Healthy Food & Healthy Living by Dr. Ayala

Chocolate became a health food; is it really good for you?

Chocolate, long associated with indulgence, romance and guilty pleasures has become a health food. A large expose in Vox last week traces the transformation.

Apparently, over the past three decades Nestle, Mars and Hershey, among others, have poured millions into scientific studies and research grants that support cocoa research. The research has been fruitful, flooding the scientific journals with many peer-reviewed papers. The media relishes on these studies and coats them with extra chocolate syrup – there’s nothing as appealing and eye-catching as revealing that vices are actually good for you.

Cocoa, these studies found, lowers the risk of heart disease, autoimmune disorders, cognitive decline and diabetes, and is linked with lower body weight. And industry funding warped our perception of chocolate, Vox reports.

Let me demonstrate with an example. Consider this trio of studies about cocoa and our brain.

In a study published in Nature Neuroscience, 37 middle aged people, who drank a mixture rich in cocoa’s flavonols for three months, improved their cognitive function. Functional MRI imaging after ingesting the cocoa drink found greater activity in the area of the brain called the dentate gyrus, an area associated with memory.

Another study in the American Journal of Clinical Nutrition in 90 elderly people who didn’t have cognitive impairment tested 3 cocoa drinks: with high, medium or low flavonol content. The people who drank the intermediate and high flavonol drinks showed improved cognitive performance and improvement in some mental tasks. Blood pressure and insulin resistance also improved in the high cocoa flavonol group. 

The same researchers conducted a similar study with older people that already suffered mild cognitive impairment. The study demonstrated that the 90 people that were randomly assigned to drink the intermediate and high cocoa flavonol drinks improved verbal fluency and increased the speed of mental processing when compared to the volunteers on the low flavonol drink.

These are encouraging, interesting findings, about cocoa. The titles in the popular media, however, took these findings all the way to “Chocolate Protects Against Alzheimer’s” and “Chocolate Makes You Smarter.”

Spending money and time on cocoa

Concentrating on cocoa’s merits creates distortion in perception, even if all the research is done diligently and honestly. Engaging researchers’ time and focusing it on one – food industry sponsored – food, diverts attention from other topics and foods they could and should be studying.

And by the time the results are reported in popular media, they’re hyped to the point that an association with lower risk is understood as a cure – no less – for the associated condition.

Is chocolate really good for you?

Chocolate research centers on cocoa flavonols. Flavonols are plant molecules, abundant in many foods. Cocoa beans are seeds, and seeds are generally packed with important phytochemicals to protect the seed and enable its development into a full-grown plant. Tea, onions, kale, grapes and apples also contain similar flavonols. That's why we should eat lots of and mostly plants.

Had we been eating pure cocoa the positive findings would have been somewhat applicable.

But eating chocolate for its flavonols is like putting young kids in front of the TV for language skill development, or promoting video games for fine motor skills. Yes, there’s some educational value in TV programing, and there are flavonols in chocolate.

Those beneficial specks are bundled, however, with lots of other stuff.

In chocolate’s case the flavonol package includes added sugar, lots of it. And fat.

Investing in research on any whole plant food usually leads to encouraging results.

I’ve confessed to my love for chocolate before. It’s my favorite treat. But a treat is exactly what it is. To deliver enough flavonols from chocolate to make a difference you’d need to consume lots and lots of calories and sugar. I eat chocolate for pleasure, and don't intend to give it up.

If you're seeking the benefits of cocoa flavonols, however, I suggest a handful of cacao nibs. These are pure, crunchy crushed bits of cocoa beans; they’re great in salads, smoothies and on yogurt, and are slightly bitter – because they have no sugar added. The taste of pure cocoa is not sweet. 

Dr. Ayala

The weight we can’t see

 

“Am I fat?”

It's a frequent question among girlfriends and spouses, and a rather weird and awkward one. Weight is, after all, measurable, a fact, and a second opinion from family members shouldn’t be necessary.

Maybe the question really begs for other reassurance, way beyond BMI, waist circumference, and pounds; sort of an “Am I pretty?”

But a new article by Eric Robinson, published in Obesity Reviews, shows that the question is actually relevant in its literal sense.

People just don’t know where they stand.

Studies consistently show that people underestimate their weight status. A study from the UK showed that 55 percent of men and 31 percent of overweight women assessed their weight as ‘about right’. Another study including 16,000 Americans found that 48 percent of men and 23 percent of women – all of whom were overweight – thought their weight was just right. Even among obese people there’s remarkable underestimation, and in one study fewer than 10 percent of obese people thought they were ‘very overweight’.

People not only fail to assess their own weight status, they also don’t see it in their kids. In an analysis including 60,000 kids and their families 50 percent of parents failed to see their child is overweight or obese. A significant percentage even thought an obese child is ‘about right’.

Is our subjectivity regarding ourselves our family and friends obscuring our clarity? Perhaps, but consider this: even doctors regularly failed to identify overweight men from visuals alone. In a study of experienced physicians from Germany doctors correctly assessed only 30 percent of overweight and only 50 percent of obese patients.

And if doctors can’t do it, lay people definitely can’t.

Not seeing what’s right in front us

One of the key features of us humans is that we’re, overall, an optimistic bunch. Most of us imagine the best possible outcomes, think that we’re above average, and think that we can beat the odds. It’s a wonderful trait that keeps us going.

And perhaps that comes into play in our blindness to our obesity crisis.

Robinson, though, offers another explanation: visual normalization. Since the entire population gained weight we have recalibrated our own normal, and in much the same way that you stop hearing crickets once they’ve been chirping for days, overweight stops being noticeable. Studies show that as obesity spread over the past decades, as our body size gradually increased, we’ve become less likely to notice it. Support for this notion comes from studies that demonstrate that in areas were obesity is more prevalent, moms, classmates and friends are less likely to identify overweight and obesity than in areas with slimmer networks.

In other words, our eyes and minds recalibrate depending on what’s around us, and since overweight and obesity are so common it’s become the new normal – unnoticed and unremarkable. We have adapted to the new normal, and our perception has changed.

What’s wrong with the new normal?

Since food’s so tasty, and losing weight’s so hard, can’t we just live in ignorant bliss? Isn’t it better that people who are overweight think their weight is just fine and feel good about it?

Well, the stigma attached to being overweight is certainly something we should fight. But overweight – especially severe overweight – is a health issue; it affects quality of life and is a risk factor for many nasty diseases. Failing to notice when the pounds pile on leads to further weight gain.

Ignorance of the situation is guaranteed inaction in the face of a growing problem. What you don’t see you don’t treat.

As to the “Am I fat?” question: perhaps it should be best addressed to someone who doesn’t just eyeball you. The correct answer, evidently, requires some objective measurements. And maybe the right question should be more clinical, devoid of beauty and acceptability factors, and of judgment.

“Is my weight healthy?” is a better way to phrase it.

Dr. Ayala

 

How many calories should a kid eat?

Many of us are familiar with the caloric information on nutrition labels, stating that nutrition facts are based on an average daily budget of 2000 calories.

Have you ever wondered where this 2000 number comes from? Does this number refer to men? Women?

And how about kids?

“Kids should eat more because they’re growing,” some say. “Kids should eat less, small bodies need less fuel,” say others. So which one is it?

If this issue mystifies you you’re not alone.

As more kids struggle with overweight and obesity, this question becomes more relevant, especially since kids are eating many of their meals out of home. When a meal is plated for us, the serving implies, at least subconsciously, that this is a normal amount to eat. And now that calorie counts are popping up in fast food restaurants, and we can see the calorie count of a kids’ meal, parents need some context for this number -- is an 800 calorie kids’ meal reasonable?

A new study in Public Health Nutrition looked at what parents make of these numbers.

How much should my kid eat?

The researchers asked about 1200 parents of 5-12 year olds how many calories a kid should consume in a meal – that includes all courses and drinks.

Only one third of parents correctly estimated that a child should have 400-600 calories per meal, but even those considered their answer kind of a guess – most parents admitted that they were far from confident about their answer.

A third of the parents overestimated kids’ needs, while a third underestimated them.

(An average 5-year-old boy or girl needs about 1200 calories. An average 12-year-old boy needs 1800. Caloric needs vary greatly, and depend on activity level and individual metabolic rate, among many other variables, but if we take these averages into account, and assume that daily needs are divided to 3 meals, it brings us to 400-600 per meal.)

A good kids’ meal

Back to the original question, do kids need more calories because they are growing, or less, because they’re small? Both arguments are correct, and need to go into account when thinking about what a child should eat.

Since caloric need is a moving target, and changes by activity level, and in a child, also by his developmental stage and growth, the best way to eat is by self-regulation determined by satiety and hunger. Which is easier said than done nowadays. Given our stimulating food, endless choices, and the powerful marketing and sugar, fat and salt combinations that entice kids to eat even not hungry, many kids have lost that kind of control.

A good kids meal should have as few as possible of these distractions. A plate with real food, half of which is fruits and veggies, makes kids less likely to overeat. And when it comes to drinks, with a 400-600 calorie budget, one could hardy afford a sugary drink – even the smallest ones have more than 100 calories, and add nothing to health or good habits.

Fast food joints offer different options in kids’ meals. I’d argue that none are ideal, but if you look at the calorie postings, you can see that choosing the apple slices (30 calories) as opposed to the small bag of fries (260 calories) brings the meal down to a more reasonable total calorie count.

A rule mandating that all chain restaurants have to post calorie counts on their menus was supposed to go into effect this month, but it was given a last-minute one-year delay by the Food and Drug Administration. Many places are posting calorie counts voluntarily already, and I think this information could be very helpful and of interest to many people, but to make the best use of it we need to be able to put it into context.

My general advice to kids, including my own, is to eat real food, seated at a table, eat when hungry, only until they’re no longer hungry, and minimize the junk. Kids should learn about nutrition and about food, but counting calories should not be part of a kid's routine. Nevertheless, a casual glimpse of a calorie board leaves an impression — it shows us which foods are calorie-dense and which are lighter. Kids and teens notice these numbers, and over time a general picture emerges that helps a more informed decision.

Dr. Ayala

Low-sugar, low-fat, reduced-salt, but is it healthy?

What you eat will affect your health. You must have heard this first from your mother, who learned it from her ancestors; ancient physicians knew it (“let food be thy medicine and medicine be thy food”), and modern medicine continues to support this finding with scientific research.

What exactly makes for a healthy food is still something we debate, but we’ve targeted sugar, fat and salt as things our food clearly has too much of. Health conscious consumers seek foods that have less of these ingredients and fewer calories, and highly processed foods with a reduced-sodium, reduced-sugar and reduced-fat claim on their from label seem healthier, or at least less unhealthy.

But is that really so? Are these low-content claims on packages helping our food choices and waistlines, or are they just pushing our buttons, persuading us to buy products that are not really any healthier?

A new study from the University on North Carolina at Chapel Hill, published in the Journal of the Academy of Nutrition and Dietetics, looks to see if these nutrition claims actually lead to healthier purchases.

What’s inside?

A staggering 35 percent of beverages and 13 percent of foods bought by 40,000 US households in this study had low-content claims.

In what seems like good news these products tended to have lower caloric density, less sugar, salt and fat compared to the full-calorie, full-sugar, full-salt and full-fat version.

So, a low-fat Oreo cookie has lower fat that a regular Oreo. But that doesn’t mean it’s healthier that another brand’s cookie – which might have less fat in its original, claim-less product to begin with. Nor does it mean that it’s healthy – it actually has just as much sugar. In other cases, such as low fat chocolate milks, the low-fat versions had higher sugar. Some of the ready-to-eat cereals claiming low-calorie were more calorically dense than other cereal brands with no such claim.

Unhealthy products can easily reframe themselves as better by comparing themselves to something even less healthy. If a potential basketball recruit is faster and taller, or a profile states would-be date is smarter and kinder it means nothing unless we know what the reference point is.

“In many cases, foods containing low-sugar, low-fat or low-salt claims had a worse nutritional profile than those without claims,” the lead investigator Lindsey Smith Taillie, said in a press release.

What the claim promises is that it’s less than something. Fewer, less of, and healthier don’t mean much when compared to a very low standard. If the label said “healthier than a donut”, would you consider it healthy?

Another worry is that when consumers see low-anything-bad it gives them conscious or subconscious permission to eat more of this product – and by increasing the serving size of this food they outdo any potential healthier-for-you benefit that food could offer.

The bottom line is, to know the nature of what’s in that package there’s no avoiding reading the nutrition label and going through the ingredient list. The claims on the front label are for marketing. It’s the back label that has the facts.

Dr. Ayala

Eating healthy for pleasure -- it can be done!

“Ethereal fluffiness with rich crispy edges, a delight in every bite.”

“So good it’s addicting.”

These aren’t the terms used when describing healthy food. Good for you foods usually emphasize how they’d help us achieve health goals and meet nutritional needs. They appeal to our knowledge and cognition, not to our emotions, desires and imagination.

But what if healthy foods connected in the way foods whose main – dare I say only – selling point is pleasure did?

Perhaps we’d start chipping away at the notion that healthy food doesn’t taste so good. Perhaps we’d find out that if kids expect a food – any food -- to be yummy, expectation itself would increase the chances that that’s exactly what their taste buds, aroma sensors and brain pleasure centers will feel. Expectations are self-fulfilling prophecies when it comes to food, attest many experiments on wine ratings.

There’s urgency in shifting people’s eating to healthier foods. Healthier eating habits would lead to less obesity and fewer people suffering from chronic diseases, but appealing to people with information about health has limited success, especially when messages about those other, less healthy foods appeal viscerally. Let’s face it, better health somewhere down the line vs. sugar fat and salt’s instant gratification – in that perfectly combined convenient, inexpensive, cool and normalized package – not a chance.

If you can’t beat them, join them

A recent article in Appetite focuses on emphasizing the pleasure aspect of healthy food. While some people are attuned to the health message, most are not, claims Professor Simone Pettigrew, and a message that would speak to them should be one of taste, convenience and price – the classic messages food makers use to market their wares. The power of social pressure and environmental influence, that push us to eat poorly, should be harnessed to help communities eat well, and have fun together doing so.

How does one increase the pleasure from healthy food?

The article briefly cites three such examples.

• The Slow Food Movement emphasizes indulgence. It promotes wholesome food, food traditions; it celebrates nourishment, biodiversity and joy of preparing and sharing meals.

• International EPODE, which stand for Ensemble Prévenons l'ObésitéDes Enfants’ (Together Let's Prevent Childhood Obesity), promotes enjoyment of healthy eating, active play and recreation. Here’s an example of EPODE ‘s ‘Let's meet with the fruit’ coordinated campaign in France:

“Actions may be designed and organized during the campaign. These can take the form of drama lessons and artistic contests in leisure centres, fruit tasting in market places, walking trails with fruit tasting stops with local producers, afternoon fruit snack distribution in schools, fruit taste education workshops in pre-schools, fruit consumption favoured during a town's events (e.g. sports meetings and receptions) and distribution of materials to families (e.g. storybooks, recipes, magnets, etc.). Actions can similarly be built continuously or by recurring events that provide the opportunity to promote fruit consumption (e.g. tasting and cooking workshops with families in social centres, breakfast events in schools, open days of local producers and farms, annual EPODE week of local associations for nutrition and physical activity, etc.).”

• The Body and Soul is run in US churches, and increases fruit and veggie intake by normalizing, incorporating and reveling in these foods in joyful community events. The program calls itself a celebration of healthy eating and wellbeing, and when peers come together to support each other, it’s bound to be easier and more fun.

A message to parents and educators

Before you repeat any of those old sayings you heard from your grandmother: “Eat carrots to improve your vision” (a myth, BTW) or “Eat your carrots, they have lots of Vitamin A,” consider another option: “I found these amazingly fresh, crunchy, sweet carrots at the Farmers’ Market; can’t stop nibbling on them.”

By all means, do educate your kids about nutrition.

Thinking isn’t the enemy of feeling. It’s best when they go hand in hand.

The most beautiful person is the one whose external features are matched with stunning character and kindness; in just the same way, when healthy and tasty meet, they’re unbeatable.

And just another thought: no one falls in love with coffee or wine with the first sip, but their allure and reputation make people acquire a taste, a passion, for them. We can probably learn to love many foods if they were presented in an enticing way.

Dr. Ayala

Is the glycemic index reliable and of any use?

The glycemic index has crept upon our food experience. Once a term used by people in white lab coats, reserved to diabetes clinics, it’s now part of popular weight-loss programs (South Beach, Zone) and disease prevention plans; the low glycemic index claim is now a selling point plastered on food labels.

Haven’t immersed yourself in the glycemic index yet? It’s never too late. Or maybe it’s still too early. We’ll get to that in just a bit, but first, a little introduction.

Glycemic index, explained

The glycemic index, developed initially for the treatment of diabetes, ranks carbohydrate-containing foods based on how they affect blood glucose levels when eaten in isolation. The glycemic index charts were developed by testing people’s blood glucose after ingestion of 50 grams (almost 2 ounces) of carbs from different foods.

Carbs that break down quickly, like white bread and potatoes, have a high glycemic index, and those that release sugar into the blood stream more gradually, like fruit, have a low glycemic index. Foods are scored on a scale of 0 to 100.

Since blood glucose fluctuations elicit a cascade of hormonal reactions, which can potentially affect satiety, hunger, blood lipids and inflammation, the glycemic index of a meal sounds like useful thing to control.

We’re all different

A new study, led by Nirupa Matthan from Tufts Medical Center, and published in the American Journal of Clinical Nutrition, looked at the blood glucose reaction of 63 healthy people after they were given 50 grams of glucose, either in white bread or in a glucose drink – each experiment was repeated in each volunteer twice.

This is basically a testing of the glycemic index of the bread, and if the glycemic index is a characteristic of the food itself, the results should be similar between the volunteers and between tests.

But that’s not what the researchers found. There was a 20 percent change in measured glycemic index of the exact same food between tests in the same individual, and there was 25 percent difference between people.

The glycemic index of the same exact bread ranged from 35 to 103, making it a both low and high on the glycemic index. 

In other words glycemic index wasn’t at all consistent, even when the food was eaten in isolation and in a controlled environment.

Is the glycemic index useful?

According to this new study, the glycemic index is not a dependable measurement.

It is also just partial data.

Eating 50 grams of carbs from white bagels is doable. But when it comes to other high glycemic foods, watermelon, for instance (glycemic index - 80) a normal serving will have just a few grams of sugar; you’d have to eat almost 2 pounds of watermelon to load yourself up with 2 ounces of carbs, and therefore, in reality, watermelon’s high glycemic index is quite irrelevant. To anticipate glycemic responses you’d also have to familiarize yourself with glycemic load – which also takes into account the amount of carbs consumed.

On top of that, although the type and proportion of sugar or starch in a food affects glycemic index, so do a lot of other factors in the meal—the way the food’s been cooked, the presence of fiber, protein, fat, alcohol or acid will all affect the glucose response. Exercising and activity around a meal will affect it, too.

So is it worth bothering with? At this point the evidence of glycemic index centered diets’ helpfulness for weight loss or disease prevention is inconsistent (it is helpful for the management of diabetes.)

If you don’t have diabetes, it’s much easier to follow the well-proven guidelines of limiting added sugar (sugary drinks are especially harmful), eating more plants and whole grains, and minimizing hyper-processed foods.

These simple principles happen to also yield a low glycemic diet – they are a practical shortcut to the same end.

Dr. Ayala

The downside of gluten-freeing your kids

The gluten-free food industry has seen tremendous growth, and while celiac disease – which requires lifelong complete avoidance of gluten – is also on the rise, consumers who do not have celiac or any other medical reason to avoid gluten are the main engine propelling the gluten-free boom.

Why do they do this, and is this a healthy trend?

Norelle Reilly, gastroenterologist and director of the Celiac Disease Center at Columbia University Medical Center, in a commentary in the Journal of Pediatrics, cites a 2015 survey of 1500 American adults. “No reason” is the most common reason for going gluten free – 35 percent of those surveyed explained their choice just so. 26 percent choose gluten-free food because they think it’s a healthier option, and 19 percent perceive it as better for digestive health.

If gluten-free foods are indeed a healthy trend, the fact that 20 percent of Americans are seeking them for no medical reason might be a good thing. If, on the other hand, gluten free carries risk, this fad might be an expensive gamble.

The risk of gluten free

For people who do not have celiac, wheat allergy, or non-celiac gluten sensitivity, there is no data to support the notion that gluten free is healthy, states Dr. Reilly. In fact, packaged gluten-free food often contains more sugar and fat, and has higher caloric density. Contrary to what people believe, going gluten free without medical supervision can lead to packing extra weight, to insulin resistance, and to vitamin deficiencies, since gluten-free foods are not fortified the way wheat is.

And then there’s arsenic. Gluten-free diets often rely heavily on rice, and rice quite often, contains arsenic, which comes from the soil. The amounts are small, and probably not a problem if one eats a varied diet, but on a gluten-free diet rice becomes the predominant grain, and that can be especially problematic for babies and pregnant women.

A gluten-free diet, just like many other exclusion diets, comes with a quality of life price tag. And these specialty foods often cost more and are sold at a premium.

And since in kids there are only two indications for excluding gluten from the diet: celiac disease and wheat allergy (non-celiac gluten sensitivity has not been described in kids), putting kids on this diet carries risk with no apparent benefits. There is no support to the misconception that gluten is toxic, and no evidence that gluten-free diets treat a myriad of afflictions such as autism, arthritis or obesity.

Dr. Reilly concludes:

“Patients self-prescribing a GFD (gluten-free diet) should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation.”

The food industry uses the health halo of the gluten-free health claim to better sell. It’s really important to emphasize that just like one knows that foods that are peanut free are not generally healthier, gluten-free foods are not a panacea; avoiding gluten isn’t a recipe for health for those of us who don’t have a sensitivity or autoimmunity that involves gluten.

Dr. Ayala

What do spoons, small tables and healthy food have in common?

We're not particularly rational when it comes to food. Time and time again it has been shown that external cues, habit and based-on-nothing hunches affect our food choices, our hunger and appetite, our sense of taste, and even our happiness.

The Journal of the Association for Consumer Research is a new quarterly publication, and in its inaugural issue it's tackling the behavioral science of eating. In this issue are a few deliciously surprising and counterintuitive findings from studies.

Let's see which of these you'd have guessed.

Making small bigger 

A larger table makes room for your elbows and for polite eating. But apparently, a smaller table can provide more than intimacy: it can lead you to eat more. Researchers divided pizza pies to 8 or to 16, and then placed them on small tables - just slightly larger than the pie - or larger ones. Students were invited to eat as many slices as they wanted.

Those eating on the small table thought the 1/16 slices were half as big as the 1/8 pies - which is correct - and ate twice as many when the slices were small. Those eating on the larger tables thought the 1/16 slice were the same as the 1/8 slices, and ate just about the same number of slices when those were half the size, practically halving their caloric intake.

A fork or a spoon?

Does cutlery choice affect how much we eat? If it's soup, it obviously does, but a new paper suggests we're unknowingly influenced by the instrument of our choice even with foods that can be picked up by either. Experiments report that the spoon makes people think the food is lower in calories, and they want to eat more of it.

Forks over spoons, is what this research recommends.

Is there a downside to healthy food?

Researchers studied the relationship between people's perception of food's healthfulness, and how filling it's going to be, and found that not only do people believe healthy food causes less satiety, they also order more, and eat more of it - and too much healthy food causes weight gain, which certainly isn't healthy.

Since so many food labels make health claims or subconsciously suggest health this might be pushing us all to overeat.

What should we do about these silent signals that push our buttons to eat more? I certainly don't think we should do away with spoons and insist on getting the largest table at a restaurant. Like magic tricks, once you know how it's done the illusion is broken. Knowing that these are tricks our mind - and in some cases the food industry - is playing on us can be immunity enough.

Dr. Ayala

"Whole grain" on food labels may not mean what you think it does

Whole grains are gaining ground, and ‘whole grain’ is one of the hottest selling health claims. The USDA’s 2010 Dietary Guidelines recommend that at least half of daily grains be whole, and school lunch programs are required to serve half of the grains offered during the school week as whole ones.

Why whole grain?

Whole grain foods have a higher content of micronutrients, polyphenols, ‘good’ fats and fiber. They also have a lower glycemic index. Whole grain food consumption is associated lower risk of heart disease, weight gain and diabetes. Whole grains are also preferred for what they’re not: refined grains have lots of pure carbs – plain sugars, which supply energy, but little else.

But how do we define a whole grain food?

You’d be surprised to learn that there’s very little standardization of the whole grain declaration. In the US, a food product can use the official whole grain health claim if it contains at least 51 percent whole grain ingredients by wet weight. But not all genuine whole grain foods carry the official claim, and a food can qualify for the whole grain claim despite containing lots of added sugar and trans-fat – so whole grain junk food certainly exists. Foods can boast “made with” and “contains” whole grains without any specifics about the percentage of such grains.

So when you’re standing next to the cereal isle, what do you look for? The Whole Grain Stamp on the front of the package? Whole grain flour as the first ingredient? Did you bring your glasses and a calculator?

Navigating whole grains

A study from the Harvard School of Public Health in Public Health Nutrition identified 545 grain products from the virtual shelves of Wal-Mart and Stop&Shop, looked at them through 5 different whole grain criteria, and evaluated which criteria better measures the healthfulness of the product.

The 5 ways whole grains were assessed were:

• The Whole Grain Stamp: the icon created by the Whole Grains Council can be displayed if the products have at least 8 g of whole grain per serving. Companies pay $1000 to $9000 in annual dues be part of this program
• Whole grain as the first ingredient on the ingredient list
• Whole grain as first ingredient and no added sugars in the product
• The word ‘whole’ before any grain anywhere in the ingredient list
• A ratio of 10:1 or less of total carbohydrate to fiber: This is The American Heart Association’s strategy. 10:1 is approximately the ratio of carbohydrate to fiber in whole-wheat flour.

Useful criteria would be practical, identify foods that are healthier, and find enough of them to give customers (and schools) plenty of options to choose from.

The best guideline according to the authors, led by Rebecca Mozaffarian, was the 10:1 ratio. This method asks for a little bit of work: divide the total carbs by the total fiber on the nutrition label, for instance, one serving of Cheerios has 22 grams of carbs, and 3 grams of fiber, and without doing the exact calculation it’s clear that the ratio is less than 10:1 (it’s about 7), which puts this cereal in the satisfactory list. The 10:1 identifies foods with more fiber and less sugars (the neat point about this method is that if there were lots of added sugar it would add to the total carbs, changing the score for the worse).

One obvious loophole in this approach is that manufacturers can easily add bran to the product, upping the fiber content, and reaching a lower than 10:1. (Sugar-water with vitamins isn’t the same as fruit, and refined grain products with added fiber just aren’t whole grain – our body does know the difference.)

The industry supported Whole Grain Stamp helped identify products with more fiber, but many of them also had more sugar, and a higher caloric count, and many whole grain products don’t carry the stamp.

Whole grain as the first ingredient, which I think is quite popular among health conscious consumers, and ‘whole-anywhere’, were much less restrictive, and qualified more products, but they, too, failed to weed out foods with more sugar and more calories.

Whole grain as first ingredient and no added sugars was quite restrictive, and qualified only 17 percent of the tested products. Another downside is that this method requires a very careful read of the ingredient list – added sugars hide under many guises such as brown rice syrup and fruit juice concentrate, and our food label doesn’t give us any idea about how much sugar was added.

The take home message

This article will definitely make me look further into the 10:1 ratio, which, frankly, I’d never thought of before.

And it definitely sheds new light on the industry-supported Whole Grain Stamp. The symbol signifies the presence of significant amounts of whole grains, but consumers should know it looks at no other ingredients and factors affecting healthfulness.

No matter which guideline -- or combination of guidelines -- you use, you need to read the ingredient list, because as this study reemphasizes, the words ‘whole grain’ don’t necessarily mean this food’s wholesome, and in case you’re using the 10:1 ratio, make sure the product didn’t get there by adding fiber. Clearly, consumers could benefit from a clever food label makeover that can better assist them in whole grain product selection.

One of the best ways to eat whole grains is to make them yourself, and while I’m not suggesting you start baking your daily loaf from wheat you grew in your back yard, cooking brown rice, oatmeal (oatmeal is always whole grain), quinoa and wheat berries is practical, inexpensive and 100 percent whole grain!

Dr. Ayala

 

13 diet lies you shouldn't fall for

The worst lies are the ones we tell ourselves. Feel free to add your own in the comment section.

 

Olive oil is good for you

(it is; it also has 120 calories per tablespoon)

 

This pack’s only 100 calories

(that’s when you eat just 1, not 4)

 

It’s only 120 calories

(per serving! There were 3 serving in the pack – all gone!)

 

I’ll sweat this dessert off

(speed-walk for an hour, and it won’t make a dent)

 

It’s fat-free 

(yeah, but did you look at the sugar?)

 

It’s sugar-free

(did you look at the fat?)

 

It says no added sugar

(just evaporated cane juice and fruit juice concentrate. Who are you kidding?)

 

I found this miracle diet

(there are no miracle diets)

 

Chocolate is good for your brain and can help you win a Nobel Prize 

(brain candy is still candy. Who pays for these studies, anyway?)

 

Wine is good for your heart

(it’s also bad for your liver and has 120 calories a glass)

 

It was a small portion

(smaller than a mountain, for sure)

 

After this, I’ll eat nothing ‘till tomorrow

(it’s 2pm!) 

 

But I skipped breakfast!

(skipping breakfast awards no prizes)

 

Final thought:

The scale and your old clothes won’t lie, and on the flip hand, some feasts are well worth their caloric price.

Dr. Ayala

Tricking parents into bad choices

Parents usually have their kids’ best interest in mind. They want them to grow healthy, acquire eating habits that promote wellness, and have beautiful, strong teeth. 

So how come kids are drinking so much sugar, an ingredient on the top of the list of foods to consume-less-of? Are kids buying it themselves? Are parents unable to resist kids’ appeals for the sweet stuff? Or are parents unaware that sugary drinks are unhealthy?   

A group of researchers from the Rudd Center for Food Policy and Obesity, led by Jennifer Harris set out to understand what parents think about sugary drinks for their kids. The findings appear in Public Health Nutrition.

The researchers collected data from almost 1000 parents. And while it would be expected that parents would provide some sugary drinks as an occasional treat – to be enjoyed yet not promoted as a building block of good nutrition – the study found parents actually thought many of the sugary drinks did promote health. The majority of parents (56 percent) perceived Vitamin Water as somewhat or very healthy.  Sunny D (a fruit drink), Gatorade (a sports drink) and Capri Sun were considered healthy by about 40 percent of parents.

While most of the parents in this study (94 percent) thought soda was unhealthy, many believed that vitamin, fruit and sports drinks were healthy, and while ingredients like artificial sweeteners, high fructose corn syrup and caffeine raised red flags, claims for naturalness, antioxidants and vitamin C made parents believe a drink was a good addition to their kids’ diet. A third of the parents said they actually looked for such claims on the label and that it influenced purchasing behavior. 

Marketing liquid candy as health

Parents’ confusion isn’t accidental. The study reports that $784 million were spent in 2010 on sugary drinks ads and that adults saw on average 364 TV ads that year, about one a day. Many of these ads are directed at parents, and emphasize nutrition, planting the misperception that vitamins or electrolytes in a drink make it a good choice.

Which is the better choice?

So which should kids have, soda or vitamin drinks? The correct reply is neither. Both offer pretty much nothing kids need and sweeteners that they don’t. They are special occasion indulgences at best. As to sports drinks, they have specific limited usefulness – they are for athletes involved in prolonged, vigorous physical activity – and are not for everyday hydration even when exercising. Fruit drinks, as opposed to 100 percent fruit juice (which has its own issues), may contain some fruit juice, but are mostly sugar or HFCS, color and flavor (natural or artificial), with the occasional added vitamins to suggest health. They, too, should be viewed as soda.

It’s a pity that it’s perfectly legal and so easy to misinform parents with bogus health claims and misleading marketing messages.

Dr. Ayala

Chocolate: A treat for Valentine’s Day or the cure for aging brains?

It doesn’t take much to persuade me to eat chocolate. Chocolate is my favorite treat, and to me, all worthwhile desserts are nothing more than chocolate delivery systems.

So I welcome chocolate in starring roles in eat-for-your-health studies.

Last fall, a neat 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. The 37 people in the study also underwent functional MRI imaging after ingesting the cocoa drink, that found greater activity in the area of the brain called the dentate gyrus, an area associated with memory.

In a new study in the American Journal of Clinical Nutrition researchers gave 90 elderly people who don’t have cognitive impairment one of 3 cocoa drinks: high, medium or low in flavonol. Cognitive function was tested at the beginning and after 8 weeks of daily drinks. The groups that drank the intermediate and high flavonol drinks showed improved cognitive performance and improvement in some mental tasks. On top of that, blood pressure and insulin resistance also improved in the high cocoa flavonol group. 

These same researchers conducted a similar study with older people that already suffered mild cognitive impairment. In that study too, those of the 90 people that were randomly assigned to drink the intermediate and high cocoa flavonol drinks showed improved verbal fluency and higher speed of mental processing than those on the low flavonol drink.

Chocolate for your brain?

These studies provide further proof that food can affect your health and well-being, even your intellect.

But does it prove that eating chocolate strengthens your brain?

Getting the amount of flavonols that were useful in the study group from chocolate would involve eating so much chocolate that whatever protection you’d gain from these beneficial molecules, you’d lose from the harms associated with sugar and calorie overload. The people in the high cocoa group consumed the equivalent of what’s in 6 oz. of dark chocolate (~900 calories), and forget about milk chocolate, – it has much less flavonols – you’d need 3 pounds (thousands of calories) a day.

Reasonable consumption of chocolate would place you in the low flavonol arm of the experiment, at best. 

If you’re wondering why the sudden scientific interest in chocolate, note that the studies cited above were partially funded by Mars (the chocolate maker). That’s not to say that the results are anything but accurate and independent of the funding source.

But maybe when you study a plant food and fund that research, you’ll find many positive effects and headlines will announce it as a new cure. It’s very likely that investing in research on any traditional plant food would have led to equally encouraging results. After all, there are flavonols similar to the one in cocoa in tea, onions, kale, grapes and apples. That's why we should eat our plants. And if you want to help protect your brain from aging the best piece of advice remains the same: exercise regularly!

Dr. Ayala

Need help with picking a whole grain loaf?

White bread is out, whole grains are in, and ‘whole grain’ is one of the hottest selling health claims. The USDA’s 2010 Dietary Guidelines recommend that at least half of daily grains be whole, and school lunch programs are required to serve half of the grains offered during the school week as whole ones.

Why whole grain?

Whole grain foods have a higher content of micronutrients, polyphenols, ‘good’ fats and fiber. They also have a lower glycemic index. Whole grain food consumption is associated lower risk of heart disease, weight gain and diabetes. Whole grains are also preferred for what they’re not: refined grains have lots of pure carbs – plain sugars, which supply energy, but little else.

But how do we define a whole grain food?

You’d be surprised to learn that there’s very little standardization of the whole grain declaration. In the US, a food product can use the official whole grain health claim if it contains at least 51 percent whole grain ingredients by wet weight. But not all genuine whole grain foods carry the official claim, and a food can qualify for the whole grain claim despite containing lots of added sugar and trans-fat – so whole grain junk food certainly exists. Foods can boast “made with” and “contains” whole grains without any specifics about the percentage of such grains.

So when you’re standing next to the cereal isle, what do you look for? The Whole Grain Stamp on the front of the package? Whole grain flour as the first ingredient? Did you bring your glasses and a calculator?

Navigating whole grains

A new study from the Harvard School of Public Health in Public Health Nutrition identified 545 grain products from the virtual shelves of Wal-Mart and Stop&Shop, looked at them through 5 different whole grain criteria, and evaluated which criteria better measures the healthfulness of the product.

The 5 ways whole grains were assessed were:

• The Whole Grain Stamp: the icon created by the Whole Grains Council can be displayed if the products have at least 8 g of whole grain per serving. Companies pay $1000 to $9000 in annual dues be part of this program
• Whole grain as the first ingredient on the ingredient list
• Whole grain as first ingredient and no added sugars in the product
• The word ‘whole’ before any grain anywhere in the ingredient list
• A ratio of 10:1 or less of total carbohydrate to fiber: This is The American Heart Association’s strategy. 10:1 is approximately the ratio of carbohydrate to fiber in whole-wheat flour.

Useful criteria would be practical, identify foods that are healthier, and find enough of them to give customers (and schools) plenty of options to choose from.

The best guideline according to the authors, led by Rebecca Mozaffarian, was the 10:1 ratio. This method asks for a little bit of work: divide the total carbs by the total fiber on the nutrition label, for instance, one serving of Cheerios has 22 grams of carbs, and 3 grams of fiber, and without doing the exact calculation it’s clear that the ratio is less than 10:1 (it’s about 7), which puts this cereal in the satisfactory list. The 10:1 identifies foods with more fiber and less sugars (the neat point about this method is that if there were lots of added sugar it would add to the total carbs, changing the score for the worse).

One obvious loophole in this approach is that manufacturers can easily add bran to the product, upping the fiber content, and reaching a lower than 10:1. (Sugar-water with vitamins isn’t the same as fruit, and refined grain products with added fiber just aren’t whole grain – our body does know the difference.)

The industry supported Whole Grain Stamp helped identify products with more fiber, but many of them also had more sugar, and a higher caloric count, and many whole grain products don’t carry the stamp.

Whole grain as the first ingredient, which I think is quite popular among health conscious consumers, and ‘whole-anywhere’, were much less restrictive, and qualified more products, but they, too, failed to weed out foods with more sugar and more calories.

Whole grain as first ingredient and no added sugars was quite restrictive, and qualified only 17 percent of the tested products. Another downside is that this method requires a very careful read of the ingredient list – added sugars hide under many guises such as brown rice syrup and fruit juice concentrate, and our food label doesn’t give us any idea about how much sugar was added.

The take home message

This article will definitely make me look further into the 10:1 ratio, which, frankly, I’d never thought of before.

And it definitely sheds new light on the industry-supported Whole Grain Stamp. The symbol signifies the presence of significant amounts of whole grains, but consumers should know it looks at no other ingredients and factors affecting healthfulness.

No matter which guideline -- or combination of guidelines -- you use, you need to read the ingredient list, because as this study reemphasizes, the words ‘whole grain’ don’t necessarily mean this food’s wholesome, and in case you’re using the 10:1 ratio, make sure the product didn’t get there by adding fiber. Clearly, consumers could benefit from a clever food label makeover that can better assist them in whole grain product selection.

One of the best ways to eat whole grains is to make them yourself, and while I’m not suggesting you start baking your daily loaf from wheat you grew in your back yard, cooking brown rice, oatmeal (oatmeal is always whole grain), quinoa and wheat berries is practical, inexpensive and 100 percent whole grain!

Dr. Ayala

 

Where not to get your nutrition advice

The new year is a chance for new beginnings, an opportunity to eat better, to take better care of ourselves; many look to popular media for ideas on how to best achieve these goals.

Dr. Oz dispenses such advice regularly on his TV show and many health related resolutions start with “I heard it on Dr. Oz”, but how sound are his recommendations?

A new study in the BMJ randomly selected 40 episodes of the Dr. Oz Show and The Doctors – the most popular medical talk shows on TV -- and looked at the quality of their recommendations.

If this sample is representative, Dr. Oz is the program for those asking what they should eat. Dietary advice was 4 times more common on Dr. Oz compared to The Doctors and of the 479 recommendations (about 12 per show) 40 percent were nutritional in nature. 

Now came the arduous task of checking out the recommendations. The researchers looked to see if there was evidence to back the advice, if the advice was believable, and if the recommendation was given in a way in which it could be properly weighed:  were both benefits, including their magnitude, and the treatment’s risk and costs mentioned.

The programs, rich in entertainment value and in dietary suggestions, fell short on proof and precision, the researchers found. Of the many recommendations, only a third were based on some believable evidence. On the other hand there was proof that the treatment didn’t work for about 1 in 10 recommendations. For a third of Oz’s recommendations no evidence at all could be found in the medical and scientific literature. As far as the advice goes, it was generally non-specific, the extent of the benefit (does vitamin E help brainpower a lot or a little?), the potential harm and the costs where rarely mentioned. 

Last summer, Senator Claire McCaskill grilled Dr. Oz on Capitol Hill regarding false and misleading weight loss miracles endorsed on his program. In a written testimony to the US Senate Committee Dr. Oz explains:

“To make the Dr. Oz Show succeed in its mission, we have to overcome certain obstacles I learned in years of conversations with patients. We have to simplify complicated information. We have to make the material seem interesting and focus on the “wow” factor.”

And indeed, if you’re looking for “wow”, over-the-top enthusiasm, for inspiration and endless hope, TV shows such as those studied will supply you with plenty.

If you’re looking for practical, tested, realistic nutrition advice, look elsewhere, and unfortunately, that kind doesn't usually "wow". 

Dr. Ayala

The best silly food and silly diets of 2014

I’m very excited to share with you my end of year best of the best in diets and food innovation. Celebrating these contributions to humankind is a fond tradition and will, at the very least, take your mind off ISIS and Ebola for a bit.

An insult to kids' intelligence: Bubblegum flavored broccoli

This year, McDonald’s experimented with bubblegum flavored broccoli. The venture has been called off -- kids didn’t like it. Whoever came up with the idea of improving the taste of a food by making it taste like a non-food deserves this years’ award for underestimating kids. It’s ok – more honest even -- for fake food to taste like fake food, but can dressing up real as fake be an upgrade? Kids notice a fake from miles. 

Other contenders for this years’ silliest innovation: a park bench that weighs you, and then tells you – and the world – your weight and what you should do about it. Oh, and let’s not forget the company that offers to deliver to your home the food you’d only consider as a hungry captive at 30,000 feet. Yes, you heard that right, plane food on the ground. 

Bulletproof your common sense

Enjoying a cult-like following and celebrity endorsements, this new diet promises to make you energized, alert and focused, melt body fat, increase muscle mass without exercise and taste great. What’s this miracle food? A mixture of grass fed butter, pharmaceutical grade MCT oil, and specially selected Upgraded Coffee Beans ($18.95 for a small ¾ pound bag).  At 450 plus calories a cup it sure should fuel your day, but if you want to really bulletproof yourself, the next time you see the word ‘miracle’, ‘effortless’ or ‘melt’ connected to a diet, save time and money by following this simple step: close that tab/change that channel/throw away that ad. Here’s my prediction: 2015 won’t bring a slimness and health magic potion either. 

Party with IV hydration rescue

We all know how important it is to be well hydrated, but who knew that your vein is better than your mouth? If you’re hungover, feeling tired or sniffing a cold IVme will hook you up with fluids and electrolytes, maybe add some vitamins, and within an hour you’ll be as good as new, so they promise. Reviv offers several specialty IV formulations, the Slimboost one sounds especially tempting: it promises to increase energy levels, increase red blood cell production, help regulate sleep, mood and appetite, detoxify the body and rev up amino acids metabolism (what does that even mean?).

I’m here to defend the old fashioned mouth. I think that (provided you’re in good enough shape to step into these clinics) the mouth remains the safest orifice for fluids, it practically evolved for just that. It has a lovely mechanism that enables us to take in non-sterile, hardly even clean food and drink. It has safeguards that allow for enormous variations in intake. Oh, and instead of the slight pain of the needle you can get great pleasure from your taste buds and smell receptors that welcome the fluids.

And if someone you love is feeling fuzzy, achy and hungover, an instant redemption IV might be robbing them of the only benefit of their miserable state: the power of immediate consequences might save them from their next binge. Sounds cruel, but a big headache can be a liver’s best friend.

Wishing you a happy, healthy and lighthearted holiday season,

Dr. Ayala