials set to examine honey’s health effects.

It found that a median dose of 40 grams (about 2 tablespoons) daily over 8 weeks reduced blood fasting sugar, cholesterol, and triglycerides levels. Raw honey was more effective than honey that was heat treated – most of the benefits demonstrated are from studies that use raw honey.

This review is in line with animal studies: several studies in rats show that regular honey intake results in better sugar control and lipid profiles.

Honey’s wellness benefits are plausible: Honey is 80 percent sugar, mostly fructose and glucose, but there are also “rare sugars” in honey, those include monosaccharides and their derivatives (such as isomaltulose), which have effects on fats on gut microbes. Honey contains phenolic compounds and flavonoids and other important antioxidants. Raw honey contains probiotic beneficial bacteria that are known to regulate the immune system and improve lipid profiles.

The flower source of the honey also matters – clover honey, and robinia honey were especially beneficial for fasting blood sugar control and cholesterol reduction.

Swapping sugar with honey

Honey is still in the “added sugar” category, and as such, should be enjoyed in moderation. Replacing sugar with honey can help with moderation, as you’ll be skipping most processed foods – which are made with refined sugar and high fructose corn syrup. Honey’s price point and nuisance value can help limit your consumption.

A “no refined added sugar” principal that allows for natural sweeteners can make sense if it helps you keep a lid on your sweet tooth. 

The added nutrients in honey can also add a bit of wellness.

The authors of the study also suggest that honey should not be lumped with the other refined added sugars which provide nothing but energy (empty calories): “as honey, when taken in moderation, may offer a variety of benefits for glycemic control and lipid levels.”

The key is moderation. I do believe that sweets and dessert have a place in a healthy diet. But a cake doesn't become “health food” because it’s sweetened by honey – cake is still cake.

Dr. Ayala

The rise and rise of tempting flavor and calorie bombs

Obesity rates have doubled in the US over the past three decades, and are now at about 42 percent. This rise follows a dramatic change in our food environment and our eating habits. Over the last few decades food technologists and food manufacturers have increased and popularized food products that are abundant, relatively inexpensive, calorically dense, and are what’s called “highly palatable”.

What’s highly palatable? A winning formula is one that combines sugars, fat and salt in a way that pleases our reward systems, giving us pleasure. The food industry has been busy making highly processed products from low-cost raw ingredients, and formulating them into super pleasing things to eat. They’re so pleasing that it’s hard to stop eating them – and we’re encouraged to never forget an opportunity to snack on them by massive and ever present marketing efforts.

A new study in the journal Public Health Nutrition examines just how much reformulation occurred in the past decades. While other studies focused on the rise in sugar in the American diet, the authors say theirs is the first longitudinal study of the spread of hyper palatable foods.

The researchers looked at the prevalence of hyperpalatable foods in a statistically representative US food system between 1988 and 2018 using three USDA and CDC food databases. Hyperpalatable foods were identified by criteria that look at the content and proportion of sugars, fat and salt in processed foods.

And the results: Hyperpalatable foods rose by 20 percent in three decades. Hyperpalatable foods now make up 70 percent of available foods in the US! The same grain food items were 50 times more likely to be hyperpalatable in 2018 compared to 1988. Foods in categories such as dairy and meats also went through reformulation, making them more exciting to the palate.

The authors suggest that this reformulation may be one key factor contributing to the rise in obesity: “Our findings indicate that the practices introduced to the food companies in the 1980s focused on product reformulation and enhancement may have had ongoing deleterious effects on our food system, contributing to the current obesogenic food environment in the US.”

An interesting finding is that the biggest rise in hyperpalatable foods was in ones with extra fat and salt – these are meal items and savory foods, rather than desserts and sweets. This may represent the expansion in frozen and ready to heat meals.

Resisting temptation

The authors call for public health policies limiting the addition of fat, sugar and salt to processed foods to below the threshold of hyper-palatability. 

Since that’s unlikely to happen anytime soon, the personal health solution is to minimize highly processed foods and prepared meals as much as possible. There’s a reason it’s so hard to stop eating highly processed foods – they’re designed to entice and to leave you wanting more, while at the same time giving you little nourishment. 

In this food environment it’s no wonder vegetables and fruit find it so hard to compete for attention.

Dr. Ayala

Eating together is a wellness tool

The family meal institution is an endangered species. Losing this important practice is worrisome, since family meals are linked with better nutrition, improved social skills, healthier eating habits, improved family connections and with lower obesity rates.

A meta-analysis in Pediatrics including 17 studies found that shared meals are linked with better nutritional health in kids – healthier weight, healthier choices and fewer eating disorders. Another meta-analysis, published in Obesity Reviews, including 57 studies with over 200,000 participants, finds that family meals are associated with lower risk of overweight, a healthier diet, and fewer unhealthy diet habits.

These pooled studies are correlational, but one can intuitively see why family meals could actually cause better habits: Family meals are usually composed of more nutritious foods, eating together enables role modeling of good habits by caregivers, it nurtures spending time and interacting with others, and it encourages slower, more mindful eating.

Frequent family meals, however, are likely more common in more organized homes, in homes with a higher socioeconomic status – homes with better eating habits and less obesity anyway.

The researchers therefore controlled for socioeconomic status in the meta-analysis, and even when controlling for socioeconomic status, more frequent family meals were correlated with better nutrition and weight status.

But whether eating together conclusively causes better nutrition or not, eating in company is a very good idea. The family meal offers a great opportunity to lead by example, communicate good habits and to bond.

Yet only about half of US households with two or more people eat meals together regularly.

Bringing families together – what works?

With busy and demanding schedules and the availability of processed and prepared foods increasing family meal frequency is challenging.

Which interventions support family meals? 

A new study in the journal Appetite looks at which interventions work best to improve the frequency and healthfulness of family meals especially among low-income families. Six different interventions were put to the test in different combinations, with 2 of the 6 intervention components tested together in each experiment, which makes for 64 different combinations. The interventions were:

• Cooking/Serving Resources: All the tools you need for cooking and serving a meal, including pots, pans, utensils, dishes etc.
• Meal Delivery: Prepared meals once a week , ready to warm up and serve.
• Ingredient Delivery: Delivery of ingredients to supply one meal a week.
• Community Kitchen: Participants were invited to a weekly group session in which you prepare one main dish to take home.
• Nutrition Education Classes: Participants were invited to attend a weekly group nutrition class that included food prep and tastings.
• Cooking Demos: Participants were invited to attend weekly group cooking lessons that included tastings.

These were tried with about 400 families recruited through Head Start, the age of children at the start of the trial was 3-4 years, and the interventions were tested for 8 weeks each.

The families were asked: “How many nights a week out of 7 did you and your child eat dinner together in the same place at home (such as around the table) for most of the meal?”. Families were also asked how many evening a week dinner was made mostly from scratch, how many nights a week dinner was cooked mostly or only from ready made foods (such as canned soup or boxed macaroni), how many nights food was from ready made dinners (such as frozen meals), and how many nights the parent/s or kid/s ate fast food (such as KFC, McDonalds) either at home or on premise.

The combination of Cooking/Serving Resources and Meal Delivery performed best and increased family meal frequency, cooking dinner from scratch, and prioritization of family meals; it also decreased the use of ready made and fast foods.

As you might imagine, supplying cooking and serving utensils, and supplying meals or ingredients garnered good participation. But getting busy parents to take part in weekly nutrition and cooking classes and demos was more challenging, and only 13-15 percent attended. Participation was so low that the researchers couldn’t even test the effectiveness of this intervention.

Eat with pleasure

Gathering around the table works even better to foster normal weight and health benefits when the atmosphere is positive. A study published in Pediatrics looks at key risk and protective factors for childhood obesity in the home, and includes 120 low–income kids and families from the Minneapolis/St Paul area, recording family meals at home for 8 days. These were all families that regularly shared meals, and told that the study focuses on “modern day” dinner, and to just eat as they always do. The video recordings were analyzed for interpersonal and food related behaviors. 

The researchers found that the atmosphere around the table matters: Families that enjoyed the meal, had warm, calm and positive conversations around the meal, had a higher frequency of normal weight. These results held true even after they were adjusted for parental weight.

On the other hand, hostility, frequent criticism, yelling, food lecturing (“children in other countries are starving”) and indulgent and inconsistent parenting were associated with heavier kids. Overweight kids also sat at the table for significantly shorter times.

Sharing meals with the people in your life depends on physical preconditions, such as arranging the time, space, utensils and food. These are barriers that may not be trivial, but well worth overcoming.

A virtuous cycle in which family members await this time to connect, talk and enjoy food and company – and reap the benefits – depends on making mealtimes as pleasurable as possible. 

Dr. Ayala

No meat, low meat, and what really matters for health

The calls to cut back on meat are coming from many directions. The meat industry is a major contributor to greenhouse gasses, climate change, and environmental degradation. Billions of animals suffer and die to satisfy our eating choices.

These altruistic reasons to cut down on meat come on top of the self-serving rationale to do so: Eating less meat is good for you.

Studying the outcomes of a lifetime of dietary habits is difficult – the range of what and how much a person eats is extensive and diets change over time – but decades of research show that the risk of cardiovascular disease is overall lower among vegetarians and vegans. Vegetarians and vegans tend to be thinner, have lower total LDL cholesterol, and lower blood pressures. 

A link between meat and cancer is also well studied. The American Cancer Society recommends limiting or avoiding red and processed meats in order to lower the risk of cancers. The World Cancer Research Fund states that if you eat red meat, shoot for no more than 3 portions (12-18 oz cooked weight) a week, and consume very little if any processed meat.

Low meat, fish, and vegetarian diets and cancer risk 

As noted from the above recommendations, it’s not just vegetarians that can lower their disease hazard, as the risk from meat is cumulative and dose dependent.

A new study in BMC Medicine analyzed the nutrition data from almost half a million British adults, aged 40-70 years, and looked at the incidence of cancer over 11 years, also controlling for diabetes, socioeconomic factors, smoking and obesity.

About half (52 percent) of the cohort ate meat more than 5 times a week, 44 percent ate meat less than 5 times a week, 2 percent ate only fish but no meat, and 2 percent were vegetarian or vegan.

The study finds that those who ate meat less than 5 times a week had a 2 percent reduction in cancer incidence, fish eaters had a 10 percent reduction, and vegetarians and vegans had a 14 percent reduced risk. Low meat, fish and vegetarian eaters had lower risks of all-cause cancer, and especially colorectal, prostate and breast cancer.

But although the study controlled for confounders such as weight status and exercise, the authors note that: “Vegetarians and fish-eaters differ from meat-eaters in many non-dietary lifestyle factors such as lower smoking and alcohol consumption, and higher physical activity. Although relevant potential confounders were added to the multivariable models to adjust for these differences, imperfect measurements and/or changes in these confounders over time may result in incomplete adjustment for these variables.”

Not all meat-free diets are created equal

Not all foods of plant origin are healthy though: French fries, chips and soda are utterly vegan, and obviously don't promote health.

Meat avoidance, in and of itself, doesn’t tell us enough about what people actually eat, therefore studies that look at the content of plant-based diets are informative.

The longest living group of Americans are probably The Seventh Day Adventists, whose health habits—promoted by their religion—include vegetarianism, as well as avoiding alcohol and smoking. Adventists as a group aspire to these rules, and are generally health conscious, but individual adherence is variable, and not all adventists avoid meat. Studying and subgrouping this diverse cohort is revealing.

A new study in the American Journal of Clinical Nutrition following about 77,000 members of the Adventist church for about 7.5 years looked at their rates of death from any cause, and correlated it with how much ultra-processed foods and meat they ate. 

And the results: Eating more ultra processed foods was associated with a 14 percent higher incidence of death. Eating more red meat was also linked with an 8 percent increase in all cause mortality.

The quality of any diet is determined by what you eat more of, and also what you eat less of. 

Instead of categorizing a food just as plant-based you should also question its nutritional quality.

A recent study in the American Journal of Clinical Nutrition including almost 130,000 people, followed for 20 years, sought to see if  plant-based diets affect weight gain, which is an important risk factor for many chronic diseases.

The study uses three indexes of plant-based diets. The first is an overall plant-based index, in which plant-based foods receive a positive score, and animal foods receive a negative one. The other two are subcategories of the first one and rate the healthfulness of of the plant based components of the diet, adding points for healthful plant based foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) and reducing score for less healthy plant foods (sweetened beverages, refined grains, sweets/desserts).

Participants gained on average 2 to 4.5 pounds every 4 years. Diets that were more plant-based mitigated weight gain. But not all plant-foods and meat avoidance regimens fared equally: People who ate a more healthy plant based diet gained 1.5 pounds less. People who ate an unhealthy plant-based diet gained about 1 pound more.

Similar results are seen studying type 2 diabetes: Overall a high plant-based diet and especially healthy plant-based diets are linked with lower the risk of diabetes. Unhealthy plant-based diets, however, are actually associated with higher rates of type 2 diabetes.

And the same goes for cardiovascular disease: although sticking to a more plant-based diet seems to be protective, when examined more carefully the subgroups of plant-based eating patterns diverge – healthier plant-based diets are linked with lower heart disease risk, but an unhealthy plant-based diet confers a higher risk.

Watch out for highly processed food

As plant based meat and milk alternatives expand – clearly a blessing for animal rights and environmental benefits – make sure that you’re not replacing an eat-less-of ingredient with yet another one that we should watch for: highly processed food.

Many in the meat avoiding population are health conscious, and their wellbeing can be attributed to the myriad of healthy routines they practice, in diet, physical activity, mental wellbeing, smoking avoidance etc., all working in conjunction. 

Vegetables and plants are the essence of a healthy vegetarian lifestyle, meat avoidance alone doesn’t do the trick – and meatless burgers are hardly a plant.

Dr. Ayala

Two thirds of kids’ calories come from highly processed food

Rates of childhood obesity have skyrocketed over the last decades, and there’s little doubt that the main culprit is our diet. Caloric intake has risen, as did the consumption of ultra-processed foods. Ultra processed foods make overeating incredibly easy: there’s very little you need to do in order to prepare them – they’re ready to eat or need a brief moment in the microwave or a little mix-in – they’re usually calorically dense, they provide lower satiety, and the flavors and mouthfeel are seductive. They’re also relatively inexpensive.

The more ultra-processed food in a society’s diet the greater the obesity rates. A recent large prospective study found a 10 percent increase in ultra-processed food was associated with a 10 percent increased risk in overall cancer and breast cancer rates. Another study following about 12,000 Americans with no underlying illness for more than 20 years found that consuming more ultra-processed food is associated with a 30 percent higher risk of dying.

A new study in JAMA looked at the diets of American kids and found that two thirds of calories now come from highly-processed foods. 

The study looked at a nationally representative sample of almost 34,000 2-19 year olds, and found that although sugary drinks intake decreased somewhat in the last two decades, those sugar calories were more than made up for by greater intake of bakery products and sweet snacks. Ultra processed food consumption increased especially among ethnic minorities, such as non-Hispanic Black kids, who are especially targeted for junk food marketing. Highly processed food use is rampant and pervasive in the entire population though, in all parental education levels and across all income levels.

What are the negatives of ultra processed foods? Most have low-quality carbs, coming from added sugar. Most are low in fiber. They contain additives, such as emulsifiers, stabilizers, preservatives and artificial sweeteners, which have been linked to unfavorable metabolic outcomes.

Beyond that, the authors note that: “processing itself may convey adverse health effects by changing the physical structure and chemical composition of food, which could elicit elevated glycemic response and reduced satiety.”

A recent study in the BMJ simulated what would happen if the use of ultra processed foods were to be reduced, and estimated that the prevalence of childhood overweight would go down from from 37 to 21 percent and obesity rates would move from from 20 to 11 percent. This study is just a simulation, extrapolating from a randomized controlled trial in which volunteers alternated between highly processed and less processed diets which were matched for total calories, energy density, carbs, protein and fat, fiber, sugars and salt and instructed to eat as much as they wanted. People on an ultra processed diet ate a daily average of 500 calories more than they did on an unprocessed diet.

But phasing out ultra-processed foods when they’re already a habit isn’t easy.

The Covid-19 pandemic brought about a return to home cooking for many families, but it seems like the rush to bakers’ yeast and kitchenware was temporary – people have reverted to ordering in and to ready-made foods. Childhood obesity rates, which we hoped had already leveled off, may be rising again during the pandemic.

Watching out for over-processed food

Think of ultra-processed foods as the polar opposite of whole foods, which should comprise the majority of what we eat. 

But cooking from scratch using whole foods isn't always practical, and let’s not over romanticize the era in which people spent all their waking hours preparing a meal – we do need someone else to do our food prep at least to a certain degree.

To enjoy the best of both worlds, when purchasing packaged food ignore marketing claims on the front of the label, and instead, read the ingredient list watching out for these indicators:

Artificial ingredients: 

If you can’t pronounce an ingredient, it’s probably a chemical, added for flavor, color, texture or preservation.

Lots of sugars/sweeteners:

Look at the “added sugar” quantity or look for sugars among the top three ingredients of non-dessert foods.  Watch out for sugar’s many versions, such as dextrose, evaporated cane juice etc. Foods with lots of added sugar are the embodiment of highly processed food, and the worst are sugary drinks. Desserts and treats are ordinarily made with plenty of sugar and sweeteners, whether they’re highly processed or made from scratch, and those are best eaten in moderation, regardless of processing level. High-fructose corn syrup is the embodiment of high processing and industrialized food.

Highly processed category until proven otherwise:

Fast food, most fully prepared and frozen meals, most mass produced chips, crackers, and highly sweetened cereals, cured meats (ham, salami, bacon, some sausages.)

What are your tips for minimizing highly processed foods?

Dr. Ayala

 

Why does losing sleep make you overeat?

We’ve all missed a good night’s sleep at one time or another, so we know first hand how important sleep is. Chronic lack of sleep is a bigger issue, it can make us moody and anxious, it reduces mental acuity, and it’s associated with increased likelihood of several diseases – such as viral infections, diabetes and heart disease.

Insufficient sleep is also associated with weight gain and overeating. 

A recent meta-analysis including 11 interventional studies – in which people with partial sleep deprivation were compared to controls who slept normally – found that shortened sleep is associated with eating an extra 385 calories.

Lack of sleep is now considered an established risk factor for childhood obesity, even though the data is mostly observational. An analysis of seven studies, including 14738 participants finds that from infancy into adolescence, sleeping less is linked with the development of obesity.

Sleep and weight gain are linked, but that doesn’t explain how one affects the other. What is it about sleeplessness that triggers weight gain? 

It may be that the lack of sleep activates hunger through a cascade of hormones. Lack of sleep may also just move people to eat in the absence of hunger – an emotional kind of eating that has more to do with comfort or mindlessness, not with real hunger urges.   

Not hungry, still eating

A new study in the American Journal of Clinical Nutrition including 105 kids aged 8-12 looks at what sleep deprivation does to eating in the absence of hunger, ie: eating for the sake of eating.

The kids, who all had normal sleep (8-11 hours a night), were assigned to 2 weeks of sleep restriction in which they went to bed one hour later, and the same kids were also tested with 2 weeks of sleep extension, in which they went to bed one hour earlier, the sleep settings done in random order. On the last day of each week the kids were given a buffet style meal, and told to eat until they were full. After a 15 minute break the kids were asked back into the dining room and given a free range of things like ice cream, chips, cookies and chocolate. Each kid’s consumption was measured in both the meal and the after meal by weighing what’s missing from the serving plates.

The authors found that the kids – who are basically compared to themselves – didn’t increase caloric intake when they lost an hour of sleep compared to when they gained one. What they did find is that after the first meal experiment the kids lowered their consumption during the first course, leaving more room for the dessert session for the remaining 3 weeks of their experiment. In other words, the kids learned that there’s sweet and salty stuff coming later, and adjusted accordingly.

When the researchers looked at all the kids together, after just the first week, before kids could learn that dessert was coming, they found that the mild sleep deprivation did increase the eating-while-not-hungry intake by a little, but the study sample wasn’t big enough to prove this point.

In this respect, this experimental model failed to prove that sleep deprivation leads to a greater tendency of eating while not hungry.

Eating while sleep deprived

This is, however, just the way science moves on. The observational data finds that sleep deprivation is clearly linked with overeating. Designing and implementing randomized controlled studies and manipulating sleep to further understand the mechanism and to establish causality is still needed, and obviously challenging. And we can never completely control for biases such as screen time and socioeconomic factors even though the statistical models take those into account. Questions remain.

But we can already say with some confidence that chronic sleeplessness is a common trigger for overeating.

It may simply be that being awake longer gives us more time to engage in our favorite activity.

And being tired may also make us more susceptible to the temptations of the kinds of foods that make us overeat: fast and energy dense ones – tired people aren’t likely to chop kale and dress it in lemon juice in the middle of the night.

Solving sleep isn’t easy, but being aware of the connection between sleep deprivation and overeating can make us a little more mindful of what we do when we don’t get enough sleep.

Dr. Ayala

Why soda may increase the risk of early-age colon cancer

Chadwick Boseman's death from colon cancer at the shockingly young age of 43 was a wake up call. Colon cancer, like most cancers, is more common in older people, and early detection has been focused on the over-50 population. Rates of colon cancer have indeed been declining in the older population – the development of cancer in the gut can be prevented when polyps are removed during colonoscopy before they have a chance to turn into a cancerous tumor – but the rates have risen sharply in younger adults. For people born in the 1990s the risk of colon cancer is twice that of people born in the 1950s.

What explains the rise in cancer among Millennials and Gen Xers? 

The most likely explanation is lifestyle risk factors: Colon cancer risk factors include poor diet, obesity, smoking, alcohol consumption and lack of exercise. In other words, as fast food, obesity and unhealthy sedentary practices rise, so would the risk of colon cancer.

A new study in the journal Gut looks at the leading source of added sugar in the US diet – sugary drinks – and the risk of early-age colon cancer. The researchers analyzed data from almost 120,000 women who were part of the Nurses’ Health Study II between the years 1991-2015, with a 24 year follow up, looking at diet and health outcomes. 

Among this large group there were 109 cases of early-age (before the age of 50 years) colon cancer.

Women who drank more sugary drinks were more likely to be less physically active and have lower diet quality – eat less fruits, vegetables and fiber, and eat more processed meat. But even after adjusting for all the above colon-cancer risk factors, as well as for obesity, alcohol intake etc., higher sugary drink intake was associated with an increased risk of early colon cancer.

Women who drank more than 2 servings of sugary drinks had more than double the risk of developing early onset colon cancer, with a dose-response additional risk with each additional sugary drink. The increased risk was associated with sugary drinks, and not with fruit juices.

Added sugar and your gut

Americans’ consumption of sugary drinks rose dramatically in the second half of the 20th century, with kids drinking soda earlier in life and in greater quantities. 

We already know that sugary drinks are linked with obesity, as well as with several chronic diseases such as type 2 diabetes and heart disease.

This study shows a link between sugary drinks and early-age colon cancer in a large women cohort. What could explain that? We already know that sugary drinks promote weight gain by the sheer fact that they introduce plenty of calories, yet lead to very little satiety, and therefore can result in overeating and weight gain. They can also make blood sugar rise quickly, leading to a rise in insulin, which can long-term result in insulin-resistance, inflammation, type-2 diabetes and weight gain. All of these are known risk factors for colon cancer.

But beyond that, the authors write:

“By causing dysbiosis and endotoxaemia, fructose can impair gut barrier function and increase gut permeability, which could promote colorectal carcinogenesis. A recent experimental study demonstrated that HFCS-treated mice had substantial colon tumour growth with aggressive tumour grade, independent of obesity and metabolic syndrome,30 which lends additional support to the link between SSBs (sugar sweetened beverages) and CRC (colorectal cancer) risk.”

Allow me to explain. Fructose is part of most of the added sugars we consume, including table sugar and high fructose corn syrup. Fructose in sugary drinks overwhelms the small intestine’s absorption capacity and reaches the large intestine where it can cause imbalance in the microorganisms living within the gut (the microbiome), and lead to the production of bacterial toxic materials, resulting in further changes in the gut that promote the formation of cancer cells.

Colon cancer rates are rising among young people, but fortunately this disease is still relatively rare. 

The other afflictions associated with the soda habit are much more common, and much more evidence connects the sugary-drink habit with outcomes such as hypertension, type 2 diabetes and heart disease.

Dr. Ayala

Why are food allergies on the rise?

Food allergies are on a steady rise, especially in the last two decades – an alarming 8 percent of kids in the US report such reactions, a third of these are severe allergic reactions.

Why would the immune system react in nasty (rashes, diarrhea, vomiting, abdominal pain) and life threatening (anaphylaxis: blood pressure drop, tightening of the airways) ways to something as peaceful and necessary as food? Why would the immune system mistake food proteins, such as tree nuts, peanuts, eggs, shellfish and soy as enemies?

You’ve probably heard of the hygiene hypothesis. Lower incidence of microbial infections in developed countries, this theory proposes, may have shifted the immune system’s attention to other targets, leading to the rise in both autoimmune and allergic diseases. 

In a new paper in the journal Cell, Yale immunologists suggest several other environmental culprits that may have triggered this crippling hypersensitivity to food.

Our “quality control” system

Natural foods contain thousands of chemicals, some of them are nutrients: fats, proteins, carbohydrates, vitamins and minerals. Some are not nutrients: they include stuff that we can’t absorb and sometimes also all kinds of toxic molecules. Our body has a way of sensing and detecting these chemicals all along our digestive tract, from nose and mouth, throughout the gut. It senses both the quality and the quantity of these substances, and is very sensitive to harmful substances. An animal’s gut “knows”; it calculates a food’s benefits in energy and nutrients against its determinants in hazardous substances, and has a mechanism to elicit reactions to it that are both learned through experience and automatic and hard-wired.

Our body’s quality control system, the authors explain, has two lines of defense in dealing with suspect food: avoiding ingestion of that food through food aversion, and minimizing its absorption.

Sensory control: why we avoid certain tastes

The gut doesn’t sense everything. It senses some but not all chemicals. Some foods may not have an unpleasant taste or smell, but after they elicit an adverse reaction the eater learns to avoid that specific taste in the future. After a negative experience we may lump together all foods that have that specific taste profile and avoid all things that taste like that, even though other foods with that taste pose no danger at all. 

Our sense of smell and taste err on the side of caution, and we may become averse to anything that reminds our senses of an offensive food. An extreme example of that may sound familiar: some women report that they first realized they were pregnant when they became acutely sensitive to the smell and taste of some foods, and were suddenly turned off by foods they previously loved, such as soft cheeses and coffee – this over-caution may to the benefit of the developing fetus.

Secondary defense: minimizing absorption

If the food’s already in the digestive system the gut can still block its entry into our cells. This may involve increasing the amount of mucus in our gut, the secretions acting as a barrier to absorption, hence the runny nose, sneezing and coughing; it also intensifies the movement of the bowel, which makes the food’s passage in the gut shorter, decreasing absorption, and making us rush to the bathroom in discomfort. 

Our body rejects food through nausea, vomiting, diarrhea, and malabsorption.

Food allergy as quality control gone haywire

Is food allergy an exaggeration of these beneficial defense mechanisms, designed to protect us from food poisoning? 

The authors postulate that in order for a food protein to elicit an allergic reaction, that protein – which is a beneficial food – has to be associated with a toxic substance. The protein and the poison can be associated by just happening to be in the gut at the same time by pure chance, or by being tied together physically. Either way, the body learns to attack the protein as if it were the toxic component of the pair. The gut, which is equipped with protections against the poison, recognizes the innocent protein as an enemy and fires in full force. 

And since this system is designed to minimize the risk from poison, it’s prone to err on the side of over-protection and caution, causing food aversions and allergic reactions that exclude perfectly good foods.

The changed environment

So what’s happening here, why are food allergies on the rise?

“One such factor could be the increasing reliance on processed foods depleted from natural compounds,” the authors explain. 

Edible plant foods naturally contain thousands of substances, among them are compounds, such as alkaloids, terpenoids, phenolics and glycosides, that are designed to protect the plant itself from munching animals, microbes and from the elements. Animal food products also contain such compounds. It’s the quantity of such compounds and the unique way they’re presented to the gut that determine how our body reacts to them. The right amount preconditions animals to accept the substance, and with it the whole food that contains it.

Large amounts and, surprisingly, amounts that are too low, cause the body to mark the food as enemy – exposure that's too small fails to desensitize the gut to the toxin.

“Another factor is the increasing consumption of artificial chemicals (food preservatives, dishwasher detergents, etc.) that we have not evolved to handle with natural defenses,” the authors continue. These chemicals that we have not evolved with and that are new to human consumption may lead to dysregulated allergic reactions.

In order to prevent and treat food allergies we need to understand the underlying biology of such disorders, and what’s quite clear is that our food environment has indeed changed dramatically. And while the hygiene hypothesis, even if completely proven, won’t convince us to revert to the days of parasite-infested food and contaminated water, the highly processed food diet is one that we should reject for many other reasons – its link to a multitude of chronic diseases is clear.

Dr. Ayala

Is sourdough bread really better for you?

 

My sourdough starter is part of my home. Like a pet, it needs attention – a morning and evening feed. It's all the pet I want as it has asks for so very little, yet like a pet, it gives back so much more than it receives. 

Feeding my starter has been part of my daily routine in the past few months, as has been the baking of the daily loaf. When I have too many I give them away, sometimes with an offer of a jar of the starter – or leaven – that’s the magic behind the sourdough.

My starter is indeed some kind of reflection on my home, as it contains the unique microorganisms collected in it. No two starters are alike, even if they started from the same batch, or came from your favorite bakery, and today’s starter is different from the one you’ll have next month. It took me around two weeks to get from whole wheat flour and water to a reliable starter, but now my baby’s strong, resilient, and as long as it’s fed, it will make delicious, nourishing bread.

A sourdough bread is made out of four ingredients: flour, water, salt and the starter. Seemingly simple ingredients, except the starter – many bakers name theirs and speak of them in terms of endearment – is no ordinary ingredient. 

The starter is a complex microbial ecosystem, consisting mostly of lactic acid bacteria and yeast. These microbes ferment the dough, give it its unique flavor characteristics, and change the bread’s nutritional profile.

In the beginning

Fermentation must have started as a happy accident thousands of years ago.

In order to digest dry cereal ancient people had to process it: grind the hard grain, and mix it with water. At some point they must have noticed the pleasant sour aroma from the left-on-its-own porridge, and the accompanying airy quality it took, and when they heated this puffed up sponge it rose even more, like magic, emitting the most magnificent scent.

The rest is history. Sourdough was already part of the European diet 5000 years ago; murals of baking leavened dough in Egypt date from 1500 BC. Sourdough was how bread was leavened up until the 19th century, when it was largely replaced by baker’s yeast, Saccharomyces cerevisiae, a monoculture of yeast that gives predictable results. Nowadays, sourdough starter is used mainly in artisan breads.

What’s in that starter?

Each starter is unique, and because it’s a living culture of organisms, which produce their next generation several times an hour, it also evolves constantly. The dominant bacteria are Lactobacillus species, bacteria that produce lactic acid, which vary from region to region, as the typical San Francisco environment has native inhabitants that are distinct from those in Rome. Lactobacillus sanfranciscensis, a common species of lactic acid producing bacteria is named after San Francisco, where it was first identified in this city’s famous sourdough, but it’s by no means endemic to the Bay area. Yeasts are less abundant, there are generally 100 bacteria to each yeast. There are many different kinds of yeast typically in sourdough starter, and those, too, depend on variables such as where the leaven originated, the type of grain used, humidity, and temperature. The yeast and the bacteria are everywhere, in the air and in flour; by nurturing your starter you’re giving them an opportunity to form a colony and collaborate in bread making.

No wonder homemade sourdough bread holds so many surprises.

Professional bakeries go to great lengths to get a consistent loaf, but for the home baker the endless mystery of the sourdough experiment may be part of the appeal – you can nurture your starter, but total control isn’t possible, and serendipity is part of the game.

During the sourdough’s long fermentation, typically 12-24 hours, the microorganisms extract energy from the carbs in the dough, and develop flavor molecules – mainly organic acids, alcohols, esters, and carbonyls – through that process. The yeast in the starter is responsible for most of the rise of the bread, and this negative space, created by the gasses that the microorganisms emit, is as important as its substance. A perfect sourdough inner texture will have holes both big and small, alveoli in baker speak.

Is sourdough healthier?

Sourdough’s flavor and mouthfeel are its main selling points – devotees swear it’s the best bread with no parallels – and it’s a more natural and traditional loaf.

But is it nutritionally superior to other breads? 

The long fermentation process is one in which the microbial culture changes and digests the dough, hydrolysing proteins, using up sugars, and chemically transforming an amorphous blob into a plump crusted loaf. 

During fermentation, sourdough bacteria and yeast produce bioactive peptides, which are fragments of protein made of 3-20 amino acids with antioxidant and anti-inflammatory activity, at least in the test tube. These peptides remain active after baking, and may promote health. Lunasin, for instance, is a strong anti-tumoral peptide that's produced during sourdough fermentation.

Sourdough, as the name suggests, is sour, acidic. The bacteria’s produce lactic acid, as well as bacteriocins and antifungals, which act as biopreservatives, protecting the bread from spoilage microbes, that’s why sourdough keeps so well despite having no added preservatives.

Phytic acid, or phytate, which is part of cereal grains, is considered anti-nutritional: it interferes with absorption of grain’s minerals such as iron, magnesium, potassium and zinc. The enzyme,, phytase, present in flour, breaks down phytic acid, making these minerals bioavailable, but this enzyme is usually quite inactive. The acidity of sourdough, as well as the phytase made by the culture, degrade phytate significantly, therefore increasing the bioavailability of the hidden micronutrients.

Sourdough may be better tolerated by people with gluten sensitivity. Sourdough fermentation results in some breakdown of gluten, especially the gliadin component of gluten, and wheat flour sourdough may be better tolerated by people sensitive to gluten. Wheat sourdough isn’t gluten free, though, and people with celiac should avoid it.

Sourdough typically has a lower glycemic index than regular bread – 54, which puts it in the low GI food category – and may elicit lower spikes in blood sugar and insulin, making it more suitable for people with diabetes and insulin resistance (regular breads have a glycemic index in the 70s).

The friendly bacteria in sourdough don’t survive the high temperatures of the oven, therefore sourdough is not a probiotic. It’s a prebiotic though – the fiber and absence of additives may benefit a healthy microbiome.

Each sourdough bread is of course different, sourdough can be made with whole or refined flour, with wheat and with rye and many other grains, and the more whole grains in the dough, the healthier the bread.

Outsourced

A sourdough routine has been somewhat popular in these crazy Covid-19 times for many reasons. Once you look at a sourdough recipe you’ll realize the time and space commitments and that sourdough bread making is more logically outsourced. Even in old times bread was at least baked in a central location – I kind of feel bad about heating my oven to 500 °F daily for just one or two loaves. It’s more hobby than practicality. 

I strongly believe in healthy homemade meals – those needn't be complicated, or terribly time consuming, and they’re key to taking charge of your health and wellbeing. 

Look at sourdough as metaphor. When you do through the exercise of telling this bread apart from factory-made fast loaves, you see the nutritional sacrifice on the one hand, and the time saving on the other. Bread making is perhaps best left to the specialists; not so with something like a salad, which you can make in minutes, with incredible results.

Dr. Ayala

Watch out for ultra-processed food

A time traveler transported from a century ago to a mainstream supermarket today would be astonished by the technological marvels of our food industry. Food manufacturing gradually moved from light processing to heavy, industrial processing, creating lots of convenient, flavorful, long-lasting, ready-to-eat products made with peculiar ingredients – hard to pronounce chemical additives, preservatives, colors and flavorings. These heavily processed foods have taken over much of the global food system in the US and in many other countries.

Nowadays, highly processed foods such as soft drinks, French fries, processed meats, cookies, sweetened cereals and salty snacks, make up more than half of the caloric intake of the average American.

And after decades of enchantment with the convenience of getting someone else to do our cooking, for cheap, we woke up to the realization that heavy processing carries a heavy price. We’re paying for this inexpensive food with our heaviness and our health.

Highly processed food has been linked to rising obesity rates and high blood pressure. A recent large study found a 10 percent increase in ultra-processed food was associated with a 10 percent higher risk of overall cancer and breast cancer.

A newly published study in in Public Health Nutrition included about 12,000 Americans with no underlying illness, who were followed for more than 20 years, to see whether a highly processed diet might shorten people’s lives.

30 percent more likely to die

Highly processed foods in this study were defined as: “foods containing substances that are not typically used in culinary preparation such as hydrogenated oils, hydrolysed protein or emulsifiers, and have few whole foods. Ultra-processed foods contain industrial substances to mimic sensorial qualities of whole foods and create foods that are highly palatable.”

Participants ate highly processed foods 4 times a day on average. Those with the highest usage of ultra-processed foods did so more than 5 times a day, and tended to be male and younger. During follow up there were 2451 deaths.

There was a very clear link. Eating more ultra-processed food was associated with a 30 percent higher risk of dying, even after adjusting for demographic, socio-economic and health confounders such as smoking, weight and exercise.

A diet high in ultra-processed foods was found after analysis to be high in added sugar, fat and calories and low in fiber and micronutrients.

Low diet quality is linked to chronic diseases and premature death, that we already know, but the authors suggest that ultra-processed foods elevate the risk not only by their low nutritional value: they also contain other ingredients that may pose an extra risk. Besides the hydrogenated oils, colors and preservatives, ultra processed foods may contain hazardous contaminants and environmental chemicals: from acrylamide, polycyclic aromatic hydrocarbons, heterocyclic amines and furans in the foods, to the phthalates and bisphenol A in their packaging.

Regardless of the mechanism, the highly processed diet is probably one of the worst ways one can eat.

Not only is it of low nutritional value, and loaded with stuff that isn’t food, it is also designed with the specific goal of pleasing us, and manipulating our reward system. Food chemists make sure the product has a perfect sugar-fat-salt and flavor combination, the right mouthfeel and crunch, they optimize it so that it gives us maximum pleasure and ease. Drinks are designed to be chuggable. It’s a recipe for overeating, and compared with ultra-processed foods, foods in their original form are understated and pale. No zucchini or tomato can give you the flavor punch of an crunchy chip.

How to spot over-processed food?

What to look for when you’re reading the ingredient list:

Artificial ingredients: If you can’t pronounce or identify the ingredients, they’re probably chemicals, added for flavor, color, texture or preservation.

Sugars and sweeteners in large amounts (including sugar’s many incarnations, such as dextrose, evaporated cane juice etc.): Look at the “added sugar” quantity or look for sugars among top 3 ingredients of non-dessert foods. Foods with lots of added sugar are the hallmark of highly processed food, and the worst offenders are sugary drinks. Desserts and treats usually are made with plenty of sugar and sweeteners, whether highly processed or made from scratch, and those are best eaten in moderation, regardless of processing level. High-fructose corn syrup is the symbol of high processing and industrialized food.

Foods that generally belong in the highly processed category:

Fast food, most fully prepared and frozen meals, many of the mass produced chips, crackers, and highly sweetened cereals, cured meats (ham, salami, bacon, some sausages.)

Dr. Ayala

How to fight unhealthy snacking – and save your sanity

Over-snacking may be one of the major drivers of the obesity epidemic.

Kids now snack, on average, three times a day, and while frequent snacking wouldn’t be a problem if the snacks were healthy and nutritious – carrots and apples for instance – the typical snack is energy-dense, and capitalizes on sugar, fat and salt.

Snacking opportunities are everywhere, and snacks are sold and promoted wherever kids go. So what should a parent do? Urge his child to eat just half the pack? Forbid these sweets and sugary drinks altogether?

Parents can try to influence kids’ eating directly, through restrictions and urging, or covertly, by designing their environment – keeping certain foods out of the house, and avoiding places that serve mainly unhealthy foods.

The first method sounds like a good idea, but studies have shown that parents who try to restrict food achieve the opposite results: The more they restrict a food the greater the child’s desire for it, and when that same food becomes freely available kids overeat it. Most studies find a link between parental restriction and kids’ overweight and over-snacking. These results, however, can be bidirectional: It might be that parents of kids who’re overweight and already indulge on junk food tend to urge and pressure their kids to stop, as a response to the situation.

To actually prove causality and to help disentangle the connection between parents’ feeding actions and kids habits it’s better to follow families over time.

Which is what a new study conducted in Australia and recently published in the journal Appetite does. The study included 252 moms and their 3-11 year-old kids from diverse socioeconomic backgrounds.

Parents first reported on their strategy for “Managing Kids’ Food”.

To assess parents’ restrictions and control on eating the questionnaire included questions like “I have to be sure that my child does not eat too many high-fat foods” and “If I did not guide or regulate my child’s eating s/he would eat too many junk foods.” Parents responded to these on a sliding scale.

To assess parents veiled methods of controlling snacking the questionnaire asked them to scale themselves on questions like: “How often do you avoid taking your child to places that sell unhealthy food”, and “How often do you avoid buying sweets, crisps [chips], biscuits and cakes and bringing them into the home.”

Kids intake of all snacks, healthy and unhealthy, was evaluated at two time points, separated by 3 years.

The study found that parents who used more restrictive methods had kids who increased their unhealthy snacks 3 years later.

Parents who used more covert methods – such as not keeping high-calorie, nutrition-poor snacks at home – managed to decrease their kids unhealthy snacking over time.

These results held true even after adjusting for parents’ and kids’ weight, parental education and socioeconomic status.

This study joins others in showing that over time, well-meaning parents’ attempts to curb unhealthy snacking by restricting them backfires and achieves the opposite results. On the other hand, if parents remove unhealthy foods and replace them with healthy foods, without comment of fuss, kids eat better after 3 years.

Moreover, this study showed that snack intake in the first point of data collection did not predict parents’ strategy – on the other hand, the strategy parents used predicted snacking after 3 years. In other words, parents in this study weren’t responding to kids bad habits by restricting snacks; kids’ snacking, however was shaped by parents restriction and pressure, and in a totally counterproductive way.

Tips for healthier snacking

Snacking has become a way of life, and many parents are scrambling for ways to get kids to eat better ­– and to do so without unpleasantness and friction.

Here are a few favorite nuggets of wisdom and helpful tips from nutrition advocates and health experts who deal with this problem constantly:

Avoid pressure, struggle, restriction, guilt and deprivation

Because you’ll never win a power-struggle with your kid! Especially not in the long run.

Exerting control can lead to a feeling of deprivation, and “deprivation often leads to rebound eating and sneaking foods,” says Karen Koenig a psychotherapist specializing in the psychology of eating. “Sadly, parents often create the behavior they’re trying to prevent by being too rigid with food rules to begin with.”

“Don’t make snacking into a moral issue.” Karen adds. “Calling foods “good/bad” makes children (and adults) transfer the morality of food choice onto themselves, causing them to feel, say, virtuous eating broccoli and naughty eating a donut. Language matters a great deal, so it’s important to explain to children that foods go from less to more nutritious and that they aren’t good or bad children because they choose one food or another.”

Let your kids choose

“Bring your kids to the grocery store, and focus on the fruit and vegetable aisle. By allowing them to participate in choosing food you will increase the likelihood that they will eat the food later,” suggests internist and pediatrician Dr. Olatokunbo Famakinwa.

Registered dietitian Courtney Meidenbauer also emphasized giving kids the autonomy to select their food: “When it comes to snack options for children, the key is to offer many choices, but ideally all those are healthy options. When options A, B and C are all considered "healthy" snacks, there's no poor choice.”

Set an example

Kids are keen observers, and what you do matters more than what you say.

“Kids often want what YOU have, so make your own choices good ones. It'll be in both of your best interests,” advises health coach and personal trainer Robyn Lanci of Well Rooted Kitchen.

Provide a safe haven

Just like the study mentioned above suggests, removing junky snacks is a useful method parents should utilize. 

Pediatrician Heather Finlay-Morreale says: “One thing parents can do is simply not buy processed food for snacks. Provide healthy snacks low in simple carbs and high in protein. Options include yoghurt, fruit, carrots with hummus dip, nut butter on whole grain crackers, and cheese sticks. Sugary drinks should simply be eliminated. Other options are water or milk. Ultra-pasturized milk boxes do not need refrigeration and are a great portable option.”

“If it doesn’t make it into your shopping cart, it won’t make it into your pantry and subsequently into your kiddo’s mouths,” advises Registered Dietician Trish Brimhall. But make sure you keep your guidelines moderate and balanced so your kids won’t raid their friends’ pantries. “It is important that you don’t go overboard with extreme nutrition such as limiting all favorite snack foods, forbidding chips or sweets,” Trish concludes.

Choose your battles

You really can’t win them all, and many situations are beyond reasonable parental control.

“We eat very healthy at home, so if the kids are at a birthday party or when we’re on vacation, we can be a little more lax at those times,” Says Therapist Heidi McBain.

Therapist Rachel Gersten, likewise, doesn’t impose the house rules out of home: “I suggest parents try to let go of what their kid eats outside of the home. It's important to do as much as you can (like sending healthy lunches and snacks to school or activities), but also accept that they're kids and will eat the occasional sugary treat or maybe drink a soda when they're away from home. I think the lessons on nutrition and continuously emphasizing the importance of healthy eating is crucial to making sure they grow up knowing the importance of nutritious foods, even if they eat junk food as kids sometimes."

Although it may seem like too many outside forces are acting against our kids healthy eating choices, we parents still have tremendous influence over kids’ food habits, and good habits can protect our kids for life.

Dr. Ayala

Serving up real food in the coming new year

It’s the season to celebrate – December festivities bring a little too much to eat – but come January, it’ll be time to get back on track for a healthy 2018.

And there must be a better way than counting carbs, fats, calories and sodium.

The nutrient discussion isn’t just old and tiresome; it also shifts our attention away from what’s perhaps the most important attribute defining what’s good to eat.

What if it’s not the nutrients, not even the foods, so much as what’s done to these poor foods? What if processing is the main issue? What do I mean by what’s done to food? Let’s take cereal; it can be intact wheat in a wheat-berry salad, a 4-ingredient whole-wheat bread freshly baked, or a packaged breakfast cereal. Nutrients aside, the processing of these three types of cereal is very different. Does it matter? Nutrition research certainly suggests it does.

Public Health Nutrition will devote a whole special issue to the subject in the coming January.

All food is processed to some degree; even raw-food vegans and Paleo enthusiasts don’t graze in fields.

But foods range from minimally processed all the way to ultra-processed foods – foods made mostly or entirely from substances derived from foods and additives, with little intact food.

Visit a supermarket in the US (or any other developed country), and you’ll find that ultra-processed foods dominate the shelves, especially the central aisles. Ultra-proceed foods are heavily marketed and dominate ads in old media and in social media. Fast food franchises are everywhere, and vending machines sell salty and sweet ultra-proceed stuff in every building, every corner. Ultra-processed foods now supply almost 60 percent of calories in the American diet.

What is highly processed food?

As mentioned above, all food is processed. It has been processed for hundreds of years. And some of the processing is not only tasty and convenient, it’s also important for safety and health. Drying, fermentation, cooling, freezing and pasteurization protect food from spoilage. On the other hand, adding sugar (as in sugary drinks and so many other foods), and partial hydrogenation (as in trans-fat) are clearly harmful.

NOVA is a widely used classification of food processing; its definition of highly processed food is an eye opener to those unfamiliar with modern food manufacturing:

“Ultra-processed foods, such as soft drinks, sweet or savoury packaged snacks, reconstituted meat products and pre-prepared frozen dishes, are not modified foods but formulations made mostly or entirely from substances derived from foods and additives, with little if any intact Group 1 (unprocessed or minimally processed) food.

Ingredients of these formulations usually include those also used in processed foods, such as sugars, oils, fats or salt. But ultra-processed products also include other sources of energy and nutrients not normally used in culinary preparations. Some of these are directly extracted from foods, such as casein, lactose, whey and gluten. Many are derived from further processing of food constituents, such as hydrogenated or interesterified oils, hydrolysed proteins, soya protein isolate, maltodextrin, invert sugar and high-fructose corn syrup.

Additives in ultra-processed foods include some also used in processed foods, such as preservatives, antioxidants and stabilizers. Classes of additives found only in ultra-processed products include those used to imitate or enhance the sensory qualities of foods or to disguise unpalatable aspects of the final product. These additives include dyes and other colours, colour stabilizers; flavours, flavour enhancers, non-sugar sweeteners; and processing aids such as carbonating, firming, bulking and anti-bulking, de-foaming, anti-caking and glazing agents, emulsifiers, sequestrants and humectants.

A multitude of sequences of processes is used to combine the usually many ingredients and to create the final product (hence ‘ultra-processed’). The processes include several with no domestic equivalents, such as hydrogenation and hydrolysation, extrusion and moulding, and pre-processing for frying.

The overall purpose of ultra-processing is to create branded, convenient (durable, ready to consume), attractive (hyper-palatable) and highly profitable (low-cost ingredients) food products designed to displace all other food groups. Ultra-processed food products are usually packaged attractively and marketed intensively.”

What’s the harm?

Ultra-processed food has been associated with poor diet and obesity, as well as with hypertension and metabolic syndrome.

New research in this issue reinforces this point.

A review of 26 studies finds that eating ultra-processed food is associated with obesity in kids and teens. Another study finds that availability of ultra-proceed foods at home ranged from 10 percent in Portugal and 13 percent in Italy to about 50 percent in Germany and the UK. There was a significant positive association between household availability of ultra-processed foods and obesity rates. A study from Lebanon looked at 302 adults’ diets, and found that those consuming the highest amount of ultra-processed diets had the highest rates of metabolic syndrome, high blood sugar and a risky lipid profile.

New year, new pantry

If you’re looking for an easy to follow, realistic,  positive,  healthy living goal for 2018, try eating real.

I’m not suggesting you make all your food from scratch. It would also be highly impractical to mill your own wheat, or press your own oil. Just try to avoid the highly-processed stuff.

And the best way to do that is to make it less available. Don’t keep it at home, in your car or your desk.

Make this the year in which you notice highly-processed food – it’s usually beautifully packaged, and often even has health claims on it, which is particularly confusing – and call it by name.

I’ve been reading the definition above again and again; it really makes me look at sugary drinks, snacks and prepared meals in a whole different way.

Happy holidays, and to a happy and healthy 2018!

Dr. Ayala

Are late-night meals always bad for your waistline?

Eating after 8pm has been associated with weight gain. Some argue that our bodies have evolved to be active during daylight, and daytime is the best time to exercise, to think and to digest food, while nighttime is best for sleep and fasting. Messing with that natural rhythm increases the risk of obesity and also of diseases such as diabetes and heart disease.

But what if 8pm is the middle of your day?

Many of today’s teens and college-aged kids are creatures of the night. They live in social jetlag. Weekend breakfast is an afternoon affair, typical dinner can only keep them going for so long, and they therefore eat a very late additional meal or snack. When your day begins at 12pm and ends at 3am, midnight meals are almost called for.

When the internal clock shifts in such a way do late meals still affect weight gain?

Social jetlag makes mealtimes relative

A new study, published in the American Journal of Clinical Nutrition looked not only at clock time, but also at the circadian timing – the body’s internal clock – and at body fat.

The study recruited 110 18-22 year olds, followed their sleep and wakefulness, regular daily routines, and all food intake using a time-stamped-picture app that was followed by nutritional analysis of the meals and snacks. On top of that, their melatonin release patterns were assessed in the lab – melatonin release above a certain concentration level is an established marker of our internal clocks’ night onset.

The researchers found that lean and overweight students had similar mealtimes if you looked at the clock.

But when you looked at these young people’s internal clocks it was a whole other story: lean people finished most of their daily calories 1.1 hours earlier according to the onset of their personal nighttime, as determined by their melatonin release. Those with more body fat ate more of their calories later according to their internal biological clock.

In this study, the biological clock mattered, not the actual time of day.

Which makes sense.

If you fly from San Francisco to New York in the morning, and get really hungry at 10pm Eastern Time, it’s hardly a surprise: This is a very ordinary time to eat dinner in Pacific Time. For many College kids the internal clock strikes 8pm at midnight, and by their own clock and metabolic point of view they’re not eating a midnight snack at all – this is just dinner.

Eat and drink better at night

This study suggests that the actual time of day and the setting of the sun matter less than what your internal clock is showing. The no-food-after-8pm is advice that doesn’t jibe with many young people’s sleep-wake routines.

Instead, I recommend stopping eating 2 hours before you go to sleep.

If you find yourself hungry at night, try hydration. People who feel hungry sometimes are actually low on fluids; they’re a little thirsty, and water or a non-sweetened no-calorie drink can alleviate this craving for midnight snacks. Drink, wait a bit, and see if the hunger subsides.

If you truly are hungry, do eat; what you eat matters more than the meal timing. Instead of highly processed, easy to grab junk food, eat a nutritious meal or snack, or another serving of fruit or nuts. One of the problems with late-night eating is that there’s no game plan, not many healthy options, and when you’re hungry at night your defenses are down. If you know you’re prone to late night eating, plan for it and have a few healthy options handy.

Dr. Ayala

Coffee and sugar: An unhappy couple

Sugar’s on a lot of people’s minds. It’s an ingredient we love yet struggle with. Sugar is a key target on all current eat-less-of lists, and we’re all trying to cut our consumption. It’s not easy.

Coffee, on the other hand, is enjoying some good press. As a coffee lover myself, I’m on the lookout for this welcome evidence, reinforcing my habit of a daily cup. Or two, or three. Coffee by itself, research shows, may even benefit your health, providing protection from type 2 diabetes, stroke, Parkinson’s and dementia.

Now, let’s look at these two beloved foods together.

A lot of people do. They drink their coffee sweetened. Many cold coffee drinks come already sweetened – Starbucks’ Bottled Frappuccino and their Iced Vanilla Coffee have as much sugar as soda. They’re really a candy bar with caffeine.

I’ve always liked coffee without. Actually, I’ve never tried it with sugar. Adding sugar and sweeteners to espresso blunts its already gorgeous taste, in my mind. Unlike cocoa, which we fall in love with in its sweet chocolaty incarnation, I’ve accepted and fell for coffee as a slightly bitter, rich, non-sweet food.

But coffee and sugar are connected in more than one way. So today, two recent bits of research about the coffee sugar connection.

Sneaky calories

Coffee and tea are virtually calorie free. More than half of the American population drinks coffee daily, but few Americans drink their coffee plain. A study in Public Health found that two thirds of Americans add sugar, cream and other calorie-rich additives.

How much does this contribute to caloric intake? Although just a spoonful of sugar doesn’t seem like much, it adds up, and this study, that included more than 13,000 Americans, found that adding stuff to your coffee adds about 70 calories daily on average.

If these calories are unaccounted for and are just extra, they can translate to another pound of weight every 2 months.

Does coffee make you reach for a cookie?

Researchers from Cornell University showed that coffee might increase our sugar intake because it reduces the perception of sweetness. The results of their new study of 107 participants appear in the Journal of Food Science.

Volunteers drank a caffeinated and a decaf drink, unaware of the drink’s caffeine content. The caffeinated drink was perceived as less sweet that the decaf one.

Caffeine blocks adenosine receptors in the brain. This is why coffee helps with alertness; adenosine promotes relaxation and blocking it awakens us. We have adenosine receptors in our taste buds, too. Suppressing adenosine reduces our ability to taste sweet foods, potentially altering our perception of sweetness and making us reach for more sugar.

Our growing coffee habit – coffee consumption is on the rise – might be adding extra fuel to our sugar cravings.

So watch out! There’s nothing wrong with a cup of coffee. On the contrary: coffee by itself is actually part of a healthy diet and lifestyle, and much better than many other drink options.

But try to resist the temptation to accompany it with a sweet treat or a sweetener.

Let coffee speak for itself.

Dr. Ayala